TY - JOUR AU - Somerville, Mari AU - Wozney, Lori AU - Gallant, Allyson AU - Curran, A. Janet PY - 2025/4/14 TI - Designing eHealth Interventions for Pediatric Emergency Departments: Protocol for a Usability Testing Study With Youth, Parent, and Clinician Participants JO - JMIR Res Protoc SP - e64350 VL - 14 KW - eHealth intervention KW - emergency department KW - usability testing KW - youth KW - health services KW - parents KW - pediatric KW - digital health tools KW - mixed methods KW - quantitative surveys N2 - Background: Usability tests provide important insight into user preferences, functional issues, and differences between target groups for health interventions and products. However, there is limited guidance on how to adapt the usability testing approach for a youth audience, especially for digital health interventions. Objective: This protocol paper outlines a novel approach for conducting usability tests with a diverse audience of youth, parents, and clinicians in the development of 2 digital health tools for the pediatric emergency department (ED) setting. Methods: This paper outlines a protocol for usability testing as part of a broader study aimed at co-designing ED discharge communication tools with youth, parents, and clinicians. The broader study involved co-designing 2 digital tools: one for asthma and one for concussions. A multimethods approach to usability testing was used to assess the functionality of these tools through 2 rounds of testing. A mix of youth, parents, and ED clinicians were invited to participate in each round of usability testing. Participants were asked to provide feedback on the tools through quantitative surveys and open-ended qualitative questions. The usability testing approach was adapted to suit each target group, such as including a youth in the data collection process, to enhance the quality of the data. The severity of usability problems was analyzed following the first round of testing, and each tool was refined based on this feedback. The second round of usability tests involved collecting both qualitative and quantitative feedback on the revised tools. Results: All usability data have been collected and are being analyzed. Outcomes will be disseminated through a subsequent publication. Results will include demographic characteristics from each user group from both rounds of testing, severity of usability scores, qualitative and quantitative feedback, and differences in test outcomes between each target group. Conclusions: This paper provides novel guidance for conducting usability tests with youth participants when designing digital health tools. By using a comprehensive co-design and usability testing approach, we anticipate that final tools will be highly relevant to the end users and will lead to better uptake and patient outcomes when pilot-tested in future studies. The outlined approach may be adapted to different health care contexts for other youth participants. Further research should continue to explore ways to design usability tests that are suitable for youth audiences, as there is still a significant gap in the literature around this topic. International Registered Report Identifier (IRRID): DERR1-10.2196/64350 UR - https://www.researchprotocols.org/2025/1/e64350 UR - http://dx.doi.org/10.2196/64350 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64350 ER - TY - JOUR AU - Louvel, Anne-Claire AU - Dopff, Cécile AU - Loron, Gauthier AU - Michelet, Daphne PY - 2025/3/21 TI - Impact of a 3-Month Recall Using High-Fidelity Simulation or Screen-Based Simulation on Learning Retention During Neonatal Resuscitation Training for Residents in Anesthesia and Intensive Care: Randomized Controlled Trial JO - JMIR Serious Games SP - e57057 VL - 13 KW - screen-based simulation KW - high-fidelity simulation KW - neonatal resuscitation KW - pediatric KW - infant KW - neonatal KW - newborns KW - emergency KW - urgent KW - simulation KW - resuscitation KW - intensive care KW - medical education KW - anesthesia KW - anesthesiology KW - high fidelity KW - educational KW - student KW - resident KW - knowledge retention KW - learner KW - teaching KW - intensive care unit KW - ICU N2 - Background: Retention capacities are dependent on the learning context. The optimal interval between two learning sessions to maintain a learner?s knowledge is often a subject of discussion, along with the methodology being used. Screen-based simulation could represent an easy alternative for retraining in neonatal resuscitation. Objective: The aim of the study was to evaluate the benefits of a 3-month recall session using high-fidelity simulation or screen-based simulation, assessed 6 months after an initial neonatal resuscitation training session among anesthesia and intensive care residents. Methods: All participating anesthesia and intensive care residents were volunteers, and they underwent training in the same session, which included a theoretical course and high-fidelity simulation. The attendees were then randomized into three groups: one with no 3-month recall, one with a high-fidelity simulation recall, and one with a screen-based simulation recall. To reassess the skills of each participant, a high-fidelity simulation was performed at 6 months. The primary outcomes included expert assessment of technical skills using the Neonatal Resuscitation Performance Evaluation score and nontechnical skills assessed by the Anesthesia Non-Technical Skills score. Secondary outcomes included a knowledge quiz and self-assessment of confidence. We compared the results between groups and analyzed intragroup progressions. Results: Twenty-eight participants were included in the study. No significant differences were observed between groups at the 6-month evaluation. However, we observed a significant improvement in theoretical knowledge and self-confidence among students over time. Regarding nontechnical skills, as evaluated by the Anesthesia Non-Technical Skills score, there was significant improvement between the initial training and the 6-month session in both recall groups (16 vs 12.8, P=.01 in the high-fidelity group; 16 vs 13.9, P=.05 in the simulation group; 14.7 vs 15.1, P=.50 in the control group). For technical skills assessed by the Neonatal Resuscitation Performance Evaluation score, a nonsignificant trend toward improvement was observed in the two recall groups, while a regression was observed in the control group (all Ps>.05). The increase in students? self-confidence was significant across all groups but remained higher in the two 3-month recall groups. Conclusions: Initial neonatal resuscitation training for anesthesia and intensive care residents leads to improved knowledge and self-confidence that persist at 6 months. A 3-month recall session, whether through high-fidelity simulation or screen-based simulation, improves nontechnical skills (eg, situation management and team communication) and technical skills. Screen-based simulation, which saves time and resources, appears to be an effective educational method for recall after initial training. The study outcomes justify the need for further studies with larger sample sizes to confirm the promising role of serious games in educational programs for medical students. UR - https://games.jmir.org/2025/1/e57057 UR - http://dx.doi.org/10.2196/57057 ID - info:doi/10.2196/57057 ER - TY - JOUR AU - Fedele, A. David AU - Ray, M. Jessica AU - Mallela, L. Jaya AU - Bian, Jiang AU - Chen, Aokun AU - Qin, Xiao AU - Salloum, G. Ramzi AU - Kelly, Maria AU - Gurka, J. Matthew AU - Hollenbach, Jessica PY - 2025/3/18 TI - Development of a Clinical Decision Support Tool to Implement Asthma Management Guidelines in Pediatric Primary Care: Qualitative Study JO - JMIR Form Res SP - e65794 VL - 9 KW - clinical decision support KW - asthma KW - primary care KW - guidelines KW - pediatric KW - asthma care KW - morbidity KW - health information technology KW - electronic health record KW - EHR KW - user-centered design KW - inductive approach KW - digital health KW - health technology N2 - Background: There is a longstanding gap between national asthma guidelines and their implementation in primary care. Primary care providers (PCPs) endorse numerous provider and practice or clinic-related barriers to providing guidelines-based asthma care. To reduce asthma morbidity in primary care, PCPs need access to tools that facilitate adherence to national guidelines, which can be delivered at the point of care, are minimally burdensome, and fit within the clinic workflow. Clinical decision support (CDS) tools are health IT systems that can be housed in the electronic health record (EHR) system. Objective: This study aimed to follow user-centered design principles and describe the formative qualitative work with target stakeholders (ie, PCPs and IT professionals) to inform our design of an EHR-embedded CDS tool that adheres to recent, significant changes in asthma management guidelines. Methods: Purposive sampling was used to recruit three separate subgroups of professionals (n=15) between (1) PCPs with previous experience using a paper-based CDS tool for asthma management, (2) PCPs without previous experience using CDS tools for asthma management, and (3) health care IT professionals. The PCP interview guide focused on their practice, familiarity with national asthma guidelines, and how a CDS tool embedded in the EHR might help them provide guideline-based care. The health care IT professional guide included questions on the design and implementation processes of CDS tools into the EHR. Qualitative data were audio-recorded, transcribed, and then analyzed using an inductive approach to develop themes. Results: Themes were organized into 2 domains, current practice and CDS tool development. The themes that emerged from PCPs included descriptions of assessments conducted to make an asthma diagnosis, previous attempts or opportunities to implement updated national asthma guidelines, and how a CDS tool could be implemented using the EHR and fit into the current asthma management workflow. The themes that emerged from health care IT professionals included processes used to design CDS tools and strategies to collect evidence that indicated a tool?s value to a practice and the broader health system. Conclusions: In this study, user-centered design principles were used to guide a qualitative study on perceived barriers and facilitators to a primary care?based, EHR-integrated asthma CDS tool. PCPs expressed their interest in adopting an asthma CDS tool that was low burden and efficient but could help them adhere to national asthma guidelines and improve clinic workflow. Similarly, health care IT professionals perceived an asthma CDS tool to be useful, if it adhered to EHR design standards. Implementation of a CDS tool to improve adherence of PCPs to recently updated national asthma guidelines could be beneficial in reducing pediatric asthma morbidity. UR - https://formative.jmir.org/2025/1/e65794 UR - http://dx.doi.org/10.2196/65794 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65794 ER - TY - JOUR AU - Selak, ?pela AU - Horvat, Janja AU - ?mavc, Mark PY - 2025/3/18 TI - Problematic Digital Technology Use Measures in Children Aged 0 to 6 Years: Scoping Review JO - JMIR Ment Health SP - e59869 VL - 12 KW - scoping review KW - measures KW - problematic digital technology use KW - children KW - early childhood KW - mobile phone N2 - Background: In the interest of accurately assessing the effects of digital technology use in early childhood, researchers and experts have emphasized the need to conceptualize and measure children?s digital technology use beyond screen time. Researchers have argued that many patterns of early digital technology use could be problematic, resulting in the emerging need to list and examine their measures. Objective: We aimed to review existing empirical literature that is using measures for problematic digital technology use in preschool children with the end goal of identifying a set of reliable and valid measures, predicting negative outcomes for children?s health, development, or well-being. Methods: We conducted a scoping review across the Web of Science, PubMed, and Google Scholar databases to identify peer-reviewed publications that were published from January 2012 to December 2023, were written in the English language, described an empirical study, and included a measure of problematic digital technology use beyond exposure (ie, screen time) in children aged 0 to 6 years. Results: The search yielded 95 empirical studies, in which 18 composite measures of problematic use and 23 measures of specific problematic use aspects were found. Existing composite measures conceptualize problematic use as either a group of risky behaviors or as a group of symptoms of a presumed underlying disorder, with the latter being more common. Looking at their conceptual background and psychometric properties, existing composite measures fall short of reliably assessing all the crucial aspects of problematic digital technology use in early childhood. Therefore, the benefits and shortcomings of single-aspect problematic digital technology use measures are evaluated and discussed. Conclusions: On the basis of current research, early exposure to digital technologies, device use before sleep, and solitary device use represent measures that have been consistently associated with negative outcomes for children. In addition, potential measures of problematic use include device use during meals, device use for emotional regulation, device multitasking, and technoference, warranting further research. Public health benefits of defining problematic digital technology use as a group of risky behaviors rather than a group of addiction symptoms are discussed. UR - https://mental.jmir.org/2025/1/e59869 UR - http://dx.doi.org/10.2196/59869 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59869 ER - TY - JOUR AU - Dolón-Poza, María AU - Gabaldón-Pérez, Ana-Marta AU - Berrezueta-Guzman, Santiago AU - López Gracia, David AU - Martín-Ruiz, María-Luisa AU - Pau De La Cruz, Iván PY - 2025/3/14 TI - Enhancing Early Language Disorder Detection in Preschools: Evaluation and Future Directions for the Gades Platform JO - JMIR Hum Factors SP - e60424 VL - 12 KW - developmental language disorder KW - simple language delay KW - adaptive screening system KW - early childhood education KW - pervasive therapy N2 - Background: Language acquisition is a critical developmental milestone, with notable variability during the first 4 years of life. Developmental language disorder (DLD) often overlaps with other neurodevelopmental disorders or simple language delay (SLD), making early detection challenging, especially for primary caregivers. Objective: We aimed to evaluate the effectiveness of the Gades platform, an adaptive screening tool that enables preschool teachers to identify potential language disorders without direct support from nursery school language therapists (NSLTs). Methods: The study took place in a nursery school and an early childhood educational and psychopedagogical center in Madrid, Spain, involving 218 children aged 6 to 36 months, 24 preschool teachers, and 2 NSLTs. Initially, NSLTs conducted informational sessions to familiarize teachers with DLDs and how to identify them. Following this, the teachers used the Gades platform to conduct language screenings independently, without ongoing support from NSLTs. The Gades platform was enhanced to collect detailed profiles of each child and implemented an adaptive screening model tailored to account for variability in language development. This setup allowed preschool teachers, who are not language experts, to observe and assess language development effectively in natural, unsupervised educational environments. The study assessed the platform?s utility in guiding teachers through these observations and its effectiveness in such settings. Results: Gades identified language difficulties in 19.7% (43/218) of the children, with a higher prevalence in boys (29/218, 13.3%) than in girls (14/218, 6.4%). These challenges were most frequently observed in children aged 15 to 27 months. The platform demonstrated a high accuracy rate of 97.41%, with evaluators largely agreeing with its recommendations. Teachers also found Gades to be user friendly and a valuable tool for supporting language development observations in everyday educational settings. Conclusions: Gades demonstrates potential as a reliable and accessible tool for early detection of language disorders, empowering educators to identify DLD and SLD in the absence of NSLTs. However, further refinement of the platform is required to effectively differentiate between DLD and SLD. By integrating Gades into routine preschool assessments, educators can facilitate timely interventions, bridging gaps in early childhood education and therapy. Trial Registration: Pan-African Clinical Trial Registry (PACTR) PACTR202210657553944; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24051 UR - https://humanfactors.jmir.org/2025/1/e60424 UR - http://dx.doi.org/10.2196/60424 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60424 ER - TY - JOUR AU - Misra, Gauri AU - Wegerif, Simon AU - Fairlie, Louise AU - Kapoor, Melissa AU - Fok, James AU - Salt, Gemma AU - Halbert, Jay AU - Maconochie, Ian AU - Mullen, Niall PY - 2025/3/14 TI - The Measurement of Vital Signs in Pediatric Patients by Lifelight Software in Comparison to the Standard of Care: Protocol for the VISION-Junior Observational Study JO - JMIR Res Protoc SP - e58334 VL - 14 KW - vital signs KW - remote photoplethysmography KW - pediatric health assessment KW - pediatric health monitoring KW - pediatric KW - infant KW - infants KW - infancy KW - child KW - children KW - Lifelight KW - software KW - app KW - observational study KW - study protocol KW - clinical deterioration KW - COVID-19 KW - SARS-CoV-2 KW - pandemic KW - telemedicine KW - medical device KW - photoplethysmography KW - eHealth KW - mobile health KW - mHealth N2 - Background: Measuring vital signs (VS) is important in potentially unwell children, as a change in VS may indicate a more serious infection than is clinically apparent or herald clinical deterioration. However, currently available methods are not suitable for regular measurement of VS in the home or community setting, and adherence can be poor. The COVID-19 pandemic highlighted a need for the contactless measurement of VS by nonclinical personnel, reinforced by the growing use of telemedicine. The Lifelight app is being developed as a medical device for the contactless measurement of VS using remote photoplethysmography via the camera on smart devices. The VISION-D (Measurement of Vital Signs by Lifelight Software in Comparison to the Standard of Care?Development) and -V (Validation) studies demonstrated the accuracy of the app compared with standard of care (SOC) measurement of blood pressure, pulse rate (PR), and respiratory rate (RR) in adults, supporting certification of Lifelight as a class I Conformité Européenne medical device. Objective: To support the development of the Lifelight app for pediatric patients, the VISION-Junior study is collecting high-quality data that will be used to develop algorithms for the measurement of VS (PR, RR, and oxygen saturation) in pediatric patients. The accuracy of the app will be assessed against SOC measurements made simultaneously with app measurements. Methods: The study is recruiting pediatric patients (younger than 18 years of age) attending the Sunderland Royal Hospital pediatric emergency department of the South Tyneside and Sunderland National Health Service Foundation Trust. High-resolution videos of the face (and torso in children younger than 5 years of age) and audio recordings (to explore the value of crying, wheezing, coughing, and other sounds in predicting illness) are made using the Lifelight Data Collect app. VS are measured simultaneously using SOC methods (finger clip sensor for PR and oxygen saturation; manual counting of RR). Feedback from patients, parents, carers, and nurses who use Lifelight is collected via questionnaires. Anticipated recruitment is 500 participants, with subtargets for age, sex, and skin tone distribution (Fitzpatrick 6-point scale). Early data will be used to refine the algorithms. A separate dataset will be retained to test the performance of the app against predefined targets. Results: The study started on June 12, 2023, and reached its recruitment target (n=532) in April 2024 after extending the deadline. Algorithm refinement is in progress, after which the performance of Lifelight will be compared with the SOC measurement of VS. The analyses are expected to be completed by mid-August 2024. Conclusions: Data collected in this study will be used to develop and assess the accuracy of the app for the measurement of VS in pediatric patients of all ages. Trial Registration: ClinicalTrials.gov NCT05850013; https://clinicaltrials.gov/study/NCT05850013 International Registered Report Identifier (IRRID): DERR1-10.2196/58334 UR - https://www.researchprotocols.org/2025/1/e58334 UR - http://dx.doi.org/10.2196/58334 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58334 ER - TY - JOUR AU - Kakar, Monika AU - Rathi, Renu AU - Balakrishnan, Deepthi AU - Rathi, Bharat PY - 2025/2/21 TI - Evaluation of Comparative Efficacy of Polyherbal Steam Inhalation Versus Polyherbal Nasal Fumigation (Dhoopana) in Children With Rhinitis (Pratishyaya): Protocol for an Open-Label Randomized Controlled Trial JO - JMIR Res Protoc SP - e58197 VL - 14 KW - pratishyaya KW - Ayurveda KW - allergic rhinitis KW - rhinitis KW - dhoopana KW - nasal fumigation KW - steam inhalation KW - polyherbal KW - vasa KW - nirgundi KW - nilgiri KW - tulsi KW - sneezing KW - nasal cavity KW - nasal decongestants KW - evaluation KW - efficacy KW - child KW - adolescent KW - randomized controlled trial N2 - Background: Rhinitis is a condition characterized by inflammation of the nasal mucosa. It causes obstruction and congestion in the nasal cavity. Clinically, it resembles pratishyaya (rhinitis) in Ayurveda, which is caused by accumulation and downward movement of the tridoshas (3 elements, named vata, pitta, and kapha) in the nasal cavity. Rhinitis is one of the most common diseases among children. There is no role for antibiotics in rhinitis, and nasal decongestants have also not been found to be effective in its management. In Ayurveda, dhoopana (nasal fumigation) is mentioned in the pratishyaya treatment protocol. However, we have found no previous study regarding its efficacy. The efficacy of tulsi, vasa, nirgundi, and nilgiri is already proven when they are used for steam inhalation in respiratory tract infections. Therefore, in this study, a dhoopana of a polyherbal formulation containing tulsi, vasa, nirgundi, and nilgiri will be compared with the inhalation of steam containing arka (a liquid obtained by distillation) of tulsi, vasa, nirgundi, and nilgiri leaves in children with pratishyaya. Objective: We aim to evaluate the efficacy of polyherbal steam inhalation as a standard control against dhoopana in children aged 7 to 14 years with pratishyaya. Methods: A total of 70 participants fulfilling the inclusion criteria were selected and distributed into 2 groups of 35 each. The intervention group received dhoopana and the control group received polyherbal steam inhalation, both twice daily for 7 days. The primary outcome measure was the change in Total Nasal Symptom Score and a modified cold spatula test. At the same time, the association between prakriti (body constitution) and the prevalence of pratishyaya in children was analyzed as a secondary outcome. Assessments were performed on days 3, 5, and 7, with a follow-up time of 28 days. Appropriate descriptive and inferential statistics will be used for data analysis. Results: As of November 2024, we have completed our enrollment of 70 patients, with 35 patients in each group. Data analysis will be completed by February 2025, and we expect results to be published in March 2025. Conclusions: We anticipate that polyherbal nasal fumigation will be found to be equally as effective as polyherbal steam inhalation in the management of acute rhinitis in the pediatric population. This study may provide a standardized, herbal, safe, and cost-effective treatment for rhinitis in children in the form of dhoopana. International Registered Report Identifier (IRRID): DERR1-10.2196/58197 UR - https://www.researchprotocols.org/2025/1/e58197 UR - http://dx.doi.org/10.2196/58197 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58197 ER - TY - JOUR AU - Jeung, Joan AU - Nguyen, Andrew AU - Martinez, Jennifer AU - Zhang, Li PY - 2025/2/10 TI - A Primary Care Group Resilience Intervention Promotes Child and Caregiver Behavioral Health JO - JMIR Pediatr Parent SP - e67638 VL - 8 KW - parenting education KW - parent-child relationship KW - adverse childhood experiences KW - child behavior KW - children KW - caregiver KW - caretaker KW - parenting KW - family KW - stress KW - anxiety KW - behavior KW - relational health KW - psychoeducation KW - psychological education KW - resilience intervention KW - group-based KW - pilot study UR - https://pediatrics.jmir.org/2025/1/e67638 UR - http://dx.doi.org/10.2196/67638 ID - info:doi/10.2196/67638 ER - TY - JOUR AU - Jiménez-Díaz, Alba AU - Pierantonelli, Maitena AU - Morte Coscolín, Patricia AU - Salinas-Uhalte, Amaia AU - Quer-Palomas, Silvia AU - Rivera-Romero, Octavio AU - Herrero, Rocío AU - Fernández-Luque, Luis AU - Baños, Rosa AU - Berrios, C. Ricardo AU - de Arriba, Antonio PY - 2025/2/5 TI - Digital Health Program to Support Family Caregivers of Children Undergoing Growth Hormone Therapy: Qualitative Feasibility Study JO - JMIR Pediatr Parent SP - e55023 VL - 8 KW - growth hormone deficiency KW - mobile based solutions KW - caregivers KW - technology acceptance KW - digital health KW - children KW - therapy KW - feasibility study KW - health condition KW - psychological burden KW - quality of life KW - wellbeing KW - pediatric KW - mobile Health KW - mHealth KW - behavioral change KW - parent-child relationship N2 - Background: Caregivers of children with growth hormone deficiency often face emotional challenges (eg, stress) associated with their children?s health conditions. This psychological burden might affect children?s adherence to treatment and hinder their health-related quality of life (HrQoL). This assumption is leading to seriously considering multidimensional clinical approaches to pediatric health conditions where the emotional well-being of caregivers should be accounted for to optimize children?s health outcomes. Novel mobile health (mHealth) solutions based on emotional and behavioral change techniques can play a promising role because they are increasingly used within different health areas to support adaptive psychological functioning. However, whether and how mHealth solutions of this type of emotional well-being support caregivers of children with growth-related problems is an issue that needs to be clarified. Objective: This study aimed to gather qualitative information to better understand individualized experiences of caregiving of children undergoing growth hormone therapy (GHt) and perceived barriers or facilitators for the adoption of an mHealth solution called Adhera Caring Digital Program (ACDP). Methods: A total of 10 family caregivers were recruited at Miguel Servet Children?s Hospital, and they engaged with the ACDP for 1 month. The ACDP is a mobile-based digital intervention focused on promoting the overall well-being of family caregivers which provides access to personalized education, motivational mobile-based messages, and mental well-being exercises such as mindfulness or respiratory exercises. Subsequently, an individual semistructured interview was performed to gather qualitative user experience information. Results: The digital intervention was well-received. The ACDP was found to be useful, easy to use, and understandable, addressing all the difficulties expressed by caregivers. It was also noted to be particularly helpful at the beginning of the treatment and, for some families, became a natural tool that strengthened the parent-child relationship. Conclusions: The ACDP is a promising and well-accepted tool that enhances the experience of patients and caregivers. It improves the management of growth hormone deficiency and promotes the overall well-being of family caregivers. Trial Registration: ClinicalTrials NCT04812665; https://clinicaltrials.gov/study/NCT04812665 International Registered Report Identifier (IRRID): RR2-10.1186/s12911-022-01935-1 UR - https://pediatrics.jmir.org/2025/1/e55023 UR - http://dx.doi.org/10.2196/55023 UR - http://www.ncbi.nlm.nih.gov/pubmed/39908086 ID - info:doi/10.2196/55023 ER - TY - JOUR AU - Feusner, D. Jamie AU - Farrell, R. Nicholas AU - Nunez, Mia AU - Lume, Nicholas AU - MacDonald, W. Catherine AU - McGrath, B. Patrick AU - Trusky, Larry AU - Smith, Stephen AU - Rhode, Andreas PY - 2025/1/27 TI - Effectiveness of Video Teletherapy in Treating Obsessive-Compulsive Disorder in Children and Adolescents With Exposure and Response Prevention: Retrospective Longitudinal Observational Study JO - J Med Internet Res SP - e66715 VL - 27 KW - digital behavioral health KW - youth KW - cognitive-behavioral therapy KW - exposure and response prevention KW - CBT KW - ERP KW - OCD KW - psychiatry KW - clinical trial KW - psychology KW - video therapy KW - teletherapy KW - e-therapy KW - e-counseling KW - cyber-counseling KW - adolescents KW - adolescence KW - obsessive-compulsive disorder KW - retrospective study KW - longitudinal study KW - observational study KW - ERP therapy N2 - Background: An effective primary treatment for obsessive-compulsive disorder (OCD) in children and adolescents as well as adults is exposure and response prevention (ERP), a form of intervention in the context of cognitive-behavioral therapy. Despite strong evidence supporting the efficacy and effectiveness of ERP from studies in research and real-world settings, its clinical use remains limited. This underuse is often attributed to access barriers such as the scarcity of properly trained therapists, geographical constraints, and costs. Some of these barriers may be addressed with virtual behavioral health, providing ERP for OCD through video teletherapy and supplemented by app-based therapeutic tools and messaging support between sessions. Studies of teletherapy ERP in adults with OCD have shown benefits in research and real-world settings in both small and large samples. However, studies of teletherapy ERP in children and adolescents thus far have been in small samples and limited to research rather than real-world settings. Objective: This study reports on the real-world effectiveness of teletherapy ERP for OCD in the largest sample (N=2173) of child and adolescent patients to date. Methods: Children and adolescents with OCD were treated with live, face-to-face video teletherapy sessions, with parent or caregiver involvement, using ERP. Assessments were conducted at baseline, after 7-11 weeks, and after 13-17 weeks. Additionally, longitudinal assessments of OCD symptoms were performed at weeks 18-30, 31-42, and 43-54. We analyzed longitudinal outcomes of OCD symptoms, depression, anxiety, and stress using linear mixed models. Results: Treatment resulted in a median 38.46% (IQR 12.50%-64.00%) decrease in OCD symptoms at 13-17 weeks, and 53.4% of youth met full response criteria at this point. Improvements were observed in all categories of starting symptom severity: mild (median 40.3%, IQR 8.5%-79.8%), moderate (median 38.4%, IQR 13.3%-63.6%), and severe (median 34.1%, IQR 6.6%-58.5%). In addition, there were significant reductions in the severity of depression, anxiety, and stress symptoms. The median amount of therapist involvement was 13 (IQR 10.0-16.0) appointments and 11.5 (IQR 9.0-15.0) hours. Further, symptom improvements were maintained or improved upon in the longitudinal assessment periods of weeks 18-30, 31-42, and 43-54. Conclusions: These results show that remote ERP treatment, assisted by technology, can effectively improve both core OCD and related depression, anxiety, and stress symptoms in children and adolescents with OCD in a real-world setting. Notable outcomes were achieved in a relatively small amount of therapist time, demonstrating its efficiency. Demonstrating the usefulness of a delivery format that overcomes several traditional barriers to treatment, these findings have implications for widespread dissemination of accessible, evidence-based care for children and adolescents with OCD. UR - https://www.jmir.org/2025/1/e66715 UR - http://dx.doi.org/10.2196/66715 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66715 ER - TY - JOUR AU - Ganzevoort, N. Ilse AU - van der Veen, L. Adriëlla AU - Alma, A. Manna AU - Berger, Y. Marjolein AU - Holtman, A. Gea PY - 2025/1/27 TI - Children?s and Their Parents? Experiences With Home-Based Guided Hypnotherapy: Qualitative Study JO - JMIR Pediatr Parent SP - e58301 VL - 8 KW - qualitative study KW - primary health care KW - children KW - functional abdominal pain KW - irritable bowel syndrome KW - hypnotherapy KW - eHealth KW - abdominal pain KW - child KW - parents KW - accessibility KW - questionnaire KW - interviews KW - thematic analysis KW - home guided KW - primary care KW - mobile phone N2 - Background: Management of children with functional abdominal pain (FAP) or irritable bowel syndrome (IBS) is difficult in primary care. When education and reassurance do not alleviate symptoms, primary care physicians lack treatment options for children with FAP or IBS. Home-based guided hypnotherapy is a promising treatment because of its accessibility. To address feasibility, it is of utmost importance to take experiences from children and their parents into account. Objective: We aimed to explore children?s and their parents? experiences with home-based guided hypnotherapy for children with FAP or IBS. Methods: This qualitative study used open-ended questions from a questionnaire and in-depth semistructured interviews with children and their parents who had a hypnotherapy intervention prescribed. The interviews were audio-recorded and transcribed verbatim. Data were collected and analyzed iteratively using thematic content analysis. Results: A total of 76 children were eligible, and we collected questionnaire data from 56 children. A total of 23 interviews were conducted with 10 children and 15 parents. Six themes emerged from questionnaire data and interviews: impression of the exercises, not for everyone, influence of perceived effect, integrating exercises in daily life, content and practicalities of the website, and customization to personal preferences. Children with FAP or IBS experienced home-based guided hypnotherapy and the exercises differently, ranging from boring to fun. From interviews with the parents, it emerged that hypnotherapy is not suitable for everyone; for example, when children are very young or have a low developmental level, cannot sit still, cannot surrender to the exercises, or are too energetic or stressed, it might be difficult to comply. Experiences were shaped by the influence of a perceived effect and to which extent children were able to integrate exercises in daily life. The content and practicalities of the website also influenced experiences, and hypnotherapy that is adaptable to personal preferences, including by appearance and content, would be highly appreciated. Conclusions: The children and parents experienced home-based guided hypnotherapy differently, ranging from boring to fun. Hypnotherapy might be difficult or boring for some children. The children enjoyed hypnotherapy when they liked the topic or story, felt positive effects, could easily integrate exercises in daily life, or enjoyed the website in general. The children?s experiences and adherence can be further improved by adding short exercises and customizing hypnotherapy to their personal preferences on the website?s appearance and content. This could increase effectiveness but must be studied further. Trial Registration: ClinicalTrials.gov NCT05636358; https://clinicaltrials.gov/study/NCT05636358 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-069653 UR - https://pediatrics.jmir.org/2025/1/e58301 UR - http://dx.doi.org/10.2196/58301 ID - info:doi/10.2196/58301 ER - TY - JOUR AU - Zvulunov, Alex AU - Lenevich, Stepan AU - Migacheva, Natalia PY - 2025/1/22 TI - Mobile Health App as an Auxiliary Tool in Management of Atopic Dermatitis in Children: Randomized Controlled Trial JO - JMIR Dermatol SP - e60479 VL - 8 KW - atopic dermatitis KW - skin KW - disease management KW - children KW - pediatric KW - feasibility KW - mHealth KW - mobile health KW - app KW - eczema KW - Atopic App KW - dermatology N2 - Background: Mobile health apps can boost treatment adherence and support disease management at home. The Atopic App and web-based Atopic School patient education program offer a chance to enhance adherence to atopic dermatitis (AD) management. Objective: We aim to evaluate the feasibility, acceptability, and preliminary efficacy of the Atopic App mobile health intervention in the managing of AD in children. Methods: A randomized controlled study in children with AD divided participants into 3 groups: a control group (no app), an observational group with the app, and an interventional group with investigator supervision. Patients were examined at screening and follow-up visits 1 and 2 at 3-month intervals. Outcome measures included SCORAD (Scoring Atopic Dermatitis) for objective severity and Patient-Oriented Eczema Measure (POEM) for subjective effectiveness. Statistical analysis used paired t tests (2-tailed), the Mann-Whitney U test, and multiple regression. Results: Fifty-eight participants entered this study (38 boys and 20 girls): group 1 (control) comprised 17 patients, while experimental groups 2 and 3 consisted of 20 and 21 patients, respectively. The rates of missed appointments were similar and statistically insignificant across the groups. All groups showed a significant decrease in SCORAD and POEM scores (P<.05). Usage of the app for ?8 days showed a more significant decrease in severity scores compared to those who used it for ?7 days, or did not use it at all. Participants who used the app for ?8 days had a median SCORAD of 6.25 (95% CI 4.6?14.1; IQR 4-16.3) at visit 1, significantly lower than nonusers (17.9, 95% CI 13.9?24.0; IQR 13.9-24; P=.03) and those using it ?7 days (13, 95% CI 9.35?27; IQR 7.2-27; P=.04). Their median POEM of 2 (95% CI 1.0?4.5; IQR 1-5.3) was also significantly lower than those using the app ?7 days (9, 95% CI 2?12; IQR 2-12; P=.04) and lower, though not significantly, than nonusers (7, 95% CI 1?9; IQR 1-9; P=.14). Additionally, using the Atopic App for ?8 days after the screening visit strongly predicted a decrease in both SCORAD and POEM scores (P=.01 and P=.04, respectively). The time since the screening visit significantly predicted increased outcome scores, while prescriptions of topical calcineurin inhibitors, oral antihistamines, and oral antibiotics were weak and insignificant predictors of score changes. Conclusions: Our findings indicate that the Atopic App is helpful tool in managing AD in children, and they underscore the potential of mobile health interventions in the disease management. Trial Registration: ClinicalTrials.gov NCT06412094; https://clinicaltrials.gov/study/NCT06412094 UR - https://derma.jmir.org/2025/1/e60479 UR - http://dx.doi.org/10.2196/60479 ID - info:doi/10.2196/60479 ER - TY - JOUR AU - Krishnamurti, Tamar AU - Moon, Rachel AU - Richichi, Rudolph AU - Berger, Rachel PY - 2025/1/14 TI - Integrating Infant Safe Sleep and Breastfeeding Education Into an App in a Novel Approach to Reaching High-Risk Populations: Prospective Observational Study JO - JMIR Pediatr Parent SP - e65247 VL - 8 KW - SIDS KW - infant death KW - sleep KW - sudden infant death KW - US KW - United States KW - infant KW - infancy KW - baby KW - prenatal KW - safe sleep KW - breastfeeding KW - infant care KW - pregnancy KW - app KW - randomized controlled study KW - TodaysBaby KW - mobile health KW - mHealth KW - smartphone N2 - Background: Sudden unexpected infant death (SUID) is a leading cause of death for US infants, and nonrecommended sleep practices are reported in most of these deaths. SUID rates have not declined over the past 20 years despite significant educational efforts. Integration of prenatal safe sleep and breastfeeding education into a pregnancy app may be one approach to engaging pregnant individuals in education about infant care practices prior to childbirth. Objective: This study aims to assess whether pregnant individuals would engage with prenatal safe sleep and breastfeeding education provided within a pre-existing pregnancy app. Secondary objectives were to compare engagement among those at high and low risk of losing an infant to SUID and to assess the importance of end user push notifications for engagement. Methods: This prospective observational study was conducted from September 23, 2019 to March, 22 2022; push notifications were removed on October 26, 2021. TodaysBaby (University of Virginia, Boston University, and Washington University), a mobile health program in which safe sleep and breastfeeding video education was originally provided via texts, was embedded into the MyHealthyPregnancy app (Naima Health LLC). Pregnant mothers who received prenatal care within the University of Pittsburgh Medical Center hospital system were randomized to receive either safe sleep or breastfeeding education beginning at the start of the third trimester of pregnancy and ending 6 weeks post partum. Pregnant persons were designated as high risk if they lived in the 5% of zip codes in Allegheny County, Pennsylvania with the highest rates of SUID in the county. The primary outcome was engagement, defined as watching at least 1 video either in response to a push notification or directly from the app?s learning center. Results: A total of 7572 pregnant persons were enrolled in the TodaysBaby Program?3308 with push notifications and 4264 without. The TodaysBaby engagement rate was 18.8% with push notifications and 3.0% without. Engagement was highest in the initial weeks after enrollment, with a steady decline through pregnancy and very little postpartum engagement. There was no difference in engagement between pregnant persons who were low and high risk. The most viewed videos were ones addressing the use of pacifiers, concerns about infant choking, and the response of the body to the start of breastfeeding. Conclusions: Integrating safe sleep and breastfeeding education within a pregnancy app may allow for rapid dissemination of infant care information to pregnant individuals. Birthing parents at high risk of losing an infant to SUID?a leading cause of infant death after 1 month of age?appear to engage with the app at the same rates as birth parents who are at low risk. Our data demonstrate that push notifications increase engagement, overall and for those in high-risk zip codes where the SUID education is likely to have the most impact. UR - https://pediatrics.jmir.org/2025/1/e65247 UR - http://dx.doi.org/10.2196/65247 ID - info:doi/10.2196/65247 ER - TY - JOUR AU - Huang, Chien-Yu AU - Yu, Yen-Ting AU - Chen, Kuan-Lin AU - Lien, Jenn-Jier AU - Lin, Gong-Hong AU - Hsieh, Ching-Lin PY - 2025/1/10 TI - Predicting Age and Visual-Motor Integration Using Origami Photographs: Deep Learning Study JO - JMIR Form Res SP - e58421 VL - 9 KW - artificial intelligence KW - origami KW - child development screening KW - child development KW - visual motor integration KW - children KW - developmental status KW - activity performance KW - deep learning N2 - Background: Origami is a popular activity among preschool children and can be used by therapists as an evaluation tool to assess children?s development in clinical settings. It is easy to implement, appealing to children, and time-efficient, requiring only simple materials?pieces of paper. Furthermore, the products of origami may reflect children?s ages and their visual-motor integration (VMI) development. However, therapists typically evaluate children?s origami creations based primarily on their personal background knowledge and clinical experience, leading to subjective and descriptive feedback. Consequently, the effectiveness of using origami products to determine children?s age and VMI development lacks empirical support. Objective: This study had two main aims. First, we sought to apply artificial intelligence (AI) techniques to origami products to predict children?s ages and VMI development, including VMI level (standardized scores) and VMI developmental status (typical, borderline, or delayed). Second, we explored the performance of the AI models using all combinations of photographs taken from different angles. Methods: A total of 515 children aged 2-6 years were recruited and divided into training and testing groups at a 4:1 ratio. Children created origami dogs, which were photographed from 8 different angles. The Beery?Buktenica Developmental Test of Visual-Motor Integration, 6th Edition, was used to assess the children?s VMI levels and developmental status. Three AI models?ResNet-50, XGBoost, and a multilayer perceptron?were combined sequentially to predict age z scores and VMI z scores using the training group. The trained models were then tested using the testing group, and the accuracy of the predicted VMI developmental status was also calculated. Results: The R2 of the age and the VMI trained models ranged from 0.50 to 0.73 and from 0.50 to 0.66, respectively. The AI models that obtained an R2>0.70 for the age model and an R2>0.60 for the VMI model were selected for model testing. Those models were further examined for the accuracy of the VMI developmental status, the correlations, and the mean absolute error (MAE) of both the age and the VMI models. The accuracy of the VMI developmental status was about 71%-76%. The correlations between the final predicted age z score and the real age z score ranged from 0.84 to 0.85, and the correlations of the final predicted VMI z scores to the real z scores ranged from 0.77 to 0.81. The MAE of the age models ranged from 0.42 to 0.46 and those of the VMI models ranged from 0.43 to 0.48. Conclusion: Our findings indicate that AI techniques have a significant potential for predicting children?s development. The insights provided by AI may assist therapists in better interpreting children?s performance in activities. UR - https://formative.jmir.org/2025/1/e58421 UR - http://dx.doi.org/10.2196/58421 ID - info:doi/10.2196/58421 ER - TY - JOUR AU - Skovslund Nielsen, Eva AU - Kallesøe, Karen AU - Bennedsen Gehrt, Tine AU - Bjerre-Nielsen, Ellen AU - Lalouni, Maria AU - Frostholm, Lisbeth AU - Bonnert, Marianne AU - Rask, Ulrikka Charlotte PY - 2025/1/7 TI - Trajectories of Change, Illness Understanding, and Parental Worries in Children and Adolescents Undergoing Internet-Delivered Cognitive-Behavioral Therapy for Functional Abdominal Pain Disorders: Protocol for a Single-Case Design and Explorative Pilot Study JO - JMIR Res Protoc SP - e58563 VL - 14 KW - functional abdominal pain disorders KW - abdominal pain KW - internet-based intervention KW - cognitive behavioral therapy KW - interoception KW - attentional bias KW - parental distress KW - single case study KW - children KW - adolescents KW - youth KW - study protocol KW - quality of life KW - treatment KW - medication KW - psychological treatment KW - psychology N2 - Background: Functional abdominal pain disorders (FAPDs) are common in young people and are characterized by persistent or recurrent abdominal symptoms without apparent structural or biochemical abnormalities. FAPDs are associated with diminished quality of life, school absence, increased health care use, and comorbid anxiety and depression. Exposure-based internet-delivered cognitive behavioral therapy (ICBT) has demonstrated efficacy in alleviating abdominal symptoms and improving quality of life. However, a deeper understanding of effect mechanisms and identification of possible additional treatment targets could refine treatment. Objective: This protocol paper aims to describe a study focusing on children and adolescents undergoing ICBT for FAPDs, aiming to further investigate the underlying mechanisms of effect. Methods: Children (8-12 years), adolescents (13-17 years) with FAPDs, and their respective parents will be included for 10 weeks for ICBT. First, detailed trajectories of effect are examined through a randomized single-case design study involving 6 children and 6 adolescents (substudy 1). Following this, an open-ended explorative pilot study with 30 children and 30 adolescents explores potential illness-related cognitive biases and interoceptive accuracy before and after treatment (substudy 2). Finally, spanning across these 2 substudies, including all parents from substudies 1 and 2, we will assess parental distress and illness worries before and after treatment, and how these factors impact the treatment adherence and outcomes of the child or adolescent (substudy 3). Results: Recruitment of participants began in June 2022 and is finalized for substudy 1 and ongoing for substudies 2 and 3. Recruitment is expected to be completed by January 2025, with final data collection during April 2025. Conclusions: The findings have the potential to contribute to the ongoing improvement of specialized psychological treatment for FAPDs in young people. Trial Registration: ClinicalTrials.gov NCT05237882; https://clinicaltrials.gov/study/NCT05237882; ClinicalTrials.gov NCT05486585; https://clinicaltrials.gov/study/NCT05486585; OSF Registries osf.io/c49k7; https://osf.io/c49k7 International Registered Report Identifier (IRRID): DERR1-10.2196/58563 UR - https://www.researchprotocols.org/2025/1/e58563 UR - http://dx.doi.org/10.2196/58563 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58563 ER - TY - JOUR AU - Schafer, Moa AU - Lachman, Jamie AU - Zinser, Paula AU - Calderón Alfaro, Antonio Francisco AU - Han, Qing AU - Facciola, Chiara AU - Clements, Lily AU - Gardner, Frances AU - Haupt Ronnie, Genevieve AU - Sheil, Ross PY - 2025/1/3 TI - A Digital Parenting Intervention With Intimate Partner Violence Prevention Content: Quantitative Pre-Post Pilot Study JO - JMIR Form Res SP - e58611 VL - 9 KW - intimate partner violence KW - SMS text messaging KW - chatbot KW - user engagement KW - parenting KW - violence KW - mobile phone N2 - Background: Intimate partner violence (IPV) and violence against children are global issues with severe consequences. Intersections shared by the 2 forms of violence have led to calls for joint programming efforts to prevent both IPV and violence against children. Parenting programs have been identified as a key entry point for addressing multiple forms of family violence. Building on the IPV prevention material that has been integrated into the parenting program ParentText, a digital parenting chatbot, this pilot study seeks to explore parents? engagement with the IPV prevention content in ParentText and explore preliminary changes in IPV. Objective: This study aimed to assess parents? and caregivers? level of engagement with the IPV prevention material in the ParentText chatbot and explore preliminary changes in experiences and perpetration of IPV, attitudes toward IPV, and gender-equitable behaviors following the intervention. Methods: Caregivers of children aged between 0 and 18 years were recruited through convenience sampling by research assistants in Cape Town, South Africa, and by UNICEF (United Nations Children's Fund) Jamaica staff in 3 parishes of Jamaica. Quantitative data from women in Jamaica (n=28) and South Africa (n=19) and men in South Africa (n=21) were collected electronically via weblinks sent to caregivers? phones using Open Data Kit. The primary outcome was IPV experience (women) and perpetration (men), with secondary outcomes including gender-equitable behaviors and attitudes toward IPV. Descriptive statistics were used to report sociodemographic characteristics and engagement outcomes. Chi-square tests and 2-tailed paired dependent-sample t tests were used to investigate potential changes in IPV outcomes between pretest and posttest. Results: The average daily interaction rate with the program was 0.57 and 0.59 interactions per day for women and men in South Africa, and 0.21 for women in Jamaica. The rate of completion of at least 1 IPV prevention topic was 25% (5/20) for women and 5% (1/20) for men in South Africa, and 21% (6/28) for women in Jamaica. Exploratory analyses indicated significant pre-post reductions in overall IPV experience among women in South Africa (P=.01) and Jamaica (P=.01) and in men?s overall harmful IPV attitudes (P=.01) and increases in men?s overall gender-equitable behaviors (P=.02) in South Africa. Conclusions: To the best of our knowledge, this is the first pilot study to investigate user engagement with and indicative outcomes of a digital parenting intervention with integrated IPV prevention content. Study findings provide valuable insights into user interactions with the chatbot and shed light on challenges related to low levels of chatbot engagement. Indicative results suggest promising yet modest reductions in IPV and improvements in attitudes after the program. Further research using a randomized controlled trial is warranted to establish causality. UR - https://formative.jmir.org/2025/1/e58611 UR - http://dx.doi.org/10.2196/58611 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58611 ER - TY - JOUR AU - Keim-Malpass, Jessica AU - Muir, Jane K. AU - Letzkus, C. Lisa AU - Scheer, Eleanore AU - Valdez, S. Rupa PY - 2024/12/30 TI - Examining the Spillover Economic Impacts of Caregiving Among Families of Children With Medical Complexity to Inform Inclusive Economic Models: Qualitative Study JO - J Particip Med SP - e60666 VL - 16 KW - caregiving KW - children with medical complexity KW - social network KW - qualitative KW - self-management KW - care coordination KW - economic evaluation KW - spillover KW - economic model KW - care KW - mobile phone N2 - Background: Children with medical complexity represent a heterogeneous group of children with multiple chronic health care conditions. Caregivers of children with medical complexity experience a high intensity of caregiving that is often variable, extends across several networks of care, and often lasts for the entirety of the child?s life. The spillover, or indirect, economic impacts of caregiving are understudied in the context the family units of children with medical complexity. There have been recognized limitations to the sole use of quantitative methods when developing economic models of disease, because they lack direct caregiver voice and context of caregiving activities, and existing methods have been noted to be ableist. Objective: This study aimed to explore the economic spillover impacts of caregiving among families of children with medical complexity using their own words and perspectives, with the intent of expanding caregiver-centered perspectives when developing economic models. Methods: This study was a secondary analysis of a qualitative study that was conducted to examine family management practices among caregivers of children with medical complexity and their social networks. Caregivers of children with medical complexity were recruited through a pediatric complex care clinic at an academic medical center in the mid-Atlantic region, United States. This study used inductive qualitative descriptive methods and a template to define features of the person impacted and to define the economic construct as either a direct or indirect (spillover) cost. Results: A total of 20 caregivers were included in this study. Perspectives from the caregivers of children with medical complexity revealed several key themes: (1) time lost from employment, impacting the primary caregivers; (2) physical and mental health impacts, impacting the child themselves, siblings, and the primary caregivers; (3) impacts to leisure activities and self-care, impacting the child themselves, siblings, and the primary caregivers; and (4) impacts to the social network or social capital. Conclusions: The themes described can be operationalized into inclusive family-centered models that represent the impacts of caregiving in the context of the family units of children with medical complexity. The use of qualitative methods to expand our development of quantitative economic models can be adapted to other populations where caregivers are involved in care. Caregivers can and should have an active voice in preference-based assessments that are operationalized in economic contexts to make them more inclusive. International Registered Report Identifier (IRRID): RR2-10.2196/14810 UR - https://jopm.jmir.org/2024/1/e60666 UR - http://dx.doi.org/10.2196/60666 UR - http://www.ncbi.nlm.nih.gov/pubmed/38758728 ID - info:doi/10.2196/60666 ER - TY - JOUR AU - Segal, Hila AU - Benis, Arriel AU - Saar, Shirley AU - Shachar-Lavie, Iris AU - Fennig, Silvana PY - 2024/12/26 TI - Digital Platform for Pediatric Mental Health Support During Armed Conflicts: Development and Usability Study JO - JMIR Form Res SP - e63777 VL - 8 KW - pediatric mental health KW - digital platform KW - pediatricians KW - prevention KW - early intervention N2 - Background: The prevalence of mental health disorders among children and adolescents presents a significant public health challenge. Children exposed to armed conflicts are at a particularly high risk of developing mental health problems, necessitating prompt and robust intervention. The acute need for early intervention in these situations is well recognized, as timely support can mitigate long-term negative outcomes. Pediatricians are particularly suited to deliver such interventions due to their role as primary health care providers and their frequent contact with children and families. However, barriers such as limited training and resources often hinder their ability to effectively address these issues. Objectives: This study aimed to describe the rapid development of a digital mental health tool for community pediatricians, created in response to the urgent need for accessible resources following the October 7th terror attack in Israel. The goal was to create a comprehensive resource that addresses a wide range of emotional and behavioral challenges in children and adolescents, with a particular focus on those affected by armed conflict and significant trauma exposure. In addition, the study aimed to evaluate the platform?s usability and relevance through feedback from primary users, thereby assessing its potential for implementation in pediatric practice. Methods: A digital platform was developed using a collaborative approach that involved pediatricians and mental health professionals from various hospital clinics. The initial framework for the modules was drafted based on key emotional and behavioral issues identified through prior research. Following this, the detailed content of each module was cocreated with input from specialized mental health clinics within the hospital, ensuring comprehensive and practical guidance for community pediatricians. A focus group of 7 primary users, selected for their relevant hospital and community roles, provided feedback on the platform?s user experience, content relevance, and layout. The evaluation was conducted using a structured questionnaire complemented by qualitative comments. Results: Fifteen detailed modules were created, each providing information, including anamnesis, initial intervention strategies, parental guidance, and referral options. The focus group feedback demonstrated high satisfaction, indicating a very good user experience (mean 4.57, SD 0.53), content relevance (mean 4.71, SD 0.48), and layout suitability (mean 4.66, SD 0.52). Specific feedback highlighted the value of concise, actionable content and the inclusion of medication information. Participants expressed a strong willingness to regularly use the platform in their practice (mean 4.40, SD 0.53), suggesting its potential for broad application. Conclusions: This study demonstrates the effectiveness of a collaborative development process in creating a digital tool that addresses the mental health needs of children in crisis situations. The positive feedback from pediatricians indicated that the platform has the potential to become a valuable resource for early recognition, crisis intervention, and parental support in community pediatric settings. Future research will focus on broader implementation and assessing the platform?s impact on clinical outcomes. UR - https://formative.jmir.org/2024/1/e63777 UR - http://dx.doi.org/10.2196/63777 ID - info:doi/10.2196/63777 ER - TY - JOUR AU - Lai, Byron AU - Chaviano, Kelli AU - Richman, S. Joshua AU - Ahmad, Mahmoud AU - Wright, Ashley AU - Young, Raven AU - Davis, Drew AU - Rimmer, H. James AU - Madan-Swain, Avi AU - Chewning, H. Joseph PY - 2024/12/23 TI - Extended Reality Gaming for Exercise and Mindfulness Throughout Pediatric Cancer Rehabilitation: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e64879 VL - 13 KW - oncology KW - rehabilitation KW - bone marrow transplant KW - virtual reality KW - VR KW - physical activity KW - exercise KW - extended reality KW - XR KW - pediatric cancer N2 - Background: Pediatric patients with cancer have limited options to self-manage their health while they are undergoing treatments in the hospital and after they are discharged to their homes. Extended reality (ER) using head-mounted displays has emerged as an immersive method of improving pain and mental health and promoting health-enhancing physical activity among a variety of clinical groups, but there is currently no established protocol for improving both physical and mental health in pediatric cancer rehabilitation. Objective: This phase I, pilot, feasibility randomized controlled trial aims to investigate the potential effects of a 14-week ER program on physical activity participation and indicators of health among pediatric patients with cancer who undergo bone marrow transplantation. An ancillary aim is to evaluate the feasibility of the program through participant engagement. Methods: This study includes a 2-arm parallel group design with a 1-group crossover (the control group will start the intervention after a waiting period). Overall, 16 pediatric patients with cancer undergoing rehabilitation (aged ?8 years) at a children?s hospital will be randomly allocated into one of two groups: (1) an immediate start group that undergoes an ER program in the hospital until discharge and then for 8 weeks at home (total duration of approximately 14 weeks), and (2) a waitlist control group that undergoes usual care in the hospital and for 8 weeks at home, before receiving the 8-week home ER program. The program will include active video gaming with rhythmic music exercises as well as mindfulness-based practices using a high-quality app. Home-based programming will include behavioral coaching calls. Physical activity will be measured daily through step counts using a tri-axial accelerometer. Health outcomes will be measured across time and include global health, measured by the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Global Health Scale Short Form 7+2, and lung function, measured by a forced expiratory volume using a peak flow meter. Feasibility will be evaluated through participant engagement metrics, such as enrollment, dropout, adverse events, and attendance rates. Descriptive statistics will be obtained for all study variables. Outcomes will be modeled using mixed modeling procedures, and changes in means will be estimated with CIs. Results: The study was funded in February 2024. Recruitment procedures started on June 27, 2024. All data are anticipated to be collected by February 2026. Full trial results are anticipated to be analyzed and submitted for publication by March 2026. The study?s anticipated end date is March 31, 2026. Conclusions: This trial tests an accessible remote program for improving both physical and mental health among pediatric patients with cancer. The knowledge obtained from this study will inform the development of a larger trial. Trial Registration: ClinicalTrials.gov NCT06298357; https://clinicaltrials.gov/study/NCT06298357 International Registered Report Identifier (IRRID): DERR1-10.2196/64879 UR - https://www.researchprotocols.org/2024/1/e64879 UR - http://dx.doi.org/10.2196/64879 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64879 ER - TY - JOUR AU - Dassaye, Reshmi AU - Chetty, Terusha AU - Daniels, Brodie AU - Gaffoor, Zakir AU - Spooner, Elizabeth AU - Ramraj, Trisha AU - Mthethwa, Ncengani AU - Nsibande, Faith Duduzile AU - Pillay, Saresha AU - Bhana, Arvin AU - Magasana, Vuyolwethu AU - Reddy, Tarylee AU - Mohlabi, Khanya AU - Moore, Linda Penelope AU - Burgers, A. Wendy AU - de Oliveira, Tulio AU - Msomi, Nokukhanya AU - Goga, Ameena PY - 2024/12/19 TI - SARS-CoV-2 Infections in a Triad of Primary School Learners (Grades 1-7), Their Parents, and Teachers in KwaZulu-Natal, South Africa: Protocol for a Cross-Sectional and Nested Case-Cohort Study JO - JMIR Res Protoc SP - e52713 VL - 13 KW - COVID-19 KW - SARS-CoV-2 KW - learners KW - seroprevalence KW - long COVID KW - transmission dynamics N2 - Background: In low- and middle-income countries (LMICs) such as South Africa, there is paucity of data on SARS-CoV-2 infections among children attending school, including seroprevalence and transmission dynamics. Objective: This pilot study aims to assess (1) the prevalence of self-reported or confirmed SARS-CoV-2 prior infections, COVID-19 symptoms (including long COVID), seroprevalence of SARS-CoV-2 antibodies, and general/mental health, (2) longitudinal changes in SARS-CoV-2 seroprevalence, and (3) SARS-CoV-2 acute infections, immune responses, transmission dynamics, and symptomatic versus asymptomatic contacts in a unique cohort of unvaccinated primary school learners, their parents, teachers, and close contacts in semirural primary school settings. Methods: Learners (grades 1-7) from primary schools in KwaZulu-Natal, South Africa, their parents, and teachers will be invited to enroll into the COVID kids school study (CoKiDSS). CoKiDSS comprises 3 parts: a cross-sectional survey (N=640), a follow-up survey (n=300), and a nested case-cohort substudy. Finger-prick blood and saliva samples will be collected for serological and future testing, respectively, in the cross-sectional (451 learners:147 parents:42 teachers) and follow-up (210 learners:70 parents:20 teachers) surveys. The nested case-cohort substudy will include cases from the cross-sectional survey with confirmed current SARS-CoV-2 infection (n=30) and their close contacts (n=up to 10 per infected participant). Finger-prick blood (from all substudy participants), venous blood (from cases), and nasal swabs (from cases and contacts) will be collected for serological testing, immunological testing, and viral genome sequencing, respectively. Questionnaires covering sociodemographic and general and mental health information, prior and current SARS-CoV-2 symptoms and testing information, vaccination status, preventative behavior, and lifestyle will be administered. Statistical methods will include generalized linear mixed models, intracluster correlation, descriptive analysis, and graphical techniques. Results: A total of 645 participants were enrolled into the cross-sectional survey between May and August 2023. A subset of 300 participants were followed up in the follow-up survey in October 2023. Screening of the participants into the nested case-cohort substudy is planned between November 2023 and September 2024. Data cleanup and analysis for the cross-sectional survey is complete, while those for the follow-up survey and nested case substudy will be completed by the third quarter of 2024. The dissemination and publication of results is anticipated for the fourth quarter of 2024. Conclusions: This study provides data from an LMIC setting on the impact of SARS-CoV-2 on school-attending learners, their parents, and teachers 3 years after the SARS-CoV-2 pandemic was declared and 21-24 months after resumption of normal school attendance. In particular, this study will provide data on the prevalence of self-reported or confirmed SARS-CoV-2 prior infection, prior and current symptoms, seroprevalence, changes in seroprevalence, SARS-CoV-2 transmission, SARS-CoV-2 adaptive immune responses, and symptoms of long COVID and mental health among a triad of learners, their parents, and teachers. International Registered Report Identifier (IRRID): DERR1-10.2196/52713 UR - https://www.researchprotocols.org/2024/1/e52713 UR - http://dx.doi.org/10.2196/52713 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52713 ER - TY - JOUR AU - Zhao, Yanan AU - Fan, Huiyun AU - Luo, Yanan AU - Zhang, Rong AU - Zheng, Xiaoying PY - 2024/12/17 TI - Gender Inequalities in Employment of Parents Caring for Children With Autism Spectrum Disorder in China: Cross-Sectional Study JO - JMIR Pediatr Parent SP - e59696 VL - 7 KW - autism spectrum disorder KW - family KW - employment status KW - influencing factors KW - autism KW - child care KW - children KW - China KW - parent KW - online survey KW - mother KW - father KW - adolescent KW - youth KW - ASD KW - children with autism N2 - Background: The increasing need for child care is placing a burden on parents, including those with children with autism. Objective: The aim of this study was to examine the employment status of Chinese mothers and fathers with children with autism spectrum disorder (ASD), as well as to investigate the factors that affected their employment decisions. Methods: An online national survey was completed by the parents of 5018 children and adolescents with ASD aged 2-17 years (4837 couples, 181 single mothers, and 148 single fathers). The dependent variable was employment status?whether they kept working or quit to take care of their child. The independent variables were those characterizing the needs of the child and the sociodemographic characteristics of the family. Results: The employment rate of mothers with children and adolescents with ASD was 37.3% (1874/5018), while 96.7% (4823/4988) of fathers were employed. In addition, 54.3% (2723/5018) of mothers resigned from employment outside the home to care for their children, while only 2.8% (139/4988) of fathers resigned due to caring obligations. Mothers? employment was positively associated with their single marital status, lower educational level, and having assistance from grandparents. Having the grandparents? assistance was positively associated with fathers? employment. Conclusions: Gender inequalities in employment exist in China. Mothers caring for children with ASD had lower workforce participation than fathers. More female-friendly policies and a stronger gender equality ideology would be of benefit to Chinese society. UR - https://pediatrics.jmir.org/2024/1/e59696 UR - http://dx.doi.org/10.2196/59696 ID - info:doi/10.2196/59696 ER - TY - JOUR AU - Miladinovi?, Aleksandar AU - Quaia, Christian AU - Kresevic, Simone AU - Aj?evi?, Milo? AU - Diplotti, Laura AU - Michieletto, Paola AU - Accardo, Agostino AU - Pensiero, Stefano PY - 2024/12/9 TI - High-Resolution Eye-Tracking System for Accurate Measurement of Short-Latency Ocular Following Responses: Development and Observational Study JO - JMIR Pediatr Parent SP - e64353 VL - 7 KW - ocular following response KW - stereopsis KW - video-oculography KW - ocular KW - tracker KW - vision KW - pediatric KW - children KW - youth KW - infrared KW - algorithm KW - eye tracking N2 - Background: Ocular following responses (OFRs)?small-amplitude, short-latency reflexive eye movements?have been used to study visual motion processing, with potential diagnostic applications. However, they are difficult to record with commercial, video-based eye trackers, especially in children. Objective: We aimed to design and develop a noninvasive eye tracker specialized for measuring OFRs, trading off lower temporal resolution and a smaller range for higher spatial resolution. Methods: We developed a high-resolution eye-tracking system based on a high-resolution camera operating in the near-infrared spectral range, coupled with infrared illuminators and a dedicated postprocessing pipeline, optimized to measure OFRs in children. To assess its performance, we: (1) evaluated our algorithm for compensating small head movements in both artificial and real-world settings, (2) compared OFRs measured simultaneously by our system and a reference scleral search coil eye-tracking system, and (3) tested the system?s ability to measure OFRs in a clinical setting with children. Results: The simultaneous measurement by our system and a reference system showed that our system achieved an in vivo resolution of approximately 0.06°, which is sufficient for recording OFRs. Head motion compensation was successfully tested, showing a displacement error of less than 5 ?m. Finally, robust OFRs were detected in 16 children during recording sessions lasting less than 5 minutes. Conclusions: Our high-resolution, noninvasive eye-tracking system successfully detected OFRs with minimal need for subject cooperation. The system effectively addresses the limits of other OFR measurement methods and offers a versatile solution suitable for clinical applications, particularly in children, where eye tracking is more challenging. The system could potentially be suitable for diagnostic applications, particularly in pediatric populations where early detection of visual disorders like stereodeficiencies is critical. UR - https://pediatrics.jmir.org/2024/1/e64353 UR - http://dx.doi.org/10.2196/64353 ID - info:doi/10.2196/64353 ER - TY - JOUR AU - Kohn, Charmaine AU - Turner, Lauren AU - Yang, Zhixing AU - Absoud, Michael AU - Casbard, Angela AU - Gomes, Manuel AU - Grant, Gemma AU - Hassiotis, Angela AU - Kennedy, Eilis AU - Levitt, Sophie AU - McNamara, Rachel AU - Randell, Elizabeth AU - Totsika, Vasiliki PY - 2024/12/5 TI - Remotely Delivered Video Interaction Guidance for Families of Children With an Intellectual Disability Referred to Specialist Mental Health Services: Protocol for a Feasibility Randomized Controlled Trial JO - JMIR Res Protoc SP - e54619 VL - 13 KW - learning disability KW - intellectual disability KW - ID KW - child mental health KW - challenging behavior KW - family therapy KW - parent-child relations KW - parenting N2 - Background: Children with an intellectual disability (ID) are 3-4 times more likely to present with behaviors that challenge and mental health problems than typically developing children. Parenting and the quality of parent-child relationships are risk factors for these families. The COVID-19 pandemic further exacerbated difficulties, leading to an increase in child mental health problems and behaviors that challenge, a deterioration in parental mental health, and further strain on family relationships. Remote family interventions could be an effective solution for both families and specialist mental health services. Video interaction guidance (VIG) has shown promise for improving child mental health. However, it is unclear whether it is widely acceptable to families and feasible to implement across specialist child mental health services. Objective: This randomized controlled trial aims to evaluate the feasibility of delivering VIG as a remote intervention for parents of children aged 6-12 years with ID who have been referred to specialist mental health services. Methods: The study will be undertaken across 5-7 National Health Service specialist mental health services in England, involving 50 participants randomly allocated on a 1:1 basis to either the intervention group (receiving remote VIG) or the treatment-as-usual (TAU) group. The intervention group will engage in 3-5 cycles of VIG delivered remotely over 12 weeks. The primary feasibility outcomes include the recruitment rate, retention at 6-month follow-up, and VIG cycle completion rate. The secondary outcomes will assess the acceptability of VIG and the feasibility of remote implementation, including fidelity to the intervention protocol. Data will be gathered through online surveys and telephone interviews at baseline, 3 months, and 6 months. Feasibility outcomes will be summarized using descriptive statistics, while thematic analysis will be applied to qualitative data from semistructured interviews with participants, VIG practitioners, and service managers. An embedded process evaluation will explore barriers and facilitators to engagement with VIG, and a parallel health economics evaluation will assess the feasibility of capturing service use data and intervention costs. Results: The trial was open to recruitment between December 2022 and March 2024. The first results should be available in 2025. Conclusions: The study is the first randomized evaluation of VIG as offered to parents of children with ID who have been referred to specialist mental health settings. The outcomes from this feasibility trial will inform the decision to proceed with a definitive trial, using a traffic light system to evaluate recruitment, retention, and VIG completion rates alongside qualitative insights and economic evaluations. Trial Registration: ISRCTN Registry ISRCTN13171328; http://www.isrctn.com/ISRCTN13171328 International Registered Report Identifier (IRRID): DERR1-10.2196/54619 UR - https://www.researchprotocols.org/2024/1/e54619 UR - http://dx.doi.org/10.2196/54619 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54619 ER - TY - JOUR AU - Yewale, Prasad AU - Rathi, Renu AU - Mate, Swapnali PY - 2024/11/11 TI - Study to Evaluate the Comparative Efficacy of Medhya Rasayana (Pharmacological) Versus Nonpharmacological Interventions in Management of Gadget Addiction in Children: Protocol for Parallel, Triple-Arm, Randomized Clinical Trial JO - JMIR Res Protoc SP - e51833 VL - 13 KW - addiction KW - Ayurveda KW - gadget addiction KW - children KW - Kaumarbhritya KW - Medhya Rasayana KW - yoga KW - complementary and alternative medicine N2 - Background: Gadget addiction is a common behavioral problem among children. It is known to hamper social and academic life as well as adversely affect the lives of children. Ayurveda offers many therapeutic modalities and Ayurvedic medicines that can be used in the management of gadget addiction in children. The purpose of this study is to evaluate and compare the effectiveness of nonpharmacological therapies and the pharmaceutical intervention Medhya Rasayana in treating childhood gadget addiction. Objective: This study aims to provide a detailed description of the study methodology that will be used to compare the efficacy of nonpharmacological versus pharmaceutical interventions in the treatment of children?s gadget addiction. Methods: A randomized, parallel, triple-arm interventional study will be conducted on diagnosed participants of gadget addiction with an age group of 6- to 16-year-old children, which will be selected and equally distributed in 2 groups. Group P will be given Medhya Rasayana (pharmacological intervention), group N will be nonpharmacological Ayurveda intervention, and group C (cognitive behavioral therapy) will be an external group. The Study duration is 180 days with assessment at baseline, midpoint, and endpoint Appropriate statistical techniques, such as ANOVA and regression analysis, will be used to examine the data and evaluate the efficacy of the 3 groups? interventions. We will perform subgroup analysis according to initial addiction severity, gender, and age. Primary outcome measures include a reduction in gadget addiction and changes in the psychosocial well-being of participants. Standardized questionnaires and instruments will be used to collect data. Results: In December 2023, the randomized controlled study got underway. Since participants may begin at any time, our goal is for everyone to be finished by December 2024. Conclusions: This research will provide crucial new information about the relative effectiveness of Ayurveda nonpharmacological therapies and Medhya Rasayana in treating children?s gadget addiction. The results will guide evidence-based treatments aimed at reducing the negative impact of excessive gadget use on this susceptible population?s psychosocial development. In the end, the findings are meant to help policy makers and medical professionals create sensible plans to deal with the rising issue of childhood gadget addiction. International Registered Report Identifier (IRRID): PRR1-10.2196/51833 UR - https://www.researchprotocols.org/2024/1/e51833 UR - http://dx.doi.org/10.2196/51833 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51833 ER - TY - JOUR AU - Gargot, Thomas AU - Vachaud, Amandine AU - Gilard, Clémence AU - Audrain, Alexia AU - Gomot, Marie AU - Guidotti, Marco AU - Briend, Frédéric AU - Malvy, Joëlle AU - Bonnet Brilhault, Frédérique PY - 2024/11/5 TI - A Compressive Armchair (OTO) to Perform Deep Pressure Therapy in Children With Autism Spectrum Disorder: User-Centered Design and Feasibility Study JO - JMIR Hum Factors SP - e55754 VL - 11 KW - deep pressure therapy KW - proprioception KW - compression KW - autism spectrum disorder N2 - Background: Deep pressure therapy (DPT) is widely used to reduce anxiety in children with autism spectrum disorder (ASD), but evidence of its efficacy is limited. Objective: This study aims to design a usable, nonstigmatizing compressive armchair that can be easily controlled, electronically, by the user. Methods: A user-centered approach was used to assess the usability of the device. Testing was carried out in a day hospital for children with ASD in France, with a convenience sample of children with severe forms of ASD and intellectual deficiency (N=39). The Witteman design guideline was used. The System Usability Scale and time of use were reported. Results: The final product is a compressive armchair designed to be user centered, with 4 different cells that can be inflated to induce tailored pressure on the body. The pressure level is recorded electronically. Usability was between good and excellent. The device was used by 39 children, once or twice weekly, over a period of 31 months. Each session lasted between 3 and 20 minutes. The armchair takes up less space than a hug machine. Performing sessions with the chair is feasible. Conclusions: First clinical impressions show a decrease in anxiety, improved emotional regulation, and improved attention. DPT is widely used in occupational therapy and frequently requested by parents, but efficacy studies are too scarce to make evidence-based recommendations for its use. The results presented here support further controlled efficacy studies of DPT in the treatment of anxiety in children with ASD. UR - https://humanfactors.jmir.org/2024/1/e55754 UR - http://dx.doi.org/10.2196/55754 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55754 ER - TY - JOUR AU - Brunner, Loïc AU - Siebert, N. Johan AU - Ehrler, Frédéric AU - Manzano, Sergio AU - Marti, Joachim PY - 2024/10/25 TI - Evaluating the Economic Impact of the PedAMINES App in Reducing Medication Errors in Pediatric Emergency Care: Cost-Effectiveness Analysis JO - J Med Internet Res SP - e52077 VL - 26 KW - adverse drug event KW - health information technology KW - pediatric care KW - emergency care KW - ambulance care KW - economic evaluation KW - cost-effectiveness KW - epinephrine KW - norepinephrine KW - midazolam KW - dopamine KW - evidence-based KW - medical app KW - medication error KW - pediatric KW - child KW - pediatric emergency care KW - PedAMINES KW - Pediatric Accurate Medication in Emergency Situations KW - Switzerland KW - child care KW - mobile phone N2 - Background: The administration of drugs in pediatric emergency care is a time-consuming process and is associated with a higher occurrence of medication errors compared with adult care. This is attributed to the intricacies of administration, which involve calculating doses based on the child?s weight or age. To mitigate the occurrence of adverse drug events (ADEs), the PedAMINES (Pediatric Accurate Medication in Emergency Situations; Geneva University Hospitals) mobile app has been developed. This app offers a step-by-step guide for preparing and administering pediatric drugs during emergency interventions by automating the dose calculation process. Although previous simulation-based randomized controlled trials conducted in emergency care have demonstrated the efficacy of the PedAMINES app in reducing drug administration errors, there is a lack of evidence regarding its economic implications. Objective: This study aims to evaluate the cost-effectiveness of implementing the PedAMINES app for 4 emergency drugs: epinephrine, norepinephrine, dopamine, and midazolam. Methods: The economic evaluation was conducted by combining hospital data from 2019, previous trial outcomes, information extracted from existing literature, and PedAMINES maintenance costs. The cost per avoided medication error was calculated, along with the number of administrations needed to achieve a positive return on investment. Subsequently, Monte Carlo simulations were used to identify the key parameters contributing to result uncertainty. Results: The study revealed the number of preventable errors per administration for the 4 examined drugs: 0.513 for epinephrine, 0.484 for norepinephrine, 0.500 for dopamine, and 0.671 for midazolam. The cost-effectiveness ratios per ADE prevented were computed as follows: US $4808 for epinephrine, US $9705 for norepinephrine, US $6957 for dopamine, and US $2074 for midazolam. Accounting for the economic impact of ADEs, the analysis estimated that 16 administrations of epinephrine, 17 of norepinephrine and dopamine, and 13 of midazolam would be required to attain a positive return on investment. This corresponds to roughly one-third of the annual administrations at a major university hospital in Switzerland. The primary factors influencing the uncertainty in the estimated cost per ADE include the cost of maintenance of the app, the likelihood of an ADE resulting from an administration error, and the frequency of underdosing in the trial?s control group. Conclusions: A dedicated mobile app presents an economically viable solution to alleviate the health and economic burden of drug administration errors in in-hospital pediatric emergency care. The widespread adoption of this app is advocated to pool costs and extend the benefits on a national scale in Switzerland. UR - https://www.jmir.org/2024/1/e52077 UR - http://dx.doi.org/10.2196/52077 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52077 ER - TY - JOUR AU - Rawat, Kumar Sumit AU - Asati, Anand Ajit AU - Mishra, Nitu AU - Jain, Ashish AU - Ratho, Kanta Radha PY - 2024/10/11 TI - Identification of COVID-19?Associated Hepatitis in Children as an Emerging Complication in the Wake of SARS-CoV-2 Infections: Ambispective Observational Study JO - JMIRx Med SP - e48629 VL - 5 KW - COVID-19 KW - coronavirus KW - SARS-CoV-2 KW - liver KW - hepatic KW - hepatitis KW - child KW - children KW - pediatric KW - pediatrics KW - retrospective KW - observational KW - jaundice KW - youth KW - inflammatory KW - inflammation N2 - Background: Although the pediatric population has largely remained free of severe COVID-19 symptoms, in some cases, SARS-CoV-2 infection has been associated with complications such as multiple inflammatory syndrome in children (MIS-C). We identified another a unique form of hepatitis occurring subsequent to asymptomatic SARS-CoV-2 infection, designated by us as COVID-19?associated hepatitis in children (CAH-C), in a subset of children who presented with hepatitis. Objective: Our study describes the clinical presentations, temporal association, and viral parameters of the CAH-C cases and compares them to those of MIS-C cases or other known forms of hepatitis in children. Methods: In an ambispective (retrospective and follow-up) observational study, records from April to July 2021 were reviewed for all children aged ?14 years who were previously healthy and presented with a sudden onset of hepatitis, elevated transaminases, and nonobstructive jaundice. After performing all routine tests, those lacking marked inflammatory responses and without evidence of (1) other known causes of acute hepatitis or previous underlying liver disease and (2) multisystem involvement were classified as having CAH-C. Their characteristics were compared to those of children with MIS-C or other known forms of hepatitis. Results: Among the 5539 children tested for SARS-CoV-2, a total of 475 (8.6%) tested positive and 47 (0.8%) presented with hepatitis. Among the 47 children with hepatitis, 37 (79%) had features of CAH-C: having symptoms of hepatitis only, without protracted illness (mean length of stay 5 d), and an uneventful recovery following supportive treatment. In contrast, the remaining 10 (21%) had features of MIS-C?associated hepatitis: multiple system involvement; protracted illness (mean length of stay 8 d); and requiring admission to critical care, with a mortality rate of 30% (3/10). Conclusions: Our data suggest that CAH-C might be one of the new clinical complications associated with the emergence of newer variants of concern of SARS-CoV-2, which often result in changing presentations. Our findings should facilitate its early identification and thorough workup and aid its differentiation from other emerging syndromes in children, which would help initiate appropriate measures, enable better resource prioritization, and thus limit adversities. UR - https://xmed.jmir.org/2024/1/e48629 UR - http://dx.doi.org/10.2196/48629 ID - info:doi/10.2196/48629 ER - TY - JOUR AU - Deribe, Leul AU - Girma, Eshetu AU - Lindström, Nataliya AU - Gidey, Abdulkadir AU - Teferra, Solomon AU - Addissie, Adamu PY - 2024/10/10 TI - Association of Family-Centered Care With Psychological Distress Among Caregivers of Children With Cancer at a Tertiary-Level Hospital in Ethiopia: Cross-Sectional Study JO - JMIR Cancer SP - e54715 VL - 10 KW - child cancer KW - psychological distress KW - Ethiopia KW - parent KW - caregivers KW - family N2 - Background: Psychological distress (PD) is a common mental health problem faced by caregivers of children with cancer. The involvement of families in childcare was found to be associated with lower levels of distress. Objective: The study aims to determine the associations between family-centered care (FCC) and PD among caregivers of children with cancer receiving treatment at Tikur Anbessa Specialized Hospital (TASH), Ethiopia. Methods: An institution-based, cross-sectional study was conducted from June to December 2022. Caregivers of children with cancer aged 0-14 years receiving cancer treatment at the pediatric oncology unit completed a face-to-face, interviewer-administered, structured questionnaire during a routine inpatient or outpatient visit. The questionnaire included questions on the characteristics of the child and caregiver, PD (measured by the Kessler Psychological Distress Scale [K10]), FCC (measured by the Measure of Processes of Care [MPOC-20]), and social support (measured by the Oslo-3 Social Support Scale [OSS-3]). Data were collected using the Kobo toolbox and exported to SPSS (version 26; IBM Corp) for cleaning and analysis. A multivariable logistic regression model was used. An odds ratio with a 95% CI was calculated, and a P value less than .05 was considered statistically significant. Results: A total of 384 caregivers of children with cancer participated in the study. The total PD score ranged from 10 to 50, with a mean score of 17.30 (SD 8.96; 95% CI 16.84-18.60). The proportion of caregivers found to have mild, moderate, and severe levels of PD was 43 (11.2%), 35 (9.1%), and 51 (13.3%), respectively. The overall prevalence of mild to severe PD symptoms was 33.6% (95% CI 28.9%-38.3%). A statistically significant negative association was found between FCC and PD (adjusted odds ratio [AOR] 0.68, 95% CI 0.53-0.86). In addition, having no formal education (AOR 2.87, 95% CI 1.28-6.45), having a history of relapse (AOR 3.24, 95% CI 1.17-9.02), beginning cancer treatment at TASH (AOR 2.82, 95% CI 1.4-4.85), beginning treatment within the last 3 months (AOR 3.99, 95% CI 1.73-9.23), and beginning treatment within the last 4 to 18 months (AOR 2.68, 95% CI 1.25-5.76) were significantly associated with higher level of PD. Conclusions: A total of 1 in 3 caregivers have reported PD. FCC was found to be protective of PD. The finding of this study suggests the need for FCC intervention to improve the mental health condition of caregivers. In addition, the intervention needs to consider the educational status of the caregivers, the time since the cancer diagnosis, and the history of relapse. UR - https://cancer.jmir.org/2024/1/e54715 UR - http://dx.doi.org/10.2196/54715 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54715 ER - TY - JOUR AU - Sosanya, Eloho Mercy AU - Samuel, Olukemi Folake AU - Bashir, Sadia AU - Omoera, Osariemen Victoria AU - Freeland-Graves, H. Jeanne PY - 2024/9/26 TI - A Mobile Gaming App to Train Teenage Mothers on Appropriate Child Feeding Practices: Development and Validation Study JO - J Med Internet Res SP - e53560 VL - 26 KW - mobile health KW - mHealth KW - mobile gaming app KW - validation KW - infant and young child feeding KW - teenage mother KW - Nigeria KW - mobile phone N2 - Background: Undernutrition is an underlying factor in nearly 50% of 1 million estimated annual deaths among Nigerian children aged <5 years. Inappropriate maternal infant and young child feeding (IYCF) practices are basic contributors to child undernutrition. Teenage motherhood exacerbates the problem of inadequate child feeding. One possible intervention method to improve IYCF knowledge and practices of teenage mothers is the use of mobile gaming technologies. Despite extreme poverty in low- and middle-income countries, a ubiquity of mobile phone networks exists. Objective: This study aims to develop and validate a mobile gaming app, called BabyThrive, to train Nigerian teenage mothers on appropriate IYCF practices. Methods: To identify gaps in current IYCF practices in northern Nigeria, we conducted an extensive search of the literature and held 2 focus group interviews with 16 teenage mothers with low-income status. An initial app content design was then created, and content validity was established by 10 nutrition experts. Next, we developed an app prototype, which was assessed for quality by 7 nutrition and mobile gaming experts and evaluated for usability by 90 teenage mothers from rural areas in Abuja, the country?s capital. The final app, BabyThrive, is a 2D mobile game that is fully functional offline and available in English as well as Hausa, which is commonly spoken in northern Nigeria. The efficacy of the BabyThrive app was assessed using IYCF knowledge scores obtained from the administration of the validated Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa. Construct validity was established via crossover design by comparing the total IYCF knowledge scores of the teenage mothers obtained after a verbal training program and BabyThrive app use. Results: Large proportions of the study participants were married (53/90, 59%) and had no personal income (63/90, 70%). The mean quality rating for the BabyThrive app was 4.3 (SD 0.39) out of 5.0. High levels (>80%) of usability and user satisfaction were documented. Knowledge of exclusive breastfeeding (P<.001) and total knowledge scores (P=.002) were significantly higher in the BabyThrive group than in the verbal training group. The IYCF knowledge scores obtained from both groups showed coherence, with a statistically significant Spearman correlation coefficient of 0.50 (P<.001). Conclusions: This research developed and validated a novel, offline mobile gaming app. It will be an easy, effective, and acceptable method to disseminate critical knowledge on IYCF practices to teenage mothers in rural Nigeria. UR - https://www.jmir.org/2024/1/e53560 UR - http://dx.doi.org/10.2196/53560 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53560 ER - TY - JOUR AU - Cederved, Catarina AU - Ljungman, Gustaf AU - Back, Jon AU - Ångström-Brännström, Charlotte AU - Engvall, Gunn PY - 2024/9/23 TI - Acceptability of a Serious Game About Proton Radiotherapy Designed for Children Aged 5 to 14 Years and Its Potential Impact on Perceived Anxiety: Feasibility and Randomized Controlled Pilot Trial JO - JMIR Serious Games SP - e54082 VL - 12 KW - anxiety KW - feasibility KW - acceptability KW - pediatric oncology KW - psychological preparation KW - proton radiotherapy KW - serious game KW - games KW - cancer N2 - Background: Children who are going to undergo radiotherapy have displayed fear and anxiety. Therefore, a web-based serious game was developed as a psychological preparation to investigate if it could affect anxiety levels. In an earlier stage, children with experience of radiotherapy had been part of the developmental process. Objective: The study aimed to investigate the feasibility in terms of reach, usability, and acceptability of a serious game about proton radiotherapy and to pilot that it did not increase anxiety levels in children aged 5 to 14 years undergoing radiotherapy. Methods: The design was a randomized controlled pilot trial with predefined feasibility criteria. In total, 28 children were assessed for eligibility, and 23 met the inclusion criteria. They were consecutively randomized into 1 of 2 study arms. One child was excluded after randomization. If randomized into arm 1, the children received the intervention before treatment started. Children in arm 2 were treated as controls. Questionnaires with fixed answers were used to assess anxiety levels (an adapted version of the State-Trait Anxiety Inventory for Children) and experiences of gameplay (an adapted version of Player Experience of Need Satisfaction [PENS]). The children were asked to answer questionnaires at 5 different measurement occasions during their radiotherapy treatment. Results: In arm 1, age ranged from 5 to 13 (mean 8.4, SD 2.4) years. In arm 2, age ranged from 5 to 11 (mean 7.6, SD 2.3) years. The sample consisted of 15 girls and 7 boys. The feasibility criterion that the children should play the game for 20 minutes or more was not met. Mean playtime for children in arm 1 was 32.1 (SD 23.8) minutes, where 18 children had played for at least 15 minutes. The criterion that 70% (n=16) or more of the participants should return all of the questionnaires was not met; however, more than 73% (n=16) returned the PENS questionnaires. The State-Trait Anxiety Inventory for Children was returned by 73% (n=16) on day 0, 77% (n=17) on day 1, 82% (n=18) on day 3, 82% (n=18) on day 6, and 86% (n=19) on day 15. Conclusions: All feasibility criteria set for the study were not met, suggesting that adaptions need to be made if a future study is to be undertaken. Further, the analysis revealed that there was no indication that playing increased the children?s self-reported anxiety. The PENS questionnaire adapted for children showed promising results regarding player satisfaction when using the serious game. When studying children with severe conditions and young age, 5 measurement occasions seemed to be too many. Measuring both player satisfaction or experience and knowledge transfer would be preferable in future studies. Trial Registration: ClinicalTrials.gov NCT04728555; https://clinicaltrials.gov/study/NCT04728555 UR - https://games.jmir.org/2024/1/e54082 UR - http://dx.doi.org/10.2196/54082 ID - info:doi/10.2196/54082 ER - TY - JOUR AU - Hillyar, Timothy Christopher Robert AU - Bishop, Natalie AU - Nibber, Anjan AU - Bell-Davies, Jean Frances AU - Ong, Juling PY - 2024/9/18 TI - Assessing the Evidence for Nonobstetric Risk Factors for Deformational Plagiocephaly: Systematic Review and Meta-Analysis JO - Interact J Med Res SP - e55695 VL - 13 KW - deformational plagiocephaly KW - plagiocephaly KW - flat head syndrome KW - back to sleep KW - meta-analysis KW - systematic review KW - meta-analyses KW - systematic reviews KW - vitamin D KW - vit D KW - head position preference KW - head position KW - head positioning KW - bottle feeding KW - tummy time KW - sleeping position KW - motor milestones KW - obesity KW - maternal education level KW - male sex KW - formula feeding KW - macrocephaly KW - head circumference KW - mechanical ventilation KW - pediatric KW - pediatrics KW - paediatric KW - paediatrics KW - infant KW - infants KW - infancy KW - baby KW - babies KW - neonate KW - neonates KW - neonatal KW - toddler KW - toddlers KW - child KW - children N2 - Background: Plagiocephaly is defined as an asymmetrical distortion of the skull, resulting in an oblique trapezoid or parallelogram head shape. Deformational plagiocephaly (DP) is caused by forces acting on one side of the back of the head, distorting normal skull symmetry. Objective: The aims of this systematic review and meta-analysis were to critically assess the evidence for nonobstetric risk factors for DP and to make evidence-based recommendations for reducing the prevalence of DP. Methods: The selection criterion was studies reporting risk factors for DP. Case reviews, case series, expert opinions, and systematic reviews were excluded. PubMed and Web of Science were searched from August 21, 2010, to August 21, 2022. Publication bias was assessed using funnel plots. Meta-analyses were presented using forest plots. Results: A total of 19 studies (cohort studies: n=13, 68%; case-control studies: n=5, 26%; and cross-sectional studies: n=1, 5%) with a total of 14,808 participants were included. Of the 43 investigated potential nonobstetric factors, 16 (37%) were associated with DP. Of these 16 factors, 12 (75%) had odds ratios (ORs) with 95% CIs not crossing 1: insufficient vitamin D intake (OR 7.15, 95% CI 3.77-13.54), head position preference (OR 4.75, 95% CI 3.36-6.73), bottle-only feeding (OR 4.65, 95% CI 2.70-8.00), reduced tummy time (OR 3.51, 95% CI 1.71-7.21), sleeping position (OR 3.12, 95% CI 2.21-4.39), fewer motor milestones reached by the age of 6 months (OR 2.56, 95% CI 1.66-3.96), obesity (OR 2.45, 95% CI 1.02-5.90), maternal education level (OR 1.66, 95% CI 1.17-2.37), male sex (OR 1.51, 95% CI 1.07-2.12), formula feeding (OR 1.51, 95% CI 1.00-2.27), head circumference (OR 1.22, 95% CI 1.06-1.40), and mechanical ventilation (OR 1.10, 95% CI 1.00-1.14). No evidence of publication bias was detected. Conclusions: This study provides a comprehensive assessment of the nonobstetric factors associated with DP and presents 11 evidence-based recommendations for reducing its prevalence. The primary limitation is that only publication bias was assessed. Trial Registration: PROSPERO CRD42020204979; https://www.crd.york.ac.uk/prospero/display_record.php? ID=CRD42020204979 UR - https://www.i-jmr.org/2024/1/e55695 UR - http://dx.doi.org/10.2196/55695 UR - http://www.ncbi.nlm.nih.gov/pubmed/39292504 ID - info:doi/10.2196/55695 ER - TY - JOUR AU - Murgueitio, Nicolas AU - Tate, Maresa AU - Lurie, Lucy AU - Priddy, Zoe AU - Boda, Sneha AU - Shipkova, Michelle AU - Rodriguez, Micaela AU - Machlin, Laura AU - Furlong, Sarah AU - Mitchell, Amanda AU - McLaughlin, Katie AU - Sheridan, Margaret PY - 2024/9/17 TI - Testing a Conceptual Model of Early Adversity, Neural Function, and Psychopathology: Protocol for a Retrospective Observational Cohort Study JO - JMIR Res Protoc SP - e59636 VL - 13 KW - early adversity KW - psychopathology KW - neurodevelopment KW - adverse childhood events KW - child development N2 - Background: Early adversity, broadly defined as a set of negative exposures during childhood, is extremely common and increases risk for psychopathology across the life span. Previous research suggests that separate dimensions of adversity increase risk through developmental plasticity mechanisms shaping unique neurobiological pathways. Specifically, research suggests that deprivation is associated with deficits in higher order cognition, while threat is associated with atypicality in fear learning and emotion dysregulation. However, most of this research has been conducted in adolescent and adult samples, long after exposure to adversity occurs and far from periods of peak developmental plasticity. Objective: The Wellness Health and Life Experiences (WHALE) study examines the neurobiological and behavioral mechanisms by which deprivation, threat, and unpredictability increase risk for psychopathology in early childhood (age 4-7 years) directly following periods of peak developmental plasticity. The objective of this study is to describe the study rationale and aims, the research design and procedures, and the analytical plan to test the study hypotheses. Methods: This is a retrospective cohort study that examines associations between exposure to deprivation and threat and their hypothesized neurobiological mechanisms, how these neurobiological mechanisms link early adversity and psychopathology, and associations between unpredictability, reward learning, and psychopathology. The sample was a convenience sample of children (aged 4-7 years) and their families, identified through flyers, email blasts to listserves, school-based advertising, and involvement in community events. Data were collected during a home visit, a subsequent laboratory visit, and a final neuroimaging visit. Planned analyses include linear regression, path analyses, and functional magnetic resonance imaging analyses to explore the role of neural function in the association between early adversity and psychopathology. Results: Participants (N=301) have been recruited into the study, and data collection has commenced. The expected results will be available in 2024. Conclusions: The findings of this study will help elucidate the neurobiological mechanisms by which early adversity increases risk for psychopathology in early childhood. This study represents the earliest test of an influential theory of biological embedding of early adversity. International Registered Report Identifier (IRRID): DERR1-10.2196/59636 UR - https://www.researchprotocols.org/2024/1/e59636 UR - http://dx.doi.org/10.2196/59636 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59636 ER - TY - JOUR AU - Kisvarday, Susannah AU - Yan, Adam AU - Yarahuan, Julia AU - Kats, J. Daniel AU - Ray, Mondira AU - Kim, Eugene AU - Hong, Peter AU - Spector, Jacob AU - Bickel, Jonathan AU - Parsons, Chase AU - Rabbani, Naveed AU - Hron, D. Jonathan PY - 2024/9/12 TI - ChatGPT Use Among Pediatric Health Care Providers: Cross-Sectional Survey Study JO - JMIR Form Res SP - e56797 VL - 8 KW - ChatGPT KW - machine learning KW - surveys and questionnaires KW - medical informatics applications KW - OpenAI KW - large language model KW - LLM KW - pediatric KW - chatbot KW - artificial intelligence KW - AI KW - digital tools N2 - Background: The public launch of OpenAI?s ChatGPT platform generated immediate interest in the use of large language models (LLMs). Health care institutions are now grappling with establishing policies and guidelines for the use of these technologies, yet little is known about how health care providers view LLMs in medical settings. Moreover, there are no studies assessing how pediatric providers are adopting these readily accessible tools. Objective: The aim of this study was to determine how pediatric providers are currently using LLMs in their work as well as their interest in using a Health Insurance Portability and Accountability Act (HIPAA)?compliant version of ChatGPT in the future. Methods: A survey instrument consisting of structured and unstructured questions was iteratively developed by a team of informaticians from various pediatric specialties. The survey was sent via Research Electronic Data Capture (REDCap) to all Boston Children?s Hospital pediatric providers. Participation was voluntary and uncompensated, and all survey responses were anonymous.  Results: Surveys were completed by 390 pediatric providers. Approximately 50% (197/390) of respondents had used an LLM; of these, almost 75% (142/197) were already using an LLM for nonclinical work and 27% (52/195) for clinical work. Providers detailed the various ways they are currently using an LLM in their clinical and nonclinical work. Only 29% (n=105) of 362 respondents indicated that ChatGPT should be used for patient care in its present state; however, 73.8% (273/368) reported they would use a HIPAA-compliant version of ChatGPT if one were available. Providers? proposed future uses of LLMs in health care are described. Conclusions: Despite significant concerns and barriers to LLM use in health care, pediatric providers are already using LLMs at work. This study will give policy makers needed information about how providers are using LLMs clinically. UR - https://formative.jmir.org/2024/1/e56797 UR - http://dx.doi.org/10.2196/56797 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56797 ER - TY - JOUR AU - Werner, E. Nicole AU - Morgen, Makenzie AU - Kooiman, Sophie AU - Jolliff, Anna AU - Warner, Gemma AU - Feinstein, James AU - Chui, Michelle AU - Katz, Barbara AU - Storhoff, Brittany AU - Sodergren, Kristan AU - Coller, Ryan PY - 2024/9/9 TI - Effectiveness of a Mobile App (Meds@HOME) to Improve Medication Safety for Children With Medical Complexity: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e60621 VL - 13 KW - medication safety KW - children with medical complexity KW - caregiving KW - polypharmacy KW - medication management N2 - Background: This study will pilot-test the mobile app, Medication Safety @HOME?Meds@HOME intervention to improve medication administration accuracy, reduce preventable adverse drug events, and ultimately improve chronic care management for children with medical complexity (CMC). The Meds@HOME app was co-designed with CMC families, secondary caregivers (SCGs), and health professionals to support medication management for primary caregivers (PCGs) and SCGs of CMC. We hypothesize that Meds@HOME will improve caregivers? medication administration accuracy, reduce preventable adverse drug events, and ultimately improve chronic care management. Objective: This study aims to evaluate the effectiveness of Meds@HOME on medication administration accuracy for PCGs and SCGs. Methods: This study will recruit up to 152 PCGs and 304 SCGs of CMC who are prescribed at least 1 scheduled high-risk medication and receive care at the University of Wisconsin American Family Children?s Hospital. PCGs will be randomly assigned, for the 6-month trial, to either the control group (not trialing Meds@HOME) or the intervention group (trialing Meds@HOME) using 1:1 ratio. The Meds@HOME app allows caregivers to create a child profile, store medication and care instructions, and receive reminders for upcoming and overdue care routines and medication refills. Surveys completed both at the start and end of the trial measure demographics, medication delivery knowledge, confidence in the CMC?s caregiving network, and comfort with medical information. Univariate and multivariate generalized estimation equations will be used for primary statistical analysis. The primary outcome is the PCG?s rate of medication administration accuracy measured as correct identification of each of the following for a randomly selected high-risk medication: indication, formulation, dose, frequency, and route at baseline and after 6 months. Secondary outcomes include SCG medication administration accuracy (indication, formulation, dose, frequency, and route), count of University of Wisconsin hospital and emergency department encounters, PCG-reported medication adherence, count of deaths, and PCG medication confidence and understanding. Results: Recruitment for this study began on November 29, 2023. As of May 15, 2024, we have enrolled 94/152 (62%) PCGs. We expect recruitment to end by August 1, 2024, and the final participant will complete the study by January 28, 2025, at which point we will start analyzing the complete responses. We expect publication of results at the end of 2025. Conclusions: The Meds@HOME mobile app provides a promising strategy for improving PCG medication safety for CMC who take high-risk medications. In addition, this protocol highlights novel procedures for recruiting SCGs of CMC. In the future, this app could be used more broadly across diverse caregiving networks to navigate complex medication routines and promote medication safety. Trial Registration: ClinicalTrials.gov NCT05816590; https://clinicaltrials.gov/study/NCT05816590 International Registered Report Identifier (IRRID): DERR1-10.2196/60621 UR - https://www.researchprotocols.org/2024/1/e60621 UR - http://dx.doi.org/10.2196/60621 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60621 ER - TY - JOUR AU - Hodson, Nathan AU - Woods, Peter AU - Solano, Luque Juan AU - Talbot, Charlotte AU - Giacco, Domenico PY - 2024/9/5 TI - Evaluating a Mobile App Supporting Evidence-Based Parenting Skills: Thematic Analysis of Parent Experience JO - JMIR Pediatr Parent SP - e53907 VL - 7 KW - digital microintervention KW - parenting app KW - product management KW - parent KW - parents KW - parenting KW - app KW - apps KW - usability KW - acceptability KW - family KW - families KW - interview KW - interviews KW - pediatric KW - pediatrics KW - child KW - children KW - youths KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - behavior KW - behaviors KW - disruptive behavior KW - thematic analysis N2 - Background: Disruptive behavior disorders are among the most common disorders of childhood, and evidence-based parenting programs are the first-line treatment. Digital microinterventions have been proposed as one possible means of supporting parenting style change by giving parents in-the-moment advice about how to respond to challenging behavior. Until now, no digital microintervention supporting evidence-based parenting skills programs has been evaluated. Objective: The aim of this study is to evaluate the subjective experience of parents using a digital microintervention to support evidence-based parenting skills, with particular attention to acceptability, usability, family relationships, and parents? values. Methods: We conducted serial interviews with 11 parents of 33 children before and after spending 3 weeks using an app including 3 digital microinterventions. Parents were recruited via local authorities in the Midlands region of the United Kingdom. Previous participation in a parenting program was an inclusion criterion. Interviews explored family composition; child behavior problems; and experience of using the mobile app, including barriers to use. Thematic analysis was conducted from a user-centered design perspective, and illustrative case vignettes were produced. Results: Many parents used the app in ways that helped them rather than strictly following the instructions they were given. Parents described a range of barriers to using the app including practical problems and failure to change child behavior. Parents and children responded in a variety of ways to the use of the phone, with many wholeheartedly embracing the convenience of technology. Case vignettes illustrate the uniqueness of each family?s experience. Conclusions: Parents? use of a mobile app supporting evidence-based parenting skills is difficult to predict due to the unique challenges each family encounters. Many parents found it an acceptable and helpful addition to family life, but increased personalization is likely to be key to supporting parents. Future digital microintervention developers should keep in mind that parents are likely to use the app pragmatically rather than following instructions, may struggle to use a complex app under pressure, and are likely to hold complex feelings about parenting with an app. UR - https://pediatrics.jmir.org/2024/1/e53907 UR - http://dx.doi.org/10.2196/53907 ID - info:doi/10.2196/53907 ER - TY - JOUR AU - Landman, Benjamin AU - Khoury, Elie AU - Cohen, Alicia AU - Trebossen, Vincent AU - Michel, Alexandre AU - Lefebvre, Aline AU - Delorme, Richard PY - 2024/8/15 TI - Acceptance of a French e?Mental Health Information Website (CléPsy) for Families: A Web-Based Survey JO - JMIR Pediatr Parent SP - e50978 VL - 7 KW - mental health education KW - children KW - family KW - child KW - pediatrics KW - pediatric KW - mental health KW - parent KW - parents KW - parenting KW - psychiatry KW - website KW - acceptance KW - patient education KW - online information KW - health information KW - ease of use KW - usefulness KW - survey KW - surveys KW - user KW - experience KW - questionnaire KW - questionnaires KW - families N2 - Background: Childhood mental health issues concern a large amount of children worldwide and represent a major public health challenge. The lack of knowledge among parents and caregivers in this area hinders effective management. Empowering families enhances their ability to address their children?s difficulties, boosts health literacy, and promotes positive changes. However, seeking reliable mental health information remains challenging due to fear, stigma, and mistrust of the sources of information. Objective: This study evaluates the acceptance of a website, CléPsy, designed to provide reliable information and practical tools for families concerned about child mental health and parenting. Methods: This study examines user characteristics and assesses ease of use, usefulness, trustworthiness, and attitude toward using the website. Platform users were given access to a self-administered questionnaire by means of mailing lists, social networks, and posters between May and July 2022. Results: Findings indicate that the wide majority of the 317 responders agreed or somewhat agreed that the website made discussions about mental health easier with professionals (n=264, 83.3%) or with their relatives (n=260, 82.1%). According to the ANOVA, there was a significant effect between educational level and perceived trust (F6=3.03; P=.007) and between frequency of use and perceived usefulness (F2=4.85; P=.008). Conclusions: The study underlines the importance of user experience and design in web-based health information dissemination and emphasizes the need for accessible and evidence-based information. Although the study has limitations, it provides preliminary support for the acceptability and usefulness of the website. Future efforts should focus on inclusive co-construction with users and addressing the information needs of families from diverse cultural and educational backgrounds. UR - https://pediatrics.jmir.org/2024/1/e50978 UR - http://dx.doi.org/10.2196/50978 ID - info:doi/10.2196/50978 ER - TY - JOUR AU - Xie, Yijun AU - Wu, Jing AU - Li, Yao AU - Liu, Hui AU - Peng, Yanyan AU - Zhou, Ping AU - Sun, Yizhou AU - Kang, Luyan AU - Jiang, Chenghua AU - Wu, Hengjing PY - 2024/8/7 TI - Requirements for and Barriers to Rehabilitation Services for Children With Disabilities in Middle- and High-Income Countries: Scoping Review JO - Interact J Med Res SP - e50047 VL - 13 KW - children with disabilities KW - barriers KW - health services KW - middle- and high-income countries KW - child KW - low income KW - middle income KW - disability KW - children KW - disabilities KW - income KW - barrier KW - rehabilitation KW - suitability KW - availability KW - affordability KW - support system KW - support KW - awareness KW - policy N2 - Background: The rehabilitation of children with disabilities has received considerable attention from the United Nations. However, the state of rehabilitation services for children with disabilities worldwide remains far from optimistic, even in economically affluent middle- and high-income countries. Objective: This scoping review aimed to identify the rehabilitation needs of children with disabilities and their barriers to rehabilitation services in middle- and high-income countries. Methods: A systematic search was conducted using MEDLINE and Web of Science for papers published from January 2013 to December 2023. Studies were included if they were peer-reviewed, full-text articles related to children with disabilities, reporting on their access to rehabilitation services, and conducted in countries classified by the World Bank 2023 as middle- and high-income economies. Exclusion criteria included duplicates, unavailable full texts, and studies without distinct outcomes. A total of 27 studies were selected following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on children, their families, or service providers. Results: The suitability, availability, and affordability of rehabilitation services were identified as the major needs and barriers for children with disabilities in middle- and high-income countries. This included communication barriers, a need for more personnel and facilities, and the stagnation and inadequacy of economic subsidies. Conclusions: Middle- and high-income countries have relatively well-established rehabilitation infrastructure and support systems. They are nevertheless insufficient for meeting the needs of children with disabilities. More attention should be paid to these issues to improve the well-being of children with disabilities. The data provided by this review can help raise awareness of rehabilitation needs and barriers at the policy level. UR - https://www.i-jmr.org/2024/1/e50047 UR - http://dx.doi.org/10.2196/50047 UR - http://www.ncbi.nlm.nih.gov/pubmed/39110502 ID - info:doi/10.2196/50047 ER - TY - JOUR AU - Li, K. Brian S. AU - Fereday, Brendan AU - Wang, Ellen AU - Rodriguez, Samuel AU - Forssell, Karin AU - Bollaert, N. André AU - Menendez, Maria AU - Caruso, J. Thomas PY - 2024/7/30 TI - Enhancement of Immersive Technology Use in Pediatric Health Care With Accessible, Context-Specific Training: Descriptive Feasibility Study JO - JMIR XR Spatial Comput SP - e56447 VL - 1 KW - immersive technology KW - implementation KW - adult learning KW - education KW - pediatric KW - accessibility KW - training KW - therapeutic KW - pediatric care KW - utilization KW - virtual reality KW - VR KW - monitoring KW - license KW - development KW - software KW - monitoring software N2 - Background: Immersive technology provides adjuncts for pediatric care. However, accessibility and inadequate training limit implementation of this technology. Standardized instruction with no-cost software licensing may improve health care professionals? facility with immersive technologies. Objective: This descriptive feasibility study aimed to examine the applications of immersive technologies in pediatric health care, including virtual reality (VR) and projectors. Methods: We developed immersive technology instructional guides for pediatric health care. The training guides were created for multiple software content and hardware types across several clinical scenarios. Content was available in print and digital versions. The primary outcome was technology use across sites with no-cost software agreements. The secondary outcome was the specific application types used at a single site, stratified by sessions and minutes. Data were analyzed using descriptive statistics. Results: Data were collected from 19 licensed sites from January through June 2022. Among the 19 sites, 32% (n=6) used 10 or more VR units. Among the 6 sites that had projectors, half used 5 or more units. The mean minutes of use per month of all sites combined was 2199 (IQR 51-1058). Three sites had more than 10,000 minutes of total use during the 6-month review period. Secondary results indicated that active VR (977 total sessions) and passive projector streaming (1261 total sessions) were the most popular application types by session, while active projector (66,849 total minutes) and passive projector streaming (32,711 total minutes) were the most popular types when stratified by minutes of use. The active VR application with the most minutes of use was an application often used in physical therapy. Conclusions: Context-specific technological instruction coupled to no-cost licenses may increase access to immersive technology in pediatric health care settings. UR - https://xr.jmir.org/2024/1/e56447 UR - http://dx.doi.org/10.2196/56447 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56447 ER - TY - JOUR AU - Sawires, Rana AU - Clothier, J. Hazel AU - Burgner, David AU - Fahey, Collingwood Michael AU - Buttery, Jim PY - 2024/7/25 TI - Kawasaki Disease and Respiratory Viruses: Ecological Spatiotemporal Analysis JO - JMIR Public Health Surveill SP - e49648 VL - 10 KW - Kawasaki disease KW - pediatric KW - infection KW - RSV KW - human metapneumovirus KW - respiratory virus KW - virology KW - community KW - viral infection KW - respiratory disease KW - respiratory diseases KW - children KW - epidemiology KW - respiratory syncytial virus N2 - Background: Kawasaki disease is an uncommon vasculitis affecting young children. Its etiology is not completely understood, although infections have been frequently postulated as the triggers. Respiratory viruses, specifically, have often been implicated as causative agents for Kawasaki disease presentations. Objective: We aimed to conduct an ecological spatiotemporal analysis to determine whether Kawasaki disease incidence was related to community respiratory virus circulation in a shared region and population, and to describe viral associations before and during the COVID-19 pandemic. Methods: We obtained independent statewide data sets of hospital admissions of Kawasaki disease and respiratory multiplex polymerase chain reaction tests performed at two large hospital networks in Victoria, Australia, from July 2011 to November 2021. We studied spatiotemporal relationships by negative binomial regression analysis of the monthly incidence of Kawasaki disease and the rate of positive respiratory polymerase chain reaction tests in different regions of Victoria. Peak viral seasons (95th percentile incidence) were compared to median viral circulation (50th percentile incidence) to calculate peak season increased rate ratios. Results: While no seasonal trend in Kawasaki disease incidence was identified throughout the study period, we found a 1.52 (99% CI 1.27?1.82) and a 1.43 (99% CI 1.17?1.73) increased rate ratio of Kawasaki disease presentations in association with human metapneumovirus and respiratory syncytial virus circulation, respectively, before the COVID-19 pandemic. No respiratory viral associations with Kawasaki disease were observed during the COVID-19 pandemic. Conclusions: Our large ecological analysis demonstrates novel spatiotemporal relationships between human metapneumovirus and respiratory syncytial virus circulation with Kawasaki disease. The disappearance of these associations in the COVID-19 pandemic may reflect the reduced circulation of non?SARS-CoV-2 viruses during this period, supporting the prepandemic associations identified in this study. The roles of human metapneumovirus and respiratory syncytial virus in Kawasaki disease etiology warrant further investigation. UR - https://publichealth.jmir.org/2024/1/e49648 UR - http://dx.doi.org/10.2196/49648 ID - info:doi/10.2196/49648 ER - TY - JOUR AU - Park, J. Jay AU - Tiefenbach, Jakov AU - Anwar, Ma'arij Mohammed AU - Narayanan, Sandhya AU - Ope, Beatrice AU - Bin Han, Seo Selene AU - Ale, Maxime Boni AU - Adeloye, Davies AU - Rudan, Igor PY - 2024/7/16 TI - Estimating the Global and Regional Burden of Streptococcus pneumoniae Meningitis in Children: Protocol for a Systematic Review and Meta-Analysis JO - JMIR Res Protoc SP - e50678 VL - 13 KW - Streptococcus pneumoniae KW - meningitis KW - streptococcal meningitis KW - pneumococcal meningits KW - global burden KW - pediatric meningitis KW - infectious disease KW - pneumonia KW - sepsis KW - infection KW - infection prevention and control KW - IPC KW - child health KW - global health KW - systematic review KW - pneumococcal N2 - Background: Streptococcus pneumoniae (Spn) has been a leading cause of bacterial meningitis in children. The most recent estimation of the global burden of Spn meningitis indicates a positive trajectory in eliminating Spn through the implementation of pneumococcal conjugate vaccines. However, continuous monitoring and assessment of the disease burden are necessary due to the evidence of serotype replacement, antibiotic resistance, and the impact of the recent COVID-19 pandemic. Objective: The aim of this systematic review is to provide an updated and focused assessment of the global and regional burden of Spn meningitis in children, which can guide policies and strategies to reduce the disease burden. Methods: Population-based studies published from January 1, 2000, to January 1, 2022, were preliminarily searched from the electronic databases PubMed, Embase, Global Health (CABI), and CINAHL Plus without any language restrictions. Studies were included if they reported the incidence, prevalence, mortality, or case-fatality ratio (CFR) for Spn meningitis in children aged 0-4 years; meningitis was confirmed by cerebrospinal fluid culture; the study period was a minimum of 1 year; the number of reported cases was at least 10; and the study had no methodological ambiguities. The article screening process follows the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Characteristics including study period, setting, World Health Organization region, income level, vaccination information, and participant data (age, number of cases, deaths, sequelae, and risk factors) will be extracted from the included studies. Search results will be updated and incorporated into our review prior to finalizing the extraction of data. Generalized linear mixed models meta-analysis will be performed to estimate the pooled incidence and CFR. We will further assess the risk of bias and heterogeneity, and will perform subgroup and sensitivity analyses to provide a meaningful interpretation of the current burden and literature for pneumococcal meningitis. Results: Our preliminary search in December 2021 yielded 9295 articles. Out of 275 studies that were assessed with our eligibility criteria, 117 articles were included. Data extraction and analysis are expected to be complete by January 2025. We plan to publish the results from the full study, including an updated search in 2024, by March 2025. Conclusions: Given that the major burden of Spn meningitis affects children under the age of 5 years, this systematic review will provide a thorough understanding of the global burden of Spn meningitis in this vulnerable population over a span of 2 decades. Insights into incidence trends, geospatial distribution, risk factors, and sequelae will be valuable for stakeholders, policy makers, and the academic community. This information will aid in the ongoing monitoring of the disease and in enhancing targeted vaccine programs to further mitigate the impact of the disease on children worldwide. Trial Registration: PROSPERO CRD42021293110; https://tinyurl.com/kc3j5k4m International Registered Report Identifier (IRRID): DERR1-10.2196/50678 UR - https://www.researchprotocols.org/2024/1/e50678 UR - http://dx.doi.org/10.2196/50678 UR - http://www.ncbi.nlm.nih.gov/pubmed/39012685 ID - info:doi/10.2196/50678 ER - TY - JOUR AU - Gómez-Valverde, J. Juan AU - Sánchez-Jacob, Ramón AU - Ribó, Luis José AU - Schaaf, Simon H. AU - García Delgado, Lara AU - Hernanz-Lobo, Alicia AU - Capellán-Martín, Daniel AU - Lancharro, Ángel AU - Augusto, Orvalho AU - García-Basteiro, L. Alberto AU - Santiago-García, Begoña AU - López-Varela, Elisa AU - Ledesma-Carbayo, J. María PY - 2024/7/1 TI - Chest X-Ray?Based Telemedicine Platform for Pediatric Tuberculosis Diagnosis in Low-Resource Settings: Development and Validation Study JO - JMIR Pediatr Parent SP - e51743 VL - 7 KW - telemedicine KW - telehealth KW - pediatric tuberculosis KW - tuberculosis KW - screening KW - chest radiograph KW - usability KW - low-resource settings N2 - Background: Tuberculosis (TB) remains a major cause of morbidity and death worldwide, with a significant impact on children, especially those under the age of 5 years. The complex diagnosis of pediatric TB, compounded by limited access to more accurate diagnostic tests, underscores the need for improved tools to enhance diagnosis and care in resource-limited settings. Objective: This study aims to present a telemedicine web platform, BITScreen PTB (Biomedical Image Technologies Screen for Pediatric Tuberculosis), aimed at improving the evaluation of pulmonary TB in children based on digital chest x-ray (CXR) imaging and clinical information in resource-limited settings. Methods: The platform was evaluated by 3 independent expert readers through a retrospective assessment of a data set with 218 imaging examinations of children under 3 years of age, selected from a previous study performed in Mozambique. The key aspects assessed were the usability through a standardized questionnaire, the time needed to complete the assessment through the platform, the performance of the readers to identify TB cases based on the CXR, the association between the TB features identified in the CXRs and the initial diagnostic classification, and the interreader agreement of the global assessment and the radiological findings. Results: The platform?s usability and user satisfaction were evaluated using a questionnaire, which received an average rating of 4.4 (SD 0.59) out of 5. The average examination completion time ranged from 35 to 110 seconds. In addition, the study on CXR showed low sensitivity (16.3%-28.2%) but high specificity (91.1%-98.2%) in the assessment of the consensus case definition of pediatric TB using the platform. The CXR finding having a stronger association with the initial diagnostic classification was air space opacification (?21>20.38, P<.001). The study found varying levels of interreader agreement, with moderate/substantial agreement for air space opacification (?=0.54-0.67) and pleural effusion (?=0.43-0.72). Conclusions: Our findings support the promising role of telemedicine platforms such as BITScreen PTB in enhancing pediatric TB diagnosis access, particularly in resource-limited settings. Additionally, these platforms could facilitate the multireader and systematic assessment of CXR in pediatric TB clinical studies. UR - https://pediatrics.jmir.org/2024/1/e51743 UR - http://dx.doi.org/10.2196/51743 UR - http://www.ncbi.nlm.nih.gov/pubmed/38949860 ID - info:doi/10.2196/51743 ER - TY - JOUR AU - Reshetnikov, Aleksey AU - Shaikhattarova, Natalia AU - Mazurok, Margarita AU - Kasatkina, Nadezhda PY - 2024/6/20 TI - Dental Tissue Density in Healthy Children Based on Radiological Data: Retrospective Analysis JO - JMIRx Med SP - e56759 VL - 5 KW - density KW - teeth KW - tooth KW - dental KW - dentist KW - dentists KW - dentistry KW - oral KW - tissue KW - enamel KW - dentin KW - Hounsfield KW - pathology KW - pathological KW - radiology KW - radiological KW - image KW - images KW - imaging KW - teeth density KW - Hounsfield unit KW - diagnostic imaging N2 - Background: Information about the range of Hounsfield values for healthy teeth tissues could become an additional tool in assessing dental health and could be used, among other data, for subsequent machine learning. Objective: The purpose of our study was to determine dental tissue densities in Hounsfield units (HU). Methods: The total sample included 36 healthy children (n=21, 58% girls and n=15, 42% boys) aged 10-11 years at the time of the study. The densities of 320 teeth tissues were analyzed. Data were expressed as means and SDs. The significance was determined using the Student (1-tailed) t test. The statistical significance was set at P<.05. Results: The densities of 320 teeth tissues were analyzed: 72 (22.5%) first permanent molars, 72 (22.5%) permanent central incisors, 27 (8.4%) second primary molars, 40 (12.5%) tooth germs of second premolars, 37 (11.6%) second premolars, 9 (2.8%) second permanent molars, and 63 (19.7%) tooth germs of second permanent molars. The analysis of the data showed that tissues of healthy teeth in children have different density ranges: enamel, from mean 2954.69 (SD 223.77) HU to mean 2071.00 (SD 222.86) HU; dentin, from mean 1899.23 (SD 145.94) HU to mean 1323.10 (SD 201.67) HU; and pulp, from mean 420.29 (SD 196.47) HU to mean 183.63 (SD 97.59) HU. The tissues (enamel and dentin) of permanent central incisors in the mandible and maxilla had the highest mean densities. No gender differences concerning the density of dental tissues were reliably identified. Conclusions: The evaluation of Hounsfield values for dental tissues can be used as an objective method for assessing their densities. If the determined densities of the enamel, dentin, and pulp of the tooth do not correspond to the range of values for healthy tooth tissues, then it may indicate a pathology. UR - https://xmed.jmir.org/2024/1/e56759 UR - http://dx.doi.org/10.2196/56759 ID - info:doi/10.2196/56759 ER - TY - JOUR AU - Denis, Fabrice AU - Le Goff, Florian AU - Desbois, Madhu AU - Gepner, Agnes AU - Feliciano, Guillaume AU - Silber, Denise AU - Zeitoun, Jean-David AU - Assuied, Peretz Guedalia PY - 2024/6/18 TI - Early Detection of 5 Neurodevelopmental Disorders of Children and Prevention of Postnatal Depression With a Mobile Health App: Observational Cross-Sectional Study JO - JMIR Public Health Surveill SP - e58565 VL - 10 KW - mobile phone KW - pediatric KW - infant KW - baby KW - neonate KW - newborn KW - toddler KW - child KW - early detection KW - app KW - application KW - screening KW - algorithm KW - NDD KW - neurodevelopmental disorder KW - autism KW - ASD KW - autism spectrum disorder KW - attention deficit/hyperactivity disorder KW - ADHD KW - attention deficit KW - PND KW - postnatal depression KW - mHealth KW - mobile health KW - real-world study KW - smartphone KW - dyspraxia KW - delayed KW - language KW - dyslexia KW - incidence KW - prevalence N2 - Background: Delay in the diagnosis of neurodevelopmental disorders (NDDs) in toddlers and postnatal depression (PND) is a major public health issue. In both cases, early intervention is crucial but too rarely implemented in practice. Objective: Our goal was to determine if a dedicated mobile app can improve screening of 5 NDDs (autism spectrum disorder [ASD], language delay, dyspraxia, dyslexia, and attention-deficit/hyperactivity disorder [ADHD]) and reduce PND incidence. Methods: We performed an observational, cross-sectional, data-based study in a population of young parents in France with at least 1 child aged <10 years at the time of inclusion and regularly using Malo, an ?all-in-one? multidomain digital health record electronic patient-reported outcome (PRO) app for smartphones. We included the first 50,000 users matching the criteria and agreeing to participate between May 1, 2022, and February 8, 2024. Parents received periodic questionnaires assessing skills in neurodevelopment domains via the app. Mothers accessed a support program to prevent PND and were requested to answer regular PND questionnaires. When any PROs matched predefined criteria, an in-app recommendation was sent to book an appointment with a family physician or pediatrician. The main outcomes were the median age of the infant at the time of notification for possible NDD and the incidence of PND detection after childbirth. One secondary outcome was the relevance of the NDD notification by consultation as assessed by health professionals. Results: Among 55,618 children median age 4 months (IQR 9), 439 (0.8%) had at least 1 disorder for which consultation was critically necessary. The median ages of notification for probable ASD, language delay, dyspraxia, dyslexia, and ADHD were 32.5 (IQR 12.8), 16 (IQR 13), 36 (IQR 22.5), 80 (IQR 5), and 61 (IQR 15.5) months, respectively. The rate of probable ADHD, ASD, dyslexia, language delay, and dyspraxia in the population of children of the age included between the detection limits of each alert was 1.48%, 0.21%, 1.52%, 0.91%, and 0.37%, respectively. Sensitivity of alert notifications for suspected NDDs as assessed by the physicians was 78.6% and specificity was 98.2%. Among 8243 mothers who completed a PND questionnaire, highly probable PND was detected in 938 (11.4%), corresponding to a reduction of ?31% versus our previous study without a support program. Suspected PND was detected a median 96 days (IQR 86) after childbirth. Among 130 users who filled in the satisfaction survey, 99.2% (129/130) found the app easy to use and 70% (91/130) reported that the app improved follow-up of their child. The app was rated 4.8/5 on Apple?s App Store. Conclusions: Algorithm-based early alerts suggesting NDDs were highly specific with good sensitivity as assessed by real-life practitioners. Early detection of 5 NDDs and PNDs was efficient and led to a possible 31% reduction in PND incidence. Trial Registration: ClinicalTrials.gov NCT06301087; https://www.clinicaltrials.gov/study/NCT06301087 UR - https://publichealth.jmir.org/2024/1/e58565 UR - http://dx.doi.org/10.2196/58565 UR - http://www.ncbi.nlm.nih.gov/pubmed/38888952 ID - info:doi/10.2196/58565 ER - TY - JOUR AU - Cardinale, Fabio AU - Barattini, Franco Dionisio AU - Sbrocca, Federica AU - Centi, Alessandro AU - Giuntini, Greta AU - Morariu Bordea, Maria AU - Herteg, Dorina AU - Rosu, Serban AU - Matei, Radu Cristian PY - 2024/5/31 TI - The Effects of a Dietary Supplement (PediaFlù) Plus Standard of Care in Children With Acute Tonsillopharyngitis/Rhinopharyngitis: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e53703 VL - 13 KW - dietary supplements KW - tonsillitis KW - pharyngitis KW - nasopharyngitis KW - Pelargonium KW - propolis KW - zinc KW - severity score N2 - Background: A dietary supplement containing Pelargonium sidoides extract, propolis, zinc, and honey has been recently developed and proven to be an effective adjuvant in clinical practice for seasonal diseases and the treatment of respiratory tract disorders. Objective: This trial aims to verify the efficacy of the tested dietary supplement in a pediatric population with acute tonsillopharyngitis/rhinopharyngitis (ATR). Methods: The trial includes children aged between 3 and 10 years with ATR ?48 h, a negative rapid test for beta-hemolytic streptococcus or culture identification of nasal and/or pharyngeal exudates, and SARS-CoV-2 infection. The dietary supplement tested is an oral solution already on the market based on Pelagon P-70 (equivalent to Pelargonium sidoides d.e. 133.3 mg/100 ml), propolis, zinc, and honey. The product is administered at 5 ml 3 times a day for 6 days for children younger than 6 years and 10 ml 3 times a day for 6 days for children older than 6 years. The study design is open label, randomized, and controlled, with the tested dietary supplement plus standard of care (SoC) versus SoC alone. Patients are enrolled from 3 sites in Romania. The change in Tonsillitis Severity Score and number of treatment failures (using ibuprofen or high-dose paracetamol as rescue medication) are the primary end points. Based on the Tonsillitis Severity Score and the 2-sample comparison of the means formula with a 5% significance level, 80% power, and a minimally clinically important difference of 2 (SD 3.85) points, 120 patients are required. To account for potential screening failures and dropouts, we need to screen a population of approximately 150 children. Results: Patient enrollment began on June 3, 2021 (first patient?s first visit), and ended on August 12, 2021 (last patient?s last visit). The data collection period was from June 3, 2021, to September 16, 2021. The study was funded in February 2023. Data analysis is currently ongoing (April 2024). We expect the results to be published in a peer-reviewed clinical journal in the third quarter of 2024 and presented at scientific meetings in the last quarter of 2024. Conclusions: The data from this trial may help identify new adjuvant treatments for children with ATR when streptococcal infection is excluded by a negative rapid test, thereby avoiding unnecessary antibiotic administration. Trial Registration: ClinicalTrials.gov NCT04899401 https://clinicaltrials.gov/study/NCT04899401 International Registered Report Identifier (IRRID): DERR1-10.2196/53703 UR - https://www.researchprotocols.org/2024/1/e53703 UR - http://dx.doi.org/10.2196/53703 UR - http://www.ncbi.nlm.nih.gov/pubmed/38819917 ID - info:doi/10.2196/53703 ER - TY - JOUR AU - Matthes, Jörg AU - Binder, Alice AU - Naderer, Brigitte AU - Forrai, Michaela AU - Spielvogel, Ines AU - Knupfer, Helena AU - Saumer, Melanie PY - 2024/5/22 TI - Effects of Food Depictions in Entertainment Media on Children?s Unhealthy Food Preferences: Content Analysis Linked With Panel Data JO - JMIR Pediatr Parent SP - e51429 VL - 7 KW - children KW - health KW - unhealthy food preferences KW - food depictions KW - centrality KW - coviewing KW - longitudinal linkage study KW - child KW - food KW - eating KW - diet KW - dietary KW - preference KW - preferences KW - nutrition KW - nutritional KW - media KW - entertainment KW - panel KW - foods KW - pediatric KW - pediatrics KW - food preference KW - food preferences N2 - Background: Entertainment media content is often mentioned as one of the roots of children?s unhealthy food consumption. This might be due to the high quantity of unhealthy foods presented in children?s media environments. However, less is known about the role of the centrality of food placement, that is, whether foods are interacted with, consumed, verbally mentioned, or appear unobtrusively. We also lack longitudinal research measuring both children?s unhealthy and healthy food consumption behaviors as outcomes. Objective: The aim is to connect content analytical data based on children?s actual media diet with panel data in order to explain children?s food preferences. Moreover, this study not only focuses on the amount of healthy and unhealthy foods children are exposed to, but also on how these foods are presented (ie, centrally or not). Furthermore, we looked at the question of how parental coviewing can diminish (or enhance) the effects of unhealthy (or healthy) food depictions, and we measured healthy and unhealthy consumption as dependent variables. Methods: We conducted a 2-wave panel study with children and one of their parents (of 2250 parents contacted, 829 responded, for a response rate of 36.84%; 648 valid cases, ie, parent-child pairs, were used for analysis), with 6 months between the 2 panel waves. We linked the 2-wave panel data for the children and their parents to content analytical data for movies (n=113) and TV series (n=134; 3 randomly chosen episodes per TV series were used) that children were exposed to over the course of 6 months. Results: There was no significant relationship between exposure to unhealthy food presentation and unhealthy (b=0.008; P=.07) or healthy (b=?0.003; P=.57) food consumption over time. Also, healthy food presentation was unrelated to unhealthy (b=0.009; P=.18) or healthy (b=0.000; P=.99) food consumption over time. However, there was a significant, positive interaction between unhealthy food presentation and presentation centrality on unhealthy food consumption (b=0.000; P=.03), suggesting that the effects of unhealthy food presentation rise with increasing levels of centrality. There was no interaction between unhealthy food presentation and presentation centrality on the consumption of healthy foods (b=0.000; P=.10). Also, exposure to healthy food presentation interacted with centrality (b=?0.001; P=.003). That is, when a healthy product was presented at maximum centrality, it led to less unhealthy food consumption in children. Coviewing did not interact with exposure to unhealthy foods when explaining unhealthy (b=0.003; P=.08) or healthy (b=?0.001; P=.70) food consumption. Conclusions: We conclude that simply presenting more healthy foods is not sufficient to combat children?s unhealthy food preferences. Further regulations may be necessary with respect to representations of unhealthy foods in children?s media. UR - https://pediatrics.jmir.org/2024/1/e51429 UR - http://dx.doi.org/10.2196/51429 ID - info:doi/10.2196/51429 ER - TY - JOUR AU - Shi, M. Jiaxiao AU - Chiu, Y. Vicki AU - Avila, C. Chantal AU - Lewis, Sierra AU - Park, Daniella AU - Peltier, R. Morgan AU - Getahun, Darios PY - 2024/5/14 TI - Coding of Childhood Psychiatric and Neurodevelopmental Disorders in Electronic Health Records of a Large Integrated Health Care System: Validation Study JO - JMIR Ment Health SP - e56812 VL - 11 KW - autism KW - autism spectrum disorder KW - ASD KW - attention deficit hyperactivity disorder KW - ADHD KW - disruptive behavioral disorders KW - DBD KW - anxiety disorders KW - AD KW - major depression disorder KW - MDD KW - autistic KW - coding KW - neurodevelopmental KW - psychiatric KW - electronic health record KW - electronic health records KW - validation KW - accuracy KW - mental health KW - emotional KW - behavior KW - behaviors KW - behavioral KW - disorder KW - disorders KW - pediatric KW - pediatrics KW - paediatric KW - infant KW - paediatrics KW - infants KW - infancy KW - baby KW - babies KW - neonate KW - neotnates KW - neonatal KW - toddler KW - toddlers KW - child KW - children KW - hospital KW - hospitals N2 - Background: Mental, emotional, and behavioral disorders are chronic pediatric conditions, and their prevalence has been on the rise over recent decades. Affected children have long-term health sequelae and a decline in health-related quality of life. Due to the lack of a validated database for pharmacoepidemiological research on selected mental, emotional, and behavioral disorders, there is uncertainty in their reported prevalence in the literature. Objectives: We aimed to evaluate the accuracy of coding related to pediatric mental, emotional, and behavioral disorders in a large integrated health care system?s electronic health records (EHRs) and compare the coding quality before and after the implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding as well as before and after the COVID-19 pandemic. Methods: Medical records of 1200 member children aged 2-17 years with at least 1 clinical visit before the COVID-19 pandemic (January 1, 2012, to December 31, 2014, the ICD-9-CM coding period; and January 1, 2017, to December 31, 2019, the ICD-10-CM coding period) and after the COVID-19 pandemic (January 1, 2021, to December 31, 2022) were selected with stratified random sampling from EHRs for chart review. Two trained research associates reviewed the EHRs for all potential cases of autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), major depression disorder (MDD), anxiety disorder (AD), and disruptive behavior disorders (DBD) in children during the study period. Children were considered cases only if there was a mention of any one of the conditions (yes for diagnosis) in the electronic chart during the corresponding time period. The validity of diagnosis codes was evaluated by directly comparing them with the gold standard of chart abstraction using sensitivity, specificity, positive predictive value, negative predictive value, the summary statistics of the F-score, and Youden J statistic. ? statistic for interrater reliability among the 2 abstractors was calculated. Results: The overall agreement between the identification of mental, behavioral, and emotional conditions using diagnosis codes compared to medical record abstraction was strong and similar across the ICD-9-CM and ICD-10-CM coding periods as well as during the prepandemic and pandemic time periods. The performance of AD coding, while strong, was relatively lower compared to the other conditions. The weighted sensitivity, specificity, positive predictive value, and negative predictive value for each of the 5 conditions were as follows: 100%, 100%, 99.2%, and 100%, respectively, for ASD; 100%, 99.9%, 99.2%, and 100%, respectively, for ADHD; 100%, 100%, 100%, and 100%, respectively for DBD; 87.7%, 100%, 100%, and 99.2%, respectively, for AD; and 100%, 100%, 99.2%, and 100%, respectively, for MDD. The F-score and Youden J statistic ranged between 87.7% and 100%. The overall agreement between abstractors was almost perfect (?=95%). Conclusions: Diagnostic codes are quite reliable for identifying selected childhood mental, behavioral, and emotional conditions. The findings remained similar during the pandemic and after the implementation of the ICD-10-CM coding in the EHR system. UR - https://mental.jmir.org/2024/1/e56812 UR - http://dx.doi.org/10.2196/56812 ID - info:doi/10.2196/56812 ER - TY - JOUR AU - Tahmasebi, Neda AU - Zarifian, Talieh AU - Ashtari, Atieh AU - Biglarian, Akbar PY - 2024/4/19 TI - Telepractice Parent Training of Enhanced Milieu Teaching With Phonological Emphasis (EMT+PE) For Persian-Speaking Toddlers With Nonsyndromic Cleft Palate: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e54426 VL - 13 KW - telepractice KW - cleft palate KW - language intervention KW - parent training KW - Phonological Emphasis KW - Enhanced Milieu Teaching KW - Persian-speaking toddlers KW - toddler KW - toddlers KW - children KW - child KW - cleft lip KW - language development KW - speech sound disorders KW - speech sound disorder KW - effectiveness KW - parent-based KW - intervention KW - speech KW - therapy N2 - Background: Children born with a cleft palate with or without a cleft lip (CP/L) are at increased risk for delayed language development and speech sound disorders. Enhanced Milieu Teaching with Phonological Emphasis (EMT+PE) is a recommended naturalistic intervention for toddlers with CP/L. The parents? role in providing naturalistic interventions is critical and they need training based on learning principles to implement these interventions. Telepractice is an appropriate method for training parents and children with various speech-related disorders. Objective: This study aims to determine and compare the effectiveness of telepractice and the parent-implemented EMT+PE intervention on language and speech measures in toddlers with CP/L with usual interventions and determine the effectiveness maintenance of the intervention. Methods: A randomized controlled trial (RCT) will assess the efficacy of telepractice and the parent-implemented EMT+PE intervention in enhancing speech and language measures in toddlers with CP/L. Eligible participants will be randomly assigned to one of 2 groups: the conventional intervention group and the EMT+PE intervention group. Participants? speech and language measures will be evaluated remotely by trained raters before and after the intervention and 2 months after the intervention. Parents of participants in the intervention group will receive 3 months of training in speech and language supportive strategies from trained therapists using telehealth fidelity scales. Parents of participants in the control group will receive the conventional speech and language intervention by cleft team therapists. Study outcomes will include language variables (mean length of utterance) and speech production variables (percent correct consonants). Results: The protocol was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences in February 2022. The selection process of participants, as well as training therapists and raters, commenced in January 2022, the therapy and follow-up period ended in June 2023, and pre- and postintervention assessments have been conducted. Data analysis is ongoing, and we expect to publish our results by the summer of 2024. Funding is yet to be received. Conclusions: The results of this study may help us develop a speech and language intervention with a different delivery model for toddlers with CP/L, and the cleft team care can use these results in service delivery. Consistent with our hypothesis, speech and language measures are expected to improve. International Registered Report Identifier (IRRID): DERR1-10.2196/54426 UR - https://www.researchprotocols.org/2024/1/e54426 UR - http://dx.doi.org/10.2196/54426 UR - http://www.ncbi.nlm.nih.gov/pubmed/38640014 ID - info:doi/10.2196/54426 ER - TY - JOUR AU - Howdle, Charlotte AU - Wright, Alexander William James AU - Mant, Jonathan AU - De Simoni, Anna PY - 2024/4/16 TI - Factors Influencing Recovery From Pediatric Stroke Based on Discussions From a UK-Based Online Stroke Community: Qualitative Thematic Study JO - J Med Internet Res SP - e49409 VL - 26 KW - child KW - stroke KW - rehabilitation KW - barriers KW - facilitators KW - internet-based intervention KW - self-help group KW - thematic analysis N2 - Background: The incidence of stroke in children is low, and pediatric stroke rehabilitation services are less developed than adult ones. Survivors of pediatric stroke have a long poststroke life expectancy and therefore have the potential to experience impairments from their stroke for many years. However, there are relatively few studies characterizing these impairments and what factors facilitate or counteract recovery. Objective: This study aims to characterize the main barriers to and facilitators of recovery from pediatric stroke. A secondary aim was to explore whether these factors last into adulthood, whether they change, or if new factors impacting recovery emerge in adulthood. Methods: We performed a qualitative thematic analysis based on posts from a population of participants from a UK-based online stroke community, active between 2004 and 2011. The analysis focused on users who talked about their experiences with pediatric stroke, as identified by a previous study. The posts were read by 3 authors, and factors influencing recovery from pediatric stroke were mapped into 4 areas: medical, physical, emotional, and social. Factors influencing recovery were divided into short-term and long-term factors. Results: There were 425 posts relating to 52 survivors of pediatric stroke. Some survivors of stroke posted for themselves, while others were talked about by a third party (mostly parents; 31/35, 89% mothers). In total, 79% (41/52) of survivors of stroke were aged ?18 years and 21% (11/52) were aged >18 years at the time of posting. Medical factors included comorbidities as a barrier to recovery. Medical interventions, such as speech and language therapy and physiotherapy, were also deemed useful. Exercise, particularly swimming, was deemed a facilitator. Among physical factors, fatigue and chronic pain could persist decades after a stroke, with both reported as a barrier to feeling fully recovered. Tiredness could worsen existing stroke-related impairments. Other long-standing impairments were memory loss, confusion, and dizziness. Among emotional factors, fear and uncertainty were short-term barriers, while positivity was a major facilitator in both short- and long-term recovery. Anxiety, grief, and behavioral problems hindered recovery. The social barriers were loneliness, exclusion, and hidden disabilities not being acknowledged by third parties. A good support network and third-party support facilitated recovery. Educational services were important in reintegrating survivors into society. Participants reported that worrying about losing financial support, such as disability allowances, and difficulties in obtaining travel insurance and driving licenses impacted recovery. Conclusions: The lived experience of survivors of pediatric stroke includes long-term hidden disabilities and barriers to rehabilitation. These are present in different settings, such as health care, schools, workplaces, and driving centers. Greater awareness of these issues by relevant professional groups may help ameliorate them. UR - https://www.jmir.org/2024/1/e49409 UR - http://dx.doi.org/10.2196/49409 UR - http://www.ncbi.nlm.nih.gov/pubmed/38625726 ID - info:doi/10.2196/49409 ER - TY - JOUR AU - Sakamoto, Masahiko AU - Ishikawa, Hirono AU - Suzuki, Asuka PY - 2024/4/11 TI - Evaluation of Parents? Use of a Child Health Care Information App and Their Health Literacy: Cross-Sectional Study JO - JMIR Pediatr Parent SP - e48478 VL - 7 KW - health literacy KW - European Health Literacy Survey Questionnaire KW - HLS-EU-Q47 KW - child KW - preschool KW - parent education KW - health care knowledge KW - apps KW - digital media KW - emergency room visit KW - mobile phone N2 - Background: Recently, digital media, including internet websites and smartphone apps, have become popular resources for parents in searching for child health care information. Higher health literacy among parents in obtaining adequate health care information and making proper decisions may lead to improved child health outcomes and a reduction in the burden on health care professionals. However, few studies have examined the association between the provision of child health care information apps and parents? health literacy. Objective: This study aims to evaluate whether parents? use of an app that provides child health care information is associated with their health care knowledge, their health literacy, and emergency room visits for their children. Methods: Participants were recruited during checkups for their 1.5-year-old children at health centers within Saku City in 2022. Parents who agreed to participate were included in this study; individuals were excluded if they were not the mother or father of the child or did not have a smartphone. Participants were asked if they had used the Oshiete-Doctor app, which was distributed by Saku City free of charge to improve the home nursing skills of parents and guardians. Sociodemographic data of parents and children, data on health care knowledge about children, data on the frequency of emergency room visits in the past 6 months, and health literacy scores (HLSs) of parents (measured with the HLS-EU-Q47 [European Health Literacy Survey Questionnaire]) were collected from participants in this cross-sectional survey. Univariable and multivariable analyses were conducted to examine the associations of app use with health care knowledge, health literacy, and emergency room visits. Results: In total, 251 respondents completed the survey (response rate: 251/267, 94%). Although the proportion of health care workers was significantly higher among app users than among non?app users (P=.005), no other participant attributes were significantly associated with the use of the app. The proportions of participants with higher health care knowledge and participants with higher total HLSs were significantly higher among app users than among non?app users (P=.001 and P=.003, respectively). After adjusting for potentially confounding covariates, these proportions were still significantly higher among app users than among non?app users (P=.02 and P=.007, respectively). Emergency room visits were significantly more frequent among app users than among non?app users (P=.007) in the univariable analysis, but the association was not significant (P=.07) after adjusting for sociodemographic variables. Conclusions: This study showed a significant association between parents? use of a child health care information app and higher child health care knowledge and health literacy. The use of the app may lead to more appropriate health decisions and behaviors in children?s health care. Future studies are needed to evaluate the association between app use and emergency room visits. UR - https://pediatrics.jmir.org/2024/1/e48478 UR - http://dx.doi.org/10.2196/48478 ID - info:doi/10.2196/48478 ER - TY - JOUR AU - Livermore, Polly AU - Kupiec, Klaudia AU - Wedderburn, R. Lucy AU - Knight, Andrea AU - Solebo, L. Ameenat AU - Shafran, Roz AU - Robert, Glenn AU - Sebire, J. N. AU - Gibson, Faith AU - PY - 2024/4/3 TI - Designing, Developing, and Testing a Chatbot for Parents and Caregivers of Children and Young People With Rheumatological Conditions (the IMPACT Study): Protocol for a Co-Designed Proof-of-Concept Study JO - JMIR Res Protoc SP - e57238 VL - 13 KW - caregivers KW - chatbot KW - paediatric rheumatology KW - parents and caregivers KW - parents/carers KW - pediatric KW - proof-of-concept KW - quality of life KW - rheumatology N2 - Background: Pediatric rheumatology is a term that encompasses over 80 conditions affecting different organs and systems. Children and young people with rheumatological chronic conditions are known to have high levels of mental health problems and therefore are at risk of poor health outcomes. Clinical psychologists can help children and young people manage the daily difficulties of living with one of these conditions; however, there are insufficient pediatric psychologists in the United Kingdom. We urgently need to consider other ways of providing early, essential support to improve their current well-being. One way of doing this is to empower parents and caregivers to have more of the answers that their children and young people need to support them further between their hospital appointments. Objective: The objective of this co-designed proof-of-concept study is to design, develop, and test a chatbot intervention to support parents and caregivers of children and young people with rheumatological conditions. Methods: This study will explore the needs and views of children and young people with rheumatological conditions, their siblings, parents, and caregivers, as well as health care professionals working in pediatric rheumatology. We will ask approximately 100 participants in focus groups where they think the gaps are in current clinical care and what ideas they have for improving upon them. Creative experience-based co-design workshops will then decide upon top priorities to develop further while informing the appearance, functionality, and practical delivery of a chatbot intervention. Upon completion of a minimum viable product, approximately 100 parents and caregivers will user-test the chatbot intervention in an iterative sprint methodology to determine its worth as a mechanism for support for parents. Results: A total of 73 children, young people, parents, caregivers, and health care professionals have so far been enrolled in the study, which began in November 2023. The anticipated completion date of the study is April 2026. The data analysis is expected to be completed in January 2026, with the results being published in April 2026. Conclusions: This study will provide evidence on the accessibility, acceptability, and usability of a chatbot intervention for parents and caregivers of children and young people with rheumatological conditions. If proven useful, it could lead to a future efficacy trial of one of the first chatbot interventions to provide targeted and user-suggested support for parents and caregivers of children with chronic health conditions in health care services. This study is unique in that it will detail the needs and wants of children, young people, siblings, parents, and caregivers to improve the current support given to families living with pediatric rheumatological conditions. It will be conducted across the whole of the United Kingdom for all pediatric rheumatological conditions at all stages of the disease trajectory. International Registered Report Identifier (IRRID): DERR1-10.2196/57238 UR - https://www.researchprotocols.org/2024/1/e57238 UR - http://dx.doi.org/10.2196/57238 UR - http://www.ncbi.nlm.nih.gov/pubmed/38568725 ID - info:doi/10.2196/57238 ER - TY - JOUR AU - Rojas-Anaya, Hector AU - Kapur, Akshat AU - Roberts, Graham AU - Roland, Damian AU - Gupta, Atul AU - Lazner, Michaela AU - Bayreuther, Jane AU - Pappachan, John AU - Jones, Christina AU - Bremner, Stephen AU - Cantle, Fleur AU - Seddon, Paul PY - 2024/3/28 TI - High-Flow Humidified Oxygen as an Early Intervention in Children With Acute Severe Asthma: Protocol for a Feasibility Randomized Controlled Trial JO - JMIR Res Protoc SP - e54081 VL - 13 KW - asthma KW - child KW - wheezing KW - oxygen therapy KW - high-flow humidified oxygen therapy N2 - Background: Acute severe asthma (ASA) is a leading cause of hospital attendance in children. Standard first-line therapy consists of high-dose inhaled bronchodilators plus oral corticosteroids. Treatment for children who fail to respond to first-line therapy is problematic: the use of intravenous agents is inconsistent, and side effects are frequent. High-flow humidified oxygen (HiFlo) is widely used in respiratory conditions and is increasingly being used in ASA, but with little evidence for its effectiveness. A well-designed, adequately powered randomized controlled trial (RCT) of HiFlo therapy in ASA is urgently needed, and feasibility data are required to plan such an RCT. In this study, we describe the protocol for a feasibility study designed to fill this knowledge gap. Objective: This study aims to establish whether a full RCT of early HiFlo therapy in children with ASA can be conducted successfully and safely, to establish whether recruitment using deferred consent is practicable, and to define appropriate outcome measures and sample sizes for a definitive RCT. The underlying hypothesis is that early HiFlo therapy in ASA will reduce the need for more invasive treatments, allow faster recovery and discharge from hospital, and in both these ways reduce distress to children and their families. Methods: We conducted a feasibility RCT with deferred consent to assess the use of early HiFlo therapy in children aged 2 to 11 years with acute severe wheeze not responding to burst therapy (ie, high-dose inhaled salbutamol with or without ipratropium). Children with a Preschool Respiratory Assessment Measure score ?5 after burst therapy were randomized to commence HiFlo therapy or follow standard care. The candidate primary outcomes assessed were treatment failure requiring escalation and time to meet hospital discharge criteria. Patient and parent experiences were also assessed using questionnaires and telephone interviews. Results: The trial was opened to recruitment in February 2020 but was paused for 15 months owing to the COVID-19 pandemic. The trial was reopened at the lead site in July 2021 and opened at the other 3 sites from August to December 2022. Recruitment was completed in June 2023. Conclusions: This feasibility RCT of early HiFlo therapy in children with ASA recruited to the target despite major disturbances owing to the COVID-19 pandemic. The data are currently being analyzed and will be published separately. Trial Registration: International Standard Randomised Controlled Trial Number Registry ISRCTN78297040; https://www.isrctn.com/ISRCTN78297040 International Registered Report Identifier (IRRID): DERR1-10.2196/54081 UR - https://www.researchprotocols.org/2024/1/e54081 UR - http://dx.doi.org/10.2196/54081 UR - http://www.ncbi.nlm.nih.gov/pubmed/38546733 ID - info:doi/10.2196/54081 ER - TY - JOUR AU - O'Kane, K. Kiarah M. AU - Otamendi, Thalia AU - Silverberg, D. Noah AU - Choi, Esther AU - Sicard, Veronik AU - Zemek, Roger AU - Healey, Katherine AU - Brown, Olivier AU - Butterfield, Lauren AU - Smith, Andra AU - Goldfield, Gary AU - Kardish, Rachel AU - Saab, J. Bechara AU - Ledoux, Andrée-Anne AU - Cairncross, Molly PY - 2024/3/22 TI - Development of Therapeutic Alliance and Social Presence in a Digital Intervention for Pediatric Concussion: Qualitative Exploratory Study JO - JMIR Form Res SP - e49133 VL - 8 KW - adolescent KW - concussion KW - digital therapeutics KW - eHealth KW - mHealth KW - mindfulness KW - mobile health KW - social presence KW - working alliance N2 - Background: Despite the promising benefits of self-guided digital interventions for adolescents recovering from concussion, attrition rates for such interventions are high. Evidence suggests that adults can develop therapeutic alliance with self-guided digital interventions, which is in turn associated with intervention engagement. However, no research has examined whether adolescents develop therapeutic alliance with self-guided digital interventions and what factors are important to its development. Additionally, social presence?the extent to which digital encounters feel like they are occurring in person?may be another relevant factor to understanding the nature of the connection between adolescents and a self-guided digital intervention, though this has yet to be explored. Objective: This qualitative study explored the extent to which adolescents recovering from concussion developed therapeutic alliance and social presence during their use of a self-guided digital mindfulness-based intervention. Additionally, this study aimed to determine factors important to adolescents? development of therapeutic alliance and social presence with the intervention. Methods: Adolescents aged between 12 and 17.99 years who sustained a concussion were recruited from 2 sites: a pediatric emergency department up to 48 hours after a concussion and a tertiary care clinic over 1 month following a concussion to capture adolescents who had both acute and persisting symptoms after concussion. Participants (N=10) completed a 4-week mindfulness-based intervention delivered through a smartphone app. Within the app, participants listened to audio recordings of mindfulness guides (voice actors) narrating psychoeducation and mindfulness practices. At 4 weeks, participants completed questionnaires and a semistructured interview exploring their experience of therapeutic alliance and social presence with the mindfulness guides in the intervention. Results: Themes identified within the qualitative results revealed that participants developed therapeutic alliance and social presence by ?developing a genuine connection? with their mindfulness guides and ?sensing real people.? Particularly important to the development of therapeutic alliance and social presence were the mindfulness guides? ?personal backgrounds and voices,? such that participants felt more connected to the guides by knowing information about them and through the guides? calm tone of voice in audio recordings. Quantitative findings supported qualitative results; participants? average score for therapeutic alliance was far above the scale midpoint, while the mixed results for social presence measures aligned with qualitative findings that participants felt that the mindfulness guides seemed real but not quite as real as an in-person connection would. Conclusions: Our data suggest that adolescents can develop therapeutic alliance and social presence when using digital interventions with no direct human contact. Adolescents? development of therapeutic alliance and social presence with self-guided digital interventions can be bolstered by increasing human-like qualities (eg, real voices) within interventions. Maximizing therapeutic alliance and social presence may be a promising way to reduce attrition in self-guided digital interventions while providing accessible treatment. UR - https://formative.jmir.org/2024/1/e49133 UR - http://dx.doi.org/10.2196/49133 UR - http://www.ncbi.nlm.nih.gov/pubmed/38517472 ID - info:doi/10.2196/49133 ER - TY - JOUR AU - Wright, A. William J. AU - Howdle, Charlotte AU - Coulson, S. Neil AU - De Simoni, Anna PY - 2024/3/15 TI - Exploring the Types of Social Support Exchanged by Survivors of Pediatric Stroke and Their Families in an Online Peer Support Community: Qualitative Thematic Analysis JO - J Med Internet Res SP - e49440 VL - 26 KW - child KW - internet-based intervention KW - online health communities KW - peer support KW - qualitative analysis KW - rehabilitation KW - self-help group KW - self-help KW - social support KW - stroke KW - support groups KW - thematic analysis N2 - Background: Pediatric stroke is relatively rare and underresearched, and there is little awareness of its occurrence in wider society. There is a paucity of literature on the effectiveness of interventions to improve rehabilitation and the services available to survivors. Access to online health communities through the internet may be a means of support for patients with pediatric stroke and their families during recovery; however, little research has been done in this area. Objective: This study aims to identify the types of social support provided by an online peer support group to survivors of pediatric stroke and their families. Methods: This was a qualitative thematic analysis of posts from a pediatric stroke population on a UK online stroke community active between 2004 and 2011. The population was split into 2 groups based on whether stroke survivors were aged ?18 years or aged >18 years at the time of posting. The posts were read by 2 authors who used the adapted Social Support Behavior Code to analyze the types of social support exchanged. Results: A total of 52 participants who experienced a pediatric stroke were identified, who posted a total of 425 messages to the community. About 41 survivors were aged ?18 years at the time of posting and were written about by others (31/35 were mothers), while 11 were aged >18 years and were writing about themselves. Survivors and their families joined together in discussion threads. Support was offered and received by all participants, regardless of age. Of all 425 posts, 193 (45.4%) contained at least 1 instance of social support. All 5 types of social support were identified: informational, emotional, network, esteem support, and tangible aid. Informational and emotional support were most commonly exchanged. Emotional support was offered more often than informational support among participants aged ?18 years at the time of posting; this finding was reversed in the group aged >18 years. Network support and esteem support were less commonly exchanged. Notably, the access subcategory of network support was not exchanged with the community. Tangible aid was the least commonly offered type of support. The exchanged social support provided insight into rehabilitation interventions and the unmet needs of pediatric stroke survivors. Conclusions: We found evidence of engagement of childhood stroke survivors and their families in an online stroke community, with peer support being exchanged between both long- and short-term survivors of pediatric stroke. Engagement of long-term survivors of pediatric stroke through the online community was key, as they were able to offer informational support from lived experience. Further interventional research is needed to assess health and rehabilitation outcomes from engagement with online support groups. Research is also needed to ensure safe, nurturing online communities. UR - https://www.jmir.org/2024/1/e49440 UR - http://dx.doi.org/10.2196/49440 UR - http://www.ncbi.nlm.nih.gov/pubmed/38488858 ID - info:doi/10.2196/49440 ER - TY - JOUR AU - Fronteira, Ines AU - Pacheco, Matilde AU - Schaltz-Buchholzer, Frederik AU - Ferrinho, Paulo PY - 2024/3/14 TI - Nonspecific Effects of the Bacillus Calmette-Guérin Vaccine in Portuguese Children Under 5 Years of Age: Protocol for a Population-Based Historical Birth Cohort Study JO - JMIR Res Protoc SP - e55332 VL - 13 KW - BCG KW - Bacillus Calmette-Guérin vaccine KW - policy KW - Portugal KW - nonspecific effects KW - vaccines KW - heterologous immunity N2 - Background: The Bacillus Calmette-Guérin vaccine (BCG) against tuberculosis (TB) shows beneficial nonspecific effects, which are likely related to innate immune training. Until 2016, a single BCG dose was administered to all newborns in Portugal. In July 2016, a clinical guideline established that only children under 6 years belonging to high-risk groups should receive BCG. This might have prevented nonvaccinated children from developing trained immunological responses as effectively as BCG-vaccinated children. Objective: This study aims to investigate if there is variation in TB-related and all-cause mortality, and severe, moderate, or mild morbidity in children under 5 years of age, and whether such variation might be explained by the BCG vaccination policy change in 2016. Methods: This population-based historical birth cohort study includes children under 5 years of age born in Portugal between July 1, 2010, and June 30, 2021. Newborns with low birth weight, premature status, or known or suspected HIV infection are excluded. The follow-up period is until the completion of 5 years of age or the end of follow-up (June 30, 2021). The study will use secondary data from the National Health Service user registry, death certificate database, vaccination registry, communicable diseases surveillance system, TB surveillance system, diagnosis-related group information system for hospital admissions and emergency department visits, and primary health care information system. The data will be linked. Primary outcomes include person-time incidence rates of death (all causes and TB), TB diagnosis, and all causes and some specific causes of severe, moderate, or mild morbidity, and the incidence rate ratio of nonvaccinated to BCG-vaccinated children. We will compare the probability of surviving the first and fifth years of life or of not having severe, moderate, or mild morbidity during the follow-up period according to exposure (BCG vaccinated or nonvaccinated, number of doses, and time from birth until the first dose), using the log-rank test for assessing differences in survival rates between exposed and nonexposed children and hazard ratios for quantifying the differences. Moreover, we will perform a proportional hazards regression analysis. Results: Ethics approval has been obtained. In March 2022, database owners were contacted to present the project and discuss the request for data. A unique identifier will be used. In July 2023, a process of redefinition of the variables per database was initiated. Data were received in October and November 2023. In November 2023, further work was conducted. By April 2024, we expect to start analyzing the full data set. Conclusions: The results will contribute to the accumulating body of knowledge and might have relevance to guide global BCG vaccination policy. Data linkage can contribute to a swifter mechanism to use available health data to conduct population-based studies and inform policy decision-making. Trial Registration: ClinicalTrials.gov NCT05471167; https://clinicaltrials.gov/study/NCT05471167 International Registered Report Identifier (IRRID): DERR1-10.2196/55332 UR - https://www.researchprotocols.org/2024/1/e55332 UR - http://dx.doi.org/10.2196/55332 UR - http://www.ncbi.nlm.nih.gov/pubmed/38328938 ID - info:doi/10.2196/55332 ER - TY - JOUR AU - Rettinger, Lena AU - Schönthaler, Erna AU - Kerschbaumer, Andrea AU - Hauser, Carina AU - Klupper, Carissa AU - Aichinger, Lea AU - Werner, Franz PY - 2024/3/7 TI - Evaluating the Experiences of Occupational Therapists and Children Using the SensoGrip Pressure-Sensitive Pen in a Handwriting Intervention: Multimethods Study JO - JMIR Rehabil Assist Technol SP - e51116 VL - 11 KW - handwriting KW - handwriting pressure KW - pen KW - children KW - occupational therapy KW - assistive technology KW - tablet KW - app N2 - Background: The acquisition of handwriting skills is essential for a child?s academic success, self-confidence, and general school performance. Nevertheless, an estimated 5% to 27% of children face handwriting challenges, where the ability to modulate pressure on the pencil and lead on the paper is a key motor component. Objective: We aimed to investigate the experience with and usability of the SensoGrip system, a pressure-measuring pen system with personalized real-time feedback about pressure modulation, in a clinical setting with children and occupational therapists (OTs). Methods: A multimethods study was conducted, incorporating qualitative interviews and questionnaires with children, user diaries, focus group discussions, and a usability questionnaire with OTs, along with a questionnaire for parents. Results: The study involved OTs (n=8), children with handwriting difficulties (n=16), and their parents (n=16), each of whom used the SensoGrip system in up to 5 therapy sessions. OTs reported that the SensoGrip system helped to focus the child?s awareness on handwriting pressure and to measure it objectively. The system received high acceptance and usability ratings from the OTs?usefulness: median score of 4 out of 7; ease of use and ease of learning: median score of 6 out of 7; and satisfaction: median score of 6 out of 7. Participants appreciated that it fosters pressure awareness and motivation to draw and write. Conclusions: The SensoGrip pressure-sensing system with real-time feedback is a promising tool for pediatric occupational therapy. It supports children with handwriting difficulties to adjust their pressure application during the task. In the future, controlled quantitative trials are warranted to further examine the system?s impact. UR - https://rehab.jmir.org/2024/1/e51116 UR - http://dx.doi.org/10.2196/51116 UR - http://www.ncbi.nlm.nih.gov/pubmed/38451584 ID - info:doi/10.2196/51116 ER - TY - JOUR AU - Alotaibi, Mansour AU - Almutairi, B. Anwar AU - Alhirsan, Saleh AU - Alkazemi, Afrah AU - Alharbi, Maha AU - Alrashdi, Naif AU - Taqi, Ahmad AU - Alamiri, Bibi AU - Vogtle, Laura AU - Alqahtani, M. Mohammed PY - 2024/3/5 TI - Psychostimulant Medications for Physical Function and Spasticity in Children With Cerebral Palsy: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e53728 VL - 13 KW - cerebral palsy KW - CNS stimulants KW - spasticity KW - motor performance KW - gross motor function KW - psychostimulant KW - medications KW - physical function KW - CP KW - children KW - child KW - pediatrics KW - pediatric KW - impairment KW - movement KW - central nervous system KW - safety KW - tolerability KW - efficacy KW - methylphenidate KW - modafinil KW - Kuwait KW - rehabilitation KW - physical therapy N2 - Background: Cerebral palsy (CP) is a prevalent nonprogressive disorder that leads to impaired movement (ie, spasticity), posture, and balance, which affects functions such as walking and upper extremity tasks. Current medical treatments show efficacy in improving motor performance but have considerable side effects. Emerging off-label use of central nervous system (CNS) medications for improving motor performance has shown promising results in children with CP and other populations. Objective: The aim of this study is to describe a protocol for a pilot randomized controlled trial (RCT) to examine the safety, tolerability, and efficacy of methylphenidate (MPH) and modafinil on spasticity and motor performance in children with CP. Methods: This will be a protocol study for a pilot, triple-masked, placebo-controlled RCT (a class I trial following the American Academy of Neurology criteria) with blinded patients, outcome assessors, and intervention delivery team. Eligible children should be diagnosed with CP levels I or II based on the Gross Motor Function Classification System and be aged between 7 and 12 years. Thirty-six children with CP will be randomized into 3 groups to receive (1) MPH (2.5 mg of MPH + 100 mg placebo), (2) modafinil (100 mg modafinil + 2.5 mg placebo), or (3) a placebo (2.5 mg placebo + 100 mg placebo), in addition to physical therapy for 12 weeks. Primary outcomes include the Gross Motor Function Measure?66 and the Modified Ashworth Scale. Secondary outcomes include the Timed Up and Go test, 5 Time Sit to Stand test, Modified Clinical Test for Sensory Interaction of Balance, and 10-Meter Walk Test. Results: The protocol has been accepted by Kuwait University (VDR/EC-225) and the Ministry of Health of Kuwait (2022/2157). The inclusion of participants will start in June 2024. Conclusions: The combination of CNS stimulant medications and controlling for rehabilitation has not been studied yet. The findings of this study may determine if using CNS stimulant medications is beneficial for the reduction of spasticity and improvement of physical function in children with spastic CP. Trial Registration: ClinicalTrials.gov NCT05675098; https://clinicaltrials.gov/study/NCT05675098 International Registered Report Identifier (IRRID): PRR1-10.2196/53728 UR - https://www.researchprotocols.org/2024/1/e53728 UR - http://dx.doi.org/10.2196/53728 UR - http://www.ncbi.nlm.nih.gov/pubmed/38441919 ID - info:doi/10.2196/53728 ER - TY - JOUR AU - Bhargava, Hansa AU - Salomon, Carmela AU - Suresh, Srinivasan AU - Chang, Anthony AU - Kilian, Rachel AU - Stijn, van Diana AU - Oriol, Albert AU - Low, Daniel AU - Knebel, Ashley AU - Taraman, Sharief PY - 2024/2/29 TI - Promises, Pitfalls, and Clinical Applications of Artificial Intelligence in Pediatrics JO - J Med Internet Res SP - e49022 VL - 26 KW - artificial intelligence KW - pediatrics KW - autism spectrum disorder KW - ASD KW - disparities KW - pediatric KW - youth KW - child KW - children KW - autism KW - autistic KW - barrier KW - barriers KW - clinical application KW - clinical applications KW - professional development KW - continuing education KW - continuing medical education KW - CME KW - implementation UR - https://www.jmir.org/2024/1/e49022 UR - http://dx.doi.org/10.2196/49022 UR - http://www.ncbi.nlm.nih.gov/pubmed/38421690 ID - info:doi/10.2196/49022 ER - TY - JOUR AU - Toma, Marian-Vladut AU - Turcu, Elena Cristina AU - Turcu, Octavian Corneliu AU - Vlad, Sorin AU - Tiliute, Eugen Doru AU - Pascu, Paul PY - 2024/2/19 TI - Extended Reality?Based Mobile App Solutions for the Therapy of Children With Autism Spectrum Disorders: Systematic Literature Review JO - JMIR Serious Games SP - e49906 VL - 12 KW - autism KW - autistic KW - autism spectrum disorder KW - ASD KW - virtual reality KW - augmented reality KW - extended reality KW - mixed reality KW - mobile app KW - children KW - preschool KW - mobile phone N2 - Background: The increasing prevalence of autism spectrum disorder (ASD) has driven research interest on the therapy of individuals with autism, especially children, as early diagnosis and appropriate treatment can lead to improvement in the condition. With the widespread availability of virtual reality, augmented reality (AR), and mixed reality technologies to the public and the increasing popularity of mobile devices, the interest in the use of applications and technologies to provide support for the therapy of children with autism is growing. Objective: This study aims to describe the literature on the potential of virtual reality, AR, and mixed reality technologies in the context of therapy for children with ASD. We propose to investigate and analyze the temporal distribution of relevant papers, identify the target audience for studies related to extended reality apps in ASD therapy, examine the technologies used in the development of these apps, assess the skills targeted for improvement in primary studies, explore the purposes of the proposed solutions, and summarize the results obtained from their application. Methods: For the systematic literature review, 6 research questions were defined in the first phase, after which 5 international databases (Web of Science, Scopus, ScienceDirect, IEEE Xplore Digital Library, and ACM Digital Library) were searched using specific search strings. Results were centralized, filtered, and processed applying eligibility criteria and using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The results were refined using a technical and IT-oriented approach. The quality criteria assessed whether the research addressed ASDs, focused on children?s therapy, involved targeted technologies, deployed solutions on mobile devices, and produced results relevant to our study. Results: In the first step, 179 publications were identified in Zotero reference manager software (Corporation for Digital Scholarship). After excluding articles that did not meet the eligibility or quality assessment criteria, 28 publications were finalized. The analysis revealed an increase in publications related to apps for children with autism starting in 2015 and peaking in 2019. Most studies (22/28, 79%) focused on mobile AR solutions for Android devices, which were developed using the Unity 3D platform and the Vuforia engine. Although 68% (19/28) of these apps were tested with children, 32% (9/28) were tested exclusively by developers. More than half (15/28, 54%) of the studies used interviews as an evaluation method, yielding mostly favorable although preliminary results, indicating the need for more extensive testing. Conclusions: The findings reported in the studies highlight the fact that these technologies are appropriate for the therapy of children with ASD. Several studies showed a distinct trend toward the use of AR technology as an educational tool for people with ASD. This trend entails multidisciplinary cooperation and an integrated research approach, with an emphasis on comprehensive empirical evaluations and technology ethics. UR - https://games.jmir.org/2024/1/e49906 UR - http://dx.doi.org/10.2196/49906 UR - http://www.ncbi.nlm.nih.gov/pubmed/38373032 ID - info:doi/10.2196/49906 ER - TY - JOUR AU - Li, Angie AU - Mullin, Sarah AU - Elkin, L. Peter PY - 2024/2/14 TI - Improving Prediction of Survival for Extremely Premature Infants Born at 23 to 29 Weeks Gestational Age in the Neonatal Intensive Care Unit: Development and Evaluation of Machine Learning Models JO - JMIR Med Inform SP - e42271 VL - 12 KW - reproductive informatics KW - pregnancy complications KW - premature birth KW - neonatal mortality KW - machine learning KW - clinical decision support KW - preterm KW - pediatrics KW - intensive care unit outcome KW - health care outcome KW - survival prediction KW - maternal health KW - decision tree model KW - socioeconomic N2 - Background: Infants born at extremely preterm gestational ages are typically admitted to the neonatal intensive care unit (NICU) after initial resuscitation. The subsequent hospital course can be highly variable, and despite counseling aided by available risk calculators, there are significant challenges with shared decision-making regarding life support and transition to end-of-life care. Improving predictive models can help providers and families navigate these unique challenges. Objective: Machine learning methods have previously demonstrated added predictive value for determining intensive care unit outcomes, and their use allows consideration of a greater number of factors that potentially influence newborn outcomes, such as maternal characteristics. Machine learning?based models were analyzed for their ability to predict the survival of extremely preterm neonates at initial admission. Methods: Maternal and newborn information was extracted from the health records of infants born between 23 and 29 weeks of gestation in the Medical Information Mart for Intensive Care III (MIMIC-III) critical care database. Applicable machine learning models predicting survival during the initial NICU admission were developed and compared. The same type of model was also examined using only features that would be available prepartum for the purpose of survival prediction prior to an anticipated preterm birth. Features most correlated with the predicted outcome were determined when possible for each model. Results: Of included patients, 37 of 459 (8.1%) expired. The resulting random forest model showed higher predictive performance than the frequently used Score for Neonatal Acute Physiology With Perinatal Extension II (SNAPPE-II) NICU model when considering extremely preterm infants of very low birth weight. Several other machine learning models were found to have good performance but did not show a statistically significant difference from previously available models in this study. Feature importance varied by model, and those of greater importance included gestational age; birth weight; initial oxygenation level; elements of the APGAR (appearance, pulse, grimace, activity, and respiration) score; and amount of blood pressure support. Important prepartum features also included maternal age, steroid administration, and the presence of pregnancy complications. Conclusions: Machine learning methods have the potential to provide robust prediction of survival in the context of extremely preterm births and allow for consideration of additional factors such as maternal clinical and socioeconomic information. Evaluation of larger, more diverse data sets may provide additional clarity on comparative performance. UR - https://medinform.jmir.org/2024/1/e42271 UR - http://dx.doi.org/10.2196/42271 UR - http://www.ncbi.nlm.nih.gov/pubmed/38354033 ID - info:doi/10.2196/42271 ER - TY - JOUR AU - Kokorelias, Marie Kristina AU - Lee, Joan Tin-Suet AU - Bayley, Mark AU - Seto, Emily AU - Toulany, Alene AU - Nelson, A. Michelle L. AU - Dimitropoulos, Gina AU - Penner, Melanie AU - Simpson, Robert AU - Munce, P. Sarah E. PY - 2024/2/7 TI - A Web-Based Peer-Patient Navigation Program (Compassionate Online Navigation to Enhance Care Transitions) for Youth Living With Childhood-Acquired Disabilities Transitioning From Pediatric to Adult Care: Qualitative Descriptive Study JO - JMIR Pediatr Parent SP - e47545 VL - 7 KW - youth KW - patient navigation KW - web-based intervention KW - peer support KW - transition KW - childhood disability KW - caregiver KW - transitional care intervention KW - social support KW - usability KW - program KW - children KW - pediatric KW - disability KW - digital health KW - eHealth KW - web-based support KW - web-based health N2 - Background: Studies have highlighted significant challenges associated with the transition from pediatric to adult health and social care services for youth living with childhood-acquired disabilities and their caregivers. Patient navigation has been proposed as an effective transitional care intervention. Better understanding of how patient navigation may support youth and their families during pediatric to adult care transitions is warranted. Objective: This study aims to describe the preferred adaptations of an existing web-based platform from the perspectives of youth with childhood-onset disabilities and their family caregivers to develop a web-based peer-patient navigation program, Compassionate Online Navigation to Enhance Care Transitions (CONNECT). Methods: A qualitative descriptive design was used. Participants included youth living with childhood-acquired disabilities (16/23, 70%) and their caregivers (7/23, 30%). Semistructured interviews and focus groups were conducted, digitally recorded, and transcribed. Thematic analysis was used to analyze the data and was facilitated through NVivo software (Lumivero). Results: Participants desired a program that incorporated (1) self-directed learning, (2) a library of reliable health and community resources, and (3) emotional and social supports. On the basis of participants? feedback, CONNECT was deemed satisfactory, as it was believed that the program would help support appropriate transition care through the provision of trusted health-related information. Participants highlighted the need for options to optimize confidentiality in their health and social care and the choice to remain anonymous to other participants. Conclusions: Web-based patient navigation programs such as CONNECT may deliver peer support that can improve the quality and experience of care for youth, and their caregivers, transitioning from pediatric to adult care through personalized support, health care monitoring, and health and social care resources. Future studies are needed to test the feasibility, acceptability, usability, use, and effectiveness of CONNECT among youth with childhood-onset disabilities. UR - https://pediatrics.jmir.org/2024/1/e47545 UR - http://dx.doi.org/10.2196/47545 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324351 ID - info:doi/10.2196/47545 ER - TY - JOUR AU - Castillo-Rodenas, Marta AU - Vidal-Alaball, Josep AU - Solanas-Bacardit, Núria AU - Farràs-Company, Clotilde AU - Fuster-Casanovas, Aïna AU - Miró Catalina, Queralt AU - López Seguí, Francesc PY - 2024/2/1 TI - Feasibility of a Pediatric Acute Video Consultation Process Among Health Care Professionals in Primary Care in a Rural Setting: Protocol for a Prospective Validation Study JO - JMIR Res Protoc SP - e52946 VL - 13 KW - primary health care KW - pediatrics KW - remote consultation KW - telemedicine KW - rural health services KW - video consultation N2 - Background: For years, in Catalonia and in the rest of Spain, there has been a deficit and an unequal geographical distribution of health professionals specializing in pediatrics, especially in rural areas. Among the proposals to improve this situation is the promotion of the use of information and communication technologies (ICT) among users and professionals. Moreover, with the outbreak of COVID-19, the use of telehealth has become an essential tool, with an overall increase in non?face-to-face visits, including in primary care pediatrics. In this context, telemedicine, when used in primary care pediatrics, can be an effective means of improving families? access to medical care. Currently, in Catalonia, telemedicine involving patients and health professionals is used in pediatric primary care through telephone consultation and asynchronous teleconsultation (eConsulta). Video consultation is in practice not used, although it could have different applications. Objective: The aim of this study is to evaluate the feasibility of a video consultation process with physical examination in acute pediatric pathology in rural areas among primary care professionals. In addition, the level of satisfaction with these remote consultations will be assessed from the perspective of both the users and the health care professionals. Methods: We will conduct a prospective experimental study to analyze the possibility of using video consultation in pediatric acute care in primary care in central Catalonia (Spain). A minimum of 170 children aged between 0 and 14 years attending the primary care center (PCC) for acute illness for a period of 1 year will be included in the study. Initially, the telemetric visit, including a physical examination, will include a nurse at the patient and family?s side and a pediatrician who will participate remotely. Subsequently, the pediatrician will visit the patient in person and the physical examination and diagnosis made during the remote visit will be compared with the physical examination and diagnosis of the face-to-face visit, which is considered the gold standard. Results: Recruitment was planned to begin in the second half of 2023 and continue for at least 1 year. It is anticipated to be a good resource for a variety of acute pediatric conditions in primary care. The evaluation will focus on the feasibility of performing live remote visits and comparing their diagnostic accuracy with that of face-to-face visits. Conclusions: We believe that this study could provide evidence on the feasibility and diagnostic accuracy of video consultation in pediatric acute primary care in a rural setting, as well as on satisfaction with video consultations among both users and professionals. If proven useful in addressing the acute needs of children in a variety of situations, it could become a digital health tool that improves the overall pediatric primary care service in rural areas, for both families and professionals. International Registered Report Identifier (IRRID): PRR1-10.2196/52946 UR - https://www.researchprotocols.org/2024/1/e52946 UR - http://dx.doi.org/10.2196/52946 UR - http://www.ncbi.nlm.nih.gov/pubmed/38300693 ID - info:doi/10.2196/52946 ER - TY - JOUR AU - Trofimchuk, Vitaliy AU - Dossanov, Bolatbek AU - Lozovoy, Vassiliy AU - Khmyzov, Sergey AU - Dossanova, Assem AU - Angelov, Aleksandr AU - Pashenko, Andrey AU - Zhukenov, Olzhas PY - 2024/1/24 TI - Quality of Life in Children With Achondroplasia Undergoing Paired Limb Lengthening With an External Fixator and Modified Distraction Control: Observational Nonrandomized Study JO - JMIR Rehabil Assist Technol SP - e49261 VL - 11 KW - achondroplasia KW - external fixator KW - quality of life KW - transosseous osteosynthesis KW - paired limb lengthening KW - bone growth disorder KW - dwarfism KW - limb lengthening KW - circular multiaxial system KW - hereditary disease KW - limb reconstruction KW - children KW - youth KW - pediatric KW - bone disorder KW - orthopedics KW - rehabilitation KW - bone KW - growth KW - disorder KW - genetic N2 - Background: Transosseous distraction osteosynthesis is prioritized in orthopedic care for children with achondroplasia. However, difficulties encountered during treatment and rehabilitation directly impact patients? quality of life. Using rod external fixators within a semicircular frame for osteosynthesis is less traumatic compared to spoke circular devices. Their straightforward assembly and mounting on the limb segment can help significantly reduce treatment duration, thereby improving children?s quality of life during treatment and rehabilitation. Objective: This study aimed to conduct a comparative analysis of the quality of life (measured by postoperative pain syndrome, physical activity, and emotional state) among children with achondroplasia undergoing paired limb lengthening using either an external fixator with modified distraction control or a circular multiaxial system developed by the authors. Methods: This was an observational, prospective, nonrandomized, and longitudinal study with historical control. The study group consisted of 14 patients ranging from 5 to 15 (mean 7.6, SD 2.3) years old with a genetically confirmed diagnosis of achondroplasia. All patients underwent paired limb lengthening with a rod external fixator and a modified distraction control developed by the authors. A total of 28 limb segments, among them 4 (14%) humeri, 8 (29%) femurs, and 16 (57%) tibias, were lengthened in 1 round. Unpublished data from the previous study served as the control group, comprising 9 patients (18 limb segments) of the same age group (mean age at surgery 8.6, SD 2.3 years), who underwent limb lengthening surgery using a circular multiaxial system?2 (11%) humeri, 6 (33%) femurs, and 10 (56%) tibias. The Wong-Baker Faces Rating Scale was used to measure pain symptoms, while the Russified Pediatric Quality of Life (PedsQL) v4.0 questionnaire assessed quality of life. Results: During the latent phase (7 to 10 days after surgery), a more pronounced decrease in the indicators of physical activity and emotional state on the PedsQL v4.0 questionnaire was noted in the control group (mean 52.4, SD 4.8 versus mean 52.8, SD 5.5 points according to children?s responses and their parents? responses, respectively) compared to the experimental group (mean 59.5, SD 6.8 points and mean 61.33, SD 6.5 points according to the children?s responses and their parents? responses, respectively). The differences between the groups were statistically significant (P<.05 for children's responses and P<.01 for parents? responses). Importantly, 6 months after surgery, these quality-of-life indicators, as reported by children in the experimental group, averaged 70.25 (SS 4.8) points. Similarly, their parents reported a mean of 70.54 (SD 4.2) points. In the control group, the corresponding values were 69.64 (SD 5.6) and 69.35 (SD 6.2), respectively. There was no statistically significant difference between the groups. Conclusions: The external fixator with modified distraction control developed by the authors provides a higher standard of living compared with the circular multiaxial system during the latency phase. UR - https://rehab.jmir.org/2024/1/e49261 UR - http://dx.doi.org/10.2196/49261 UR - http://www.ncbi.nlm.nih.gov/pubmed/38265860 ID - info:doi/10.2196/49261 ER - TY - JOUR AU - Toure, Mahamoudou AU - Shaffer, G. Jeffrey AU - Sanogo, Daouda AU - Keita, Soumba AU - Keita, Moussa AU - Kane, Fousseyni AU - Traore, Bourama AU - Dabitao, Djeneba AU - Kone, Aissata AU - Doumbia, Oumar Cheick AU - Keating, Joseph AU - Yukich, Joshua AU - Hansson, H. Helle AU - Barry, E. Alyssa AU - Diakité, Mahamadou AU - Alifrangis, Michael AU - Doumbia, Seydou PY - 2024/1/22 TI - Seasonal Malaria Chemoprevention Therapy in Children Up To 9 Years of Age: Protocol for a Cluster-Randomized Trial Study JO - JMIR Res Protoc SP - e51660 VL - 13 KW - malaria KW - seasonal malaria chemoprevention KW - RCT KW - randomized KW - controlled trial KW - controlled trials KW - parasite KW - parasites KW - mosquito KW - mosquitoes KW - vector-borne KW - malarial KW - antimalarial KW - age KW - Plasmodium falciparum, protocol, cluster-randomized trial KW - child KW - children KW - infant KW - infants KW - pediatric KW - pediatrics KW - clinical trial KW - clinical trials KW - drug KW - drugs KW - pharmacy KW - pharmacology KW - pharmaceutic KW - pharmaceutics KW - pharmaceuticals KW - pharmaceutical KW - medication KW - medications N2 - Background: Seasonal malaria chemoprevention (SMC) is recommended by the World Health Organization for the sub-Sahel region in sub-Saharan Africa for preventing malaria in children 3 months old to younger than 5 years. Since 2016, the Malian National Malaria Control Program has deployed SMC countrywide during its high malaria transmission season at a rate of 4 monthly cycles annually. The standard SMC regimen includes sulfadoxine-pyrimethamine (SP) plus amodiaquine (AQ). Resistance against SP is suspected to be rising across West Africa; therefore, assessing the effectiveness of an alternative antimalarial drug for SMC is needed to provide a second-line regimen when it is ultimately needed. It is not well understood whether SMC effectively prevents malaria in children aged 5 years or older. Objective: The primary goal of the study is to compare 2 SMC regimens (SP-AQ and dihydroartemisinin-piperaquine [DHA-PQ]) in preventing uncomplicated Plasmodium falciparum malaria in children 3 months to 9 years old. Secondly, we will assess the possible use of DHA-PQ as an alternative SMC drug in areas where resistance to SP or AQ may increase following intensive use. Methods: The study design is a 3-arm cluster-randomized design comparing the SP-AQ and DHA-PQ arms in 2 age groups (younger than 5 years and 5-9 years) and a control group for children aged 5-9 years. Standard SMC (SP-AQ) for children younger than 5 years was provided to the control arm, while SMC with SP-AQ was delivered to children aged 3 months to 9 years (arm 2), and SMC with DHA-PQ will be implemented in study arm 3 for children up to 9 years of age. The study was performed in Mali?s Koulikoro District, a rural area in southwest Mali with historically high malaria transmission rates. The study?s primary outcome is P falciparum incidence for 2 SMC regimens in children up to 9 years of age. Should DHA-PQ provide an acceptable alternative to SP-AQ, a plausible second-line prevention option would be available in the event of SP resistance or drug supply shortages. A significant byproduct of this effort included bolstering district health information systems for rapid identification of severe malaria cases. Results: The study began on July 1, 2019. Through November 2022, a total of 4556 children 3 months old to younger than 5 years were enrolled. Data collection ended in spring 2023, and the findings are expected to be published later in early 2024. Conclusions: Routine evaluation of antimalarial drugs is needed to establish appropriate SMC age targets. The study goals here may impact public health policy and provide alternative therapies in the event of drug shortages or resistance. Trial Registration: ClinicalTrials.gov NCT04149106, https://clinicaltrials.gov/ct2/show/NCT04149106 International Registered Report Identifier (IRRID): DERR1-10.2196/51660 UR - https://www.researchprotocols.org/2024/1/e51660 UR - http://dx.doi.org/10.2196/51660 UR - http://www.ncbi.nlm.nih.gov/pubmed/38252481 ID - info:doi/10.2196/51660 ER - TY - JOUR AU - Aldridge, Grace AU - Tomaselli, Alessandra AU - Nowell, Clare AU - Reupert, Andrea AU - Jorm, Anthony AU - Yap, Hui Marie Bee PY - 2024/1/19 TI - Engaging Parents in Technology-Assisted Interventions for Childhood Adversity: Systematic Review JO - J Med Internet Res SP - e43994 VL - 26 KW - systematic review KW - intervention KW - digital technology KW - parenting KW - children KW - technology KW - parenting program KW - engagement KW - support KW - adverse childhood experiences N2 - Background: Youth mental health problems are a major public health concern and are strongly associated with adverse childhood experiences (ACEs). Technology-assisted parenting programs can intervene with ACEs that are within a parent?s capacity to modify. However, engagement with such programs is suboptimal. Objective: This review aims to describe and appraise the efficacy of strategies used to engage parents in technology-assisted parenting programs targeting ACEs on the behavioral and subjective outcomes of engagement. Methods: Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines, we conducted a systematic review of peer-reviewed papers that described the use of at least 1 engagement strategy in a technology-assisted parenting program targeting ACEs that are within a parent?s capacity to modify. A total of 8 interdisciplinary bibliographic databases (CENTRAL, CINAHL, Embase, OVID MEDLINE, OVID PsycINFO, Scopus, ACM, and IEEE Xplore) and gray literature were searched. The use of engagement strategies and measures was narratively synthesized. Associations between specific engagement strategies and engagement outcomes were quantitatively synthesized using the Stouffer method of combining P values. Results: We identified 13,973 articles for screening. Of these, 156 (1.12%) articles were eligible for inclusion, and 29 (18.2%) of the 156 were associated with another article; thus, 127 studies were analyzed. Preliminary evidence for a reliable association between 5 engagement strategies (involving parents in a program?s design, delivering a program on the web compared to face-to-face, use of personalization or tailoring features, user control features, and provision of practical support) and greater engagement was found. Three engagement strategies (professional support features, use of videos, and behavior change techniques) were not found to have a reliable association with engagement outcomes. Conclusions: This review provides a comprehensive assessment and description of the use of engagement strategies and engagement measures in technology-assisted parenting programs targeting parenting-related ACEs and extends the current evidence with preliminary quantitative findings. Heterogeneous definition and measurement of engagement and insufficient engagement outcome data were caveats to this synthesis. Future research could use integrated definitions and measures of engagement to support robust systematic evaluations of engagement in this context. Trial Registration: PROSPERO CRD42020209819; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209819 UR - https://www.jmir.org/2024/1/e43994 UR - http://dx.doi.org/10.2196/43994 UR - http://www.ncbi.nlm.nih.gov/pubmed/38241066 ID - info:doi/10.2196/43994 ER - TY - JOUR AU - Burns, K. Sarah AU - Krishnamurti, Tamar AU - Doan, T. Tran AU - Hanmer, Janel AU - Hoberman, Alejandro AU - Kahn, M. Jeremy AU - Schweiberger, Kelsey AU - Ray, N. Kristin PY - 2024/1/16 TI - Parent Perceptions of Telemedicine for Acute Pediatric Respiratory Tract Infections: Sequential Mixed Methods Study JO - JMIR Pediatr Parent SP - e49170 VL - 7 KW - telemedicine KW - telehealth KW - acute care KW - acute KW - pediatrics KW - pediatric KW - family medicine KW - family-centered KW - child KW - children KW - parent KW - parents KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - expectation KW - expectations N2 - Background: Since 2020, parents have had increasing opportunities to use telemedicine for their children, but how parents decide whether to use telemedicine for acute pediatric care relative to alternative sites of care is not clear. One of the most common reasons parents seek acute care for their children is for acute respiratory tract infections (ARTIs). Objective: This study aims to examine parental expectations of care via telemedicine for pediatric ARTIs, contrasting expectations of care delivered via primary care telemedicine and direct-to-consumer (DTC) telemedicine. Methods: We performed a sequential mixed methods analysis to examine how parents assess telemedicine for their children?s acute care. We used ARTIs as a case study for examining parent perceptions of telemedicine. First, we analyzed semistructured interviews focused on parent responses about the use of telemedicine. Each factor discussed by parents was coded to reflect whether parents indicated it incentivized or disincentivized their preferences for telemedicine versus in-person care. Results were organized by a 7-dimension framework of parental health care seeking that was generated previously, which included dimensions related to care sites (expected access, affordability, clinical quality, and site quality) and dimensions related to child or family factors (perceived illness severity, perceived child susceptibility, and parent self-efficacy). Second, we analyzed responses to a national survey, which inquired about parental expectations of primary care telemedicine, commercial DTC telemedicine, and 3 in-person sites of care (primary care, urgent care, and emergency department) across 21 factors identified through prior qualitative work. To assess whether parents had different expectations of different telemedicine models, we compared survey responses for primary care telemedicine and commercial DTC telemedicine using weighted logistic regression. Results: Interview participants (n=40) described factors affecting their perceptions of telemedicine as a care modality for pediatric ARTIs. Generally, factors aligned with access and affordability (eg, decreased wait time and lower out-of-pocket cost) were discussed as potential incentives for telemedicine use, while factors aligned with perceived illness severity, child susceptibility, and clinician quality (eg, trustworthiness) were discussed as potential disincentives for telemedicine use. In survey responses (n=1206), primary care and commercial DTC telemedicine were rated similarly on items related to expected accessibility and affordability. In contrast, on items related to expected quality of care, primary care telemedicine was viewed similarly to in-person primary care, while commercial DTC telemedicine was rated lower. For example, 69.7% (weighted; 842/1197) of respondents anticipated their children would be comfortable and cooperative with primary care telemedicine versus 49.7% (weighted; 584/1193) with commercial DTC telemedicine (P<.001). Conclusions: In a mixed methods analysis focused on telemedicine for ARTIs, parents expressed more concerns about telemedicine quality in commercial DTC models compared with primary care?based telemedicine. These results could help health systems better design telemedicine initiatives to support family-centered care. UR - https://pediatrics.jmir.org/2024/1/e49170 UR - http://dx.doi.org/10.2196/49170 UR - http://www.ncbi.nlm.nih.gov/pubmed/38227360 ID - info:doi/10.2196/49170 ER - TY - JOUR AU - Nestor, A. Bridget AU - Chimoff, Justin AU - Koike, Camila AU - Weitzman, R. Elissa AU - Riley, L. Bobbie AU - Uhl, Kristen AU - Kossowsky, Joe PY - 2024/1/11 TI - Adolescent and Parent Perspectives on Digital Phenotyping in Youths With Chronic Pain: Cross-Sectional Mixed Methods Survey Study JO - J Med Internet Res SP - e47781 VL - 26 KW - acceptability KW - adolescent KW - chronic pain KW - digital phenotyping KW - mobile health KW - pediatric N2 - Background: Digital phenotyping is a promising methodology for capturing moment-to-moment data that can inform individually adapted and timely interventions for youths with chronic pain. Objective: This study aimed to investigate adolescent and parent endorsement, perceived utility, and concerns related to passive data stream collection through smartphones for digital phenotyping for clinical and research purposes in youths with chronic pain. Methods: Through multiple-choice and open-response survey questions, we assessed the perspectives of patient-parent dyads (103 adolescents receiving treatment for chronic pain at a pediatric hospital with an average age of 15.6, SD 1.6 years, and 99 parents with an average age of 47.8, SD 6.3 years) on passive data collection from the following 9 smartphone-embedded passive data streams: accelerometer, apps, Bluetooth, SMS text message and call logs, keyboard, microphone, light, screen, and GPS. Results: Quantitative and qualitative analyses indicated that adolescents and parent endorsement and perceived utility of digital phenotyping varied by stream, though participants generally endorsed the use of data collected by passive stream (35%-75.7% adolescent endorsement for clinical use and 37.9%-74.8% for research purposes; 53.5%-81.8% parent endorsement for clinical and 52.5%-82.8% for research purposes) if a certain level of utility could be provided. For adolescents and parents, adjusted logistic regression results indicated that the perceived utility of each stream significantly predicted the likelihood of endorsement of its use in both clinical practice and research (Ps<.05). Adolescents and parents alike identified accelerometer, light, screen, and GPS as the passive data streams with the highest utility (36.9%-47.5% identifying streams as useful). Similarly, adolescents and parents alike identified apps, Bluetooth, SMS text message and call logs, keyboard, and microphone as the passive data streams with the least utility (18.5%-34.3% identifying streams as useful). All participants reported primary concerns related to privacy, accuracy, and validity of the collected data. Passive data streams with the greatest number of total concerns were apps, Bluetooth, call and SMS text message logs, keyboard, and microphone. Conclusions: Findings support the tailored use of digital phenotyping for this population and can help refine this methodology toward an acceptable, feasible, and ethical implementation of real-time symptom monitoring for assessment and intervention in youths with chronic pain. UR - https://www.jmir.org/2024/1/e47781 UR - http://dx.doi.org/10.2196/47781 UR - http://www.ncbi.nlm.nih.gov/pubmed/38206665 ID - info:doi/10.2196/47781 ER - TY - JOUR AU - Cooray, Nipuna AU - Ho, Catherine AU - Bestman, Amy AU - Adams, Susan AU - Nassar, Natasha AU - Keay, Lisa AU - Brown, Julie PY - 2024/1/3 TI - Exploring the Potential of a Behavior Theory?Informed Digital Intervention for Infant Fall Prevention: Mixed Methods Longitudinal Study JO - JMIR Pediatr Parent SP - e47361 VL - 7 KW - child injury KW - digital behavior change interventions KW - user experience KW - falls KW - infant fall KW - injury KW - mobile app KW - digital intervention KW - users KW - mixed methods longitudinal study KW - behavior KW - development KW - fall risk KW - fall prevention KW - acceptability KW - app KW - children KW - internet KW - parents KW - maternal, paternal KW - accidents KW - infancy KW - infant KW - accidental fall KW - accidental falls KW - infant behavior KW - longitudinal design KW - mixed methods KW - parent KW - mobile phone N2 - Background: Falls are the most common hospitalized injury mechanism in children aged ?1 years, and currently, there are no targeted prevention interventions. The prevention of falls in children of this age requires changes in the behavior of their caregivers, and theoretically informed digital behavior change interventions (DBCIs) may provide a unique mechanism for achieving effective intervention. However, user acceptance and the ability of DBCIs to effect the required changes in behavior are critical to their likelihood of success. Objective: This study aims to evaluate a behavior theory?informed digital intervention developed following a user-centered approach for user experience, the potential for this intervention to prevent infant falls, and its impact on behavioral drivers underpinning fall risk in young children. Methods: Parents of infants aged <1 year were recruited and asked to use the intervention for 3 months. A pre-post longitudinal design was used to examine the change in the potential to reduce the risk of falls after a 3-month exposure to the intervention. Postintervention data on behavioral drivers for fall prevention, user acceptability, and engagement with the app were also collected. Interviews were conducted to explore user experiences and identify areas for further improvement of the intervention. Results: A total of 62 parents participated in the study. A statistically significant effect on the potential to reduce falls was observed after the intervention. This effect was higher for new parents. Parents agreed that the intervention targeted most of the target behavior drivers. The impact of behavior drivers and intervention on the potential for fall prevention had a positive correlation. The intervention demonstrated good levels of acceptability. Feedback from participants was mostly positive, and the primary area identified for further improvement was widening the scope of the intervention. Conclusions: This study demonstrated the promise of a newly developed digital intervention to reduce the risk of infant falls, particularly among new parents. It also showed a positive influence of the DBCI on the drivers of parental behaviors that are important for fall reduction among infants. The acceptability of the app was high, and important insights were gained from users about how to further improve the app. UR - https://pediatrics.jmir.org/2024/1/e47361 UR - http://dx.doi.org/10.2196/47361 UR - http://www.ncbi.nlm.nih.gov/pubmed/38170580 ID - info:doi/10.2196/47361 ER - TY - JOUR AU - Neves, Silveira Gabriela AU - Reis, Nogueira Zilma Silveira AU - Romanelli, Roberta AU - Batchelor, James PY - 2023/12/25 TI - Assessment of Skin Maturity by LED Light at Birth and Its Association With Lung Maturity: Clinical Trial Secondary Outcomes JO - JMIR Biomed Eng SP - e52468 VL - 8 KW - newborn infant KW - prematurity KW - neonatal respiratory distress syndrome KW - skin physiological phenomena KW - photometer KW - gestational age N2 - Background: Clinicians face barriers when assessing lung maturity at birth due to global inequalities. Still, strategies for testing based solely on gestational age to predict the likelihood of respiratory distress syndrome (RDS) do not offer a comprehensive approach to addressing the challenge of uncertain outcomes. We hypothesize that a noninvasive assessment of skin maturity may indicate lung maturity. Objective: This study aimed to assess the association between a newborn?s skin maturity and RDS occurrence. Methods: We conducted a case-control nested in a prospective cohort study, a secondary endpoint of a multicenter clinical trial. The study was carried out in 5 Brazilian urban reference centers for highly complex perinatal care. Of 781 newborns from the cohort study, 640 were selected for the case-control analysis. Newborns with RDS formed the case group and newborns without RDS were the controls. All newborns with other diseases exhibiting respiratory manifestations were excluded. Skin maturity was assessed from the newborn's skin over the sole by an optical device that acquired a reflection signal through an LED sensor. The device, previously validated, measured and recorded skin reflectance. Clinical data related to respiratory outcomes were gathered from medical records during the 72-hour follow-up of the newborn, or until discharge or death, whichever occurred first. The main outcome measure was the association between skin reflectance and RDS using univariate and multivariate binary logistic regression. Additionally, we assessed the connection between skin reflectance and factors such as neonatal intensive care unit (NICU) admission and the need for ventilatory support. Results: Out of 604 newborns, 470 (73.4%) were from the RDS group and 170 (26.6%) were from the control group. According to comparisons between the groups, newborns with RDS had a younger gestational age (31.6 vs 39.1 weeks, P<.001) and birth weight (1491 vs 3121 grams, P<.001) than controls. Skin reflectance was associated with RDS (odds ratio [OR] 0.982, 95% CI 0.979-0.985, R2=0.632, P<.001). This relationship remained significant when adjusted by the cofactors antenatal corticosteroid and birth weight (OR 0.994, 95% CI 0.990-0.998, R2=0.843, P<.001). Secondary outcomes also showed differences in skin reflectance. The mean difference was 0.219 (95% CI 0.200-0.238) between newborns that required ventilatory support versus those that did not and 0.223 (95% CI 0.205-0.241) between newborns that required NICU admission versus those that did not. Skin reflectance was associated with ventilatory support (OR 0.996, 95% CI 0.992-0.999, R2=0.814, P=.01) and with NICU admission (OR 0.994, 95% CI 0.990-0.998, R2=0.867, P=.004). Conclusions: Our findings present a potential marker of lung immaturity at birth using the indirect method of skin assessment. Using the RDS clinical condition and a medical device, this study demonstrated the synchrony between lung and skin maturity. Trial Registration: Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-3f5bm5; https://tinyurl.com/9fb7zrdb International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-027442 UR - https://biomedeng.jmir.org/2023/1/e52468 UR - http://dx.doi.org/10.2196/52468 UR - http://www.ncbi.nlm.nih.gov/pubmed/38875690 ID - info:doi/10.2196/52468 ER - TY - JOUR AU - Bogdanski, Erin PY - 2023/12/22 TI - The Effects of Virtual Reality Telemedicine With Pediatric Patients Diagnosed With Posttraumatic Stress Disorder: Exploratory Research Method Case Report JO - JMIR Form Res SP - e34346 VL - 7 KW - virtual reality KW - psychology KW - neuroscience KW - behavioral health KW - telehealth KW - eHealth KW - telemedicine KW - trauma KW - traumatic KW - PTSD KW - posttraumatic stress disorder KW - mental health KW - mental condition KW - mental illness KW - cognitive behavioral therapy KW - CBT KW - avatar KW - case study KW - pediatric KW - child KW - youth KW - psychiatric disorder N2 - Background: Trauma-focused cognitive behavioral therapy (TF-CBT) strategies are common interventions to treat child trauma and a posttraumatic stress disorder (PTSD) diagnosis in children with histories of sexual and physical abuse. With the advent of COVID-19, the disruption of child development combined with intense exposure to technology and screen time indicate a need for delivering other novel approaches to treat pediatric PTSD. Virtual reality (VR) has been used with evidence-based TF-CBT as an intervention in lab-based settings, but never as telehealth. Such technologies, including a VR head-mounted device (HMD) programmed with novel TheraVR software, for psychotherapy and treating trauma-related symptoms could redefine how pediatric populations respond to treatment. Objective: The aim of this exploratory single-case study was to reflect symptom improvement and patient engagement using VR as telehealth. Methods: The patient was a 10-year-old girl of Middle Eastern descent diagnosed with trauma and comorbid medical conditions. The patient was in divorced joint parental custody and a Child Protective Services report was made with referral for therapy. Night terrors, hallucinations, depression, anxiety, isolation, and encopresis symptoms were assessed at the beginning of treatment. Clinical analysis met the criteria for a diagnosis of early onset PTSD, which was treated over the course of 7 months using TF-CBT. A cross-analysis design was used to compare improved effectiveness in treatment and patient outcomes when moving from delivery of care with telehealth using desktop and tablet synchronous technology to 2D VR desktop telehealth with TheraVR software and subsequently HMD VR telehealth with TheraVR software. Sessions were conducted in private practice providing psychotherapy for remote patient care, collateral care with the family, and coordination of clinical care with the patient?s pediatrician. Safety and protocols for reducing triggers were clinically monitored by the provider. Results: Over the course of treatment, and moving from standard telehealth to 2D VR to TheraVR with a standalone HMD, there was a significant reduction in PTSD symptoms. The transfer from using the standard video conferencing with face-to-face video to using customizable avatar technology with an assigned scene environment presented an increase in patient retention and follow-through with the treatment goals. The continuous use of delivery of care using VR with the TheraVR software demonstrated breakthrough clinical observations where the patient devised her own interventions for coping with mood, emotional regulation, and negative cognitive processes using the 10 different VR environments. Conclusions: This study shows the potential efficacy in using VR specifically for younger populations as a better modality of pediatrics care, while improving engagement with the provider through telehealth. These findings suggest the value of further research through larger clinical trials including pediatric patients diagnosed with severe trauma or trauma-related symptoms to assess the effectiveness of TheraVR software. UR - https://formative.jmir.org/2023/1/e34346 UR - http://dx.doi.org/10.2196/34346 UR - http://www.ncbi.nlm.nih.gov/pubmed/38133920 ID - info:doi/10.2196/34346 ER - TY - JOUR AU - Zvulunov, Alex AU - Lenevich, Stepan AU - Migacheva, Natalia PY - 2023/12/13 TI - A Mobile Health App for Facilitating Disease Management in Children With Atopic Dermatitis: Feasibility and Impact Study JO - JMIR Dermatol SP - e49278 VL - 6 KW - atopic dermatitis KW - eczema KW - Atopic App mobile health application KW - artificial intelligence KW - dermatitis KW - dermatology KW - skin KW - disease management KW - child KW - children KW - pediatric KW - pediatrics KW - feasibility KW - mHealth KW - mobile health KW - app KW - apps KW - applications N2 - Background: Inadequate control of atopic dermatitis (AD) increases the frequency of exacerbations and reduces the quality of life. Mobile health apps provide information and communication technology and may increase treatment adherence and facilitate disease management at home. The mobile health app, Atopic App, designed for patients and their caregivers, and the associated web-based patient education program, Atopic School, provide an opportunity for improving patients? and caregivers? engagement and adherence to the management of AD. Objective: This noninterventional, observational study aimed to explore the feasibility and potential impact on the management of AD in children by caregivers using the Atopic App mobile health app. Methods: The patient-oriented eczema measure (POEM) and numerical rating scale for the grading of pruritus were used as severity scores (scale range: 0-28). The artificial intelligence model of the app was used to assess the severity of AD based on the eczema area and severity index approach. The deidentified data enabled the analysis of the severity of AD, treatment plan history, potential triggers of flare-ups, usage of available features of the app, and the impact of patient education. Results: During a 12-month period, of the 1223 users who installed the app, 910 (74.4%) registered users were caregivers of children with AD. The web-based Atopic School course was accessed by 266 (29.2%) caregivers of children with AD, 134 (50.4%) of whom completed the course. Usage of the app was significantly more frequent among those who completed the Atopic School program than among those who did not access or did not complete the course (P<.001). Users who completed a second POEM 21 to 27 days apart exhibited a significant improvement of AD severity based on the POEM score (P<.001), with an average improvement of 3.86 (SD 6.85) points. The artificial intelligence severity score and itching score were highly correlated with the POEM score (r=0.35 and r=0.52, respectively). Conclusions: The Atopic App provides valuable real-world data on the epidemiology, severity dynamics, treatment patterns, and exacerbation-trigger correlations in patients with AD. The significant reduction in the POEM score among users of the Atopic App indicates a potential impact of this tool on health care engagement by caregivers of children with AD. UR - https://derma.jmir.org/2023/1/e49278 UR - http://dx.doi.org/10.2196/49278 UR - http://www.ncbi.nlm.nih.gov/pubmed/38090787 ID - info:doi/10.2196/49278 ER - TY - JOUR AU - Strouf Motley, Haley AU - Kerr, Bradley AU - Sklansky, J. Daniel AU - Eickhoff, Jens AU - Moreno, A. Megan AU - Babal, C. Jessica PY - 2023/12/13 TI - Parent Perceptions of Trainees in Pediatric Care: Cross-Sectional Study JO - JMIR Form Res SP - e46631 VL - 7 KW - latent class analysis KW - medical student KW - resident KW - trainee KW - medical education KW - trust KW - comfort KW - parents KW - pediatrics KW - parent perception KW - pediatric care KW - clinical autonomy N2 - Background: Clinical experience and progressive autonomy are essential components of medical education and must be balanced with patient comfort. While previous studies have suggested that most patients accept trainee involvement in their care, few studies have focused specifically on the views of parents of pediatric patients or examined groups who may not report acceptance. Objective: This study aims to understand parental profiles of resident and medical student involvement in pediatric care and to use latent class analysis (LCA) methodology to identify classes of responses associated with parent demographic characteristics. Methods: We used data from a national cross-sectional web-based survey of 3000 parents. The survey used a 5-point Likert scale to assess 8 measures of parent perceptions of residents and medical students. We included participants who indicated prior experience with residents or medical students. We compared responses about resident involvement in pediatric care with responses about student involvement, used LCA to identify latent classes of parent responses, and compared demographic features between the latent classes. Results: Of the 3000 parents who completed the survey, 1543 met the inclusion criteria for our study. Participants reported higher mean scores for residents than for medical students for perceived quality of care, comfort with autonomously performing an examination, and comfort with autonomously giving medical advice. LCA identified 3 latent classes of parent responses: Trainee-Hesitant, Trainee-Neutral, and Trainee-Supportive. Compared with the Trainee-Supportive and Trainee-Neutral classes, the Trainee-Hesitant class had significantly more members reporting age <30 years, household income < US $50,000, no college degree, and lesser desire to receive future care at a teaching hospital (all P<.05). Conclusions: Parents may prefer greater clinical autonomy for residents than medical students. Importantly, views associated with the Trainee-Hesitant class may be held disproportionately by members of historically and currently socially marginalized demographic groups. Future studies should investigate underlying reasons for trainee hesitancy in these groups, including the possibility of mistrust in medicine. UR - https://formative.jmir.org/2023/1/e46631 UR - http://dx.doi.org/10.2196/46631 UR - http://www.ncbi.nlm.nih.gov/pubmed/38090789 ID - info:doi/10.2196/46631 ER - TY - JOUR AU - McNaughton Reyes, Luz H. AU - Armora Langoni, G. Eliana AU - Sharpless, Laurel AU - Moracco, E. Kathryn AU - Benavides, Quetzabel AU - Foshee, A. Vangie PY - 2023/12/1 TI - Web-Based Delivery of a Family-Based Dating Abuse Prevention Program for Adolescents Exposed to Interparental Violence: Feasibility and Acceptability Study JO - JMIR Form Res SP - e49718 VL - 7 KW - dating violence KW - adolescents KW - family-based prevention KW - web-based delivery KW - feasibility and acceptability KW - mobile phone N2 - Background: Numerous studies have demonstrated that exposure to caregiver intimate partner violence (IPV) can have cascading negative impacts on children that elevate the risk of involvement in dating abuse. This cascade may be prevented by programs that support the development of healthy relationships in children exposed to IPV. This paper describes the results of a study of the web-based adaptation of an evidence-based dating abuse prevention program for IPV-exposed youth and their maternal caregivers. Core information and activities from an evidence-based program, Moms and Teens for Safe Dates, were adapted to create the web-based program (e-MTSD), which comprises 1 module for mothers only and 5 modules for mother-adolescent dyads to complete together. Objective: The primary objective of this study was to evaluate the feasibility and acceptability of the e-MTSD program and the associated research processes. We also examined the practicability of randomizing mothers to receive SMS text message reminders and an action planning worksheet, which were intended to support engagement in the program. Methods: Mothers were recruited through community organizations and social media advertising and were eligible to participate if they had at least one adolescent aged 12 to 16 years of any gender identity who was willing to participate in the program with them, had experienced IPV after their adolescent was born, and were not currently living with an abusive partner. All mothers were asked to complete the program with their adolescent over a 6- to 8-week period. Participants were randomized to receive SMS text message reminders, action planning, or both using a 2×2 factorial design. Research feasibility was assessed by tracking recruitment, randomization, enrollment, and attrition rates. Program feasibility was assessed by tracking program uptake, completion, duration, and technical problems, and acceptability was assessed using web-based surveys. Results: Over a 6-month recruitment period, 101 eligible mother-adolescent dyads were enrolled in the study and were eligible for follow-up. The median age of the adolescent participants was 14 years; 57.4% (58/101) identified as female, 32.7% (33/101) identified as male, and 9.9% (10/101) identified as gender diverse. All but one mother accessed the program website at least once; 87.1% (88/101) completed at least one mother-adolescent program module, and 74.3% (75/101) completed all 6 program modules. Both mothers and adolescents found the program to be highly acceptable; across all program modules, over 90% of mothers and over 80% of adolescents reported that the modules kept their attention, were enjoyable, were easy to do, and provided useful information. Conclusions: Findings suggest the feasibility of web-based delivery and evaluation of the e-MTSD program. Furthermore, average ratings of program acceptability were high. Future research is needed to assess program efficacy and identify the predictors and outcomes of program engagement. UR - https://formative.jmir.org/2023/1/e49718 UR - http://dx.doi.org/10.2196/49718 UR - http://www.ncbi.nlm.nih.gov/pubmed/38039070 ID - info:doi/10.2196/49718 ER - TY - JOUR AU - Thornton, Christopher AU - Lanyi, Kate AU - Wilkins, Georgina AU - Potter, Rhiannon AU - Hunter, Emily AU - Kolehmainen, Niina AU - Pearson, Fiona PY - 2023/11/28 TI - Scoping the Priorities and Concerns of Parents: Infodemiology Study of Posts on Mumsnet and Reddit JO - J Med Internet Res SP - e47849 VL - 25 KW - childhood KW - child KW - toddler KW - infant KW - behavior KW - parent KW - parenting KW - topic modeling KW - data mining KW - social media KW - infodemiology KW - Reddit KW - web-based forum KW - well-being KW - children KW - data KW - family health N2 - Background: Health technology innovation is increasingly supported by a bottom-up approach to priority setting, aiming to better reflect the concerns of its intended beneficiaries. Web-based forums provide parents with an outlet to share concerns, advice, and information related to parenting and the health and well-being of their children. They provide a rich source of data on parenting concerns and priorities that could inform future child health research and innovation. Objective: The aim of the study is to identify common concerns expressed on 2 major web-based forums and cluster these to identify potential family health concern topics as indicative priority areas for future research and innovation. Methods: We text-mined the r/Parenting subreddit (69,846 posts) and the parenting section of Mumsnet (99,848 posts) to create a large corpus of posts. A generative statistical model (latent Dirichlet allocation) was used to identify the most discussed topics in the corpus, and content analysis was applied to identify the parenting concerns found in a subset of posts. Results: A model with 25 topics produced the highest coherence and a wide range of meaningful parenting concern topics. The most frequently expressed parenting concerns are related to their child?s sleep, self-care, eating (and food), behavior, childcare context, and the parental context including parental conflict. Topics directly associated with infants, such as potty training and bottle feeding, were more common on Mumsnet, while parental context and screen time were more common on r/Parenting. Conclusions: Latent Dirichlet allocation topic modeling can be applied to gain a rapid, yet meaningful overview of parent concerns expressed on a large and diverse set of social media posts and used to complement traditional insight gathering methods. Parents framed their concerns in terms of children?s everyday health concerns, generating topics that overlap significantly with established family health concern topics. We provide evidence of the range of family health concerns found at these sources and hope this can be used to generate material for use alongside traditional insight gathering methods. UR - https://www.jmir.org/2023/1/e47849 UR - http://dx.doi.org/10.2196/47849 UR - http://www.ncbi.nlm.nih.gov/pubmed/38015600 ID - info:doi/10.2196/47849 ER - TY - JOUR AU - Babayan, Katherine AU - Keilty, Krista AU - Esufali, Jessica AU - Grajales III, J. Francisco AU - PY - 2023/11/8 TI - An After-Hours Virtual Care Service for Children With Medical Complexity and New Medical Technology: Mixed Methods Feasibility Study JO - JMIR Pediatr Parent SP - e41393 VL - 6 KW - children with medical complexity KW - technology dependence KW - medical devices KW - family caregivers KW - virtual care KW - home and community care KW - emergency department visits KW - enteral feeding tubes KW - hospital-to-home transition KW - feasibility KW - mixed methods N2 - Background: Family caregivers (FCs) of children with medical complexity require specialized support to promote the safe management of new medical technologies (eg, gastrostomy tubes) during hospital-to-home transitions. With limited after-hours services available to families in home and community care, medical device complications that arise often lead to increased FC stress and unplanned emergency department (ED) visits. To improve FC experiences, enable safer patient discharge, and reduce after-hours ED visits, this study explores the feasibility of piloting a 24/7 virtual care service (Connected Care Live) with families to provide real-time support by clinicians expert in the use of pediatric home care technologies. Objective: This study aims to establish the economic, operational, and technical feasibility of piloting the expansion of an existing nurse-led after-hours virtual care service offered to home and community care providers to FCs of children with newly inserted medical devices after hospital discharge at Toronto?s Hospital for Sick Children (SickKids). Methods: This exploratory study, conducted from October 2020 to August 2021, used mixed data sources to inform service expansion feasibility. Semistructured interviews were conducted with FCs, nurses, and hospital leadership to assess the risks, benefits, and technical and operational requirements for sustainable and cost-effective future service operations. Time and travel savings were estimated using ED visit data in SickKids? electronic medical records (Epic) with a chief complaint of ?medical device problems,? after-hours medical device inquiries from clinician emails and voicemails, and existing service operational data. Results: A total of 30 stakeholders were interviewed and voiced the need for the proposed service. Safer and more timely management of medical device complications, improved caregiver and provider experiences, and strengthened partnerships were identified as expected benefits, while service demand, nursing practice, and privacy and security were identified as potential risks. A total of 47 inquiries were recorded over 2 weeks from March 26, 2021, to April 8, 2021, with 51% (24/47) assessed as manageable via service expansion. This study forecasted annual time and travel savings of 558 hours for SickKids and 904 hours and 22,740 km for families. Minimal technical and operational requirements were needed to support service expansion by leveraging an existing platform and clinical staff. Of the 212 ED visits related to ?medical device problems? over 6 months from September 1, 2020, to February 28, 2021, enteral feeding tubes accounted for nearly two-thirds (n=137, 64.6%), with 41.6% (57/137) assessed as virtually manageable. Conclusions: Our findings indicate that it is feasible to pilot the expansion of Connected Care Live to FCs of children with newly inserted enteral feeding tubes. This nurse-led virtual caregiver service is a promising tool to promote safe hospital-to-home transitions, improve FC experiences, and reduce after-hours ED visits. UR - https://pediatrics.jmir.org/2023/1/e41393 UR - http://dx.doi.org/10.2196/41393 UR - http://www.ncbi.nlm.nih.gov/pubmed/37938869 ID - info:doi/10.2196/41393 ER - TY - JOUR AU - Stanic, Tijana AU - Saygin Avsar, Tuba AU - Gomes, Manuel PY - 2023/11/3 TI - Economic Evaluations of Digital Health Interventions for Children and Adolescents: Systematic Review JO - J Med Internet Res SP - e45958 VL - 25 KW - digital health KW - cost-effectiveness KW - economic evaluation KW - children KW - adolescents N2 - Background: Digital health interventions (DHIs) are defined as digital technologies such as digital health applications and information and communications technology systems (including SMS text messages) implemented to meet health objectives. DHIs implemented using various technologies, ranging from electronic medical records to videoconferencing systems and mobile apps, have experienced substantial growth and uptake in recent years. Although the clinical effectiveness of DHIs for children and adolescents has been relatively well studied, much less is known about the cost-effectiveness of these interventions. Objective: This study aimed to systematically review economic evaluations of DHIs for pediatric and adolescent populations. This study also reviewed methodological issues specific to economic evaluations of DHIs to inform future research priorities. Methods: We conducted a database search in PubMed from 2011 to 2021 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. In total, 2 authors independently screened the titles and abstracts of the search results to identify studies eligible for full-text review. We generated a data abstraction procedure based on recommendations from the Panel on Cost-Effectiveness in Health and Medicine. The types of economic evaluations included in this review were cost-effectiveness analyses (costs per clinical effect), cost-benefit analyses (costs and effects expressed in monetary terms as net benefit), and cost-utility analyses (cost per quality-adjusted life year or disability-adjusted life year). Narrative analysis was used to synthesize the quantitative data because of heterogeneity across the studies. We extracted methodological issues related to study design, analysis framework, cost and outcome measurement, and methodological assumptions regarding the health economic evaluation. Results: We included 22 articles assessing the cost-effectiveness of DHI interventions for children and adolescents. Most articles (14/22, 64%) evaluated interventions delivered through web-based portals or SMS text messaging, most frequently within the health care specialties of mental health and maternal, newborn, and child health. In 82% (18/22) of the studies, DHIs were found to be cost-effective or cost saving compared with the nondigital standard of care. The key drivers of cost-effectiveness included population coverage, cost components, intervention effect size and scale-up, and study perspective. The most frequently identified methodological challenges were related to study design (17/22, 77%), costing (11/22, 50%), and economic modeling (9/22, 41%). Conclusions: This is the first systematic review of economic evaluations of DHIs targeting pediatric and adolescent populations. We found that most DHIs (18/22, 82%) for children and adolescents were cost-effective or cost saving compared with the nondigital standard of care. In addition, this review identified key methodological challenges directly related to the conduct of economic evaluations of DHIs and highlighted areas where further methodological research is required to address these challenges. These included the need for measurement of user involvement and indirect effects of DHIs and the development of children-specific, generic quality-of-life outcomes. UR - https://www.jmir.org/2023/1/e45958 UR - http://dx.doi.org/10.2196/45958 UR - http://www.ncbi.nlm.nih.gov/pubmed/37921844 ID - info:doi/10.2196/45958 ER - TY - JOUR AU - Ippolito, Christina AU - Canthiya, Lathushikka AU - Floreani, Amanda AU - Luckhart, Kathleen AU - Hoffman, Andrea AU - McAdam, Laura PY - 2023/11/2 TI - Twice-Weekly Outpatient Rehabilitation Intervention for Young Children With Spinal Muscular Atrophy Treated With Genetic-Based Therapies: Protocol for a Feasibility Study JO - JMIR Res Protoc SP - e46363 VL - 12 KW - active rehabilitation KW - atrophy KW - child KW - feasibility trial KW - feasibility KW - genetic-based KW - genetic-based therapy KW - infant KW - occupation therapy KW - pediatric KW - physical therapy KW - physiotherapy KW - pilot trial KW - rehabilitation KW - spinal muscular atrophy N2 - Background: Spinal muscular atrophy (SMA) is a progressive neuromuscular disorder that causes muscle weakness and is the leading genetic cause of infant mortality worldwide. While no definitive cure exists, the approval of 3 genetic-based therapies in Canada since 2018 has led to significant improvements in muscle function for children with SMA. With that, there are no evidence-based rehabilitation interventions and minimal evidence on the combined effects of genetic-based therapies and rehabilitation. Objective: This protocol describes the methodology to assess the feasibility of a twice-weekly outpatient rehabilitation intervention focusing on gross and fine motor function to inform the methodology and sample size of a definitive clinical trial. Methods: We will conduct a single-center nonrandomized pilot and feasibility trial to explore an outpatient rehabilitation intervention for children aged 6 months to 3 years with SMA treated with genetic-based therapies. Participation in the study will occur over a 25-week period, with a baseline assessment visit followed by a 12-week intervention period and a 12-week nonintervention period. The rehabilitation intervention comprises weekly physical and occupational therapy for 11 weeks. Assessments will occur at baseline (week 0), end of intervention or early withdrawal (week 12), and follow-up (week 24). Predetermined feasibility indicators will evaluate study feasibility across process (recruitment rates, eligibility criteria, adherence rates, retention rates, questionnaire suitability, and acceptability), resource (time, implementation, and execution), management (materials and data), and scientific (safety, tolerability, and preliminary efficacy) domains. Results: This project was funded in March 2022, and data will be collected between March 2023 and December 2023. Data analysis will occur between January 2024 and March 2024, with publication expected in the fall of 2024. The protocol for the feasibility trial will be considered successful if it meets the success criteria set out for the feasibility indicators. Indicators of specific interest include all process indicators, as well as time. Exploratory indicators will be reported. Pragmatically, the results of the feasibility trial will inform changes to the protocol and the start-up of a definitive multisite trial. Conclusions: This novel twice-weekly outpatient rehabilitation intervention will be the first step toward filling the need for an evidence-based rehabilitation intervention for children with SMA treated with genetic-based therapies. It is expected that consistent and intensive rehabilitation therapy will augment functional gains being observed in this population. In the future, a definitive trial will measure the efficacy of the intervention. Trial Registration: ClinicalTrials.gov NCT05638750; https://clinicaltrials.gov/study/NCT05638750 International Registered Report Identifier (IRRID): DERR1-10.2196/46363 UR - https://www.researchprotocols.org/2023/1/e46363 UR - http://dx.doi.org/10.2196/46363 UR - http://www.ncbi.nlm.nih.gov/pubmed/37917140 ID - info:doi/10.2196/46363 ER - TY - JOUR AU - Guo, Lin Lin AU - Guo, Ying Lin AU - Li, Jiao AU - Gu, Wen Yao AU - Wang, Yang Jia AU - Cui, Ying AU - Qian, Qing AU - Chen, Ting AU - Jiang, Rui AU - Zheng, Si PY - 2023/11/1 TI - Characteristics and Admission Preferences of Pediatric Emergency Patients and Their Waiting Time Prediction Using Electronic Medical Record Data: Retrospective Comparative Analysis JO - J Med Internet Res SP - e49605 VL - 25 KW - pediatric emergency department KW - characteristics KW - admission preferences KW - waiting time KW - machine learning KW - electronic medical record N2 - Background: The growing number of patients visiting pediatric emergency departments could have a detrimental impact on the care provided to children who are triaged as needing urgent attention. Therefore, it has become essential to continuously monitor and analyze the admissions and waiting times of pediatric emergency patients. Despite the significant challenge posed by the shortage of pediatric medical resources in China?s health care system, there have been few large-scale studies conducted to analyze visits to the pediatric emergency room. Objective: This study seeks to examine the characteristics and admission patterns of patients in the pediatric emergency department using electronic medical record (EMR) data. Additionally, it aims to develop and assess machine learning models for predicting waiting times for pediatric emergency department visits. Methods: This retrospective analysis involved patients who were admitted to the emergency department of Children?s Hospital Capital Institute of Pediatrics from January 1, 2021, to December 31, 2021. Clinical data from these admissions were extracted from the electronic medical records, encompassing various variables of interest such as patient demographics, clinical diagnoses, and time stamps of clinical visits. These indicators were collected and compared. Furthermore, we developed and evaluated several computational models for predicting waiting times. Results: In total, 183,024 eligible admissions from 127,368 pediatric patients were included. During the 12-month study period, pediatric emergency department visits were most frequent among children aged less than 5 years, accounting for 71.26% (130,423/183,024) of the total visits. Additionally, there was a higher proportion of male patients (104,147/183,024, 56.90%) compared with female patients (78,877/183,024, 43.10%). Fever (50,715/183,024, 27.71%), respiratory infection (43,269/183,024, 23.64%), celialgia (9560/183,024, 5.22%), and emesis (6898/183,024, 3.77%) were the leading causes of pediatric emergency room visits. The average daily number of admissions was 501.44, and 18.76% (34,339/183,204) of pediatric emergency department visits resulted in discharge without a prescription or further tests. The median waiting time from registration to seeing a doctor was 27.53 minutes. Prolonged waiting times were observed from April to July, coinciding with an increased number of arrivals, primarily for respiratory diseases. In terms of waiting time prediction, machine learning models, specifically random forest, LightGBM, and XGBoost, outperformed regression methods. On average, these models reduced the root-mean-square error by approximately 17.73% (8.951/50.481) and increased the R2 by approximately 29.33% (0.154/0.525). The SHAP method analysis highlighted that the features ?wait.green? and ?department? had the most significant influence on waiting times. Conclusions: This study offers a contemporary exploration of pediatric emergency room visits, revealing significant variations in admission rates across different periods and uncovering certain admission patterns. The machine learning models, particularly ensemble methods, delivered more dependable waiting time predictions. Patient volume awaiting consultation or treatment and the triage status emerged as crucial factors contributing to prolonged waiting times. Therefore, strategies such as patient diversion to alleviate congestion in emergency departments and optimizing triage systems to reduce average waiting times remain effective approaches to enhance the quality of pediatric health care services in China. UR - https://www.jmir.org/2023/1/e49605 UR - http://dx.doi.org/10.2196/49605 UR - http://www.ncbi.nlm.nih.gov/pubmed/37910168 ID - info:doi/10.2196/49605 ER - TY - JOUR AU - Lampl, Stephan AU - Gurunathan, Deepa AU - Krithikadatta, Jogikalmat AU - Mehta, Deepak AU - Moodley, Desigar PY - 2023/11/1 TI - Reasons for Crown Failures in Primary Teeth: Protocol for a Systematic Review and Meta-Analysis JO - JMIR Res Protoc SP - e51505 VL - 12 KW - crowns KW - primary teeth KW - biological complications KW - technical complications KW - survival rates KW - pediatric KW - dental KW - dentistry KW - teeth KW - dentists KW - survival KW - quality assessment N2 - Background: There is a tendency nowadays to restore large defects in primary dentition with pediatric crowns instead of conventional restorations. Thus, understanding the factors contributing to the survival or failure of dental crowns in pediatric dentistry is essential for optimizing treatment outcomes. Objective: The primary objective of this protocol is to outline the methodological approach for analyzing data from observational studies and randomized controlled trials to investigate reasons for the failure of dental crowns in primary teeth and to compute their survival and failure rates. Methods: A comprehensive literature review will be performed in electronic databases, including PubMed (MEDLINE), Cochrane, Embase, and Web of Science. As per predefined inclusion criteria, we will include observational studies (prospective clinical studies) and randomized clinical trials that have an English abstract and involve children aged 1-10 years undergoing crown restorations. Two independent reviewers will independently screen all retrieved records and full-text articles and extract data. The study?s methodological quality will be appraised using suitable tools. Assessments of publication bias will be performed using funnel plots. The findings will be described qualitatively for the systematic review. If possible, a meta-analysis will be performed to estimate failure rates by dividing the number of failures by the total exposure time. A Poisson regression model, assuming constant event rates, will be used to compute 3-year and 5-year survival proportions. The Pearson goodness-of-fit statistics will be used to assess the heterogeneity of the model. A P value <.05 will be considered significant. All analyses will be performed using R Statistical software (version 4.1.2; R Core Team). Results: This systematic review and synthesis aim to assess the survival and failure rates of dental crowns in pediatric dentistry. By following this rigorous methodology, we seek to provide valuable insights into the factors contributing to the success or failure of these restorations. The results of our full review will have implications for pediatric dentists, researchers, and policy makers, helping to improve dental care for children. Conclusions: This systematic review protocol helps in establishing a thorough approach for reviewing failures in pediatric crowns. By following this methodology, standardization and transparency of the process as well as accountability for the stated methods and outcomes will be ensured. The findings of this review and analysis will provide useful data on the survival of crowns to pediatric dentists and researchers. Trial Registration: PROSPERO CRD42023442266; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=442266 International Registered Report Identifier (IRRID): PRR1-10.2196/51505 UR - https://www.researchprotocols.org/2023/1/e51505 UR - http://dx.doi.org/10.2196/51505 UR - http://www.ncbi.nlm.nih.gov/pubmed/37910174 ID - info:doi/10.2196/51505 ER - TY - JOUR AU - Mills-Koonce, Roger W. AU - Grewen, Karen AU - O?Shea, Gottredson Nisha AU - Pearson, Brenda AU - Strange, Grace Chelsea AU - Meltzer-Brody, E. Samantha AU - Guintivano, Dolph Jerry AU - Stuebe, M. Alison PY - 2023/10/26 TI - The Mood, Mother and Child Study: Protocol for a Prospective Longitudinal Study and Randomized Controlled Trial JO - JMIR Res Protoc SP - e51132 VL - 12 KW - maternal depression KW - oxytocin KW - hypothalamic-pituitary-adrenal axis KW - HPA axis KW - parenting KW - executive functioning KW - socioemotional development N2 - Background: Perinatal depression affects >400,000 mother-child dyads in the United States every year and is associated with numerous adverse maternal and child developmental outcomes. Previous research implicates the dysregulation of oxytocin and the hypothalamic-pituitary-adrenal (HPA) axis functioning in mothers and children as potential mechanisms mediating or moderating the transmission of risk associated with maternal depression. Objective: The Mood, Mother and Child study will examine the psychobiological sources of risk and resilience within mother-child dyads affected by maternal depression. This manuscript describes (1) the study rationale and aims, (2) the research design and procedures and how they were altered in response to the COVID-19 pandemic, and (3) the data analysis plan to test the study hypotheses. Methods: This is a prospective longitudinal study with an embedded randomized controlled trial that examines (1) correlations among postpartum depression and anxiety symptoms, maternal and child oxytocin and HPA axis functioning, and child developmental outcomes and (2) the causal relationship between exogenous oxytocin and HPA reactivity. This study is funded by the National Institute of Child Health and Human Development with institutional review board approval. Results: Recruitment and data collection have commenced, and the expected results will be available in 2024. Analyses are presented for testing the proposed hypotheses. Conclusions: The unique combination of a prospective longitudinal research design with an embedded randomized controlled trial will allow the Mood, Mother and Child study to apply a developmental lens to the study of maternal depression and anxiety symptoms from birth to middle childhood and the psychobiological mechanisms promoting risk and resiliency for both mother and child outcomes. This will be the first study that simultaneously evaluates (1) the role of oxytocin using multiple methodologies, (2) the causal relationships between exogenous oxytocin and HPA axis functioning among mothers with differing levels of depression and anxiety symptoms, and (3) the multiple mediating and moderating roles of parenting behaviors and maternal and child psychobiological characteristics. The goals of these aims are to provide insights into the psychobiological effects of oxytocin in women and inform future clinical trials to treat perinatal mood disorders. Trial Registration: ClinicalTrials.gov NCT03593473; https://classic.clinicaltrials.gov/ct2/show/NCT03593473 International Registered Report Identifier (IRRID): DERR1-10.2196/51132 UR - https://www.researchprotocols.org/2023/1/e51132 UR - http://dx.doi.org/10.2196/51132 UR - http://www.ncbi.nlm.nih.gov/pubmed/37883133 ID - info:doi/10.2196/51132 ER - TY - JOUR AU - Bai, Zirong AU - Lyu, Xiaoxiao AU - Tang, Yichuan AU - Wang, Meng PY - 2023/10/16 TI - Pediatric Tui Na for Feeding Intolerance in Premature Infants: Protocol for a Systematic Review and Meta-Analysis JO - JMIR Res Protoc SP - e46375 VL - 12 KW - feeding intolerance KW - pediatric tui na KW - premature infants KW - protocol KW - systematic review N2 - Background: Feeding intolerance (FI), frequently resulting from gastrointestinal immaturity, is prevalent among premature infants. Current practices are gradually prioritizing nonpharmacological treatments, such as massage or ?Tui na,? considering the potential side effects of prolonged medication use. Pediatric Tui na, a specialized massage therapy based on traditional Chinese medicine, has been widely studied for treating FI in premature infants. However, to our knowledge, no systematic review specifically focusing on the effectiveness and safety of traditional Chinese medicine?based pediatric Tui na for FI in premature infants has been published yet. Objective: This study aims to develop a protocol for a systematic review and meta-analysis for evaluating the safety and efficacy of pediatric Tui na for premature infants with FI. Methods: We will perform a comprehensive search in the following databases: Springer, Cochrane Library, Embase, MEDLINE, Clarivate Analytics, Physiotherapy Evidence Database (PEDro), CINAHL, PubMed, Scopus, World Health Organization (WHO) International Clinical Trials Registry Platform, and Chinese biomedical databases (Wanfang database, the China National Knowledge Infrastructure, Chinese Scientific Journals Database, and Chinese Biomedical Literature Databases), limited to studies published in Chinese and English languages between January 2000 and January 2023. The search strategy will use MeSH (Medical Subject Headings) terms and database-specific keywords. A total of 2 independent reviewers will initially screen the studies based on titles and abstracts, followed by a full-text evaluation of the eligible studies. Studies will include any nonrandomized controlled trials, nonrandomized clinical studies, randomized controlled trials, and quasi-experimental studies wherein the treatment group involves premature infants with FI given pediatric Tui na. Primary outcomes will be necrotizing enterocolitis, gastric residual volume, emesis, and stool blood. Secondary outcomes will be abdominal distension weight gain, time to achieve full enteral feeding, any adverse effects associated with pediatric Tui na, and length of hospital stay. The Cochrane Collaboration Risk of Bias Tool will be used to assess the risk of bias and methodological quality. Funnel plots will be used for evaluating publication bias. Meta-analysis will be conducted using the Review Manager software (version 5.4; Cochrane Collaboration). Subgroup analyses will be considered according to treatment received, country or setting, sex, and birth weight of premature infants (if heterogeneity is high, I2?50%). Results: This is a systematic review and meta-analysis protocol, so the results are not yet available. The protocol has been registered with PROSPERO (CRD42023390021). We are currently in the study selection phase. Results are expected to be completed by the end of 2023. Conclusions: Following this protocol, a comprehensive and rigorous literature synthesis will be developed to assess the impact of pediatric Tui na treatment on premature infants with FI, enabling the determination of its efficacy and safety. Trial Registration: PROSPERO CRD42023390021; https://tinyurl.com/bdf4kn23 International Registered Report Identifier (IRRID): PRR1-10.2196/46375 UR - https://www.researchprotocols.org/2023/1/e46375 UR - http://dx.doi.org/10.2196/46375 UR - http://www.ncbi.nlm.nih.gov/pubmed/37843917 ID - info:doi/10.2196/46375 ER - TY - JOUR AU - Kim, Seong-Yeol AU - Song, Minji AU - Jo, Yunju AU - Jung, Youngjae AU - You, Heecheon AU - Ko, Myoung-Hwan AU - Kim, Gi-Wook PY - 2023/10/11 TI - Effect of Voice and Articulation Parameters of a Home-Based Serious Game for Speech Therapy in Children With Articulation Disorder: Prospective Single-Arm Clinical Trial JO - JMIR Serious Games SP - e49216 VL - 11 KW - articulation disorder KW - home-based therapy KW - serious game KW - children KW - speech KW - voice N2 - Background: Articulation disorder decreases the clarity of language and causes a decrease in children?s learning and social ability. The demand for non?face-to-face treatment is increasing owing to the limited number of therapists and geographical or economic constraints. Non?face-to-face speech therapy programs using serious games have been proposed as an alternative. Objective: The aim of this study is to investigate the efficacy of home therapy on logopedic and phoniatric abilities in children with articulation disorder using the Smart Speech game interface. Methods: This study is a prospective single-arm clinical trial. Children with articulation disorders, whose Urimal Test of Articulation and Phonology (U-TAP) was ?2 SDs or less and the Receptive and Expressive Vocabulary Test score was ?1 SD or more, were enrolled. A preliminary evaluation (E0) was conducted to check whether the children had articulation disorders, and for the next 4 weeks, they lived their usual lifestyle without other treatments. Prior to the beginning of the training, a pre-evaluation (E1) was performed, and the children trained at home for ?30 minutes per day, ?5 times a week, over 4 weeks (a total of 20 sessions). The Smart Speech program comprised oral exercise training, breathing training, and speech training; the difficulty and type of the training were configured differently according to the participants? articulation error, exercise, and vocal ability. After the training, postevaluation (E2) was performed using the same method. Finally, 8 weeks later, postevaluation (E3) was performed as a follow-up. A voice evaluation included parameters such as maximum phonation time (MPT), fundamental frequency (F0), jitter, peak air pressure (relative average perturbation), pitch, intensity, and voice onset time. Articulation parameters included a percentage of correct consonants (PCC; U-TAP word-unit PCC, U-TAP sentence-unit PCC, and three-position articulation test) and alternate motion evaluation (diadochokinesis, DDK). Data obtained during each evaluation (E1-E2-E3) were compared. Results: A total of 13 children with articulation disorders aged 4-10 years were enrolled in the study. In voice parameters, MPT, jitter, and pitch showed significant changes in repeated-measures ANOVA. However, only MPT showed significant changes during E1-E2 (P=.007) and E1-E3 (P=.004) in post hoc tests. Other voice parameters did not show significant changes. In articulation parameters, U-TAP, three-position articulation test (TA), and DDK showed significant changes in repeated-measures ANOVA. In post hoc tests, U-TAP (word, sentence) and TA showed significant changes during E1-E2 (P=.003, .04, and .01) and E1-E3 (P=.001, .03, and .003), and DDK showed significant changes during E1-E2 only (P=.03). Conclusions: Home-based serious games can be considered an alternative treatment method to improve language function. Trial Registration: Clinical Research Information Service KCT0006448; https://cris.nih.go.kr/cris/search/detailSearch.do/20119 UR - https://games.jmir.org/2023/1/e49216 UR - http://dx.doi.org/10.2196/49216 UR - http://www.ncbi.nlm.nih.gov/pubmed/37819707 ID - info:doi/10.2196/49216 ER - TY - JOUR AU - Francis-Oliviero, Florence AU - Loubières, Céline AU - Grové, Christine AU - Marinucci, Alexandra AU - Shankland, Rebecca AU - Salamon, Réda AU - Perez, Emmanuelle AU - Garancher, Laure AU - Galera, Cédric AU - Gaillard, Elsa AU - Orri, Massimiliano AU - González-Caballero, Luis Juan AU - Montagni, Ilaria PY - 2023/10/5 TI - Improving Children?s Mental Health Literacy Through the Cocreation of an Intervention and Scale Validation: Protocol for the CHILD-Mental Health Literacy Research Study JO - JMIR Res Protoc SP - e51096 VL - 12 KW - child KW - mental health KW - literacy KW - intervention KW - scale N2 - Background: Children?s mental health is a public health priority, with 1 in 5 European children younger than 12 years having a behavioral, developmental, or psychological disorder. Mental health literacy (MHL) is a modifiable determinant of mental health, promoting psychological well-being and reducing mental health problems. Despite its significance, no interventions or scales currently exist for increasing and measuring MHL in this population. Objective: This study has dual objectives: (1) cocreating and evaluating an intervention on children?s MHL, and (2) developing and validating a scale that measures children?s MHL. Methods: Our study focuses on children aged 9-11 years attending primary school classes in various settings, including urban and rural areas, and priority education zones within a French department. Using a participatory research approach, we will conduct workshops involving children, parents, teachers, and 1 artist to cocreate an intervention comprising multiple tools (eg, a pedagogical kit and videos). This intervention will undergo initial evaluation in 4 classes through observations, interviews, and satisfaction questionnaires to assess its viability. Concurrently, the artist will collaborate with children to create the initial version of the CHILD-MHL scale, which will then be administered to 300 children. Psychometric analyses will validate the scale. Subsequently, we will conduct a cluster randomized controlled trial involving a minimum of 20 classes, using the CHILD-MHL scale scores as the primary end point to evaluate the intervention?s efficacy. Additional interviews will complement this mixed methods evaluation. Both the intervention and the scale are grounded in the Child-Focused MHL model. Results: The first tool of the intervention is the pedagogical kit Le Jardin du Dedans, supported by the public organization Psycom Santé Mentale Info and endorsed by UNICEF (United Nations Children?s Fund) France. The second tool is a handbook by the Pan American Health Organization and the World Health Organization, which is addressed to teachers to sensitize them to children?s mental health problems. The third is a 5-page supplementary leaflet produced by the nongovernmental organization The Ink Link, which teaches children the notion of MHL. Finally, we produced 56 items of the MHL Scale and listed existing education policies for children?s mental health. Conclusions: After its robust evaluation, the intervention could be extended to several schools in France. The scale will be the first in the world to measure children?s MHL. It will be used not only to evaluate interventions but also to provide data for decision makers to include MHL in all educational policies. Both the intervention and the scale could be translated into other languages. International Registered Report Identifier (IRRID): PRR1-10.2196/51096 UR - https://www.researchprotocols.org/2023/1/e51096 UR - http://dx.doi.org/10.2196/51096 UR - http://www.ncbi.nlm.nih.gov/pubmed/37796588 ID - info:doi/10.2196/51096 ER - TY - JOUR AU - Abdou, Abdelrahman AU - Krishnan, Sridhar AU - Mistry, Niraj PY - 2023/10/2 TI - Evaluating a Novel Infant Heart Rate Detector for Neonatal Resuscitation Efforts: Protocol for a Proof-of-Concept Study JO - JMIR Res Protoc SP - e45512 VL - 12 KW - newborn KW - electrocardiogram KW - ECG KW - dry electrode KW - heart rate KW - pediatric KW - resuscitation KW - infant KW - vital signs KW - neonatal N2 - Background: Over 10 million newborns worldwide undergo resuscitation at birth each year. Pediatricians may use electrocardiogram (ECG), pulse oximetry (PO), and stethoscope in determining heart rate (HR), as HR guides the need for and steps of resuscitation. HR must be obtained quickly and accurately. Unfortunately, the current diagnostic modalities are either too slow, obtaining HR in more than a minute, or inaccurate. With time constraints, a reliable robust heart rate detector (HRD) modality is required. This paper discusses a protocol for conducting a methods-based comparison study to determine the HR accuracy of a novel real-time HRD based on 3D-printed dry-electrode single-lead ECG signals for cost-effective and quick HR determination. The HRD?s HR results are compared to either clinical-grade ECG or PO monitors to ensure robustness and accuracy. Objective: The purpose of this study is to design and examine the feasibility of a proof-of-concept HRD that quickly obtains HR using biocompatible 3D-printed dry electrodes for single-lead neonatal ECG acquisition. This study uses a novel HRD and compares it to the gold-standard 3-lead clinical ECG or PO in a hospital setting. Methods: A cross-sectional study is planned to be conducted in the neonatal intensive care unit or postpartum unit of a large community teaching hospital in Toronto, Canada, from June 2023 to June 2024. In total, 50 newborns will be recruited for this study. The HRD and an ECG or PO monitor will be video recorded using a digital camera concurrently for 3 minutes for each newborn. Hardware-based signal processing and patent-pending embedded algorithm-based HR estimation techniques are applied directly to the raw collected single-lead ECG and displayed on the HRD in real time during video recordings. These data will be annotated and compared to the ECG or PO readings at the same points in time. Accuracy, F1-score, and other statistical metrics will be produced to determine the HRD?s feasibility in providing reliable HR. Results: The study is ongoing. The projected end date for data collection is around July 2024. Conclusions: The study will compare the novel patent-pending 3D-printed dry electrode?based HRD?s real-time HR estimation techniques with the state-of-the-art clinical-grade ECG or PO monitors for HR accuracy and examines how fast the HRD provides reliable HR. The study will further provide recommendations and important improvements that can be made to implement the HRD for clinical applications, especially in neonatal resuscitation efforts. This work can be seen as a stepping stone in the development of robust dry-electrode single-lead ECG devices for HR estimations in the pediatric population. International Registered Report Identifier (IRRID): DERR1-10.2196/45512 UR - https://www.researchprotocols.org/2023/1/e45512 UR - http://dx.doi.org/10.2196/45512 UR - http://www.ncbi.nlm.nih.gov/pubmed/37782528 ID - info:doi/10.2196/45512 ER - TY - JOUR AU - Jia, Yang Xiao AU - Andreou, Pantelis AU - Brown, Cary AU - Constantin, Evelyn AU - Godbout, Roger AU - Hanlon-Dearman, Ana AU - Ipsiroglu, Osman AU - Reid, Graham AU - Shea, Sarah AU - Smith, M. Isabel AU - Zwicker, D. Jennifer AU - Weiss, K. Shelly AU - Corkum, Penny PY - 2023/9/12 TI - An eHealth Program for Insomnia in Children With Neurodevelopmental Disorders (Better Nights, Better Days): Protocol for an Economic Evaluation of a Randomized Controlled Trial JO - JMIR Res Protoc SP - e46735 VL - 12 KW - eHealth intervention KW - pediatric insomnia KW - neurodevelopmental disorders KW - attention-deficit/hyperactivity disorder KW - autism spectrum disorder KW - cerebral palsy KW - fetal alcohol spectrum disorder KW - economic evaluation KW - cost-effectiveness N2 - Background: Children with neurodevelopmental disorders have a high risk of sleep disturbances, with insomnia being the most common sleep disorder (ie, chronic and frequent difficulties with going and staying asleep). Insomnia adversely affects the well-being of these children and their caregivers. Pediatric sleep experts recommend behavioral interventions as the first-line treatment option for children. Better Nights, Better Days for Children with Neurodevelopmental Disorders (BNBD-NDD) is a 5-session eHealth behavioral intervention delivered to parents to improve outcomes (eg, Pediatric Quality of Life Inventory [PedsQL]) for their children (ages 4-12 years) with insomnia and who have a diagnosis of mild to moderate attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, or fetal alcohol spectrum disorder. If cost-effective, BNBD-NDD can be a scalable intervention that provides value to an underserved population. Objective: This protocol outlines an economic evaluation conducted alongside the BNBD-NDD randomized controlled trial (RCT) that aims to assess its costs, efficacy, and cost-effectiveness compared to usual care. Methods: The BNBD-NDD RCT evaluates the impacts of the intervention on children?s sleep and quality of life, as well as parents? daytime functioning and psychosocial health. Parent participants were randomized to the BNBD-NDD treatment or to usual care. The economic evaluation assesses outcomes at baseline and 8 months later, which include the PedsQL as the primary measure. Quality of life outcomes facilitate the comparison of competing interventions across different populations and medical conditions. Cost items include the BNBD-NDD intervention and parent-reported usage of private and publicly funded resources for their children?s insomnia. The economic evaluation involves a reference case cost-effectiveness analysis to examine the incremental cost of BNBD-NDD per units gained in the PedsQL from the family payer perspective and a cost-consequence analysis from a societal perspective. These analyses will be conducted over an 8-month time horizon. Results: Research funding was obtained from the Kids Brain Health Network in 2015. Ethics were approved by the IWK Health Research Ethics Board and the University of Calgary Conjoint Health Research Ethics Board in January 2019 and June 2022, respectively. The BNBD-NDD RCT data collection commenced in June 2019 and ended in April 2022. The RCT data are currently being analyzed, and data relevant to the economic analysis will be analyzed concurrently. Conclusions: To our knowledge, this will be the first economic evaluation of an eHealth intervention for insomnia in children with neurodevelopmental disorders. This evaluation?s findings can inform users and stakeholders regarding the costs and benefits of BNBD-NDD. Trial Registration: ClinicalTrial.gov NCT02694003; https://clinicaltrials.gov/study/NCT02694003 International Registered Report Identifier (IRRID): DERR1-10.2196/46735 UR - https://www.researchprotocols.org/2023/1/e46735 UR - http://dx.doi.org/10.2196/46735 UR - http://www.ncbi.nlm.nih.gov/pubmed/37698915 ID - info:doi/10.2196/46735 ER - TY - JOUR AU - Schulze, Annett AU - Lindemann, Ann-Kathrin AU - Brand, Fabian AU - Geppert, Johanna AU - Menning, Axel AU - Stehr, Paula AU - Reifegerste, Doreen AU - Rossmann, Constanze PY - 2023/9/6 TI - Mobile Apps Aimed at Preventing and Handling Unintentional Injuries in Children Aged <7 Years: Systematic Review JO - Interact J Med Res SP - e45258 VL - 12 KW - mobile health KW - mHealth KW - caregiver KW - parental KW - prevention KW - first aid KW - pediatric KW - review method KW - injuries KW - health app KW - needs KW - mobile phone N2 - Background: Despite various global health crises, the prevention and handling of unintentional childhood injuries remains an important public health objective. Although several systematic reviews have examined the effectiveness of different child injury prevention measures, these reviews did not address the evaluation of mobile communication intervention tools. Whether and how mobile apps were evaluated provides information on the extent to which communication theories, models, and evidence-based knowledge were considered. Previous studies have shown that the effectiveness of mobile apps increases when theories and evidence are considered during their development. Objective: This systematic review aimed to identify research on mobile apps dealing with the prevention and handling of unintentional injuries in children and examine the theoretical and methodological approaches thereof. In addition, this review analyzed the different needs of various target groups of the mobile apps described in the articles. Methods: In total, 8 electronic databases, ranging from interdisciplinary to medical and technical as well as social sciences databases, were searched for original research articles or brief reports in peer-reviewed journals or conference proceedings. Moreover, this review encompassed a systematic scan of articles published in the BMJ journal Injury Prevention. These steps were followed by a snowball search based on the literature references in the articles identified through the initial screening. The articles had to be written in English or German, published between 2008 and 2021, and evaluate mobile apps dealing with the prevention and handling of unintentional child injuries. The identified 5 studies were analyzed by 5 independent researchers using an inductive approach. Furthermore, the quality of the studies was assessed using the Mixed Methods Appraisal Tool. Results: A total of 5 articles were included and assessed with regard to overall quality of theoretical and methodological foundations, assessed variables, the focal app?s architecture, and the needs of the study participants. The overall study quality was moderate, although part of this classification was due to a lack of details reported in the studies. Each study examined 1 mobile app aimed at parents and other caregivers. Each study assessed at least 1 usability- or user experience-related variable, whereas the needs of the included study participants were detailed in only 20% (1/5) of the cases. However, none of the studies referred to theories such as the Technology Acceptance Model during the development of the apps. Conclusions: The future development and evaluation of apps dealing with the prevention and handling of child injuries should combine insights into existing models on user experience and usability with established theories on mobile information behavior. This theory-based approach will increase the validity of such evaluation studies. UR - https://www.i-jmr.org/2023/1/e45258 UR - http://dx.doi.org/10.2196/45258 UR - http://www.ncbi.nlm.nih.gov/pubmed/37672312 ID - info:doi/10.2196/45258 ER - TY - JOUR AU - Wong, Willis AU - Ming, David AU - Pateras, Sara AU - Fee, Holmes Casey AU - Coleman, Cara AU - Docktor, Michael AU - Shah, Nirmish AU - Antonelli, Richard PY - 2023/8/28 TI - Outcomes of End-User Testing of a Care Coordination Mobile App With Families of Children With Special Health Care Needs: Simulation Study JO - JMIR Form Res SP - e43993 VL - 7 KW - mobile health KW - mHealth KW - complex care KW - care coordination KW - digital health tools KW - simulation KW - family-centered design KW - user-centered design KW - participatory design KW - co-design N2 - Background: Care for children with special health care needs relies on a network of providers who work to address the medical, behavioral, developmental, educational, social, and economic needs of the child and their family. Family-directed, manually created visual depictions of care team composition (ie, care mapping) and detailed note-taking curated by caregivers (eg, care binders) have been shown to enhance care coordination for families of these children, but they are difficult to implement in clinical settings owing to a lack of integration with electronic health records and limited visibility of family-generated insights for care providers. Caremap is an electronic health record?integrated digital personal health record mobile app designed to integrate the benefits of care mapping and care binders. Currently, there is sparse literature describing end-user participation in the co-design of digital health tools. In this paper, we describe a project that evaluated the usability and proof of concept of the Caremap app through end-user simulation. Objective: This study aimed to conduct proof-of-concept testing of the Caremap app to coordinate care for children with special health care needs and explore early end-user engagement in simulation testing. The specific aims included engaging end users in app co-design via app simulation, evaluating the usability of the app using validated measures, and exploring user perspectives on how to make further improvements to the app. Methods: Caregivers of children with special health care needs were recruited to participate in a simulation exercise using Caremap to coordinate care for a simulated case of a child with complex medical and behavioral needs. Participants completed a postsimulation questionnaire adapted from 2 validated surveys: the Pediatric Integrated Care Survey (PICS) and the user version of the Mobile Application Rating Scale (uMARS). A key informant interview was also conducted with a liaison to Spanish-speaking families regarding app accessibility for non?English-speaking users. Results: A Caremap simulation was successfully developed in partnership with families of children with special health care needs. Overall, 38 families recruited from 19 different US states participated in the simulation exercise and completed the survey. The average rating for the survey adapted from the PICS was 4.1 (SD 0.82) out of 5, and the average rating for the adapted uMARS survey was 4 (SD 0.83) out of 5. The highest-rated app feature was the ability to track progress toward short-term, patient- and family-defined care goals. Conclusions: Internet-based simulation successfully facilitated end-user engagement and feedback for a digital health care coordination app for families of children with special health care needs. The families who completed simulation with Caremap rated it highly across several domains related to care coordination. The simulation study results elucidated key areas for improvement that translated into actionable next steps in app development. UR - https://formative.jmir.org/2023/1/e43993 UR - http://dx.doi.org/10.2196/43993 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639303 ID - info:doi/10.2196/43993 ER - TY - JOUR AU - Van Dooren, Martijn AU - De Croon, Robin AU - Swillen, Ann AU - Verbert, Katrien PY - 2023/8/16 TI - Bridging the Communication Gap Between People With Cognitive Impairments and Their Caregivers Using mHealth Apps: User-Centered Design and Evaluation Study With People With 22q11 Deletion Syndrome JO - JMIR Hum Factors SP - e44290 VL - 10 KW - 22q11 deletion syndrome KW - 22q11 DS KW - cognitive impairments KW - communication gap KW - mHealth N2 - Background: In families with children with cognitive impairments, both parents and children experience tension and have questions because of a lack of communication and adequate information. Therefore, there is a great need to develop tools that can help bridge the communication gap between patients and caregivers by stimulating conversations and providing psychoeducational tools. mHealth apps show great potential in this context. Objective: The objective of this research is to discover the specific ways young people with cognitive impairments and their families interact with mHealth apps in the context of bridging the communication gap. This newly discovered information leads to potentially more impactful mHealth interventions in the future. Therefore, this paper documents the design and development of a mHealth app for a specific group of people with cognitive impairments?people with 22q11 deletion syndrome (22q11 DS)?and their caregivers, as well as key learnings from the evaluation of this app. Methods: An iterative, user-centered design approach is used to design and develop the app. Design and evaluation happens in 2 phases. During the design phase, feedback is gathered from 2 medical experts and 3 human computer interaction (HCI) experts using a low-fidelity paper prototype. During the evaluation phase, feedback is gathered from 8 families with a child with 22q11 DS using a fully working proof of concept. This phase consists of a semistructured interview, a 2-4?week trial period, and a concluding semistructured interview. Results: The evaluation results of the fully working proof of concept led to design recommendations related to four different topics: (1) overcoming usage barriers, (2) stimulating conversation through a mHealth app, (3) providing information, and (4) bringing continual added value. Results are presented according to six different categories obtained in a thematic analysis: (1) feedback about the app ?as is,? (2) difficulties, (3) comparison between physical and digital tool, (4) extensions, (5) intention, and (6) other. Conclusions: In this research, the need for apps that help bridge the communication gap between a person with cognitive impairment and their caregiver is confirmed. All participating families express their gratitude and mention the added value for other families. Therefore, it is highly encouraged for clinics and institutions to take action and develop an app to be used in practice. Furthermore, considerations when developing for people with 22q11 DS, or more broadly, people with cognitive impairments, are proposed. First, one should keep design principles in mind to overcome usage barriers. Next, recognition is a key concept when stimulating conversations through mobile apps. Third, information should be provided by a trusted source, and more than just clinical information can be considered valuable. Finally, having the possibility of using a digital tool that can be personalized brings continual added value. UR - https://humanfactors.jmir.org/2023/1/e44290 UR - http://dx.doi.org/10.2196/44290 UR - http://www.ncbi.nlm.nih.gov/pubmed/37585257 ID - info:doi/10.2196/44290 ER - TY - JOUR AU - Labarta, I. José AU - Dimitri, Paul AU - Keiser, Matthew AU - Koledova, Ekaterina AU - Rivera-Romero, Octavio PY - 2023/8/2 TI - Evaluating the Usefulness and Ease of Use of a Next-Generation?Connected Drug Delivery Device for Growth Hormone Therapy: Qualitative Study of Health Care Professionals? Perceptions JO - JMIR Hum Factors SP - e46893 VL - 10 KW - connected health KW - growth hormone deficiency KW - participatory health informatics KW - recombinant human growth hormone KW - technology acceptance KW - mobile phone N2 - Background: Digital solutions targeting children?s health have become an increasingly important element in the provision of integrated health care. For the treatment of growth hormone deficiency (GHD), a unique connected device is available to facilitate the delivery of recombinant human growth hormone (r-hGH) by automating the daily injection process and collecting injection data such that accurate adherence information is available to health care professionals (HCPs), caregivers, and patients. The adoption of such digital solutions requires a good understanding of the perspectives of HCPs as key stakeholders because they leverage data collection and prescribe these solutions to their patients. Objective: This study aimed to evaluate the third generation of the easypod device (EP3) for the delivery of r-hGH treatment from the HCP perspective, with a focus on perceived usefulness and ease of use. Methods: A qualitative study was conducted, based on a participatory workshop conducted in Zaragoza, Spain, with 10 HCPs experienced in the management of pediatric GHD from 7 reference hospitals in Spain. Several activities were designed to promote discussion among participants about predefined topics based on the Technology Acceptance Model and the Unified Theory of Acceptance and Use of Technology to provide their perceptions about the new device. Results: Participants reported 2 key advantages of EP3 over previous easypod generations: the touch screen interface and the real-time data transmission functionality. All participants (10/10, 100%) agreed that the new device should be part of a digital health ecosystem that provides complementary functionalities including data analysis. Conclusions: This study explored the perceived value of the EP3 autoinjector device for the treatment of GHD by HCPs. HCPs rated the new capabilities of the device as having substantial improvements and concluded that it was highly recommendable for clinical practice. EP3 will enhance decision-making and allow for more personalized care of patients receiving r-hGH. UR - https://humanfactors.jmir.org/2023/1/e46893 UR - http://dx.doi.org/10.2196/46893 UR - http://www.ncbi.nlm.nih.gov/pubmed/37531173 ID - info:doi/10.2196/46893 ER - TY - JOUR AU - Guo, Joyce AU - Blyth, Phil AU - Clifford, Kari AU - Hooper, Nikki AU - Crawford, Haemish PY - 2023/8/2 TI - Transfer Validity of Pediatric Supracondylar Humeral Fracture Pin Placement Practice on In-Theater Performance by Orthopedic Trainees Using an Augmented Reality Simulator: Protocol for a Pilot Interventional Cohort Study With a Retrospective Comparator Cohort JO - JMIR Res Protoc SP - e38282 VL - 12 KW - pediatric orthopedics KW - augmented reality simulator KW - supracondylar humeral fractures KW - closed reduction and percutaneous pinning KW - transfer validity KW - fracture KW - surgeons KW - education KW - practice KW - trainees KW - pediatric KW - orthopedic KW - training KW - surgical procedure N2 - Background: Supracondylar humeral fractures (SCHF) are a common cause of orthopedic morbidity in pediatric populations across the world. The treatment of this fracture is likely one of the first procedures involving x-ray?guided wire insertion that trainee orthopedic surgeons will encounter in their career. Traditional surgical training methods of ?see one, do one, teach one? are reliant on the presence of real-world cases and must be conducted within an operative environment. We have developed an augmented reality simulator that allows trainees to practice this procedure in a radiation-free environment at no extra risk to patients. Objective: This study aims to examine whether training on a simulator in addition to traditional surgical training improves the in-theater performance of trainees. Methods: This multicenter, interventional cohort study will involve orthopedic trainees from New Zealand in their first year of advanced training between 2019 and 2023. Advanced trainees with no simulator exposure who were in their first year in 2019-2021 will form the comparator cohort, while those in the years 2022-2023 will receive additional regular simulator training as the intervention cohort. The comparator cohort?s performance in pediatric SCHF surgery will be retrospectively audited using routinely collected operative outcomes and parameters over a 6-month period. Data on the performance of the intervention cohorts will be collected in the same way over a comparable period. The data collected for both groups will be used to determine whether additional training with an augmented reality training shows improved real-world surgical outcomes compared to traditional surgical training. Results: As of February 2022, a total of 8 retrospective comparator trainees have been recruited by email. The study is financially supported through an external grant from the Wishbone Orthopaedic Research Foundation of New Zealand (September 2021) and an internal research grant from the University of Otago (July 2021). Conclusions: This protocol has been approved by the University of Otago Health Ethics committee (reference HD21/087), and the study is due for completion in 2024. This protocol may assist other researchers conducting similar studies in the field. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000816651; https://tinyurl.com/mtdkecwb International Registered Report Identifier (IRRID): DERR1-10.2196/38282 UR - https://www.researchprotocols.org/2023/1/e38282 UR - http://dx.doi.org/10.2196/38282 UR - http://www.ncbi.nlm.nih.gov/pubmed/37531159 ID - info:doi/10.2196/38282 ER - TY - JOUR AU - Johnson, D. Michael AU - Barney, J. Bradley AU - Rower, E. Joseph AU - Finkelstein, Yaron AU - Zorc, J. Joseph PY - 2023/7/17 TI - Intravenous Magnesium: Prompt Use for Asthma in Children Treated in the Emergency Department (IMPACT-ED): Protocol for a Multicenter Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e48302 VL - 12 KW - asthma KW - child KW - emergency service KW - feasibility studies KW - hospitalization KW - hypotension KW - magnesium KW - multicenter studies KW - randomized controlled trials N2 - Background: Children managed for asthma in an emergency department (ED) may be less likely to be hospitalized if they receive intravenous magnesium sulfate (IVMg). Asthma guidelines recommend IVMg for severely sick children but note a lack of evidence to support this recommendation. All previous trials of IVMg in children with asthma have been too small to answer whether IVMg is effective and safe.A few major questions remain about IVMg. First, it has not been tested early in the course of ED treatment, when the impact on hospitalization would be greatest. Second, the clinical impact of hypotension, a known adverse effect of IVMg, has not been well characterized in previous research. Third, no trials have compared different IVMg doses or serial serum magnesium (total and ionized) concentrations to optimize dosing, so the most effective dose is unknown.A large, conclusive, randomized, placebo-controlled clinical trial of IVMg might be challenging due to the need to enroll and complete study procedures quickly, a lack of understanding of blood pressure changes after IVMg, and a lack of pharmacologic information to guide the optimal doses of IVMg to be tested. Therefore, a pilot study to inform the above gaps is warranted before conducting a definitive trial. Objective: The objectives of this study are to (1) demonstrate the feasibility of enrolling children with severe acute asthma in the ED in a multicenter, randomized controlled trial of a placebo, low-dose IVMg, or high-dose IVMg; (2) demonstrate the feasibility of timely delivery of study medication, assessment of blood pressure, and evaluation of adverse events in a standardized protocol; and (3) externally validate a previously constructed pharmacokinetic model and develop a combined pharmacokinetic/pharmacodynamic model for IVMg using magnesium (total and ionized) serum concentrations and their correlation with measures of efficacy and safety. Methods: This pilot trial tests procedures and gathers information to plan a definitive trial. The pilot trial will enroll as many as 90 children across 3 sites, randomize each child to 1 of 3 study arms, measure blood pressure frequently, and collect 3 blood samples from each participant with corresponding clinical asthma scores. Results: The project was funded by the National Heart, Lung, and Blood Institute (1 R34HL152047-2) in March 2022. Enrollment began in September 2022, and 43 children have been enrolled as of April 2023. We will submit the results for publication in late 2023. Conclusions: The results of this study will guide the planning of a large, definitive, multicenter trial powered to evaluate if IVMg reduces hospitalization. Blood pressure measurements will inform a monitoring plan for the larger trial, and blood samples and asthma scores will be used to validate pharmacologic models to select the optimal dose of IVMg to be evaluated in the definitive trial. Trial Registration: ClinicalTrials.gov NCT05166811; https://clinicaltrials.gov/ct2/show/NCT05166811 International Registered Report Identifier (IRRID): DERR1-10.2196/48302 UR - https://www.researchprotocols.org/2023/1/e48302 UR - http://dx.doi.org/10.2196/48302 UR - http://www.ncbi.nlm.nih.gov/pubmed/37459153 ID - info:doi/10.2196/48302 ER - TY - JOUR AU - Jang, Woocheol AU - Choi, Sung Yong AU - Kim, Yoo Ji AU - Yon, Keon Dong AU - Lee, Joo Young AU - Chung, Sung-Hoon AU - Kim, Young Chae AU - Yeo, Geun Seung AU - Lee, Jinseok PY - 2023/7/10 TI - Artificial Intelligence?Driven Respiratory Distress Syndrome Prediction for Very Low Birth Weight Infants: Korean Multicenter Prospective Cohort Study JO - J Med Internet Res SP - e47612 VL - 25 KW - artificial intelligence KW - deep neural network KW - premature infants KW - respiratory distress syndrome KW - AI KW - AI model KW - pediatrics KW - neonatal KW - maternal health KW - machine learning N2 - Background: Respiratory distress syndrome (RDS) is a disease that commonly affects premature infants whose lungs are not fully developed. RDS results from a lack of surfactant in the lungs. The more premature the infant is, the greater is the likelihood of having RDS. However, even though not all premature infants have RDS, preemptive treatment with artificial pulmonary surfactant is administered in most cases. Objective: We aimed to develop an artificial intelligence model to predict RDS in premature infants to avoid unnecessary treatment. Methods: In this study, 13,087 very low birth weight infants who were newborns weighing less than 1500 grams were assessed in 76 hospitals of the Korean Neonatal Network. To predict RDS in very low birth weight infants, we used basic infant information, maternity history, pregnancy/birth process, family history, resuscitation procedure, and test results at birth such as blood gas analysis and Apgar score. The prediction performances of 7 different machine learning models were compared, and a 5-layer deep neural network was proposed in order to enhance the prediction performance from the selected features. An ensemble approach combining multiple models from the 5-fold cross-validation was subsequently developed. Results: Our proposed ensemble 5-layer deep neural network consisting of the top 20 features provided high sensitivity (83.03%), specificity (87.50%), accuracy (84.07%), balanced accuracy (85.26%), and area under the curve (0.9187). Based on the model that we developed, a public web application that enables easy access for the prediction of RDS in premature infants was deployed. Conclusions: Our artificial intelligence model may be useful for preparations for neonatal resuscitation, particularly in cases involving the delivery of very low birth weight infants, as it can aid in predicting the likelihood of RDS and inform decisions regarding the administration of surfactant. UR - https://www.jmir.org/2023/1/e47612 UR - http://dx.doi.org/10.2196/47612 UR - http://www.ncbi.nlm.nih.gov/pubmed/37428525 ID - info:doi/10.2196/47612 ER - TY - JOUR AU - Starr, C. Michelle AU - Wallace, Samantha AU - Moore, Courtney AU - Cockrum, Brandon AU - Hawryluk, Bridget AU - Carroll, Aaron AU - Bennett, William PY - 2023/7/10 TI - Development of a Family-Centered Communication Tool for Kidney Health in Premature Infants: Qualitative Focus Group Study Using Human-Centered Design Methodology JO - J Particip Med SP - e45316 VL - 15 KW - qualitative research KW - patient-reported outcomes KW - neonates KW - chronic kidney disease KW - human-centered design KW - acute kidney injury KW - kidney health N2 - Background: Premature infants are at increased risk of kidney-related complications, including acute kidney injury (AKI) and chronic kidney disease (CKD). The risk of CKD in prematurely born infants is underrecognized by health care teams and caregivers. Understanding how to communicate the risk of CKD to caregivers is essential for longitudinal clinical follow-up and adherence. Objective: This study aimed to determine family caregiver attitudes toward kidney health and risk communication during a neonatal intensive care admission. We also sought to understand caregiver preferences for the communication of information surrounding the risk of CKD in premature infants. Methods: We augmented standard qualitative group sessions with human-centered design methods to assess parent preferences and clinician perspectives. Caregivers recruited had a prematurely born child who spent time in the neonatal intensive care unit at Riley Hospital for Children in Indianapolis, Indiana, and experienced AKI or another kidney complication, which put them at risk for future CKD. We used a variety of specific design methods in these sessions, including card sorting, projective methods, experience mapping, and constructive methods. Results: A total of 7 clinicians and 8 caregivers participated in 3 group sessions. Caregivers and clinicians readily acknowledged barriers to and drivers of long-term kidney monitoring as well as opportunities for communication of the risk of long-term kidney disease. Caregivers? primary concerns were for both the type and depth of information conveyed as well as the time at which it was communicated. Participants emphasized the importance of collaboration between the hospital care team and the primary care provider. Participant input was synthesized into several prototype concepts and, ultimately, into a rough prototype of a website and an informational flyer. Conclusions: Caregivers of premature infants are open to communication about kidney health during their neonatal admission. The next phase of this work will translate caregivers? preferences into family-centered communication tools and test their efficacy in the neonatal intensive care unit. UR - https://jopm.jmir.org/2023/1/e45316 UR - http://dx.doi.org/10.2196/45316 UR - http://www.ncbi.nlm.nih.gov/pubmed/37428553 ID - info:doi/10.2196/45316 ER - TY - JOUR AU - Shouldice, Claire Ainslie AU - Beatty, Madison AU - Adams, Sherri AU - Dharmaraj, Blossom AU - Moore, Clara AU - Stinson, Nan Jennifer AU - Desai, Arti AU - Bartlett, Leah AU - Culbert, Erin AU - Cohen, Eyal AU - Orkin, Julia PY - 2023/7/5 TI - Caregivers? Experiences With a Web- and Mobile-Based Platform for Children With Medical Complexity and the Role of a Live Platform Coach: Thematic Analysis JO - JMIR Pediatr Parent SP - e43214 VL - 6 KW - care coordination KW - care KW - children with medical complexity KW - children KW - chronic condition KW - electronic data KW - engagement KW - health information exchange KW - medical KW - patient care planning KW - pediatrics KW - usage KW - utilization N2 - Background: Children with medical complexity (CMC) are individuals with complex chronic conditions who have substantial health care needs, functional limitations, and significant use of health care. By nature of their health status, they have many care providers across multiple settings, making information sharing critical to their health and safety. Connecting2gether (C2), a web- and mobile-based patient-facing platform, was codeveloped with families to support and empower parental caregivers, improve information sharing, and facilitate care delivery. C2 also provided a live platform coach to conduct parental feedback and coaching sessions, which included answering questions, providing advice on usage, and addressing technological issues. Objective: This study was conducted to understand the experience of parental caregivers using the C2 platform and the role of the live platform coach. This study is a subset of a larger study assessing the feasibility of C2 in the care of CMC. Methods: Parental caregivers (n=33) participated in biweekly sessions to provide feedback and receive real-time platform use support from a trained research team member acting as a live platform coach. Parental caregivers were asked about the utility and usability of C2?s features. Questions, platform issues, and feedback were recorded on a standardized electronic data collection tool. A thematic analysis was performed to analyze parental comments, and codes were categorized into key themes. The number of comments corresponding with each code was quantified. Results: A total of 166 parental feedback and coaching sessions were conducted, with an average of 5 sessions per parental caregiver (range 1-7). There were 33 (85%) parental caregivers that participated in at least one coaching session. Technical issues and difficulties navigating C2 were addressed in real time during the sessions to encourage platform engagement. Four key themes were identified: (1) live platform coach, (2) barriers to platform usage and technical challenges, (3) platform requests and modifications, and (4) parent partnership and empowerment. Conclusions: Parental caregivers describe C2 as a valuable tool, acting as a facilitator for enhanced care coordination and communication. Parental caregiver feedback showed that the live platform coach was a critical tool in educating on platform use and addressing technological concerns. Further study of the use of the C2 platform and its role in the care of CMC is needed to understand the possible benefits and cost-effectiveness of this technology. UR - https://pediatrics.jmir.org/2023/1/e43214 UR - http://dx.doi.org/10.2196/43214 UR - http://www.ncbi.nlm.nih.gov/pubmed/37405834 ID - info:doi/10.2196/43214 ER - TY - JOUR AU - Abang Abdullah, Fadhilah Aisha AU - Muhamad, Asiah Nor AU - Ab Ghani, Melati Rimah AU - Maamor, Hasnah Nur AU - Leman, Norhasny Fatin AU - Too, Lai Chun AU - Ismail, Hakimah Intan AU - Mohd Zulkefli, Afiah Nor AU - Mohd Nazan, Nashriq Ahmad Iqmer AU - Md Said, Salmiah PY - 2023/6/26 TI - The Effectiveness of Early Food Introduction in Preventing Childhood Allergic Diseases: Protocol for a Systematic Review and Meta-Analysis JO - JMIR Res Protoc SP - e46816 VL - 12 KW - protocol KW - systematic review KW - childhood allergic disease KW - weaning KW - early food introduction KW - food allergy KW - allergy KW - anaphylaxis KW - randomized controlled trial KW - pediatric KW - infant KW - childhood N2 - Background: Allergic diseases affect around 40% of the pediatric population worldwide. The coexistence of asthma, allergic rhinitis, eczema, and food allergy renders allergy treatment and prevention challenging. Infant feeding strategies recommend avoiding allergenic foods to prevent allergy development and anaphylaxis. However, recent evidence suggests that early consumption of food allergens during weaning in infants aged 4-6 months could result in food tolerance, thus reducing the risk of developing allergies. Objective: The aim of this study is to systematically review and carry out a meta-analysis of evidence on the outcome of early food introduction for preventing childhood allergic diseases. Methods: We will conduct a systematic review of interventions through a comprehensive search of various databases including PubMed, Embase, Scopus, CENTRAL, PsycINFO, CINAHL, and Google Scholar to identify potential studies. The search will be performed for any eligible articles from the earliest published articles up to the latest available studies in 2023. We will include randomized controlled trials (RCTs), cluster RCTs, non-RCTs, and other observational studies that assess the effect of early food introduction to prevent childhood allergic diseases. Results: Primary outcomes will include measures related to the effect of childhood allergic diseases (ie, asthma, allergic rhinitis, eczema, and food allergy). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines will be followed for study selection. All data will be extracted using a standardized data extraction form and the quality of the studies will be assessed using the Cochrane Risk of Bias tool. A summary of findings table will be generated for the following outcomes: (1) total number of allergic diseases, (2) rate of sensitization, (3) total number of adverse events, (4) improvement of health-related quality of life, and (5) all-cause mortality. Descriptive and meta-analyses will be performed using a random-effects model in Review Manager (Cochrane). Heterogeneity among selected studies will be assessed using the I2 statistic and explored through meta-regression and subgroup analyses. Data collection is expected to start in June 2023. Conclusions: The results acquired from this study will contribute to the existing literature and harmonize recommendations for infant feeding with regard to the prevention of childhood allergic diseases. Trial Registration: PROSPERO CRD42021256776; https://tinyurl.com/4j272y8a International Registered Report Identifier (IRRID): PRR1-10.2196/46816 UR - https://www.researchprotocols.org/2023/1/e46816 UR - http://dx.doi.org/10.2196/46816 UR - http://www.ncbi.nlm.nih.gov/pubmed/37358892 ID - info:doi/10.2196/46816 ER - TY - JOUR AU - Basheer N, Amitha AU - Jodalli, S. Praveen AU - Nayak, Namratha AU - K S, Aparna AU - Badekkila, R. Avinash PY - 2023/6/7 TI - Effectiveness of Silver Diamine Fluoride for Early Childhood Caries Among Children Aged 24 to 72 Months: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e46144 VL - 12 KW - silver diamine fluoride KW - children KW - caries KW - childhood KW - dental KW - dentist KW - oral health KW - child KW - pediatric KW - RCT KW - randomized KW - fluoride KW - prevention N2 - Background: Dental caries is a serious public health issue globally. It is one of the most prevalent chronic disease in children worldwide. An important public health concern is the existence of one or more decayed, missing, or filled tooth surfaces in any primary teeth of preschool children. Early childhood caries (ECC) can be halted with the use of silver diamine fluoride (SDF) solution. Previous research has indicated that it may have a preventive impact in the treatment of ECC. It is well known that 38% silver diamine fluoride (SDF) is helpful at preventing dental caries. On the other hand, there is not enough evidence on SDF?s ability to prevent caries in primary teeth. To date, no well-planned clinical study has been carried out to investigate SDF?s impact on caries protection. Objective: The study?s objective is to evaluate and compare the efficacy of 12%, 30%, and 38% silver diamine fluoride in preventing ECC in children aged 24 to 72 months in Mangaluru Taluk. Methods: This is a single-center, randomized, active-controlled, parallel-group pragmatic trial. Children attending preschool in Mangalore Taluk aged 24 to 72 months will be included in the study. There will be three study groups: group 1 will receive 12% SDF semiannually; group 2 will receive 30% SDF semiannually; and group 3 will receive 38% SDF semiannually. After 6 and 12 months, the principal examiner will conduct a clinical examination of the teeth with a visual and tactile assessment. The effectiveness of the various concentrations of SDF will be determined after 12 months. Results: The research was funded in September 2020, and data collection started in September 2022. As of February 2023, 150 participants have enrolled in the study. The project is still underway, and it is expected to be completed in December 2023. Conclusions: Uncertainty surrounds the efficacy of 38% SDF in preventing ECC. Consensus-Based Clinical Case Reporting (CARE) guidelines recommending the use of SDF for ECC prevention will be modified if the findings are as expected. Additionally, since the findings will be broadly disseminated, more nations will implement the use of SDF, easing the burden of ECC on the entire world. Future research on the treatment and prevention of ECC will benefit from the study results. If SDF is successful in preventing caries in a classroom or community context, it will mark an important turning point for preventive dentistry. Trial Registration: Clinical Trial Registry of India CTRI/2020/02/023420; https://tinyurl.com/3ju2apab International Registered Report Identifier (IRRID): PRR1-10.2196/46144 UR - https://www.researchprotocols.org/2023/1/e46144 UR - http://dx.doi.org/10.2196/46144 UR - http://www.ncbi.nlm.nih.gov/pubmed/37285186 ID - info:doi/10.2196/46144 ER - TY - JOUR AU - Kuschke, Silva AU - Moodie, Sheila AU - Kirubalingam, Keshinisuthan AU - O'Hagan, Robin AU - Glista, Danielle PY - 2023/6/6 TI - Parents? Perceptions of the Factors Influencing the Uptake of Remote Pediatric Hearing Aid Support: Development of a Conceptual Framework JO - JMIR Pediatr Parent SP - e47358 VL - 6 KW - audiology KW - care KW - child engagement KW - children KW - concept mapping KW - cost KW - hearing aid KW - hearing loss KW - hearing KW - integration KW - parents KW - pediatric audiology KW - pediatric KW - remote hearing aid support KW - support KW - virtual care N2 - Background: To achieve effective integration of virtual care into family-centered audiology practices, participatory research methods, including parents as vital participants in the delivery of pediatric audiology care, should be considered. A better understanding of the barriers and facilitators influencing the adoption of virtual care for families is warranted. Objective: This study aimed to develop a conceptual framework of the factors perceived to influence the adoption of remote pediatric hearing aid support among the parents of children with hearing loss. Methods: A total of 12 parents of children who wear hearing aids, between the ages of 0-17 years, were recruited to participate in group or individual interviews as part of the 6-step participatory-based concept mapping (CM) process. Data collection was specific to parents in a Canadian context. Analyses included multidimensional scaling and hierarchical cluster analysis. Results: The CM process resulted in 6 main themes, displayed in a cluster map according to their order of importance. These themes include access to timely, consistent care; technology considerations; convenience; child engagement; cost; and partnership considerations. Key underlying statements and subthemes are highlighted per theme. Conclusions: Findings from this study demonstrate the use of CM in participatory research with parents and as part of a family-centered care model. Future research should aim to investigate the factors that influence the uptake of remote hearing aid support in different contexts, for example, in low- to middle-income countries versus those in high-income countries. UR - https://pediatrics.jmir.org/2023/1/e47358 UR - http://dx.doi.org/10.2196/47358 UR - http://www.ncbi.nlm.nih.gov/pubmed/37279061 ID - info:doi/10.2196/47358 ER - TY - JOUR AU - Canter, S. Kimberly AU - Ritterband, Lee AU - Freyer, R. David AU - Askins, A. Martha AU - Bava, Laura AU - Loucas, Caitlyn AU - Arasteh, Kamyar AU - You, Wen AU - Kazak, E. Anne PY - 2023/6/2 TI - The Electronic Surviving Cancer Competently Intervention Program?a Psychosocial Digital Health Intervention for English- and Spanish-Speaking Parents of Children With Cancer: Protocol for Randomized Controlled Trial JO - JMIR Res Protoc SP - e46339 VL - 12 KW - pediatric cancer KW - digital health KW - parents KW - caregivers KW - psychosocial intervention KW - family systems KW - cultural and linguistic adaptation N2 - Background: The psychosocial needs and risks of children with cancer and their families are well-documented including increased risk of parental distress, posttraumatic stress, and anxiety. There is a critical need to provide evidence-based psychosocial care to parents and caregivers of children with cancer. Digital health interventions are important to address many barriers to in-person intervention delivery but are not widely used in pediatric psychosocial cancer care. The COVID-19 pandemic has reinforced the need for flexible, acceptable, and accessible psychosocial digital health interventions. The Electronic Surviving Cancer Competently Intervention Program (eSCCIP) is an innovative digital health intervention for parents and caregivers of children with cancer, delivered through a combination of self-guided web-based content and supplemented by 3 telehealth follow-up sessions with a trained telehealth guide. A Spanish language adaptation of eSCCIP, El Programa Electronico de Intervencion para Superar Cancer Competentemente (eSCCIP-SP), has been developed. The self-guided web-based cores of eSCCIP/eSCCIP-SP are a mix of didactic video content, multifamily video discussion groups featuring parents of children with cancer, and hands-on web-based activities. Objective: The objective of this study is to test eSCCIP/eSCCIP-SP in a multisite randomized controlled trial, compared to an internet-based education control condition consisting of information specifically focused on concerns relevant to parents and caregivers of children with cancer. Methods: Using a randomized controlled clinical trial design, 350 eligible parents and caregivers of children with cancer will be randomly assigned to the intervention (eSCCIP/eSCCIP-SP) or an education control condition. Data will be collected at 3 time points: preintervention (prior to randomization), immediately post intervention (after 6 weeks), and at a 3-month follow-up (from baseline). Participants randomized to either condition will receive study material (eSCCIP/eSCCIP-SP intervention or education control website) in English or Spanish, based on the primary language spoken in the home and participant preference. Results: The primary study end point is a reduction in acute distress from baseline to postintervention, with secondary end points focused on reductions in symptoms of posttraumatic stress and anxiety, and improvements in coping self-efficacy and cognitive coping. An additional exploratory aim will be focused on implementation strategies and potential costs and cost-savings of eSCCIP/eSCCIP-SP, laying the groundwork for future trials focused on dissemination and implementation, stepped-care models, and intervention refinement. Conclusions: This trial will provide necessary data to evaluate the efficacy of eSCCIP/eSCCIP-SP. This intervention has the potential to be an easily scalable and highly impactful psychosocial treatment option for parents and caregivers of children with cancer. Trial Registration: ClinicalTrials.gov NCT05294302; https://clinicaltrials.gov/ct2/show/NCT05294302 International Registered Report Identifier (IRRID): PRR1-10.2196/46339 UR - https://www.researchprotocols.org/2023/1/e46339 UR - http://dx.doi.org/10.2196/46339 UR - http://www.ncbi.nlm.nih.gov/pubmed/37267038 ID - info:doi/10.2196/46339 ER - TY - JOUR AU - Perkes, Jane Sarah AU - Huntriss, Belinda AU - Skinner, Noelene AU - Leece, Bernise AU - Dobson, Rosie AU - Mattes, Joerg AU - Hall, Kerry AU - Bonevski, Billie PY - 2023/5/26 TI - Evaluation of an mHealth Intervention (Growin? Up Healthy Jarjums) Designed With and for Aboriginal and Torres Strait Islander Mothers: Engagement and Acceptability Study JO - JMIR Pediatr Parent SP - e43673 VL - 6 KW - mobile health KW - mHealth KW - co-design KW - Aboriginal and Torres Strait Islander KW - mother KW - baby KW - young children KW - mobile phone N2 - Background: Aboriginal and Torres Strait Islander women have access to and interest in mobile health (mHealth), although few culturally relevant, evidence-based mHealth programs are available. We codeveloped an mHealth program in New South Wales with Aboriginal and Torres Strait Islander women, focusing on women?s and children's health and well-being. Objective: This study aims to assess the engagement with and acceptability of the Growin? Up Healthy Jarjums program among mothers caring for Aboriginal and Torres Strait Islander children aged <5 years and assess the acceptability of the program among professionals. Methods: Women were given access to Growin? Up Healthy Jarjums?a web-based application, a Facebook (Meta Platforms, Inc) page, and SMS text messages?for 4 weeks. Short videos of health professionals presenting health information were tested within the application and on the Facebook page. Engagement with the application was examined through the number of log-ins, page views, and links used on the application. Engagement with the Facebook page was examined through likes, follows, comments, and the reach of posts. Engagement with the SMS text messages was examined through the number of mothers who opted out, and engagement with the videos was examined through the number of plays and videos watched and duration of the video watched. The acceptability of the program was examined through posttest interviews with mothers and focus groups with professionals. Results: A total of 47 participants joined the study (n=41, 87%, mothers and n=6, 13%, health professionals). Interviews were completed by 78% (32/41) of the women and 100% (6/6) health professionals. Of the 41 mothers, 31 (76%) women accessed the application, 13 (42%) scrolled the main page only, and 18 (58%) clicked on other pages. There were 48 plays and 6 completions of the 12 videos. The Facebook page received 49 page likes and 51 followers. The post with the most reach was a supportive and affirming cultural post. No participants opted out of the SMS text messages. Almost all mothers (30/32, 94%) reported that Growin? Up Healthy Jarjums was useful, and all mothers reported that the program was culturally appropriate and easy to use. Of the 32 mothers, 6 (19%) mothers reported technical problems with accessing the application. Moreover, 44% (14/32) of mothers suggested improvements to the application. All the women reported that they would recommend the program to other families. Conclusions: This study demonstrated that the Growin? Up Healthy Jarjums program was perceived useful and culturally appropriate. SMS text messages had the highest engagement, followed by the Facebook page and then the application. This study identified areas for technical and engagement-related improvements to the application. A trial is needed to assess the effectiveness of the Growin? Up Healthy Jarjums program at improving health outcomes. UR - https://pediatrics.jmir.org/2023/1/e43673 UR - http://dx.doi.org/10.2196/43673 UR - http://www.ncbi.nlm.nih.gov/pubmed/37234043 ID - info:doi/10.2196/43673 ER - TY - JOUR AU - Bogarin, Roberto AU - Elizondo, Luis AU - Kalaitzoglou, Evangelia AU - Popovic, Jadranka AU - Rogol, Alan AU - Richmond, Erick AU - Chanoine, Jean-Pierre AU - Lopez-Pedrosa, M. Jose AU - Ruiz Salazar, Francis AU - Vuguin, Patricia PY - 2023/5/8 TI - Bringing the Pediatric Endocrine Spanish Speaking Community Together: First Virtual Pediatric Endocrine Meeting in Low- and Middle-Income Countries in Central and South America JO - Interact J Med Res SP - e41353 VL - 12 KW - continuing medical education KW - continuing education KW - medical education KW - professional development KW - pediatric KW - child KW - endocrinology KW - endocrine KW - pediatric endocrinology KW - diabetes KW - low- and middle-income countries KW - Latin America KW - Spanish KW - virtual KW - resources KW - digital N2 - Background: Pediatric endocrinology is a specialty that is struggling worldwide to maintain adequately trained professionals. Pediatric endocrine care in Central America and Caribbean countries is often performed by pediatricians or adult endocrinologists due to the limited number of pediatric endocrinologists. These health care providers are seldom members of endocrine societies and frequently lack formal training in the field. Objective: In this study, we describe the scope of a virtual conference in pediatric endocrinology and diabetes targeted to low- and middle-income countries to provide equal opportunities for access to medical education for health care professionals. Methods: The virtual conference was sponsored by the Pediatric Endocrine Society (North America), Asociación Costarricense de Endocrinología (previously, Asociación Nacional Pro Estudio de la Diabetes, Endocrinología y Metabolismo), and Asociacion Centroamericana y del Caribe de Endocrinologia Pediátrica. The conference was free to participants and comprised 23 sessions that were either synchronous with ability for real-time interactive sessions or asynchronous sessions, where content was available online to access at their convenience. Topics included idiopathic short stature, polycystic ovarian syndrome, diabetes mellitus, telemedicine, Turner syndrome, congenital adrenal hyperplasia, obesity, central precocious puberty, and subclinical hypothyroidism. The participants were asked to evaluate the conference after its completion with a questionnaire. Results: A total of 8 speakers from Spain, Canada, Costa Rica, and the United States delivered the virtual event to 668 health care professionals from Guatemala, Venezuela, Dominican Republic, Costa Rica, Ecuador, Peru, Uruguay, Mexico, Honduras, Argentina, the United States, Bolivia, Chile, Panama, El Salvador, Nicaragua, Paraguay, Belize, Spain, and Colombia. Name, profession, and country were fully disclosed by 410 (61.4%) of the 668 health care professionals. The profession or level of training of participants were as follows: pediatric endocrinologists (n=129, 19.3%), pediatricians (n=116, 17.4%), general practitioners (n=77, 11.5%), adult endocrinologists (n=34, 5.1%), medical students (n=23, 3.4%), residents in various specialties (n=14, 2.1%), and others (n=17, 2.6%). A total of 23 sessions were offered, most of which were bilingual (Spanish and English). Feedback from the evaluation questionnaire indicated that the content of the conference was very relevant to the participants? professional practice. Additionally, the participants reported that they were very satisfied with the organization, the web-based platform, and the sessions of the conference. Conclusions: Lack of accessibility to the latest and cutting-edge medical education in pediatric endocrinology and diabetes for medical professionals from low- and middle-income countries can be overcome with a virtual conference. Online availability, low cost, and easy-to-use technology were well received from the participants, who were overall very satisfied by the quality and the relevance of the sessions to their professional practice. UR - https://www.i-jmr.org/2023/1/e41353 UR - http://dx.doi.org/10.2196/41353 UR - http://www.ncbi.nlm.nih.gov/pubmed/37155229 ID - info:doi/10.2196/41353 ER - TY - JOUR AU - d'Halluin, Arnaud AU - Costa, Marie AU - Morgiève, Margot AU - Sebbane, Déborah PY - 2023/5/2 TI - Attitudes of Children, Adolescents, and Their Parents Toward Digital Health Interventions: Scoping Review JO - J Med Internet Res SP - e43102 VL - 25 KW - eHealth KW - mental health KW - children and adolescents KW - attitude KW - scoping review KW - mobile phone KW - digital health intervention KW - DHI N2 - Background: The prevalence of mental health problems in children and adolescents is high. As these problems can impact this population?s developmental trajectories, they constitute a public health concern. This situation is accentuated by the fact that children and adolescents infrequently seek help. Digital health interventions (DHIs) offer an opportunity to bridge the treatment gap between health care needs and patient engagement in care. Additional detailed research is needed to identify how children and adolescents can be empowered to access help through DHIs. In this context, an understanding of their attitudes toward digital health appears to be a necessary first step in facilitating the effective implementation of DHIs. Objective: This study aimed to establish an inventory of children?s, adolescents?, and their parents? attitudes toward DHIs. Methods: A scoping review following PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) recommendations was performed using the MEDLINE, Embase, and PsycINFO databases. This research was conducted using 3 key concepts: ?child and adolescent mental health service users,? ?digital health interventions,? and ?attitudes.? Data extracted included the name of the publishing journal, the methodology used, the target population, the DHI studied, and the principal results. Results: Of 1548 studies found, 30 (1.94%) were included in our analysis. Among these, 13 concerned satisfaction, 24 concerned preferences, 22 concerned the use of DHI, 11 concerned perception, and 10 concerned needs. Conclusions: The results of this study provide a better understanding of the factors influencing children?s and adolescents? attitudes toward digital health and DHIs. The continued growth of DHIs can help reduce barriers to mental health care. Future research on these interventions should investigate the needs of the targeted populations to increase their engagement in care. UR - https://www.jmir.org/2023/1/e43102 UR - http://dx.doi.org/10.2196/43102 UR - http://www.ncbi.nlm.nih.gov/pubmed/37129931 ID - info:doi/10.2196/43102 ER - TY - JOUR AU - Sirari, Titiksha AU - Suthar, Renu AU - Singh, Amarjeet AU - Prinja, Shankar AU - Gupta, Vishwas AU - Malviya, Manisha AU - Chauhan, Singh Akashdeep AU - Sankhyan, Naveen PY - 2023/4/28 TI - Development and Economic Evaluation of a Patient-Centered Care Model for Children With Duchenne Muscular Dystrophy: Protocol for a Quasi-Experimental Study JO - JMIR Res Protoc SP - e42491 VL - 12 KW - Duchenne muscular dystrophy KW - patient-centered care KW - disabilities KW - quality of life KW - caregivers KW - cost of illness KW - effective KW - treatment KW - policy KW - caregiver KW - pediatrics KW - intervention KW - psychological KW - disability N2 - Background: Duchenne muscular dystrophy (DMD) is a rare progressive muscular disease that primarily affects boys. A lack of comprehensive care for patients living with DMD is directly associated with a compromised quality of life (QoL) for those affected and their caregivers. This disease also has a huge economic impact on families as its treatment requires substantial direct, indirect, and informal care costs. Objective: This study presents a protocol developed to evaluate the feasibility and efficacy of a patient-centered care (PCC) model for children with DMD. The care model was designed with the aim to empower families, improve QoL, and reduce economic burden on their families. Methods: This study is planned as a quasi-experimental study that will enroll 70 consecutive families with boys (aged 5-15 years) with DMD visiting a tertiary care center. The study is being conducted in 2 phases (preintervention and postintervention phases, referred to as phase 1 and phase 2, respectively). During phase 1, the patients received routine care. The study is now in phase 2, with the intervention currently being administered. The intervention is based on the PCC model individualized by the intervention team. The model has a comprehensive DMD telecare component that includes teleconsultation as one of its key components to reduce in-person physician visits at the health facility. Teleconsultation is especially beneficial for late-ambulatory and nonambulatory patients. Data on economic burden are being collected for out-of-pocket expenses for both phases during in-person visits via telephone or messaging apps on a monthly basis. QoL data for patients and their primary caregivers are being collected at 3 time points (ie, time of enrollment, end of phase 1, and end of phase 2). Outcome measures are being assessed as changes in economic burden on families and changes in QoL scores. Results: Participant recruitment began in July 2021. The study is ongoing and expected to be completed by March 2023. The findings based on baseline data are expected to be submitted for publication in 2023. Conclusions: This paper outlines a research proposal developed to study the impact of a PCC model for patients with DMD in low- and middle-income countries (LMICs). This study is expected to provide evidence of whether a multicomponent, patient-centric intervention could reduce economic burdens on families and improve their QoL. The results of this study could guide policy makers and health professionals in India and other LMICs to facilitate a comprehensive care program for patients living with DMD. The economic impact of a rare disease is an important consideration to formulate or evaluate any health policy or intervention related to new treatments and financial support schemes. Trial Registration: Clinical Trials Registry India (ICMR-NIMS) CTRI/2021/06/034274; https://www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=56650 International Registered Report Identifier (IRRID): PRR1-10.2196/42491 UR - https://www.researchprotocols.org/2023/1/e42491 UR - http://dx.doi.org/10.2196/42491 UR - http://www.ncbi.nlm.nih.gov/pubmed/37115592 ID - info:doi/10.2196/42491 ER - TY - JOUR AU - Kodjebacheva, Damianova Gergana AU - Culinski, Taylor AU - Kawser, Bushra AU - Coffer, Katelynn PY - 2023/4/27 TI - Satisfaction With Telehealth Services Compared With Nontelehealth Services Among Pediatric Patients and Their Caregivers: Systematic Review of the Literature JO - JMIR Pediatr Parent SP - e41554 VL - 6 KW - satisfaction KW - pediatrics KW - telehealth KW - telemedicine KW - virtual care KW - caregivers KW - patients KW - children KW - COVID-19 KW - coronavirus KW - SARS-CoV-2 KW - technology use KW - caregiver KW - adolescent KW - youth KW - satisfaction survey KW - health outcome KW - review methodology KW - systematic review N2 - Background: Telehealth refers to the use of technology to deliver health care remotely. The COVID-19 pandemic has prompted an increase in telehealth services. Objective: This study aimed to review satisfaction with pediatric care in studies that had at least one group of pediatric patients and their caregivers receiving telehealth services during the COVID-19 pandemic and at least one comparison group of those receiving nontelehealth services. Methods: We searched for peer-reviewed studies published in the English language that compared the satisfaction with pediatric care between pediatric patients and their caregivers receiving telehealth services during the COVID-19 pandemic and those receiving nontelehealth services. Owing to stay-at-home orders, studies with comparison groups for nontelehealth services that took place either before or during the pandemic were eligible. We searched the PubMed, Embase, CINAHL, and PsycINFO databases on January 5, 2023. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 2 reviewers independently screened the titles and abstracts before reviewing the full text of the remaining articles. The following information was extracted from each eligible study: country, participant characteristics by comparison group, study design, telehealth approach, measurement tools to assess satisfaction, and findings by comparison group. Results: All 14 eligible studies assessed satisfaction among caregivers and pediatric patients participating in video or telephone visits during the COVID-19 pandemic compared with those having in-person appointments either before or during the pandemic. In 5 of the 14 studies, a comparison of nontelehealth services took place before the pandemic, and in the remaining 9 investigations, nontelehealth services took place during the pandemic. A total of 13 studies were observational investigations with different designs, and 1 study was a quasi-experimental intervention with 3 comparison groups for video, in-person, and hybrid visits. In 9 of the 14 studies, satisfaction with telehealth services was higher than during in-person visits. Caregivers were satisfied with video visits for the ease of use and reduced need for transportation. Reasons caregivers were not satisfied with remote care included limited personal interaction with the provider, technological challenges, and a lack of physical examination. Those participating in nontelehealth services expressed that in-person interactions promoted treatment adherence. Only 1 study assessed satisfaction where adolescent patients completed their own surveys; a higher percentage of adolescents using telehealth services reported effective communication with the provider compared with patients using in-person visits. Conclusions: In most studies, telehealth services received more favorable or comparable satisfaction ratings than in-person visits. Needed improvements in telehealth services included strategies to address technological challenges and develop better rapport among the patient, caregiver, and medical provider. Interventions may investigate the influence of telehealth services on access to and quality of care. UR - https://pediatrics.jmir.org/2023/1/e41554 UR - http://dx.doi.org/10.2196/41554 UR - http://www.ncbi.nlm.nih.gov/pubmed/37000504 ID - info:doi/10.2196/41554 ER - TY - JOUR AU - Mehdizadeh, Hamed AU - Asadi, Farkhondeh AU - Nazemi, Eslam AU - Mehrvar, Azim AU - Yazdanian, Azade AU - Emami, Hassan PY - 2023/3/30 TI - A Mobile Self-Management App (CanSelfMan) for Children With Cancer and Their Caregivers: Usability and Compatibility Study JO - JMIR Pediatr Parent SP - e43867 VL - 6 KW - Digital health KW - eHealth KW - Telehealth KW - mHealth KW - Mobile app KW - self-management KW - cancer KW - child KW - parent KW - caregiver KW - usability evaluation N2 - Background: Despite the increasing development of different smartphone apps in the health care domain, most of these apps lack proper evaluation. In fact, with the rapid development of smartphones and wireless communication infrastructure, many health care systems around the world are using these apps to provide health services for people without sufficient scientific efforts to design, develop, and evaluate them. Objective: The objective of this study was to evaluate the usability of CanSelfMan, a self-management app that provides access to reliable information to improve communication between health care providers and children with cancer and their parents/caregivers, facilitating remote monitoring and promoting medication adherence. Methods: We performed debugging and compatibility tests in a simulated environment to identify possible errors. Then, at the end of the 3-week period of using the app, children with cancer and their parents/caregivers filled out the User Experience Questionnaire (UEQ) to evaluate the usability of the CanSelfMan app and their level of user satisfaction. Results: During the 3 weeks of CanSelfMan use, 270 cases of symptom evaluation and 194 questions were recorded in the system by children and their parents/caregivers and answered by oncologists. After the end of the 3 weeks, 44 users completed the standard UEQ user experience questionnaire. According to the children?s evaluations, attractiveness (mean 1.956, SD 0.547) and efficiency (mean 1.934, SD 0.499) achieved the best mean results compared with novelty (mean 1.711, SD 0.481). Parents/caregivers rated efficiency at a mean of 1.880 (SD 0.316) and attractiveness at a mean of 1.853 (SD 0.331). The lowest mean score was reported for novelty (mean 1.670, SD 0.225). Conclusions: In this study, we describe the evaluation process of a self-management system to support children with cancer and their families. Based on the feedback and scores obtained from the usability evaluation, it seems that the children and their parents find CanSelfMan to be an interesting and practical idea to provide reliable and updated information on cancer and help them manage the complications of this disease. UR - https://pediatrics.jmir.org/2023/1/e43867 UR - http://dx.doi.org/10.2196/43867 UR - http://www.ncbi.nlm.nih.gov/pubmed/36995746 ID - info:doi/10.2196/43867 ER - TY - JOUR AU - Mattke, C. Adrian AU - Johnson, Kerry AU - Gibbons, Kristen AU - Long, Debbie AU - Robertson, Jeremy AU - Venugopal, S. Prem AU - Blumenthal, Antje AU - Schibler, Andreas AU - Schlapbach, Luregn PY - 2023/3/15 TI - Nitric Oxide on Extracorporeal Membrane Oxygenation in Neonates and Children (NECTAR Trial): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e43760 VL - 12 KW - extracorporeal membrane oxygenation KW - randomized controlled trial KW - children KW - nitric oxide KW - child KW - RCT KW - ECMO KW - neonate KW - neonatal KW - infant KW - baby KW - babies KW - life support KW - mortality KW - pulmonary KW - cardiovascular KW - heart KW - lung N2 - Background: Extracorporeal membrane oxygenation (ECMO) provides support for the pulmonary or cardiovascular function of children in whom the predicted mortality risk remains very high. The inevitable host inflammatory response and activation of the coagulation cascade due to the extracorporeal circuit contribute to additional morbidity and mortality in these patients. Mixing nitric oxide (NO) into the sweep gas of ECMO circuits may reduce the inflammatory and coagulation cascade activation during ECMO support. Objective: The purpose of this study is to test the feasibility and safety of mixing NO into the sweep gas of ECMO systems and assess its effect on inflammation and coagulation system activation through a pilot randomized controlled trial. Methods: The Nitric Oxide on Extracorporeal Membrane Oxygenation in Neonates and Children (NECTAR) trial is an open-label, parallel-group, pilot randomized controlled trial to be conducted at a single center. Fifty patients who require ECMO support will be randomly assigned to receive either NO mixed into the sweep gas of the ECMO system at 20 ppm for the duration of ECMO or standard care (no NO) in a 1:1 ratio, with stratification by support type (veno-venous vs veno-arterial ECMO). Results: Outcome measures will focus on feasibility (recruitment rate and consent rate, and successful inflammatory marker measurements), the safety of the intervention (oxygenation and carbon dioxide control within defined parameters and methemoglobin levels), and proxy markers of efficacy (assessment of cytokines, chemokines, and coagulation factors to assess the impact of NO on host inflammation and coagulation cascade activation, clotting of ECMO components, including computer tomography scanning of oxygenators for clot assessments), bleeding complications, as well as total blood product use. Survival without ECMO and the length of stay in the pediatric intensive care unit (PICU) are clinically relevant efficacy outcomes. Long-term outcomes include neurodevelopmental assessments (Ages and Stages Questionnaire, Strength and Difficulties Questionnaire, and others) and quality of life (Pediatric Quality of Life Inventory and others) measured at 6 and 12 months post ECMO cannulation. Analyses will be conducted on an intention-to-treat basis. Conclusions: The NECTAR study investigates the safety and feasibility of NO as a drug intervention during extracorporeal life support and explores its efficacy. The study will investigate whether morbidity and mortality in patients treated with ECMO can be improved with NO. The intervention targets adverse outcomes in patients who are supported by ECMO and who have high expected mortality and morbidity. The study will be one of the largest randomized controlled trials performed among pediatric patients supported by ECMO. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001518156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376869 International Registered Report Identifier (IRRID): DERR1-10.2196/43760 UR - https://www.researchprotocols.org/2023/1/e43760 UR - http://dx.doi.org/10.2196/43760 UR - http://www.ncbi.nlm.nih.gov/pubmed/36920455 ID - info:doi/10.2196/43760 ER - TY - JOUR AU - Aune, Anders AU - Vartdal, Gunnar AU - Jimenez Diaz, Gabriela AU - Gierman, Marijn Lobke AU - Bergseng, Håkon AU - Darj, Elisabeth PY - 2023/2/28 TI - Iterative Development, Validation, and Certification of a Smartphone System to Assess Neonatal Jaundice: Development and Usability Study JO - JMIR Pediatr Parent SP - e40463 VL - 6 KW - neonatal jaundice KW - neonatal hyperbilirubinemia KW - newborns KW - mobile app KW - design KW - validation KW - regulatory processes KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Medical device development is an area facing multiple challenges, resulting in a high number of products not reaching the clinical setting. Neonatal hyperbilirubinemia, manifesting as neonatal jaundice (NNJ), is an important cause of newborn morbidity and mortality. It is important to identify infants with neonatal hyperbilirubinemia at an early stage, but currently there is a lack of tools that are both accurate and affordable. Objective: This study aimed to develop a novel system to assess the presence of NNJ. The device should provide accurate results, be approved as a medical device, be easy to use, and be produced at a price that is affordable even in low-resource settings. Methods: We used an iterative approach to develop a smartphone-based system to detect the presence of NNJ. We performed technical development, followed by clinical and usability testing in parallel, after which we initiated the regulatory processes for certification. We updated the system in each iteration, and the final version underwent a clinical validation study on healthy term newborns aged 1 to 15 days before all documentation was submitted for conformity assessment to obtain Conformité Européenne (CE) certification. We developed a system that incorporates a smartphone app, a color calibration card, and a server. Results: Three iterations of the smartphone-based system were developed; the final version was approved as a medical device after complying with Medical Device Regulation guidelines. A total of 201 infants were included in the validation study. Bilirubin values using the system highly correlated with total serum or plasma bilirubin levels (r=0.84). The system had a high sensitivity (94%) to detect severe jaundice, defined as total serum or plasma bilirubin >250 µmol/L, and maintained a high specificity (71%). Conclusions: Our smartphone-based system has a high potential as a tool for identifying NNJ. An iterative approach to product development, conducted by working on different tasks in parallel, resulted in a functional and successful product. By adhering to the requirements for regulatory approval from the beginning of the project, we were able to develop a market-ready mobile health solution. UR - https://pediatrics.jmir.org/2023/1/e40463 UR - http://dx.doi.org/10.2196/40463 UR - http://www.ncbi.nlm.nih.gov/pubmed/36853753 ID - info:doi/10.2196/40463 ER - TY - JOUR AU - Tenfelde, Kim AU - Antheunis, Marjolijn AU - Krahmer, Emiel AU - Bunt, Erik Jan PY - 2023/2/7 TI - Using Digital Communication Technology to Improve Neonatal Care: Two-Part Explorative Needs Assessment JO - JMIR Pediatr Parent SP - e38435 VL - 6 KW - mobile health KW - mHealth KW - physician-patient communication KW - questions asking KW - needs assessment KW - explorative KW - mobile phone N2 - Background: The birth of a premature infant and subsequent hospitalization are stressful events for parents. Therefore, accurate and easy-to-understand communication between parents and health care professionals is crucial during this period. Mobile health (mHealth) technologies have the potential to improve communication with parents at any time and place and possibly reduce their stress. Objective: We aimed to conduct a 2-part explorative needs assessment in which the interaction between the pediatrician and parents was examined along with their digital communication technology needs and interest in an mHealth app with the aim of improving interpersonal communication and information exchange. Methods: Overall, 19 consultations between parents of preterm infants and pediatricians were observed to determine which themes are discussed the most and the number of questions asked. Afterward, the parents and the pediatrician were interviewed to evaluate the process of communication and gauge their ideas about a neonatal communication mHealth app. Results: The observations revealed the following most prevalent themes: breastfeeding, criteria for discharge, medication, and parents? personal life. Interview data showed that the parents were satisfied with the communication with their pediatrician. Furthermore, both parents and pediatricians expected that a neonatal mHealth app could further improve the communication process and the hospital stay. Parents valued app features such as asking questions, growth graphs, a diary function, hospital-specific information, and medical rounds reports. Conclusions: Both parents of hospitalized preterm infants and pediatricians expect that the hypothetical mHealth app has the potential to cater to the most prevalent themes and improve communication and information exchange. Recommendations for developing such an app and its possible features are also discussed. On the basis of these promising results, it is suggested to further develop and study the effects of the mHealth app together with all stakeholders. UR - https://pediatrics.jmir.org/2023/1/e38435 UR - http://dx.doi.org/10.2196/38435 UR - http://www.ncbi.nlm.nih.gov/pubmed/36749606 ID - info:doi/10.2196/38435 ER - TY - JOUR AU - Bocqué, Catheline AU - Wang, Jingyun AU - Rickmann, Annekatrin AU - Julich-Haertel, Henrike AU - Kaempf, Uwe AU - Januschowski, Kai PY - 2023/2/1 TI - Gamification to Support Adherence to a Therapeutic Ambylopia Treatment for Children: Retrospective Study Using a Focal Ambient Visual Acuity Stimulation Game JO - JMIR Pediatr Parent SP - e32282 VL - 6 KW - amblyopia KW - children KW - compliance KW - adherence KW - occlusion KW - patching KW - therapeutic game KW - FAVAS N2 - Background: The gold standard treatment for amblyopia is patching the better eye. Improvement of visual acuity in the amblyopic eye is significantly impacted by the adherence to the patching therapy. It is known that the overall adherence is rather low. Objective: This retrospective study evaluated whether an updated version of attention-binding digital therapeutic games based on the principle of focal ambient visual acuity stimulation (FAVAS) would result in improved patient adherence in 4- to 16-year-old patients with amblyopia associated with anisometropia or strabismus. Methods: We analyzed electronically pseudonymized recorded data from patients treated with occlusion therapy and FAVAS therapeutic games. One group used an older version (2015) and the other group used a newer version (2020) that provided more attractive therapeutic games with tablet computer functionality. Objective adherence was calculated by comparing the number of minutes using the therapeutic games as monitored in the automatized logbook versus the prescribed number of minutes for using the games. Results: Children in group 2015 (n=138) spent on average 2009.3 (SD 1372.1; range 36-5556) minutes using FAVAS; children in group 2020 (n=129) spent on average 2651.2 (SD 1557.1; range 38-5672) minutes using the newer version. Group 2020 spent on average 641.9 more minutes on FAVAS than group 2015 (t255.49=3.56, P<.001, d=0.45; 95% CI 0.69-0.20). Although patient adherence was very variable, compared to the 55.0% (SD 29.4%) in group 2015, it significantly improved up to 68.5% (SD 33.7%) in group 2020 (t254.38=3.48, P=.001, d=0.44; 95% CI 0.68-0.19). Conclusions: FAVAS 2020, with improved gamification aspect as well as tablet computer functionality, increased adherence significantly compared to the earlier version of FAVAS 2015, indicating that FAVAS 2020 could be an effective approach to support adherence to amblyopia treatment. Trial Registration: German Clinical Trials Register (DRKS) DRKS00017633; https://drks.de/search/de/trial/DRKS00017633 UR - https://pediatrics.jmir.org/2023/1/e32282 UR - http://dx.doi.org/10.2196/32282 UR - http://www.ncbi.nlm.nih.gov/pubmed/36724007 ID - info:doi/10.2196/32282 ER - TY - JOUR AU - Ugalde, T. Irma AU - Chaudhari, P. Pradip AU - Badawy, Mohamed AU - Ishimine, Paul AU - McCarten-Gibbs, A. Kevan AU - Yen, Kenneth AU - Atigapramoj, S. Nisa AU - Sage, Allyson AU - Nielsen, Donovan AU - Adelson, David P. AU - Upperman, Jeffrey AU - Tancredi, Daniel AU - Kuppermann, Nathan AU - Holmes, F. James PY - 2022/11/24 TI - Validation of Prediction Rules for Computed Tomography Use in Children With Blunt Abdominal or Blunt Head Trauma: Protocol for a Prospective Multicenter Observational Cohort Study JO - JMIR Res Protoc SP - e43027 VL - 11 IS - 11 KW - pediatric trauma KW - intra-abdominal injury KW - traumatic brain injury KW - clinical prediction rules KW - emergency medicine N2 - Background: Traumatic brain injuries (TBIs) and intra-abdominal injuries (IAIs) are 2 leading causes of traumatic death and disability in children. To avoid missed or delayed diagnoses leading to increased morbidity, computed tomography (CT) is used liberally. However, the overuse of CT leads to inefficient care and radiation-induced malignancies. Therefore, to maximize precision and minimize the overuse of CT, the Pediatric Emergency Care Applied Research Network (PECARN) previously derived clinical prediction rules for identifying children at high risk and very low risk for IAIs undergoing acute intervention and clinically important TBIs after blunt trauma in large cohorts of children who are injured. Objective: This study aimed to validate the IAI and age-based TBI clinical prediction rules for identifying children at high risk and very low risk for IAIs undergoing acute intervention and clinically important TBIs after blunt trauma. Methods: This was a prospective 6-center observational study of children aged <18 years with blunt torso or head trauma. Consistent with the original derivation studies, enrolled children underwent routine history and physical examinations, and the treating clinicians completed case report forms prior to knowledge of CT results (if performed). Medical records were reviewed to determine clinical courses and outcomes for all patients, and for those who were discharged from the emergency department, a follow-up survey via a telephone call or SMS text message was performed to identify any patients with missed IAIs or TBIs. The primary outcomes were IAI undergoing acute intervention (therapeutic laparotomy, angiographic embolization, blood transfusion, or intravenous fluid for ?2 days for pancreatic or gastrointestinal injuries) and clinically important TBI (death from TBI, neurosurgical procedure, intubation for >24 hours for TBI, or hospital admission of ?2 nights due to a TBI on CT). Prediction rule accuracy was assessed by measuring rule classification performance, using standard point and 95% CI estimates of the operational characteristics of each prediction rule (sensitivity, specificity, positive and negative predictive values, and diagnostic likelihood ratios). Results: The project was funded in 2016, and enrollment was completed on September 1, 2021. Data analyses are expected to be completed by December 2022, and the primary study results are expected to be submitted for publication in 2023. Conclusions: This study will attempt to validate previously derived clinical prediction rules to accurately identify children at high and very low risk for clinically important IAIs and TBIs. Assuming successful validation, widespread implementation is then indicated, which will optimize the care of children who are injured by better aligning CT use with need. International Registered Report Identifier (IRRID): RR1-10.2196/43027 UR - https://www.researchprotocols.org/2022/11/e43027 UR - http://dx.doi.org/10.2196/43027 UR - http://www.ncbi.nlm.nih.gov/pubmed/36422920 ID - info:doi/10.2196/43027 ER - TY - JOUR AU - Hagström, Josefin AU - Blease, Charlotte AU - Haage, Barbara AU - Scandurra, Isabella AU - Hansson, Scharlett AU - Hägglund, Maria PY - 2022/11/22 TI - Views, Use, and Experiences of Web-Based Access to Pediatric Electronic Health Records for Children, Adolescents, and Parents: Scoping Review JO - J Med Internet Res SP - e40328 VL - 24 IS - 11 KW - electronic health record KW - patient-accessible electronic health record KW - adolescents KW - parents KW - children KW - patient experience KW - patient portal KW - electronic portal KW - review KW - scoping review KW - youth KW - patient perspective KW - user experience KW - patient access KW - mobile phone N2 - Background: Ongoing efforts worldwide to provide patients with patient-accessible electronic health records (PAEHRs) have led to variability in adolescent and parental access across providers, regions, and countries. There is no compilation of evidence to guide policy decisions in matters such as access age and the extent of parent proxy access. In this paper, we outline our scoping review of different stakeholders? (including but not limited to end users) views, use, and experiences pertaining to web-based access to electronic health records (EHRs) by children, adolescents, and parents. Objective: The aim of this study was to identify, categorize, and summarize knowledge about different stakeholders? (eg, children and adolescents, parents, health care professionals [HCPs], policy makers, and designers of patient portals or PAEHRs) views, use, and experiences of EHR access for children, adolescents, and parents. Methods: A scoping review was conducted according to the Arksey and O?Malley framework. A literature search identified eligible papers that focused on EHR access for children, adolescents, and parents that were published between 2007 and 2021. A number of databases were used to search for literature (PubMed, CINAHL, and PsycINFO). Results: The approach resulted in 4817 identified articles and 74 (1.54%) included articles. The papers were predominantly viewpoints based in the United States, and the number of studies on parents was larger than that on adolescents and HCPs combined. First, adolescents and parents without access anticipated low literacy and confidentiality issues; however, adolescents and parents who had accessed their records did not report such concerns. Second, the main issue for HCPs was maintaining adolescent confidentiality. This remained an issue after using PAEHRs for parents, HCPs, and other stakeholders but was not an experienced issue for adolescents. Third, the viewpoints of other stakeholders provided a number of suggestions to mitigate issues. Finally, education is needed for adolescents, parents, and HCPs. Conclusions: There is limited research on pediatric PAEHRs, particularly outside the United States, and on adolescents? experiences with web-based access to their records. These findings could inform the design and implementation of future regulations regarding access to PAEHRs. Further examination is warranted on the experiences of adolescents, parents, and HCPs to improve usability and utility, inform universal principles reducing the current arbitrariness in the child?s age for own and parental access to EHRs among providers worldwide, and ensure that portals are equipped to safely and appropriately manage a wide variety of patient circumstances. International Registered Report Identifier (IRRID): RR2-10.2196/36158 UR - https://www.jmir.org/2022/11/e40328 UR - http://dx.doi.org/10.2196/40328 UR - http://www.ncbi.nlm.nih.gov/pubmed/36413382 ID - info:doi/10.2196/40328 ER - TY - JOUR AU - DeWitt, Akeiylah AU - Kientz, Julie AU - Liljenquist, Kendra PY - 2022/11/8 TI - Quality of Mobile Apps for Child Development Support: Search in App Stores and Content Analysis JO - JMIR Pediatr Parent SP - e38793 VL - 5 IS - 4 KW - mobile health technologies KW - early childhood health promotion KW - child development KW - parent support technologies KW - pediatrics KW - parenting KW - mobile app KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Following increases in smartphone access, more parents seek parenting advice through internet sources, including blogs, web-based forums, or mobile apps. However, identifying quality apps (ones that respond to the diverse experiences of families) for guidance on child development can be challenging. Objective: This review of mobile health apps aimed to document the landscape, design, and content of apps in the United States available to parents as they promote their child?s developmental health. Methods: To understand the availability and quality of apps for early childhood health promotion, we completed a content analysis of apps in 2 major app stores (Google Play and Apple App stores). Results: We found that most apps do not provide tailored experiences to parents, including cultural considerations, and instead promote generic guidance that may be useful to parents in some contexts. We discuss the need for an evaluative framework to assess apps aimed to support parents on child development topics. Conclusions: Future work is needed on how to support designers in this area, specifically related to avoiding potential burdens on users and providing culturally informed and equity-driven experiences. UR - https://pediatrics.jmir.org/2022/4/e38793 UR - http://dx.doi.org/10.2196/38793 UR - http://www.ncbi.nlm.nih.gov/pubmed/36346656 ID - info:doi/10.2196/38793 ER - TY - JOUR AU - Gutierrez, Robert AU - McCrady, Allison AU - Masterson, Chelsea AU - Tolman, Sarah AU - Boukhechba, Mehdi AU - Barnes, Laura AU - Blemker, Silvia AU - Scharf, Rebecca PY - 2022/10/27 TI - Upper Extremity Examination for Neuromuscular Diseases (U-EXTEND): Protocol for a Multimodal Feasibility Study JO - JMIR Res Protoc SP - e40856 VL - 11 IS - 10 KW - mHealth KW - ubiquitous computing KW - neuromuscular disorders KW - inertial measurement unit KW - motor function KW - specific torque KW - cross-sectional area KW - echogenicity N2 - Background: Neuromuscular diseases, such as spinal muscular atrophy (SMA) and Duchenne muscular dystrophy (DMD), may result in the loss of motor movements, respiratory failure, and early mortality in young children and in adulthood. With novel treatments now available, new evaluation methods are needed to assess progress that is not currently captured in existing motor scale tests. Objective: With our feasibility study, our interdisciplinary team of investigators aims to develop a novel, multimodal paradigm of measuring motor function in children with neuromuscular diseases that will revolutionize the way that clinical trial end points are measured, thereby accelerating the pipeline of new treatments for childhood neuromuscular diseases. Through the Upper Extremity Examination for Neuromuscular Diseases (U-EXTEND) study, we hypothesize that the novel objective measures of upper extremity muscle structure and function proposed herein will be able to capture small changes and differences in function that cannot be measured with current clinical metrics. Methods: U-EXTEND introduces a novel paradigm in which concrete, quantitative measures are used to assess motor function in patients with SMA and DMD. Aim 1 will focus on the use of ultrasound techniques to study muscle size, quality, and function, specifically isolating the biceps and pronator muscles of the upper extremities for follow-ups over time. To achieve this, clinical investigators will extract a set of measurements related to muscle structure, quality, and function by using ultrasound imaging and handheld dynamometry. Aim 2 will focus on leveraging wearable wireless sensor technology to capture motion data as participants perform activities of daily living. Measurement data will be examined and compared to those from a healthy cohort, and a motor function score will be calculated. Results: Data collection for both aims began in January 2021. As of July 2022, we have enrolled 44 participants (9 with SMA, 20 with DMD, and 15 healthy participants). We expect the initial results to be published in summer 2022. Conclusions: We hypothesize that by applying the described tools and techniques for measuring muscle structure and upper extremity function, we will have created a system for the precise quantification of changes in motor function among patients with neuromuscular diseases. Our study will allow us to track the minimal clinically important difference over time to assess progress in novel treatments. By comparing the muscle scores and functional scores over multiple visits, we will be able to detect small changes in both the ability of the participants to perform the functional tasks and their intrinsic muscle properties. International Registered Report Identifier (IRRID): DERR1-10.2196/40856 UR - https://www.researchprotocols.org/2022/10/e40856 UR - http://dx.doi.org/10.2196/40856 UR - http://www.ncbi.nlm.nih.gov/pubmed/36301603 ID - info:doi/10.2196/40856 ER - TY - JOUR AU - Southgate, Genevieve AU - Yassaee, A. Arrash AU - Harmer, J. Matthew AU - Livesey, Helen AU - Pryde, Kate AU - Roland, Damian PY - 2022/10/26 TI - Use of Telemedicine in Pediatric Services for 4 Representative Clinical Conditions: Scoping Review JO - J Med Internet Res SP - e38267 VL - 24 IS - 10 KW - telemedicine KW - telehealth KW - eHealth KW - digital health KW - video consultation KW - remote consultation KW - paediatric KW - child KW - safeguarding KW - diabetes KW - diabetic KW - asthma KW - epilepsy KW - epileptic KW - renal KW - kidney KW - evidence-based medicine KW - review N2 - Background: Telemedicine is becoming routine in health care. Postpandemic, a universal return to face-to-face consultations may risk a loss of some of the advantages of telemedicine. However, rapid implementation and adoption without robust evaluation of usability, efficacy, and effectiveness could potentially lead to suboptimal health outcomes and downstream challenges to providers. Objective: This review assesses telemedicine interventions against international guidance and sufficiency of evidence to support postpandemic utilization in pediatric settings. Methods: This scoping review was performed following searches on PubMed, Embase, and CINAHL databases on April 15, 2021, and May 31, 2022, and examined studies focused on telemedicine, remote consultation, video call, or remote patient monitoring in children (0-18 years) receiving outpatient care for diabetes, asthma, epilepsy, or renal disease. Exclusion criteria included studies published before 2011 as the technologies used have likely been improved or replaced, studies in adult populations or where it was not possible to disaggregate data for participants younger than 18 years as the focus of the review was on pediatric care, and studies not published in English. Data were extracted by 4 authors, and the data were corroborated by a second reviewer. Studies were examined for feasibility and usability, clinical and process outcomes, and cost-effectiveness. Results: Of the 3158 studies identified, 56 were suitable for final inclusion and analysis. Data on feasibility or usability of interventions (48 studies) were overwhelmingly positive in support of telemedicine interventions, with common themes including convenience, perceived cost savings, and ease of use. However, use in preference to usual care was rarely explored. Clinical and process outcome data (31 studies) were mostly positive. Across all studies, there was limited measurement of standardized clinical outcomes, although these were more commonly reported in asthma (peak flow) and diabetes (glycated hemoglobin [HbA1c]). Implementation science data generally supported cost-effectiveness of telemedicine with a reduction of health care costs. Conclusions: There is promising evidence supporting telemedicine in pediatric settings. However, there is a lack of evaluation of telemedicine in comparison with usual outpatient care for noninferiority of clinical outcomes, and this review highlights the need for a more standardized approach to evaluation of digital interventions. UR - https://www.jmir.org/2022/10/e38267 UR - http://dx.doi.org/10.2196/38267 UR - http://www.ncbi.nlm.nih.gov/pubmed/36287609 ID - info:doi/10.2196/38267 ER - TY - JOUR AU - Maarj, Muhammad AU - Pacey, Verity AU - Tofts, Louise AU - Clapham, Matthew AU - Gironès Garcia, Xavier AU - Coda, Andrea PY - 2022/10/26 TI - Validation of an Electronic Visual Analog Scale App for Pain Evaluation in Children and Adolescents With Symptomatic Hypermobility: Cross-sectional Study JO - JMIR Pediatr Parent SP - e41930 VL - 5 IS - 4 KW - hypermobility syndrome KW - Ehlers-Danlos syndrome KW - hypermobility KW - hypermobile KW - mobile application KW - mobile app KW - pain measurement KW - pain KW - validation KW - validate KW - scale KW - measure KW - pain severity KW - pediatric KW - visual analogue scale KW - mHealth KW - mobile health KW - children KW - adolescent KW - youth KW - child KW - digital health tool N2 - Background: Rapid advances in mobile apps for clinical data collection for pain evaluation have resulted in more efficient data handling and analysis than traditional paper-based approaches. As paper-based visual analogue scale (p-VAS) scores are commonly used to assess pain levels, new emerging apps need to be validated prior to clinical application with symptomatic children and adolescents. Objective: This study aimed to assess the validity and reliability of an electronic visual analogue scale (e-VAS) method via a mobile health (mHealth) App in children and adolescents diagnosed with hypermobility spectrum disorder/hypermobile Ehlers-Danlos syndrome (HSD/HEDS) in comparison with the traditional p-VAS. Methods: Children diagnosed with HSD/HEDS aged 5-18 years were recruited from a sports medicine center in Sydney (New South Wales, Australia). Consenting participants assigned in random order to the e-VAS and p-VAS platforms were asked to indicate their current lower limb pain level and completed pain assessment e-VAS or p-VAS at one time point. Instrument agreement between the 2 methods was determined from the intraclass correlation coefficient (ICC) and through Bland?Altman analysis. Results: In total, 43 children with HSD/HEDS aged 11 (SD 3.8) years were recruited and completed this study. The difference between the 2 VAS platforms of median values was 0.20. Bland?Altman analysis revealed a difference of 0.19 (SD 0.95) with limits of agreement ranging ?1.67 to 2.04. An ICC of 0.87 (95% CI 0.78-0.93) indicated good reliability. Conclusions: These findings suggest that the e-VAS mHealth App is a validated tool and a feasible method of collecting pain recording scores when compared with the traditional paper format in children and adolescents with HSD/HEDS. The e-VAS App can be reliably used for pediatric pain evaluation, and it could potentially be introduced into daily clinical practice to improve real-time symptom monitoring. Further research is warranted to investigate the usage of the app for remote support in real clinical settings. UR - https://pediatrics.jmir.org/2022/4/e41930 UR - http://dx.doi.org/10.2196/41930 UR - http://www.ncbi.nlm.nih.gov/pubmed/36287606 ID - info:doi/10.2196/41930 ER - TY - JOUR AU - Lou, M. Terry AU - Zhang, L. Kenneth AU - Slesinger, C. Noël AU - Taddeo, Michelle AU - Serrano, Eloisa AU - Begolka, Smith Wendy AU - Capozza, Korey AU - Paller, S. Amy AU - Griffith, W. James AU - Fishbein, B. Anna PY - 2022/9/14 TI - Positive Psychology Themes in Interviews of Children With Atopic Dermatitis: Qualitative Study JO - JMIR Pediatr Parent SP - e38725 VL - 5 IS - 3 KW - positive psychology KW - PERMA KW - positive emotion, engagement, relationships, meaning, and accomplishment KW - atopic dermatitis KW - pediatric KW - dermatology KW - children N2 - Background: Atopic dermatitis is a pruritic chronic condition associated with significant sleep disturbance, inattention, and sometimes behavioral problems. Enhancing resiliency in children with atopic dermatitis may promote coping strategies to improve quality of life. Positive psychology is one strategy that can be used to strengthen resiliency. Objective: Our objective was to identify positive psychology concepts mentioned by children with atopic dermatitis and their parent to inform strategies to strengthen resiliency in children with atopic dermatitis. Methods: A total of 20 patient-parent dyads were interviewed to share their experience with atopic dermatitis to help develop a novel psychologic intervention for atopic dermatitis. Patients were 8 to 17 years old and diagnosed with atopic dermatitis. Trained coders analyzed transcripts using a coding dictionary developed based on Seligman?s PERMA (positive emotion, engagement, relationships, meaning, and accomplishment) model of positive psychology. The frequency of unprompted mentions of PERMA themes and relevant quotations was captured. Transcripts were also separately coded for resiliency, which is the ultimate goal of PERMA. Results: Positive psychology concepts were mentioned by 100% (20/20) of children and 95% (19/20) of parents. Engagement and relationships, both negative and positive aspects, were the most common unprompted PERMA themes mentioned by children (14/20, 70%) and parents (13/20, 65%). Emotion elicited the most negative comments from children (19/20, 95%) and parents (17/20, 85%). When analyzed for resiliency, 8 participants were identified with at least one resiliency code. On average, participants with a resiliency code mentioned PERMA concepts 9.1 (SD 4.7) times compared to those who mentioned none (mean 5.9, SD 4.6) (P=.14). When participants were stratified by disease severity, on average, more positive psychology concepts were mentioned by patients with mild atopic dermatitis (mean 13, SD 3.0) than those with moderate symptoms (mean 6.2, SD 4.9) or severe symptoms (mean 6.1, SD 4.0) (P=.03). Conclusions: Among PERMA themes, engagement and relationships are the two most commonly mentioned categories for children with atopic dermatitis. Strategies targeting PERMA such as affirmations and positive reframing may improve psychosocial well-being and resiliency in pediatric atopic dermatitis. Future directions will look at incorporating ?positive medicine? into atopic dermatitis treatment to not only relieve symptoms but also strengthen positive aspects of life. UR - https://pediatrics.jmir.org/2022/3/e38725 UR - http://dx.doi.org/10.2196/38725 UR - http://www.ncbi.nlm.nih.gov/pubmed/36103242 ID - info:doi/10.2196/38725 ER - TY - JOUR AU - Ezenwa, Nkolika Beatrice AU - Umoren, Rachel AU - Fajolu, Bamikeolu Iretiola AU - Hippe, S. Daniel AU - Bucher, Sherri AU - Purkayastha, Saptarshi AU - Okwako, Felicitas AU - Esamai, Fabian AU - Feltner, B. John AU - Olawuyi, Olubukola AU - Mmboga, Annet AU - Nafula, Concepta Mary AU - Paton, Chris AU - Ezeaka, Chinyere Veronica PY - 2022/9/12 TI - Using Mobile Virtual Reality Simulation to Prepare for In-Person Helping Babies Breathe Training: Secondary Analysis of a Randomized Controlled Trial (the eHBB/mHBS Trial) JO - JMIR Med Educ SP - e37297 VL - 8 IS - 3 KW - virtual reality KW - mobile learning KW - Helping Babies Breathe KW - neonatal resuscitation KW - mobile Helping Babies Survive powered by District Health Information Software 2 KW - neonatal mortality KW - digital education KW - health care education KW - health care worker KW - medical education KW - digital intervention N2 - Background: Neonatal mortality accounts for approximately 46% of global under-5 child mortality. The widespread access to mobile devices in low- and middle-income countries has enabled innovations, such as mobile virtual reality (VR), to be leveraged in simulation education for health care workers. Objective: This study explores the feasibility and educational efficacy of using mobile VR for the precourse preparation of health care professionals in neonatal resuscitation training. Methods: Health care professionals in obstetrics and newborn care units at 20 secondary and tertiary health care facilities in Lagos, Nigeria, and Busia, Western Kenya, who had not received training in Helping Babies Breathe (HBB) within the past 1 year were randomized to access the electronic HBB VR simulation and digitized HBB Provider?s Guide (VR group) or the digitized HBB Provider?s Guide only (control group). A sample size of 91 participants per group was calculated based on the main study protocol that was previously published. Participants were directed to use the electronic HBB VR simulation and digitized HBB Provider?s Guide or the digitized HBB Provider?s Guide alone for a minimum of 20 minutes. HBB knowledge and skills assessments were then conducted, which were immediately followed by a standard, in-person HBB training course that was led by study staff and used standard HBB evaluation tools and the Neonatalie Live manikin (Laerdal Medical). Results: A total of 179 nurses and midwives participated (VR group: n=91; control group: n=88). The overall performance scores on the knowledge check (P=.29), bag and mask ventilation skills check (P=.34), and Objective Structured Clinical Examination A checklist (P=.43) were similar between groups, with low overall pass rates (6/178, 3.4% of participants). During the Objective Structured Clinical Examination A test, participants in the VR group performed better on the critical step of positioning the head and clearing the airway (VR group: 77/90, 86%; control group: 57/88, 65%; P=.002). The median percentage of ventilations that were performed via head tilt, as recorded by the Neonatalie Live manikin, was also numerically higher in the VR group (75%, IQR 9%-98%) than in the control group (62%, IQR 13%-97%), though not statistically significantly different (P=.35). Participants in the control group performed better on the identifying a helper and reviewing the emergency plan step (VR group: 7/90, 8%; control group: 16/88, 18%; P=.045) and the washing hands step (VR group: 20/90, 22%; control group: 32/88, 36%; P=.048). Conclusions: The use of digital interventions, such as mobile VR simulations, may be a viable approach to precourse preparation in neonatal resuscitation training for health care professionals in low- and middle-income countries. UR - https://mededu.jmir.org/2022/3/e37297 UR - http://dx.doi.org/10.2196/37297 UR - http://www.ncbi.nlm.nih.gov/pubmed/36094807 ID - info:doi/10.2196/37297 ER - TY - JOUR AU - Drapalik, N. Krista AU - Grodberg, David AU - Ventola, Pamela PY - 2022/9/6 TI - Feasibility and Acceptability of Delivering Pivotal Response Treatment for Autism Spectrum Disorder via Telehealth: Pilot Pre-Post Study JO - JMIR Pediatr Parent SP - e32520 VL - 5 IS - 3 KW - autism spectrum disorder KW - ASD KW - pivotal response treatment KW - PRT KW - telehealth KW - parent-implemented intervention KW - parent training KW - pediatrics KW - autism KW - children KW - digital health KW - online modules KW - online health KW - online treatment KW - pilot study KW - communication N2 - Background: Pivotal response treatment (PRT), an evidence-based and parent-delivered intervention, is designed to improve social communication in autistic individuals. Objective: The aim of this study was to assess the feasibility, acceptability, and clinical effects of an online model of PRT delivered via MindNest Health, a telehealth platform that aims to provide self-directed and engaging online modules, real-time coaching and feedback, and accessible stepped-care to large populations of parents seeking resources for their autistic children. Methods: Male and female autistic children, aged 2-7 years with single-word to phrase-level speech, and their parents were eligible to participate in the study. Families were randomized to the online parent training condition or control condition. The online component of the intervention consisted of eight 20-minute online courses of content describing parent training principles in PRT. Four 1-hour videoconferences were held after course 1, course 3, course 5, and course 8. Parents were given 1-2 weeks to complete each course. Parents completed the Client Credibility Questionnaire (CCQ) at week 2 and at the study endpoint, as well as the Behavioral Intervention Rating Scale (BIRS) at the study endpoint to assess parental expectancies, and treatment acceptability and effectiveness. Results: Nine of 14 participants completed the study curriculum in the online parent training condition, and 6 of 12 participants completed the control condition. Thus, a total of 58% (15/26) participants across both groups completed the study curriculum by study closure. Within the online parent training condition, there was a significant increase in mean CCQ total scores, from 25.38 (SD 3.25) at baseline to 27.5 (SD 3.74) at study endpoint (P=.04); mean CCQ confidence scores, from 6.0 (SD 1.07) at baseline to 6.75 (SD 0.89) at study endpoint (P=.02); and mean CCQ other improvement scores, from 5.25 (SD 0.89) at baseline to 6.25 (SD 1.28) at study endpoint (P=.009). Within the control condition, a modest increase in mean CCQ scores was noted (Confidence, difference=+0.25; Recommend, difference=+0.25; Total Score, difference=+0.50), but the differences were not statistically significant (Confidence P=.38, Recommend P=.36, Total Score P=.43). Among the 11 parents who completed the BIRS at the study endpoint, 82% (n=9) endorsed that they slightly agree or agree with over 93% of the Acceptability factor items on the BIRS. Conclusions: The feasibility of this online treatment is endorsed by the high rate of online module completion and attendance to videoconferences within the online parent training group. Acceptability of treatment is supported by strong ratings on the CCQ and significant improvements in scores, as well as strong ratings on the BIRS. This study?s small sample size limits the conclusions that can be drawn; however, the PRT MindNest Health platform holds promise to support parents of autistic children who are unable to access traditional, in-person parent-mediated interventions for their child. UR - https://pediatrics.jmir.org/2022/3/e32520 UR - http://dx.doi.org/10.2196/32520 UR - http://www.ncbi.nlm.nih.gov/pubmed/36066927 ID - info:doi/10.2196/32520 ER - TY - JOUR AU - Johnson, W. Rowan AU - White, K. Becky AU - Gucciardi, F. Daniel AU - Gibson, Noula AU - Williams, A. Sian PY - 2022/8/9 TI - Intervention Mapping of a Gamified Therapy Prescription App for Children With Disabilities: User-Centered Design Approach JO - JMIR Pediatr Parent SP - e34588 VL - 5 IS - 3 KW - neurodevelopmental disability KW - mobile health KW - self-determination theory KW - gamification KW - physiotherapy KW - occupational therapy KW - speech pathology KW - behavior change KW - mobile phone N2 - Background: Mobile health (mHealth) apps for children are increasing in availability and scope. Therapy (physiotherapy, speech pathology, and occupational therapy) prescription apps to improve home or school program adherence work best when developed to be highly engaging for children and when they incorporate behavior change techniques (BCTs) within their design. Objective: The aim of this study was to describe the development of a user-centered therapy prescription app for children (aged 6-12 years) with neurodevelopmental disabilities (eg, cerebral palsy, autism spectrum disorder, and intellectual disability) incorporating intervention mapping (IM) and gamified design. Methods: We used an iterative, user-centered app development model incorporating the first 3 steps of IM. We conducted a needs analysis with user feedback from our previous mHealth app study, a literature review, and a market audit. Change objectives were then specified in alignment with the psychological needs of autonomy, competence, and relatedness identified in self-determination theory. From these objectives, we then selected BCTs, stipulating parameters for effectiveness and how each BCT would be operationalized. A gamification design was planned and implemented focusing on maximizing engagement in children. In total, 2 rounds of consultations with parents, teachers, and therapists and 1 round of prototype app testing with children were conducted to inform app development, with a final iteration developed for further testing. Results: The IM process resulted in the specification of app elements, self-determination theory?informed BCTs, that were embedded into the app design. The gamification design yielded the selection of a digital pet avatar with a fantasy anime visual theme and multiple layers of incentives earned by completing prescribed therapy activities. Consultation groups with professionals working with children with disabilities (4 therapists and 3 teachers) and parents of children with disabilities (n=3) provided insights into the motivation of children and the pragmatics of implementing app-delivered therapy programs that informed the app development. User testing with children with disabilities (n=4) highlighted their enthusiasm for the app and the need for support in the initial phase of learning the app. App quality testing (Mobile Application Rating Scale-user version) with the children yielded means (out of 5) of 4.5 (SD 0.8) for engagement, 3.3 (SD 1.6) for function, 3.3 (SD 1.7) for aesthetics, and 4.3 (SD 1.1) for subjective quality. Conclusions: mHealth apps designed for children can be greatly enhanced with a systematic yet flexible development process considering the specific contextual needs of the children with user-centered design, addressing the need for behavior change using the IM process, and maximizing engagement with gamification and strong visual design. UR - https://pediatrics.jmir.org/2022/3/e34588 UR - http://dx.doi.org/10.2196/34588 UR - http://www.ncbi.nlm.nih.gov/pubmed/35943782 ID - info:doi/10.2196/34588 ER - TY - JOUR AU - Reyes, McNaughton H. Luz AU - Langoni, Armora Eliana Gabriela AU - Sharpless, Laurel AU - Blackburn, Natalie AU - McCort, Agnieszka AU - Macy, J. Rebecca AU - Moracco, E. Kathryn AU - Foshee, A. Vangie PY - 2022/8/5 TI - Web-Based Delivery of a Family-Based Dating Violence Prevention Program for Youth Who Have Been Exposed to Intimate Partner Violence: Protocol for an Acceptability and Feasibility Study JO - JMIR Res Protoc SP - e35487 VL - 11 IS - 8 KW - dating violence KW - adolescents KW - family-based prevention KW - web-based delivery KW - feasibility and acceptability KW - mobile phone N2 - Background: Children exposed to intimate partner violence (IPV) between caregivers are at an increased risk of becoming involved in dating violence during adolescence. However, to date, few adolescent dating violence (ADV) prevention programs have been developed for and evaluated with youth exposed to IPV. An exception is Moms and Teens for Safe Dates (MTSD), an evidence-based ADV prevention program for mothers or maternal caregivers (mothers) exposed to IPV and their teenagers. The MTSD program comprises a series of booklets that families complete together in a home that includes activities to promote positive family communication and healthy teenager relationships. We developed a web-adapted version of the MTSD program?entitled eMoms and Teens for Safe Dates (eMTSD)?to provide a delivery format that may increase program appeal for digitally oriented teenagers, lower dissemination costs, lower reading burden for low-literacy participants, and incorporate built-in cues and reminders to boost program adherence. Objective: This protocol is for a research study that has the following three main objectives: to assess the acceptability of eMTSD; to identify the feasibility of the research process, including program adherence and participant recruitment and assessment; and to explore the acceptability, feasibility, and preliminary efficacy of 2 features?text reminders and the creation of an action plan for engaging with the program?that may increase program uptake and completion. Methods: Approximately 100 mothers and their teenagers will be invited to complete eMTSD, which includes six 30-minute web-based modules over a 6-week period. Mothers will be recruited through community organizations and social media advertising and will be eligible to participate if they have at least 1 teenager aged 12 to 16 years living with them, have experienced IPV after the teenager was born, are not currently living with an abusive partner, and have access to an internet-enabled device. Using a factorial design, enrolled dyads will be randomized to the following four adherence support groups (n=25 dyads per group): text reminders and action planning, text reminders only, action planning only, and no adherence supports. All participants will complete brief web-based assessments at enrollment after each module is completed, after the full program is completed, and 90 days after enrollment. Program adherence will be tracked using website use metrics. Results: The data collected will be synthesized to assess the acceptability of the program and the feasibility of the study procedures. An exploratory analysis will examine the impact of adherence support on program completion levels. In November 2021, ethical approval was received and recruitment was initiated. Data collection is expected to continue until December 2022. Conclusions: The web-based delivery of a family-based healthy relationship program for teenagers exposed to IPV may offer a convenient, low-cost, and engaging approach to preventing ADV. The findings from this study are expected to guide future research. International Registered Report Identifier (IRRID): DERR1-10.2196/35487 UR - https://www.researchprotocols.org/2022/8/e35487 UR - http://dx.doi.org/10.2196/35487 UR - http://www.ncbi.nlm.nih.gov/pubmed/35930332 ID - info:doi/10.2196/35487 ER - TY - JOUR AU - Sadaka, Yair AU - Horwitz, Dana AU - Wolff, Leor AU - Sela, Tomer AU - Meyerovitch, Joseph AU - Peleg, Assaf AU - Bachmat, Eitan AU - Benis, Arriel PY - 2022/8/5 TI - Trends in the Prevalence of Chronic Medication Use Among Children in Israel Between 2010 and 2019: Protocol for a Retrospective Cohort Study JO - JMIR Res Protoc SP - e36756 VL - 11 IS - 8 KW - psychotropic drugs KW - central nervous system stimulants KW - mental health KW - medication therapy management KW - drug prescriptions KW - attention deficit hyperactivity disorder KW - ADHD, Israel KW - children KW - data mining KW - machine learning KW - electronic medical records KW - pediatrics KW - chronic disease KW - epidemiology N2 - Background: Prescription of psychostimulants has significantly increased in most countries worldwide for both preschool and school-aged children. Understanding the trends of chronic medication use among children in different age groups and from different sociodemographic backgrounds is essential. It is essential to distinguish between selected therapy areas to help decision-makers evaluate not only the relevant expected medication costs but also the specific services related to these areas. Objective: This study will analyze differences in trends regarding medications considered psychobehavioral treatments and medications considered nonpsychobehavioral treatments and will identify risk factors and predictors for chronic medication use among children. Methods: This is a retrospective study. Data will be extracted from the Clalit Health Services data warehouse. For each year between 2010 and 2019, there are approximately 1,500,000 children aged 0-18 years. All medication classes will be identi?ed using the Anatomical Therapeutic Chemical code. A time-trend analysis will be performed to investigate if there is a significant difference between the trends of children?s psychobehavioral and nonpsychobehavioral medication prescriptions. A logistic regression combined with machine learning models will be developed to identify variables that may increase the risk for specific chronic medication types and identify children likely to get such treatment. Results: The project was funded in 2019. Data analysis is currently underway, and the results are expected to be submitted for publication in 2022. Understanding trends regarding medications considered psychobehavioral treatments and medications considered nonpsychobehavioral treatments will support the identification of risk factors and predictors for chronic medication use among children. Conclusions: Analyzing the response of the patient (and their parents or caregivers) population over time will hopefully help improve policies for prescriptions and follow-up of chronic treatments in children. International Registered Report Identifier (IRRID): DERR1-10.2196/36756 UR - https://www.researchprotocols.org/2022/8/e36756 UR - http://dx.doi.org/10.2196/36756 UR - http://www.ncbi.nlm.nih.gov/pubmed/35775233 ID - info:doi/10.2196/36756 ER - TY - JOUR AU - Benoit, Britney AU - Cassidy, Christine AU - van Wijlen, Jacqueline AU - Correll, Quinn AU - Campbell-Yeo, Marsha AU - Hendra, Sionnach AU - Martin-Misener, Ruth AU - MacDougall, Jennifer AU - Cameron, Ashley PY - 2022/8/5 TI - Codevelopment of Implementation Interventions to Support Parent-Led Care for Pain in Infants: Protocol for a Qualitative Descriptive Study JO - JMIR Res Protoc SP - e33770 VL - 11 IS - 8 KW - breastfeeding KW - chestfeeding KW - skin-to-skin contact KW - infant pain KW - implementation KW - qualitative N2 - Background: Untreated pain in infants is associated with adverse health outcomes. Despite strong evidence for accessible, effective, and low-cost parent-led pain-relieving interventions such as breastfeeding or chestfeeding and skin-to-skin contact, these interventions are not routinely used. Objective: The objective of this study is to support the implementation of parent-led pain interventions by identifying barriers to and facilitators of parent-led, evidence-informed pain care in infants during acute procedures. In addition, this study aims to develop theory-informed, contextually relevant implementation interventions for supporting the use of parent-led pain care for infants in hospital and community contexts. Methods: This study will consist of 2 phases that follow a systematic, theoretically informed approach guided by the Theoretical Domains Framework and Behavior Change Wheel. In phase 1, we will use a qualitative descriptive design to explore barriers and facilitators to using parent-led pain care in infants from the perspectives of hospital and community-based clinicians, clinical leaders, and families. In phase 2, we will use the Behavior Change Wheel to design tailored implementation interventions that have evidence for effectively addressing identified barriers in collaboration with an advisory committee of administrative, clinical, and family leaders. Results: Ethics approval for this study was obtained in December 2020. As of May 2022, a total of 15 participants have been enrolled in phase 1. The results from all phases will be reported in 2023. Conclusions: Following the completion of this study, we will have co-designed theoretically informed implementation interventions that can be pilot-tested and experimentally applied. The findings will be used to implement parent-led interventions that improve patient safety and health outcomes for diverse families. International Registered Report Identifier (IRRID): DERR1-10.2196/33770 UR - https://www.researchprotocols.org/2022/8/e33770 UR - http://dx.doi.org/10.2196/33770 UR - http://www.ncbi.nlm.nih.gov/pubmed/35930339 ID - info:doi/10.2196/33770 ER - TY - JOUR AU - Midgett, Aida AU - Doumas, M. Diana AU - Buller, K. Mary PY - 2022/8/3 TI - Posttraining Outcomes, Acceptability, and Technology-Based Delivery of the STAC Bystander Bullying Intervention Teacher Module: Mixed Methods Study JO - JMIR Form Res SP - e40022 VL - 6 IS - 8 KW - teacher bullying interventions KW - technology-based bullying intervention KW - STAC KW - middle school N2 - Background: Bullying is a significant problem for youth associated with wide-ranging negative consequences. Providing students who witness bullying with intervention strategies to act as defenders can reduce bullying and negative associated outcomes for both targets and bystanders. Educating teachers about bullying and training them to support students to intervene as defenders may increase the efficacy of bystander programs as teachers? attitudes and responses to bullying relate to bystander behavior. This is particularly important in middle school, when bullying peaks and rates of reporting bullying to teachers begin to decline. Reducing implementation barriers, including limited time and resources, must also be considered, particularly for schools in low-income and rural areas. Technology-based programs can increase access and scalability but require participant buy-in for adoption. Objective: We used a mixed methods design to inform the development of the STAC teacher module, a companion training to a brief bullying bystander intervention. STAC stands for the four bystander intervention strategies: Stealing the Show, Turning it Over, Accompanying Others, and Coaching Compassion. Objectives included examining the effectiveness of the STAC teacher module and informing the translation of the training into a technology-based format that can be used as a companion to the technology-based STAC. Methods: A sample of 17 teachers recruited from 1 middle school in a rural, low-income community completed pre- and posttraining surveys assessing immediate outcomes (ie, knowledge, confidence, comfort, and self-efficacy), intention to use program strategies, and program acceptability and relevance, followed by a qualitative focus group obtaining feedback regarding program appropriateness, feasibility, content, perception of need, and desire for web-based training. Descriptive statistics, 2-tailed independent-sample t tests, and thematic analyses were used to analyze the data. Results: Assessment of pre- and posttraining surveys indicated that teachers reported an increase in knowledge and confidence to support defenders, confidence and comfort in managing bullying, and bullying self-efficacy. Furthermore, most participants reported that they were likely or very likely to use STAC strategies to support students who intervene in bullying. Quantitative and qualitative data revealed that participants found the training easy to use, useful, relevant, and appropriate. Qualitative data provided feedback on ways of improving the program, including revising role-plays and guidance on understanding student behavior. Participants shared positive perceptions regarding program feasibility and need for bullying-specific prevention, the most significant barriers being cost and parent buy-in, suggesting the importance of including parents in the prevention process. Finally, participants shared the strengths of a web-based program, including ease of implementation and time efficiency, while indicating the importance of participant engagement and administration buy-in. Conclusions: This study demonstrates the effectiveness of the STAC teacher module in increasing knowledge and bullying self-efficacy and provides support for developing the module, including key information regarding considerations for web-based translation. UR - https://formative.jmir.org/2022/8/e40022 UR - http://dx.doi.org/10.2196/40022 UR - http://www.ncbi.nlm.nih.gov/pubmed/35921129 ID - info:doi/10.2196/40022 ER - TY - JOUR AU - Wood, D. Michael AU - Correa, Kim AU - Ding, Peijia AU - Sreepada, Rama AU - Loftsgard, C. Kent AU - Jordan, Isabel AU - West, C. Nicholas AU - Whyte, D. Simon AU - Portales-Casamar, Elodie AU - Görges, Matthias PY - 2022/7/15 TI - Identification of Requirements for a Postoperative Pediatric Pain Risk Communication Tool: Focus Group Study With Clinicians and Family Members JO - JMIR Pediatr Parent SP - e37353 VL - 5 IS - 3 KW - eHealth KW - risk communication KW - risk KW - decision aid KW - pain KW - individualized risk KW - surgery KW - anesthesia KW - anesthetic KW - anesthesiology KW - focus group KW - requirement definition KW - prototyping KW - prototype KW - pediatrics KW - pediatric KW - child KW - postoperative KW - prediction KW - digital health KW - development KW - user feedback KW - patient feedback KW - user-centered design N2 - Background: Pediatric surgery is associated with a risk of postoperative pain that can impact the family?s quality of life. Although some risk factors for postoperative pain are known, these are often not consistently communicated to families. In addition, although tools for risk communication exist in other domains, none are tailored to pediatric surgery. Objective: As part of a larger project to develop pain risk prediction tools, we aimed to design an easy-to-use tool to effectively communicate a child?s risk of postoperative pain to both clinicians and family members. Methods: With research ethics board approval, we conducted virtual focus groups (~1 hour each) comprising clinicians and family members (people with lived surgical experience and parents of children who had recently undergone surgery/medical procedures) at a tertiary pediatric hospital to understand and evaluate potential design approaches and strategies for effectively communicating and visualizing postoperative pain risk. Data were analyzed thematically to generate design requirements and to inform iterative prototype development. Results: In total, 19 participants (clinicians: n=10, 53%; family members: n=9, 47%) attended 6 focus group sessions. Participants indicated that risk was typically communicated verbally by clinicians to patients and their families, with severity indicated using a descriptive or a numerical representation or both, which would only occasionally be contextualized. Participants indicated that risk communication tools were seldom used but that families would benefit from risk information, time to reflect on the information, and follow-up with questions. In addition, 9 key design requirements and feature considerations for effective risk communication were identified: (1) present risk information clearly and with contextualization, (2) quantify the risk and contextualize it, (3) include checklists for preoperative family preparation, (4) provide risk information digitally to facilitate recall and sharing, (5) query the family?s understanding to ensure comprehension of risk, (6) present the risk score using multimodal formats, (7) use color coding that is nonthreatening and avoids limitations with color blindness, (8) present the most significant factors contributing to the risk prediction, and (9) provide risk mitigation strategies to potentially decrease the patient?s level of risk. Conclusions: Key design requirements for a pediatric postoperative pain risk visualization tool were established and guided the development of an initial prototype. Implementing a risk communication tool into clinical practice has the potential to bridge existing gaps in the accessibility, utilization, and comprehension of personalized risk information between health care professionals and family members. Future iterative codesign and clinical evaluation of this risk communication tool are needed to confirm its utility in practice. UR - https://pediatrics.jmir.org/2022/3/e37353 UR - http://dx.doi.org/10.2196/37353 UR - http://www.ncbi.nlm.nih.gov/pubmed/35838823 ID - info:doi/10.2196/37353 ER - TY - JOUR AU - Veldscholte, Karlien AU - Cramer, G. Arnout B. AU - de Jonge, J. Rogier C. AU - Eveleens, D. Renate AU - Joosten, M. Koenraad F. AU - Verbruggen, T. Sascha C. A. PY - 2022/6/23 TI - Continuous Versus Intermittent Nutrition in Pediatric Intensive Care Patients: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e36229 VL - 11 IS - 6 KW - pediatric intensive care unit KW - PICU KW - pediatric critical illness KW - time-restricted feeding KW - intermittent fasting KW - feeding intolerance KW - ketones KW - circadian rhythm N2 - Background: Intermittent fasting is a time-restricted feeding strategy with proven health benefits, which is based on multiple metabolic and endocrine changes, in several patient populations and healthy participants. In the pediatric intensive care unit (PICU), artificial feeding is usually administered 24 hours a day, although solid evidence supporting this practice is lacking. This discards the potential benefits of fasting in this population. We hypothesize that intermittent nutrition with a focus on an overnight feeding interruption (intermittent fasting), as compared with 24-hour continuous nutrition, is a feasible and safe strategy, with potential benefits, for critically ill children. Objective: The aim of the Continuous versus Intermittent Nutrition in Pediatric Intensive Care randomized controlled trial (RCT) is to investigate a strategy of intermittent nutrition with a focus on an overnight feeding interruption period versus 24-hour nutrition during the first 14 days in the PICU. Methods: The Continuous versus Intermittent Nutrition in Pediatric Intensive Care study is an investigator-initiated RCT in a tertiary referral PICU. Critically ill children (term newborn to 18 years), expected to stay in the PICU for ?48 hours, and dependent on artificial nutrition, are eligible for inclusion. This study will randomize critically ill children (n=140) to a continuous versus intermittent nutrition strategy. In both groups, similar daily caloric targets will be prescribed. In the continuous group (control), nutrition will be administered 24 hours a day, with a maximum interruption period of 2 hours. In the intermittent group (intervention), nutrition will be interrupted during an age-dependent overnight fasting period. The study intervention will last until admission day 14, initiation of oral intake, or discharge from the PICU, whichever comes first. The primary outcome is the difference in ketosis between the groups under the condition of noninferiority regarding caloric intake. Secondary outcomes are feeding intolerance; the proportion of severe and resistant hypoglycemic events and severe gastrointestinal complications; and additional observed effects on nutritional intake, circadian rhythm, and clinically relevant outcome measures of the intermittent feeding strategy compared with continuous nutrition. Results: The study was approved by the Dutch national ethical review board in February 2020. The first patient was enrolled on May 19, 2020. By May 2022, a total of 132 patients had been included in the study. Recruitment of the last patient is expected in Q3 2022. Conclusions: Although intermittent fasting has been proven to have many health benefits in both animal and human studies, the feasibility and safety of this strategy in a PICU setting must be investigated. This RCT will help physicians gain more insight into the feasibility, safety, and potential clinical effects of intermittent feeding with overnight fasting in critically ill children. Trial Registration: Netherlands Trial Register NL7877; https://trialsearch.who.int/Trial2.aspx?TrialID=NL7877 International Registered Report Identifier (IRRID): DERR1-10.2196/36229 UR - https://www.researchprotocols.org/2022/6/e36229 UR - http://dx.doi.org/10.2196/36229 UR - http://www.ncbi.nlm.nih.gov/pubmed/35737448 ID - info:doi/10.2196/36229 ER - TY - JOUR AU - Papan, Cihan AU - Reifenrath, Katharina AU - Last, Katharina AU - Attarbaschi, Andishe AU - Graf, Norbert AU - Groll, H. Andreas AU - Huebner, Johannes AU - Laws, Hans-Jürgen AU - Lehrnbecher, Thomas AU - Liese, Johannes AU - Martin, Luise AU - Tenenbaum, Tobias AU - Weichert, Stefan AU - Vieth, Simon AU - von Both, Ulrich AU - Hufnagel, Markus AU - Simon, Arne PY - 2022/6/20 TI - Antimicrobial Use in Pediatric Oncology and Hematology: Protocol for a Multicenter Point-Prevalence Study With Qualitative Expert Panel Assessment JO - JMIR Res Protoc SP - e35774 VL - 11 IS - 6 KW - point-prevalence study KW - antimicrobial stewardship KW - pediatric oncology KW - pediatric hematology KW - expert panel KW - antimicrobial resistance KW - oncology KW - cancer KW - pediatrics N2 - Background: Because infections are a major driver of morbidity and mortality in children with hematologic or oncologic diseases, antimicrobials are frequently prescribed in pediatric oncology practice. However, excess or inappropriate use of antimicrobials is directly linked to the emergence of antimicrobial resistance. Although point-prevalence studies have examined the extent of antimicrobial use, a comprehensive qualitative evaluation of individual antimicrobial prescriptions remains lacking. Objective: The aim of this study is to identify appropriate versus inappropriate antimicrobial use among pediatric cancer patients in a point-prevalence study, followed by an expert panel adjudication process and a subsequent report of these findings to participating centers. This study also aims to improve the quality of patient care by informing centers about discrepancies between internal standards of care and national guidelines. Methods: Our point-prevalence study is performed at pediatric cancer centers in Germany and Austria. All patients under 18 years old who are hospitalized at the time of the study are included. As a supplement to the point-prevalence study, an expert panel is qualitatively assessing each of the antimicrobial prescriptions at the participating centers to review local guidelines and compare them with national guidelines. Results: As of December 2021, the point-prevalence survey has been conducted at 30 sites and expert panel adjudication for qualitative assessment of each antimicrobial use is ongoing. Results of the study are expected in 2022. Conclusions: This is the first point-prevalence study conducted among pediatric cancer centers with an integrated, multistep, qualitative approach that assesses each antimicrobial prescription. The results of this study will inform possible interventions for internal guidelines and antimicrobial stewardship programs implemented at pediatric cancer centers. In addition, local guidelines will be compared with national guidelines. Furthermore, this study will contribute to the overall integration of antimicrobial stewardship principles and initiatives in pediatric oncology and hematology, thereby improving safety and quality of care for children and adolescents with cancer and blood disorders. International Registered Report Identifier (IRRID): DERR1-10.2196/35774 UR - https://www.researchprotocols.org/2022/6/e35774 UR - http://dx.doi.org/10.2196/35774 UR - http://www.ncbi.nlm.nih.gov/pubmed/35723906 ID - info:doi/10.2196/35774 ER - TY - JOUR AU - McCrady, Emma AU - Strychowsky, E. Julie AU - Woolfson, P. Jessica PY - 2022/6/15 TI - Experience of Pediatricians and Pediatric Surgeons With Virtual Care During the COVID-19 Pandemic: Descriptive Study JO - JMIR Pediatr Parent SP - e34115 VL - 5 IS - 2 KW - virtual care KW - web-based care KW - COVID-19 KW - pediatrics KW - pandemic KW - physicians KW - digital health KW - pediatricians KW - telehealth N2 - Background: Prior to the COVID-19 pandemic, in-clinic visits were the standard of care for pediatric physicians and surgeons at our center. At the pandemic onset, web-based care was adopted at an unprecedented scale and pace. Objective: This descriptive study explores the web-based care experience of pediatric physicians and surgeons during the pandemic by determining factors that supported and challenged web-based care adoption. Methods: This study took place at the Children?s Hospital at London Health Sciences Centre, a children?s hospital in London, Ontario, Canada, which provides pediatric care for patients from the London metropolitan area and the rest of Southwestern Ontario. The Donabedian model was used to structure a web-based survey evaluating web-based care experience, which was distributed to 121 department-affiliated pediatric physicians (including generalists and subspecialists in surgery and medicine). Recruitment occurred via department listserv email. Qualitative data were collected through discrete and free-text survey responses. Results: Survey response rate was 52.1% (63/121). Before the pandemic, few physicians within the Department of Paediatrics used web-based care, and physicians saw <10% of patients digitally. During March-May 2020, the majority transitioned to web-based care, seeing >50% of patients digitally. Web-based care use in our sample fell from June to September 2020, with the majority seeing <50% of patients digitally. Telephone and Ontario Telemedicine Network were the platforms most used from March to September 2020. Web-based care was rated to be convenient for most providers and their patients, despite the presence of technical difficulties. Challenges included lack of physical exam, lower patient volumes, and poor patient digital care etiquette. Regardless of demographics, 96.4% (116/121) would continue web-based care, ideally for patients who live far away and for follow-ups or established diagnoses. Conclusions: Transition to web-based care during COVID-19 was associated with challenges but also positive experiences. Willingness among pediatricians and pediatric surgeons to continue web-based care was high. Web-based care experiences at our center could be improved with patient education and targeting select populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for web-based care. UR - https://pediatrics.jmir.org/2022/2/e34115 UR - http://dx.doi.org/10.2196/34115 UR - http://www.ncbi.nlm.nih.gov/pubmed/35666938 ID - info:doi/10.2196/34115 ER - TY - JOUR AU - Bello-Manga, Halima AU - Haliru, Lawal AU - Ahmed, Abdulkareem Kudrat AU - Tabari, Musa Abdulkadir AU - Farouk, Usman Bilkisu AU - Bahago, Yimi Gloria AU - Kazaure, Shuaibu Aisha AU - Muhammad, Sani Abdulrasheed AU - Gwarzo, Abubakar Samira AU - Baumann, A. Ana AU - DeBaun, R. Michael AU - King, A. Allison PY - 2022/6/13 TI - Primary Prevention of Stroke in Children With Sickle Cell Anemia in Nigeria: Protocol for a Mixed Methods Implementation Study in a Community Hospital JO - JMIR Res Protoc SP - e37927 VL - 11 IS - 6 KW - sickle cell anemia KW - stroke prevention KW - transcranial Doppler ultrasonography N2 - Background: In Nigeria, approximately 150,000 children with sickle cell anemia (SCA) are born annually, accounting for more than half of all SCA births worldwide. Without intervention, about 11% of children with SCA will develop a stroke before their 20th birthday. Evidence-based practices for primary stroke prevention include screening for abnormal transcranial Doppler (TCD) measurements coupled with regular blood transfusion therapy for at least one year, followed by hydroxyurea (HU) therapy indefinitely. In high-resource countries, this strategy contributes to a 92% decrease in stroke incidence rates. In 2016, as part of a capacity building objective of the Stroke Prevention Trial in Nigeria (1R01NS094041: SPRING), TCD screening was adopted as standard care at Barau Dikko Teaching Hospital in Kaduna. However, with just 70 radiologists and only 3 certified in TCD screening in the state, just 5.49% (1101/20,040) of eligible children with SCA were screened. Thus, there is a need to explore alternate implementation strategies to ensure children with SCA receive standard care TCD screening to decrease stroke incidence. Objective: This protocol describes a study to create a stroke prevention program in a community hospital in Kaduna through task shifting TCD screening to nurses and training medical officers to initiate and monitor HU utilization for stroke prevention. Methods: This study will be conducted at 2 sites (teaching hospital and community hospital) over a period of 3 years (November 2020 to November 2023), in 3 phases using both quasi-experimental and effectiveness-implementation study designs. In the needs assessment phase, focus groups and structured interviews will be conducted with health care providers and hospital administrators to identify barriers and facilitators to evidence-based stroke prevention practices. Results from the needs assessment will inform intervention strategies and a process plan to fit the needs of the community hospital. In the capacity building phase, nurses and medical officers at the community hospital will be trained on TCD screening and HU initiation and monitoring. In the implementation phase, children with SCA aged 2-16 years will be recruited into a nonrandomized single-arm prospective trial to determine the feasibility of initiating a task-shifted stroke prevention program by recording recruitment, retention, and adherence rates. The Reach and Effectiveness components of the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework will be used to evaluate implementation outcomes between the community and teaching hospitals. Results: The needs assessment phase of the study was completed in February 2021. Manuscript on findings is currently in preparation. Capacity building is ongoing with TCD training and sickle cell disease and stroke education sessions for nurses and doctors in the community hospital. Recruitment for the implementation trial is expected to commence in July 2022. Conclusions: This study proposes a structured, theory-driven approach to create a stroke prevention program in a community hospital in Kaduna, Nigeria, to decrease stroke incidence among children with SCA. Results will provide preliminary data for a definitive randomized clinical trial in implementation science. International Registered Report Identifier (IRRID): PRR1-10.2196/37927 UR - https://www.researchprotocols.org/2022/6/e37927 UR - http://dx.doi.org/10.2196/37927 UR - http://www.ncbi.nlm.nih.gov/pubmed/35700018 ID - info:doi/10.2196/37927 ER - TY - JOUR AU - Cederved, Catarina AU - Back, Jon AU - Ångström-Brännström, Charlotte AU - Ljungman, Gustaf AU - Engvall, Gunn PY - 2022/5/31 TI - Co-creation of a Serious Game About Radiotherapy: Participatory Action Research Study With Children Treated for Cancer JO - JMIR Hum Factors SP - e34476 VL - 9 IS - 2 KW - children KW - participatory action research KW - game design KW - radiotherapy KW - education KW - supportive care KW - oncology N2 - Background: Children with cancer who have to undergo radiotherapy can experience fear, because they have no prior knowledge of the treatment. One way of teaching children about the treatment and reducing their fear is to prepare them for it through serious games. Involvement of the end user in the design process within medicine is a way of ensuring that the product being developed will fit the intended user. Objective: The aim was to outline the contributions made by children and their parents through participatory action research when designing a serious game about radiotherapy. Methods: By means of participatory action research, children and their parents participated in the development of a serious game about radiotherapy. Nine children (7-10 years old) were included, each with an accompanying parent. A qualitative approach was used that included interviews and participant observation. Six rounds of iterative development process were used with the children and their parents. Meetings with the children were held either face-to-face or online. Each round resulted in a list of suggestions for changes to the game. A thematic analysis was performed based on the list of proposed changes, underpinned by all gathered data, to highlight how the children?s participation changed the game. Results: Two main themes were identified. The first theme was ?The children?s participation was affected by their health and treatment? and included the following subthemes: ?an opportunity to share emotions and perceptions of radiotherapy? and ?the possibility to participate was affected by the severity of the disease.? The second theme was ?participation allowed becoming an active part of game development? and included the following subthemes: ?the opportunity to express sentiments about the game,? ?the emergence of a playable game through the children?s contributions,? and ?the necessity of understanding the text.? Conclusions: The method used in this study made the children active participants, and our results suggest that this method can be used by health care researchers to cocreate serious games with children. It is necessary to inform the children involved that the process takes time, and that the process can be altered to allow as much participation as possible without placing a burden on them. The children?s illness affected their possibility to take part; thus, it is crucial to accommodate the children?s needs when conducting similar studies. The parents? participation facilitated the meetings for their children, even though their involvement in the game design was negligible. UR - https://humanfactors.jmir.org/2022/2/e34476/ UR - http://dx.doi.org/10.2196/34476 UR - http://www.ncbi.nlm.nih.gov/pubmed/35639467 ID - info:doi/10.2196/34476 ER - TY - JOUR AU - Long, Valencia AU - Chandran, Suyien Nisha PY - 2022/5/17 TI - A Glance at the Practice of Pediatric Teledermatology Pre- and Post?COVID-19: Narrative Review JO - JMIR Dermatol SP - e34228 VL - 5 IS - 2 KW - teledermatology KW - telehealth KW - telemedicine KW - pediatric teledermatology KW - COVID-19 KW - pandemic KW - dermatology KW - pediatric KW - children N2 - Background: The COVID-19 pandemic has accelerated the use of pediatric teledermatology, with centers showing increased uptake of teledermatology. Pediatric patients possess unique characteristics that pose different challenges with teledermatology compared to adults, in turn affecting the feasibility and uptake of pediatric teledermatology in the community. Objective: This narrative review summarizes the evolution of pediatric teledermatology from pre?COVID-19 pandemic times to the post?COVID-19 period. Methods: A search of MEDLINE, PubMed, and Embase was performed for original articles written in English and published from December 1, 2019, to April 1, 2022. Results: A total of 22 publications were included. Conclusions: Teledermatology will continue to play an increasing role in the management of skin diseases. A mindset shift in the types of conditions deemed suitable for pediatric teledermatology is needed. UR - https://derma.jmir.org/2022/2/e34228 UR - http://dx.doi.org/10.2196/34228 UR - http://www.ncbi.nlm.nih.gov/pubmed/35610984 ID - info:doi/10.2196/34228 ER - TY - JOUR AU - Moreno, P. Jennette AU - Dadabhoy, Hafza AU - Musaad, Salma AU - Baranowski, Tom AU - Thompson, Debbe AU - Alfano, A. Candice AU - Crowley, J. Stephanie PY - 2022/5/16 TI - Evaluation of a Circadian Rhythm and Sleep-Focused Mobile Health Intervention for the Prevention of Accelerated Summer Weight Gain Among Elementary School?Age Children: Protocol for a Randomized Controlled Feasibility Study JO - JMIR Res Protoc SP - e37002 VL - 11 IS - 5 KW - summer KW - circadian rhythms KW - sleep KW - child obesity KW - elementary school N2 - Background: The i?rhythm project is a mobile health adaptation of interpersonal and social rhythm therapy designed to promote healthy sleep and behavioral rhythms among 5-8-year olds during summer for the prevention of accelerated summer weight gain. Objective: This pilot study will examine the feasibility, acceptability, and preliminary efficacy of the i?rhythm intervention. This will ensure that the research protocol and procedures work as desired and are acceptable to families in preparation for the fully powered randomized controlled trial. The proposed study will examine the willingness of participants to participate in the intervention and determine whether modifications to the intervention, procedures, and measures are needed before conducting a fully powered study. We will assess our ability to (1) recruit, consent, and retain participants; (2) deliver the intervention; (3) implement the study and assessment procedures; (4) assess the reliability of the proposed measures; and (5) assess the acceptability of the intervention and assessment protocol. Methods: This study will employ a single-blinded 2-group randomized control design (treatment and no-treatment control) with randomization occurring after baseline (Time 0) and 3 additional evaluation periods (postintervention [Time 1], and 9 months [Time 2] and 12 months after intervention [Time 3]). A sample of 40 parent-child dyads will be recruited. Results: This study was approved by the institutional review board of Baylor College of Medicine (H-47369). Recruitment began in March 2021. As of March 2022, data collection and recruitment are ongoing. Conclusions: This study will address the role of sleep and circadian rhythms in the prevention of accelerated summer weight gain and assess the intervention?s effects on the long-term prevention of child obesity. Trial Registration: ClinicalTrials.gov NCT04445740; https://clinicaltrials.gov/ct2/show/NCT04445740. International Registered Report Identifier (IRRID): DERR1-10.2196/37002 UR - https://www.researchprotocols.org/2022/5/e37002 UR - http://dx.doi.org/10.2196/37002 UR - http://www.ncbi.nlm.nih.gov/pubmed/35576573 ID - info:doi/10.2196/37002 ER - TY - JOUR AU - Mulligan, Kathleen AU - Hirani, P. Shashivadan AU - Harris, Sally AU - Taylor, Jo AU - Wedderburn, R. Lucy AU - Newman, Stanton AU - PY - 2022/5/12 TI - The Effects of a Web-Based Tool for Parents of Children With Juvenile Idiopathic Arthritis: Randomized Controlled Trial JO - J Med Internet Res SP - e29787 VL - 24 IS - 5 KW - parenting stress KW - juvenile idiopathic arthritis KW - web-based intervention KW - randomized controlled trial KW - parenting KW - pediatrics KW - arthritis KW - RCT KW - rheumatology KW - children KW - youth KW - web-based tool KW - mobile phone N2 - Background: Juvenile idiopathic arthritis (JIA) is a group of autoinflammatory diseases that cause pain and disability if not controlled by treatment. Parenting a child with JIA is stressful for parents, who express concerns about their child?s treatment and may experience anxiety and powerlessness concerning their child?s illness. Parenting stress is greater in parents of children with chronic illness than in those with healthy children and is related to poorer psychological adjustment in both parents and children. It is therefore important to develop interventions to support parents. This paper reports the evaluation of a web-based tool that provides information and practical skills to help increase parents? confidence in managing their child?s illness and reduce parenting stress. Objective: The aim of this study is to evaluate the benefits of a web-based tool (WebParC) for parents of children with recently diagnosed JIA. Methods: A multicentered randomized controlled trial was conducted at pediatric rheumatology centers in England. We recruited parents of children aged ?12 years who had been diagnosed with JIA within the previous 6 months. They were randomized to the intervention (WebParC access plus standard care) or the control (standard care alone) and followed up 4 months and 12 months after randomization. Where both parents participated, they were randomized by household to the same trial arm. The WebParC intervention consists of information about JIA and its treatment plus a toolkit, based on cognitive behavioral therapy, to help parents develop skills to manage JIA-related issues. The primary outcome was the self-report Pediatric Inventory for Parents measure of illness-related parenting stress. The secondary outcomes were parental mood, self-efficacy, coping, effectiveness of participation in their child?s health care, satisfaction with health care, and child?s health-related quality of life. Results: A total of 203 households comprising 220 parents were randomized to the intervention (100/203, 49.3%) or control (103/203, 50.7%) arm. Follow-up assessments were completed by 65.5% (133/203) of the households at 4 months (intervention 60/100, 60%, and control 73/103, 70.9%) and 61.1% (124/203) of the households at 12 months (intervention 58/100, 58%, and control 66/103, 64.1%). A main effect of the trial arm was found on the Pediatric Inventory for Parents: the intervention participants reported less frequency (subscales communication F1,120627=5.37; P=.02, and role function F1,27203=5.40; P=.02) and difficulty (subscales communication F1,2237=7.43; P=.006, medical care F1,2907=4.04; P=.04, and role function F1,821=4.37, P=.04) regarding illness-related stressful events than the control participants. Conclusions: The WebParC website for parents of children with JIA reduced illness-related parenting stress. This web-based intervention offers a feasible preventive approach for parents of children with JIA and potentially could be adapted and evaluated for parents of children with other chronic illnesses. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 13159730; http://www.isrctn.com/ISRCTN13159730 UR - https://www.jmir.org/2022/5/e29787 UR - http://dx.doi.org/10.2196/29787 UR - http://www.ncbi.nlm.nih.gov/pubmed/35551065 ID - info:doi/10.2196/29787 ER - TY - JOUR AU - Stewart, Elizabeth AU - Milton, Alyssa AU - Yee, Frances Hannah AU - Song, Jae Michael AU - Roberts, Anna AU - Davenport, Tracey AU - Hickie, Ian PY - 2022/5/12 TI - eHealth Tools That Assess and Track Health and Well-being in Children and Young People: Systematic Review JO - J Med Internet Res SP - e26015 VL - 24 IS - 5 KW - eHealth KW - children KW - young people KW - health KW - technology KW - mobile phone N2 - Background: eHealth tools that assess and track health outcomes in children or young people are an emerging type of technology that has the potential to reform health service delivery and facilitate integrated, interdisciplinary care. Objective: The aim of this review is to summarize eHealth tools that have assessed and tracked health in children or young people to provide greater clarity around the populations and settings in which they have been used, characteristics of digital devices (eg, health domains, respondents, presence of tracking, and connection to care), primary outcomes, and risks and challenges of implementation. Methods: A search was conducted in PsycINFO, PubMed or MEDLINE, and Embase in April 2020. Studies were included if they evaluated a digital device whose primary purpose was to assess and track health, focused on children or young people (birth to the age of 24 years), reported original research, and were published in peer-reviewed journals in English. Results: A total of 39 papers were included in this review. The sample sizes ranged from 7 to 149,329 participants (median 163, mean 5155). More studies were conducted in urban (18/39, 46%) regions than in rural (3/39, 8%) regions or a combination of urban and rural areas (8/39, 21%). Devices were implemented in three main settings: outpatient health clinics (12/39, 31%), hospitals (14/39, 36%), community outreach (10/39, 26%), or a combination of these settings (3/39, 8%). Mental and general health were the most common health domains assessed, with a single study assessing multiple health domains. Just under half of the devices tracked children?s health over time (16/39, 41%), and two-thirds (25/39, 64%) connected children or young people to clinical care. It was more common for information to be collected from a single informant (ie, the child or young person, trained health worker, clinician, and parent or caregiver) than from multiple informants. The health of children or young people was assessed as a primary or secondary outcome in 36% (14/39) of studies; however, only 3% (1/39) of studies assessed whether using the digital tool improved the health of users. Most papers reported early phase research (formative or process evaluations), with fewer outcome evaluations and only 3 randomized controlled trials. Identified challenges or risks were related to accessibility, clinical utility and safety, uptake, data quality, user interface or design aspects of the device, language proficiency or literacy, sociocultural barriers, and privacy or confidentiality concerns; ways to address these barriers were not thoroughly explored. Conclusions: eHealth tools that assess and track health in children or young people have the potential to enhance health service delivery; however, a strong evidence base validating the clinical utility, efficacy, and safety of tools is lacking, and more thorough investigation is needed to address the risks and challenges of using these emerging technologies in clinical care. At present, there is greater potential for the tools to facilitate multi-informant, multidomain assessments and longitudinally track health over time and room for further implementation in rural or remote regions and community settings around the world. UR - https://www.jmir.org/2022/5/e26015 UR - http://dx.doi.org/10.2196/26015 UR - http://www.ncbi.nlm.nih.gov/pubmed/35550285 ID - info:doi/10.2196/26015 ER - TY - JOUR AU - Campbell, Alyson AU - Hartling, Lisa AU - Plourde, Vickie AU - Scott, D. Shannon PY - 2022/5/10 TI - Parental Knowledge, Self-confidence, and Usability Evaluation of a Web-Based Infographic for Pediatric Concussion: Multimethod Study JO - JMIR Pediatr Parent SP - e36317 VL - 5 IS - 2 KW - concussion KW - mTBI KW - usability evaluation KW - knowledge assessment KW - knowledge translation KW - parent knowledge KW - parent confidence KW - patient engagement KW - educational tool N2 - Background: Concussions, which are known as mild traumatic brain injuries, are complex injuries caused by direct or indirect blows to the head and are increasingly being recognized as a significant public health concern for children and their families. Previous research has identified few studies examining the efficacy of educational interventions on parental concussion knowledge. The aim of this research was to actively work together with children who have experienced a concussion and their parents to develop, refine, and evaluate the usability of a web-based infographic for pediatric concussion. Objective: The objective of this study was to report on the usability of the infographic, parental knowledge, and self-confidence in pediatric concussion knowledge before and after exposure to the infographic. Methods: A multiphase, multimethod research design using patient engagement techniques was used to develop a web-based infographic. For this phase of the research (usability, knowledge, and confidence evaluation), parents who could communicate in English were recruited via social media platforms and invited to complete web-based questionnaires. Electronic preintervention and postintervention questionnaires were administered to parents to assess changes to concussion knowledge and confidence after viewing the infographic. A usability questionnaire with 11 items was also completed. Results: A web-based, infographic was developed. The infographic is intended for parents and children and incorporates information that parents and children identified as both wants and needs about concussion alongside the best available research evidence on pediatric concussion. A total of 31 surveys were completed by parents. The mean scores for each item on the usability surveys ranged from 8.03 (SD 1.70) to 9.26 (SD 1.09) on a 10-point Likert scale, indicating that the usability components of the infographic were largely positive. There was no statistically significant difference between preintervention and postintervention knowledge scores (Z=?0.593; P=.55; both preintervention and postintervention knowledge scores had a median of 9 out of 10). In contrast, there was a statistically significant difference between preintervention (mean 3.9/5, SD 0.56) and postintervention (mean 4.4/5, SD 0.44) confidence in knowledge scores (t30=?5.083; P<.001). Conclusions: Our results demonstrate that parents positively rated a web-based, infographic for pediatric concussion. In addition, although there was no statistically significant difference overall in parents? knowledge scores before and after viewing the infographic, their confidence in their knowledge did significantly increase. These results suggest that using a web-based infographic as a knowledge translation intervention may be useful in increasing parents? confidence in managing their child?s concussion. UR - https://pediatrics.jmir.org/2022/2/e36317 UR - http://dx.doi.org/10.2196/36317 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536631 ID - info:doi/10.2196/36317 ER - TY - JOUR AU - Cho, Yen-Hua AU - Chiang, Yi-Chien AU - Chu, Tsung-Lan AU - Chang, Chi-Wen AU - Chang, Chun-Chu AU - Tsai, Hsiu-Min PY - 2022/4/29 TI - The Effectiveness of the Buzzy Device for Pain Relief in Children During Intravenous Injection: Quasirandomized Study JO - JMIR Pediatr Parent SP - e15757 VL - 5 IS - 2 KW - hospitalized children KW - intravenous injection KW - pain KW - Buzzy N2 - Background: Intravenous injection is the most common medical treatment and the main cause of pain in hospitalized children. If there is no appropriate health care for pain relief, the proportion of moderate and severe pain often exceeds 70%. With nonpharmaceutical-based pain management, Buzzy is recognized as an effective device for rapidly relieving injection pain in hospitalized children. However, Buzzy is not widely used in Asia and very few experimental studies in Asia have addressed the effectiveness of the Buzzy device at treating needle pain in hospitalized children. Objective: The main purpose of this study was to investigate the effectiveness of the Buzzy device for diminishing pain levels among hospitalized children in Taiwan. Methods: We applied a quasiexperimental design with random assignment. According to the time of admission, child participants were randomly assigned to treatment and nontreatment groups. The Buzzy device was applied as an intervention in this study. The samples size was 30 per group. The study participants were recruited from the pediatric ward of a medical center in northern Taiwan. The research data were collected longitudinally at three time points: before, during, and after intravenous injection. Three instruments were used for assessment: a demographic information sheet, the Wong-Baker Face Scale (WBFS), and the Faces Legs Activity Cry Consolability (FLACC) scale. The data were analyzed by descriptive analysis, the Mann-Whitney U test, the Wilcoxon signed-rank test, and the ?2 test. Results: A total of 60 hospitalized children aged 3 to 7 years participated in this study, including 30 participants in the treatment group and 30 participants in the nontreatment group. The average age of children in the treatment and nontreatment groups was 5.04 years and 4.38 years, respectively. Buzzy significantly mitigated pain in children during intravenous injection with a significant difference between the two groups in pain-related response (FLACC) and actual pain (WBFS) (Z=?3.551, P<.001 and Z=?3.880, P<.001, respectively). The children in the treatment group had a significantly more pleasant experience than those in the nontreatment group (Z=?2.387, P=.02). When Buzzy was employed, the children experienced less pain than they did during previous intravenous injections (Z=?3.643, P<.001). Conclusions: The intervention of using the Buzzy device was effective in reducing pain levels of intravenous injection among hospitalized children. The specific focus on children in Asia makes a valuable contribution to the literature. For clinical application, the reliable pain relief measure of Buzzy can be used in other Asian children to help health care providers improve noninvasive care among children. For future applications, researchers could integrate Buzzy into therapy-related games and a technology-based app to increase the efficiency of use and provide more data collection functions. UR - https://pediatrics.jmir.org/2022/2/e15757 UR - http://dx.doi.org/10.2196/15757 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486419 ID - info:doi/10.2196/15757 ER - TY - JOUR AU - El Tantawi, Maha AU - Folayan, O. Morenike AU - Bhayat, Ahmed PY - 2022/4/27 TI - Oral Health Status and Practices, and Anthropometric Measurements of Preschool Children: Protocol for a Multi-African Country Survey JO - JMIR Res Protoc SP - e33552 VL - 11 IS - 4 KW - oral health KW - early childhood caries KW - oral hygiene KW - dietary intake KW - Africa KW - preschool children KW - dentistry KW - oral disease N2 - Background: Oral diseases are among the most prevalent conditions with significant impact on the growth and development of young children. Data are required to plan effectively for the management of early childhood caries (ECC) and other oral diseases in this age. There are currently very few African countries with updated and nationally representative data on ECC prevalence, and risk indicators and regional data on ECC and other oral diseases are scarce. Objective: We aim to determine the oral health status and practices, dietary intake, and anthropometric measurements of preschool children in several African countries. Methods: A cross-sectional study will be conducted in several African countries using a standardized questionnaire and clinical examination for data collection from healthy preschool children in kindergartens and primary health care facilities. The clinical examination will assess ECC using the decayed, missing due to caries, and filled teeth (dmft) index according to the World Health Organization (WHO) criteria, dental erosion (using the Basic Erosive Wear Examination Index), deciduous molar hypomineralization (using the European Association of Paediatric Dentistry criteria), dental fluorosis (using Dean?s Index), oral hygiene status (using the Oral Hygiene Index Simplified), and oral mucosal lesions. Oral hygiene habits and dental visits will be assessed using the WHO child questionnaire, and dietary intake will be assessed using the Food and Agriculture Organization method. Anthropometric measurements will be obtained following the International Society for the Advancement of Kinanthropometry standard protocol, and the children?s nutritional status will be assessed following the WHO child growth standards. To train and calibrate examiners, educational resources and electronic forms will be used to reach interexaminer and intraexaminer reliability with ?>0.6. Descriptive analysis will determine the prevalence of clinical conditions by age and sex. Bivariate analysis and multivariable regression will assess associations between the clinical conditions and sociodemographic factors, and oral health behaviors. Results: Data collection will begin after approvals and ethical clearance are obtained. The first stage will include 3 countries, namely Egypt, Nigeria, and South Africa, and collaborators from other African countries will join afterward. Conclusions: This study will lay down the foundations for using validated tools to collect data on the oral health of young children in Africa, allowing researchers from different countries across Africa to collect standardized data on ECC and other oral conditions. This will facilitate comparisons and analysis of risk factors that might be unique to the African continent. The results will provide baseline data on the prevalence of oral diseases and enable planning to address the treatment needs of young African children and design programs to prevent oral diseases in the African continent. International Registered Report Identifier (IRRID): PRR1-10.2196/33552 UR - https://www.researchprotocols.org/2022/4/e33552 UR - http://dx.doi.org/10.2196/33552 UR - http://www.ncbi.nlm.nih.gov/pubmed/35476047 ID - info:doi/10.2196/33552 ER - TY - JOUR AU - Ntalindwa, Theoneste AU - Nduwingoma, Mathias AU - Uworwabayeho, Alphonse AU - Nyirahabimana, Pascasie AU - Karangwa, Evariste AU - Rashid Soron, Tanjir AU - Westin, Thomas AU - Karunaratne, Thashmee AU - Hansson, Henrik PY - 2022/4/19 TI - Adapting the Use of Digital Content to Improve the Learning of Numeracy Among Children With Autism Spectrum Disorder in Rwanda: Thematic Content Analysis Study JO - JMIR Serious Games SP - e28276 VL - 10 IS - 2 KW - autism KW - learning KW - ICT KW - e-learning KW - education KW - children KW - ASD KW - teaching KW - teachers KW - communication KW - communication technology KW - online content KW - Rwanda KW - gamification KW - school KW - school-age children KW - behavior N2 - Background: Many teachers consider it challenging to teach children with autism spectrum disorder (ASD) in an inclusive classroom due to their unique needs and challenges. The integration of information communication technology (ICT) in the education system allows children with ASD to improve their learning. However, these ICT tools should meet their needs to lead a productive life. Objective: This study aimed to examine the possibilities of re-creating and adapting digital content to improve the learning of numeracy among children with ASD in inclusive school settings. Methods: We conducted 7 focus group discussions (FGDs) with 56 teachers from 7 schools and 14 parents from April to November 2019. Each of the FGDs took around 1 hour. Two clustered sets of questions were used: (1) general knowledge about teaching children with ASD and (2) analysis of selected online educational video content of early math (specifically, counting numbers). The researchers used video to understand current methodologies used in teaching children with ASD, possibilities of adaptation of the content in the current teaching environment, future challenges when the content is adapted, and possible solutions to overcome those challenges. All data, including audio recordings, field notes, and participants? comments, were transcribed, recorded, and analyzed following the steps recommended in qualitative data analysis. Results: The researchers identified ten themes from the analysis of the data: (1) awareness of the existence of ASD among children in schools and the community, (2) acceptance of children with ASD in an inclusive classroom and the community, (3) methods and models used when teaching children with ASD, (4)realia used to improve the learning of children with ASD, (5) the design of educational digital content, (6) the accessibility of online educational content, (7) quality of the content of the educational multimedia, (8) the opportunity of using the translated and re-created content inside and outside the classroom, (9) the relevance of the digital content in the Rwandan educational system, and (10) enhancement of the accessibility and quality of the digital content. We found that participants assumed that the content translation, gamification, and re-creation would help teach children with ASD. Moreover, they recommended contextualizing the content, increasing access to digital devices, and further research in the education of different subjects. Conclusions: Although many studies have identified the possibilities of using ICT to support children with ASD, few studies have documented the possibilities of integrating the existing technologies tested in the international community. This study is charting new territory to investigate online content to suit the context of schools. This study recommends further exploration of possible methodologies, such as applied behavior analysis or verbal behavior therapy, and the development of contextualized technologies that respond to the educational needs of children with ASD. UR - https://games.jmir.org/2022/2/e28276 UR - http://dx.doi.org/10.2196/28276 UR - http://www.ncbi.nlm.nih.gov/pubmed/35438638 ID - info:doi/10.2196/28276 ER - TY - JOUR AU - Aminabadi, Asl Naser AU - Golsanamlou, Ozra AU - Halimi, Zohreh AU - Jamali, Zahra PY - 2022/4/18 TI - Assessing the Different Levels of Virtual Reality That Influence Anxiety, Behavior, and Oral Health Status in Preschool Children: Randomized Controlled Clinical Trial JO - JMIR Perioper Med SP - e35415 VL - 5 IS - 1 KW - virtual reality KW - anxiety KW - behavior KW - oral health training N2 - Background: Compared with a traditional behavior management strategy and oral health training, virtual reality (VR) integrated with multisensory feedback possesses potential advantages in dentistry. Objective: This study aimed to assess the impact of different levels of VR on anxiety, behavior, and oral health status. Methods: This study was carried out in the Department of Pediatric Dentistry at the Tabriz University of Medical Sciences from December 2020 to June 2021. We randomly assigned 60 healthy children aged 4 years to 6 years to 4 groups, each consisting of 15 children. The study consisted of 2 consecutive sessions. During the first visit, the plaque index was calculated, and oral health education was carried out in all groups using Immersive VR (group I), Semi-immersive VR (group II), Nonimmersive VR (group III), and tell-show-do (TSD; group IV). In the second session, an amalgam restoration was performed in all groups. Participants? anxiety and behavior were recorded using the face version of the Modified Child Dental Anxiety Scale (MCDAS[f]) and Frankl scale. The plaque index was recorded in 2 follow-up sessions. Results: The greatest prevalence of positive behavior (P=.004) and the lowest anxiety (P<.001) were recorded in group I, followed by group II, group III, and group IV. The plaque index scores showed a reduced trend between the first session and follow-up sessions (P<.001), but the values did not differ significantly between the 4 groups during the 3 sessions (P=.28, P=.54, P=.18). Conclusions: The most positive behavior was observed in the Immersive VR group, followed by the Semi-immersive VR, Nonimmersive VR, and TSD groups. Moreover, oral health education using VR resources can improve oral health status in children. Trial Registration: Iranian Registry of Clinical Trials 20210103049926N1; https://www.irct.ir/trial/53475 UR - https://periop.jmir.org/2022/1/e35415 UR - http://dx.doi.org/10.2196/35415 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436233 ID - info:doi/10.2196/35415 ER - TY - JOUR AU - Wu, Wen-Lan AU - Huang, Yu-Ling AU - Liang, Jing-Min AU - Chen, Chia-Hsin AU - Wang, Chih-Chung AU - Ho, Wen-Hsien PY - 2022/4/15 TI - Interactive Digital Game for Improving Visual?Perceptual Defects in Children With a Developmental Disability: Randomized Controlled Trial JO - JMIR Serious Games SP - e34756 VL - 10 IS - 2 KW - interactive digital game KW - visual?perceptual defect KW - developmental disability KW - Children KW - Test of Visual Perceptual Skills KW - rehabilitation N2 - Background: Visual?perceptual defects in children can negatively affect their ability to perform activities of daily living. Conventional rehabilitation training for correcting visual?perceptual defects has limited training patterns and limited interactivity, which makes motivation difficult to sustain. Objective: We aimed to develop and evaluate an interactive digital game system for correcting visual?perceptual defects and evaluate its effectiveness. Methods: Participants were children aged 5 to 10 years with a diagnosis of visual?perceptual defect associated with a developmental disability. The children were randomized into a digital game group who received the traditional course of rehabilitation combined with an interactive digital game intervention (n=12) and a standard rehabilitation group (n=11) who only received the traditional course of rehabilitation. Each group underwent rehabilitation once a week for 4 weeks. Overall improvement in Test of Visual Perceptual Skills 3rd edition (TVPS-3) score and overall improvement in performance in the interactive digital game were evaluated. Parents and therapists were asked to complete a satisfaction questionnaire. Results: After 4 weeks, the TVPS-3 score had significantly increased (P=.002) in the digital game group (pre: mean 41.67, SD 13.88; post: 61.50, SD 21.64). In the standard rehabilitation group, the TVPS-3 score also increased, but the increase was not statistically significant (P=.58). Additionally, TVPS-3 score increases were significantly larger for the digital game group compared with those for the standard rehabilitation group (P=.005). Moreover, both parents and therapists were highly satisfied with the system. All 5 themes of satisfaction had mean scores higher than 4 in a 5-point scale questionnaire (mean 4.30, SD 0.56). Conclusions: The system has potential applications for improving visual?perceptual function in children undergoing medical rehabilitation for developmental disability. Trial Registration: ClinicalTrials.gov NCT05016492; http://clinicaltrials.gov/ct2/show/NCT05016492 UR - https://games.jmir.org/2022/2/e34756 UR - http://dx.doi.org/10.2196/34756 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436215 ID - info:doi/10.2196/34756 ER - TY - JOUR AU - Cunha-Cruz, Joana AU - Ko, K. Linda AU - Mancl, Lloyd AU - Rothen, L. Marilynn AU - Harter, Catherine AU - Davis, Stephen AU - Koday, Mark PY - 2022/4/15 TI - Home Delivery of Water for Caries Prevention in Latinx Children (?Sediento por una Sonrisa,? Thirsty for a Smile): Protocol for a Single-Arm Feasibility Study JO - JMIR Res Protoc SP - e37200 VL - 11 IS - 4 KW - dental caries KW - behavioral intervention KW - environmental restructuring KW - practice-based research KW - sugar consumption KW - feasibility KW - water consumption KW - nutrition KW - oral health KW - Latino (a) health KW - dental health KW - dentistry KW - dental KW - public health N2 - Background: Dental caries has significant public health implications afflicting young children. In addition to low social economic status, the most prominent risk factor for early childhood caries is sugar in the diet, particularly sugar-sweetened beverages. Dental treatment for caries in young children is commonly performed under general anesthesia and a significant proportion of children require repeated treatment. Interventions to reduce sugar-sweetened beverage consumption could lead to reduced rates of retreatment for dental caries in young children. Objective: This protocol describes the rationale, design, and methods of the ?Thirsty for a Smile? feasibility study. The aim of the study is to assess the feasibility, acceptability, and appropriateness of a dietary intervention promoting water consumption in lieu of sugar-sweetened beverages among young patients, mostly from Latino heritage. Methods: This protocol describes a single-arm feasibility study. Twenty-one dyads of children and their caregivers will be recruited. Children between 2 and 9 years old who recently had treatment under general anesthesia for early childhood dental caries will be eligible to participate. The intervention has two components: (1) environmental, in which bottled water is delivered to participants? homes; and (2) behavioral, in which caregivers will receive patient-centered counseling to increase children?s water intake and reduce sugar-sweetened beverages consumption. Dental caries and anthropometric data will be collected at examination during baseline and final visits. The primary outcome is feasibility and secondary outcomes are acceptability and appropriateness of the intervention. Results: Funding has been obtained from the National Institute of Dental and Craniofacial Research and the University of Washington approved the study. The feasibility study was conducted from March to November 2019. Conclusions: This feasibility study will test the study processes prior to a two-arm randomized controlled trial to determine feasibility and acceptability of the intervention and study procedures. This study may provide useful information for other researchers attempting to test similar interventions. International Registered Report Identifier (IRRID): RR1-10.2196/37200 UR - https://www.researchprotocols.org/2022/4/e37200 UR - http://dx.doi.org/10.2196/37200 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436235 ID - info:doi/10.2196/37200 ER - TY - JOUR AU - Garcia-Rueda, Fernanda Maria AU - Bohorquez-Penaranda, Patricia Adriana AU - Gil-Laverde, Armando Jacky Fabian AU - Aguilar-Sierra, Javier Francisco AU - Mendoza-Pulido, Camilo PY - 2022/4/14 TI - Casting Without Reduction Versus Closed Reduction With or Without Fixation in the Treatment of Distal Radius Fractures in Children: Protocol for a Randomized Noninferiority Trial JO - JMIR Res Protoc SP - e34576 VL - 11 IS - 4 KW - radius fractures KW - distal radius KW - pediatric KW - remodeling KW - surgical reduction KW - cast immobilization KW - outcome measure N2 - Background: Acute treatment for distal radius fractures, the most frequent fractures in the pediatric population, represents a challenge to the orthopedic surgeon. Deciding on surgical restoration of the alignment or cast immobilization without reducing the fracture is a complex concern given the remodeling potential of bones in children. In addition, the lack of evidence-based safe boundaries of shortening and angulation, that will not jeopardize upper-extremity functionality in the future, further complicates this decision. Objective: The authors aim to measure functional outcomes, assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Physical Function v2.0 instrument. The authors hypothesize that outcomes will not be worse in children treated with cast immobilization in situ compared with those treated with closed reduction with or without percutaneous fixation. The authors also aim to compare the following as secondary outcomes: ulnar variance and fracture alignment in the sagittal and coronal planes, range of motion, pressure ulcers, pain control, radius osteotomy due to deformity, pseudoarthrosis cure, and remanipulation. Methods: This is the protocol of a randomized noninferiority trial comparing upper-extremity functionality in children aged 5 to 10 years, after sustaining a distal radius fracture, treated with either cast immobilization in situ or closed reduction with or without fixation in a single orthopedic hospital. Functional follow-up is projected at 6 months, while clinical and radiographic follow-up will occur at 2 weeks, 3 months, and 9 months. Results: Recruitment commenced in July 2021. As of January 2022, 23 children have been randomized. Authors expect an average of 5 patients to be recruited monthly; therefore, recruitment and analysis should be complete by October 2024. Conclusions: This experimental design that addresses upper-extremity functionality after cast immobilization in situ in children who have sustained a distal fracture of the radius may yield compelling information that could aid the clinician in deciding on the most suitable orthopedic treatment. Trial Registration: ClinicalTrials.gov NCT05008029; https://clinicaltrials.gov/ct2/show/NCT05008029 International Registered Report Identifier (IRRID): DERR1-10.2196/34576 UR - https://www.researchprotocols.org/2022/4/e34576 UR - http://dx.doi.org/10.2196/34576 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436224 ID - info:doi/10.2196/34576 ER - TY - JOUR AU - Silva-Lavigne, Nicole AU - Valderrama, Alena AU - Pelaez, Sandra AU - Bransi, Myriam AU - Balli, Fabio AU - Gervais, Yannick AU - Gaudy, Thomas AU - Tse, Man Sze PY - 2022/4/7 TI - Acceptability of Serious Games in Pediatric Asthma Education and Self-management: Pilot Study JO - JMIR Pediatr Parent SP - e33389 VL - 5 IS - 2 KW - asthma KW - pediatrics KW - video games KW - eHealth KW - self-management N2 - Background: Asthma is the most common chronic pediatric disease. Despite existing tools to manage asthma, 40%-55% of children with asthma experience uncontrolled asthma. Serious games (SGs) represent a novel approach in promoting asthma education and self-management for children. Objective: In this qualitative pilot study with an embedded quantitative design, we aim to use focus groups and questionnaires to describe the perceived role of SGs in different aspects of asthma self-management by children and their parents. These aspects include asthma perception and knowledge, the impact of asthma and barriers to asthma self-management, and the support system for asthma self-management. Methods: A total of 5 children with asthma and their parents were invited to participate in an organized gaming session. Children and their parents completed a pregaming questionnaire on their medical history and asthma knowledge. Then, they were invited to test 4 original SG prototypes, after which the children answered a postgaming questionnaire on their asthma knowledge and perception of the SGs. Children and their parents subsequently participated in parallel focus groups, which were video-recorded or audio-recorded, transcribed verbatim, and analyzed by reaching consensus among members of the research team. Results: The mean age of the children was 10.3 (SD 1.5) years, with 20% (1/5) of the children being male. Qualitative data from the transcripts were coded into three separate domains: asthma self-management perception and knowledge, impact of asthma and barriers to asthma self-management, and support system for asthma self-management. We specifically explored the perceived roles of SGs within each domain. A key takeaway message was identified for each of these three domains: heterogeneity of asthma knowledge and the ability of SGs to encourage knowledge transfer through games, consequences and limitations of asthma and the ability of SGs to allow for identification and management of real-life situations through games, and insufficient support system and the ability of SGs to encourage playing with others for support and shared knowledge. Conclusions: Our pilot study explored the role of SGs in the self-management of asthma, as perceived by children and their parents. Our findings support the acceptability of SGs in asthma education and self-management in pediatrics and the necessity for future development in this field. UR - https://pediatrics.jmir.org/2022/2/e33389 UR - http://dx.doi.org/10.2196/33389 UR - http://www.ncbi.nlm.nih.gov/pubmed/35389354 ID - info:doi/10.2196/33389 ER - TY - JOUR AU - Hatem, Reem AU - Nawaz, A. Faisal AU - Al-Sharif, A. Ghadah AU - Almoosa, Mohammad AU - Kattan, Wid AU - Tzivinikos, Christos AU - Amirali, Lila E. AU - Albanna, Ammar PY - 2022/3/21 TI - Nonalcoholic Fatty Liver Disease in Children and Adolescents Taking Atypical Antipsychotic Medications: Protocol for a Systematic Review and Meta-analysis JO - JMIR Res Protoc SP - e20168 VL - 11 IS - 3 KW - nonalcoholic fatty liver disease KW - psychopharmacology KW - antipsychotics KW - children KW - adolescents KW - overprescribing KW - pharmaceuticals KW - antipsychotic medications KW - medication KW - pediatric psychopharmacology KW - pharmacology KW - child and adolescent psychiatry N2 - Background: Atypical antipsychotics (AAP) are commonly prescribed to children and adolescents and are associated with important adverse effects including weight gain and metabolic syndrome. Nonalcoholic fatty liver disease (NAFLD) is not only the most common pediatric liver disease but is also associated with serious complications including liver cirrhosis. Objective: Given that NAFLD and AAP are associated with metabolic syndrome, we aim to comprehensively examine the association between AAP and NAFLD in children and adolescents. Methods: We will conduct a systematic review of studies exploring NAFLD in subjects younger than 18 years on AAP published in English between 1950 and 2020 following the PRISMA (Preferred Reporting items for Systematic Reviews and Meta-Analysis) guidelines. Results: A PRISMA flowchart will be used present the study results after comprehensively reviewing studies on NAFLD in children and adolescents taking AAP. The first and second systematic searches will be conducted during December 2021. The results are expected to be published in June 2022. Conclusions: This research project will serve as a foundation for future studies and assist in devising interventions and reforming clinical guidelines for using AAP to ensure improved patient safety. International Registered Report Identifier (IRRID): PRR1-10.2196/20168 UR - https://www.researchprotocols.org/2022/3/e20168 UR - http://dx.doi.org/10.2196/20168 UR - http://www.ncbi.nlm.nih.gov/pubmed/35311689 ID - info:doi/10.2196/20168 ER - TY - JOUR AU - Man, Alice AU - van Ballegooie, Courtney PY - 2022/3/16 TI - Assessment of the Readability of Web-Based Patient Education Material From Major Canadian Pediatric Associations: Cross-sectional Study JO - JMIR Pediatr Parent SP - e31820 VL - 5 IS - 1 KW - health literacy KW - accessibility KW - online health information KW - pediatrics KW - patient education N2 - Background: Web-based patient education materials (PEMs) are frequently written above the recommended reading level in North America. Poor PEM readability limits the accessibility of medical information for individuals with average literacy levels or lower. Pediatric hospital and association websites have not only been shown to be a preferred source of information among caregivers but have also become a necessity during the COVID-19 pandemic. The readability of Canadian pediatric association websites has not yet been assessed. Objective: The aim of this study is to determine if the content of PEMs from Canadian pediatric associations is written at a reading level that the majority of Canadians can understand. Methods: A total of 258 PEMs were extracted from 10 Canadian pediatric associations and evaluated for their reading level using 10 validated readability scales. The PEMs underwent a difficult word analysis and comparisons between PEMs from different associations were conducted. Results: Web-based PEMs were identified from 3 pediatric association websites, where the reading level (calculated as a grade level) was found to be an average of 8.8 (SD 1.8) for the Caring for Kids website, 9.5 (SD 2.2) for the Pediatric Endocrine Group website, and 13.1 (SD 2.1) for the Atlantic Pediatric Society website. The difficult word analysis identified that 19.9% (SD 6.6%) of words were unfamiliar, with 13.3% (SD 5.3%) and 31.9% (SD 6.1%) of words being considered complex (?3 syllables) and long (?6 letters), respectively. Conclusions: The web-based PEMs were found to be written above the recommended seventh-grade reading level for Canadians. Consideration should be made to create PEMs at an appropriate reading level for both patients and their caregivers to encourage health literacy and ultimately promote preventative health behaviors and improve child health outcomes. UR - https://pediatrics.jmir.org/2022/1/e31820 UR - http://dx.doi.org/10.2196/31820 UR - http://www.ncbi.nlm.nih.gov/pubmed/35293875 ID - info:doi/10.2196/31820 ER - TY - JOUR AU - Matava, Clyde AU - So, Jeannette AU - Williams, RJ AU - Kelley, Simon AU - PY - 2022/3/15 TI - A Canadian Weekend Elective Pediatric Surgery Program to Reduce the COVID-19?Related Backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends?Extra Lists (ORRACLE-Xtra) Implementation Study JO - JMIR Perioper Med SP - e35584 VL - 5 IS - 1 KW - waiting lists KW - quality improvement KW - patient satisfaction KW - COVID-19 KW - ambulatory surgery KW - pandemics KW - Canada N2 - Background: The COVID-19 pandemic caused by the SARS-COV-2 virus has resulted in unprecedented challenges for the health care system. A decrease of surgical services led to substantial backlogs for time-sensitive scheduled pediatric patients. We designed and implemented a novel pilot weekend surgical quality improvement project called Operating Room Ramp-Up After COVID Lockdown Ends?Extra Lists (ORRACLE-Xtra). Objective: Our overall goals are to increase patient access to surgery (and reduce the wait list), improve operating room efficiencies, and optimize parent and staff experience. Methods: Using the DMAIC (define, measure, analyze, improve, control) framework, we implemented ORRACLE-Xtra in a tertiary care academic pediatric hospital during a quiescent period of the COVID-19 pandemic. We defined process and outcome measures based on provincial targets of out-of-window cases. Parental and staff satisfaction was tracked by surveys. Results: ORRACLE-Xtra led to 247 patients receiving surgery during the pilot period, resulting in a 5% decrease in the total number of patients on our wait list with Paediatric Canadian Access Targets for Surgery IV (147/247, 59.5%), with 38.1% (94/247) out-of-window of provincial targets. Most of the process and outcome measures were met or exceeded. Overall parental satisfaction was at 95.8% (110/121), with 79% (64/81) of staff reporting satisfaction with working weekends. Conclusions: Through the ORRACLE-Xtra pilot program, we have shown that hospitals impacted by COVID-19 can reduce the surgical backlog using innovative models of service delivery in a Canadian context. Sustained funding is critical to achieving more meaningful reductions in wait times for scheduled surgeries over the longer term and needs to be balanced with staff well-being. UR - https://periop.jmir.org/2022/1/e35584 UR - http://dx.doi.org/10.2196/35584 UR - http://www.ncbi.nlm.nih.gov/pubmed/34887242 ID - info:doi/10.2196/35584 ER - TY - JOUR AU - Wiljén, Angelica AU - Chaplin, Eric John AU - Crine, Vanessa AU - Jobe, William AU - Johnson, Ensa AU - Karlsson, Katarina AU - Lindroth, Tomas AU - Schwarz, Anneli AU - Stenmarker, Margaretha AU - Thunberg, Gunilla AU - Öhlén, Joakim AU - Nilsson, Stefan PY - 2022/3/8 TI - The Development of an mHealth Tool for Children With Long-term Illness to Enable Person-Centered Communication: User-Centered Design Approach JO - JMIR Pediatr Parent SP - e30364 VL - 5 IS - 1 KW - children KW - communication KW - long-term illness KW - mHealth KW - pediatric care KW - person-centered care KW - symptom assessment KW - universal design N2 - Background: Children with long-term illnesses frequently experience symptoms that could negatively affect their daily lives. These symptoms are often underreported in health care. Despite a large number of mobile health (mHealth) tools, few are based on a theoretical framework or supported by scientific knowledge. Incorporating universal design when developing a product can promote accessibility and facilitate person-centered communication. Objective: The aim of this study is to identify the symptom-reporting needs of children with cancer and congenital heart defects that could be satisfied by using a mobile app. Another aim is to evaluate how the child might interact with the app by considering universal design principles and to identify parents? views and health care professionals? expectations and requirements for an mHealth tool. Methods: User-centered design is an iterative process that focuses on an understanding of the users. The adapted user-centered design process includes 2 phases with 4 stages. Phase 1 involved interviews with 7 children with long-term illnesses, 8 parents, and 19 health care professionals to determine their needs and wishes for support; a workshop with 19 researchers to deepen our understanding of the needs; and a workshop with developers to establish a preliminary tool to further investigate needs and behaviors. Phase 2 involved interviews with 10 children with long-term illnesses, 9 parents, and 21 health care professionals to evaluate the mock-up (prototype) of the mHealth tool. Data were synthesized using the interpretive description technique. Results: A total of 4 aspects of needs emerged from the synthesis of the data, as follows: different perspectives on provided and perceived support; the need for an easy-to-use, non?clinic-based tool to self-report symptoms and to facilitate communication; the need for safety by being in control and reaching the child?s voice; and a way of mapping the illness journey to facilitate recall and improve diagnostics. The children with long-term illnesses expressed a need to not only communicate about pain but also communicate about anxiety, fatigue, fear, and nausea. Conclusions: The findings of this study indicated that the PicPecc (Pictorial Support in Person-Centered Care for Children) app is a potential solution for providing communicative support to children with long-term illnesses dealing with multiple symptoms and conditions. The interview data also highlighted symptoms that are at risk of being overlooked if they are not included in the mobile app. Further studies are needed to include usability testing and evaluation in hospitals and home care settings. UR - https://pediatrics.jmir.org/2022/1/e30364 UR - http://dx.doi.org/10.2196/30364 UR - http://www.ncbi.nlm.nih.gov/pubmed/35258466 ID - info:doi/10.2196/30364 ER - TY - JOUR AU - Sonney, Jennifer AU - Cho, E. Emily AU - Zheng, Qiming AU - Kientz, A. Julie PY - 2022/2/17 TI - Refinement of a Parent?Child Shared Asthma Management Mobile Health App: Human-Centered Design Study JO - JMIR Pediatr Parent SP - e34117 VL - 5 IS - 1 KW - parent?child shared management KW - school-age children KW - asthma KW - participatory design KW - mHealth KW - prototype KW - usability KW - family health informatics N2 - Background: The school-age years, approximately ages 7 through 11, represent a natural transition when children begin assuming some responsibility for their asthma management. Previously, we designed a theoretically derived, tailored parent?child shared asthma management mobile health app prototype, Improving Asthma Care Together (IMPACT). Objective: The purpose of this study was to use human-centered design (HCD) to iteratively refine IMPACT to optimize user experience and incorporate evidence-based longitudinal engagement strategies. Methods: This study used a mixed methods design from December 2019 to April 2021. Our app refinement used the HCD process of research, ideation, design, evaluation, and implementation, including 6 cycles of design and evaluation. The design and evaluation cycles focused on core app functionality, child engagement, and overall refinement. Evaluation with parent?child dyads entailed in-person and remote concept testing and usability testing sessions, after which rapid cycle thematic analyses identified key insights that informed future design refinement. Results: Twelve parent?child dyads enrolled in at least one round of this study. Eight of the 12 child participants were male with a mean age of 9.9 (SD 1.6) years and all parent participants were female. Throughout evaluation cycles, dyads selected preferred app layouts, gamification concepts, and overall features with a final design prototype emerging for full-scale development and implementation. Conclusions: A theoretically derived, evidence-based shared asthma management app was co-designed with end users to address real-world pain points and priorities. An 8-week pilot study testing app feasibility, acceptability, and preliminary efficacy is forthcoming. UR - https://pediatrics.jmir.org/2022/1/e34117 UR - http://dx.doi.org/10.2196/34117 UR - http://www.ncbi.nlm.nih.gov/pubmed/35175214 ID - info:doi/10.2196/34117 ER - TY - JOUR AU - Durojaiye, Ashimiyu AU - Fackler, James AU - McGeorge, Nicolette AU - Webster, Kristen AU - Kharrazi, Hadi AU - Gurses, Ayse PY - 2022/2/4 TI - Examining Diurnal Differences in Multidisciplinary Care Teams at a Pediatric Trauma Center Using Electronic Health Record Data: Social Network Analysis JO - J Med Internet Res SP - e30351 VL - 24 IS - 2 KW - pediatric trauma KW - multidisciplinary health team KW - multi-team systems KW - social network analysis KW - electronic health record KW - process mining KW - fluid teams N2 - Background: The care of pediatric trauma patients is delivered by multidisciplinary care teams with high fluidity that may vary in composition and organization depending on the time of day. Objective: This study aims to identify and describe diurnal variations in multidisciplinary care teams taking care of pediatric trauma patients using social network analysis on electronic health record (EHR) data. Methods: Metadata of clinical activities were extracted from the EHR and processed into an event log, which was divided into 6 different event logs based on shift (day or night) and location (emergency department, pediatric intensive care unit, and floor). Social networks were constructed from each event log by creating an edge among the functional roles captured within a similar time interval during a shift. Overlapping communities were identified from the social networks. Day and night network structures for each care location were compared and validated via comparison with secondary analysis of qualitatively derived care team data, obtained through semistructured interviews; and member-checking interviews with clinicians. Results: There were 413 encounters in the 1-year study period, with 65.9% (272/413) and 34.1% (141/413) beginning during day and night shifts, respectively. A single community was identified at all locations during the day and in the pediatric intensive care unit at night, whereas multiple communities corresponding to individual specialty services were identified in the emergency department and on the floor at night. Members of the trauma service belonged to all communities, suggesting that they were responsible for care coordination. Health care professionals found the networks to be largely accurate representations of the composition of the care teams and the interactions among them. Conclusions: Social network analysis was successfully used on EHR data to identify and describe diurnal differences in the composition and organization of multidisciplinary care teams at a pediatric trauma center. UR - https://www.jmir.org/2022/2/e30351 UR - http://dx.doi.org/10.2196/30351 UR - http://www.ncbi.nlm.nih.gov/pubmed/35119372 ID - info:doi/10.2196/30351 ER - TY - JOUR AU - Kim, Hyun-Yong AU - Kang, Kyung-Ah AU - Han, Suk-Jung AU - Chun, Jiyoung PY - 2022/2/1 TI - Web-Based Research Trends on Child and Adolescent Cancer Survivors Over the Last 5 Years: Text Network Analysis and Topic Modeling Study JO - J Med Internet Res SP - e32309 VL - 24 IS - 2 KW - text network analysis KW - topic modeling KW - cancer survivors KW - child KW - adolescent KW - research trends KW - knowledge structures N2 - Background: Being diagnosed with cancer during childhood or adolescence can disrupt important periods in an individual?s physical, psychosocial, and spiritual development and potentially reduce the quality of life (QOL) after treatment. Research is urgently required to improve the QOL for child and adolescent cancer survivors, and it is necessary to analyze the trends in prior research reported in international academic journals to identify knowledge structures. Objective: This study aims to identify the main keywords based on network centrality, subgroups (clusters) of keyword networks by using a cohesion analysis method, and the main theme of child and adolescent cancer survivor?related research abstracts through topic modeling. This study also aims to label the subgroups by comparing the results of the cohesion and topic modeling. Methods: A text network analysis method and topic modeling were used to explore the main trends in child and adolescent cancer survivor research by structuring a network of keyword (semantic morphemes) co-occurrence in the abstracts of articles published in 5 major web-based databases from 2016 to 2020. A total of 1677 child and adolescent cancer survivor?related studies were used for data analyses. Data selection, processing, and analyses were also conducted. Results: The top 5 keywords in terms of degree and eigenvector centrality were risk, control interval, radiation, childhood cancer treatment, and diagnosis. Of the 1677 studies used for data analyses, cluster 1 included 780 (46.51%) documents under risk management, cluster 2 contained 557 (33.21%) articles under health-related QOL and supportive care, and cluster 3 consisted of 340 (20.27%) studies under cancer treatment and complications. Conclusions: This study is significant in that it confirms the knowledge structure based on the main keywords and cross-disciplinary trends in child and adolescent cancer survivor research published in the last 5 years worldwide. The primary goal of child and adolescent cancer survivor research is to prevent and manage the various aspects of the problems encountered during the transition to a normal life and to improve the overall QOL. To this end, it is necessary to further revitalize the study of the multidisciplinary team approach for the promotion of age-specific health behaviors and the development of intervention strategies with increased feasibility for child and adolescent cancer survivors. UR - https://www.jmir.org/2022/2/e32309 UR - http://dx.doi.org/10.2196/32309 UR - http://www.ncbi.nlm.nih.gov/pubmed/35103615 ID - info:doi/10.2196/32309 ER - TY - JOUR AU - Adroher Mas, Cristina AU - Esposito Català, Candela AU - Batlle Boada, Astrid AU - Casadevall Llandrich, Ricard AU - Millet Elizalde, Marta AU - García García, José Juan AU - del Castillo Rey, Manel AU - García Cuyàs, Francesc AU - Pons Serra, Miquel AU - López Seguí, Francesc PY - 2022/1/20 TI - Pediatric Tele?Home Care Compared to Usual Care: Cost-Minimization Analysis JO - JMIR Pediatr Parent SP - e31628 VL - 5 IS - 1 KW - cost analysis KW - pediatric tele?home care KW - home care service KW - health economics KW - telehealth KW - economic evaluation KW - telemedicine KW - pediatrics N2 - Background: Although home hospitalization has been a well-known and widespread practice for some time in the adult population, it has not been the same case in the pediatric setting. Simultaneously, telemedicine tools are a facilitator of the change in the health care model, which is increasingly focused on home care. In a pioneering way in Spain, the in-home hospitalization program of the Hospital Sant Joan de Déu in Barcelona allows the child to be in their home environment at the time they are being monitored and clinically followed by the professionals. Besides being the preferred option for families, previous experience suggests that pediatric home hospitalization reduces costs, primarily thanks to savings on the structural cost of the stay. Objective: The aim of this study is to compare the average cost of a discharge by tele?home care with the usual care and to analyze the main drivers of the differential costs of both care models. Methods: A cost-minimization analysis is conducted under a hospital?s perspective, based on observational data, and estimated retrospectively. A historical control group of similar patients in terms of clinical casuistry to children hospitalized at home was used for comparison. Results: A 24-hour stay at the hospital costs US $574.19, while the in-home hospitalization costs US $301.71 per day, representing a saving of almost half (48%) of the cost compared to usual care. The main saving drivers were the personnel costs (US $102.83/US $284.53, 35.5% of the total), intermediate noncare costs (US $6.09/US $284.53, 33.17%), and structural costs (US $55.16/US $284.53, 19.04%). Home hospitalization involves a total stay 27.61% longer, but at almost half the daily cost, and thus represents a saving of US $176.70 (9.01%) per 24-hour stay. Conclusions: The cost analysis conducted under a hospital perspective shows that pediatric tele?home care is 9% cheaper compared to regular hospital care. These results motivate the most widespread implementation of the service from the point of view of economic efficiency, adding to previous experiences that suggest that it is also preferable from the perspective of user satisfaction. UR - https://pediatrics.jmir.org/2022/1/e31628 UR - http://dx.doi.org/10.2196/31628 UR - http://www.ncbi.nlm.nih.gov/pubmed/35049513 ID - info:doi/10.2196/31628 ER - TY - JOUR AU - Doyle, Sarah AU - Pavlos, Rebecca AU - Carlson, J. Samantha AU - Barton, Katherine AU - Bhuiyan, Mejbah AU - Boeing, Bernadett AU - Borland, L. Meredith AU - Hoober, Steven AU - Blyth, C. Christopher PY - 2022/1/17 TI - Efficacy of Digital Health Tools for a Pediatric Patient Registry: Semistructured Interviews and Interface Usability Testing With Parents and Clinicians JO - JMIR Form Res SP - e29889 VL - 6 IS - 1 KW - usability testing KW - REDCap KW - discharge instructions KW - acute respiratory infection KW - digital health technology KW - mobile technology KW - semistructured interview KW - pediatric acute respiratory infection KW - mobile phone N2 - Background: Acute respiratory infection (ARI) in childhood is common, but more knowledge on the burden and natural history of ARI in the community is required. A better understanding of ARI risk factors, treatment, and outcomes will help support parents to manage their sick child at home. Digital health tools are becoming more widely adopted in clinical care and research and may assist in understanding and managing common pediatric diseases, including ARI, in hospitals and in the community. We integrated 2 digital tools?a web-based discharge communication system and the REDCap (Research Electronic Data Capture) platform?into the Pragmatic Adaptive Trial for Acute Respiratory Infection in Children to enhance parent and physician engagement around ARI discharge communication and our patient registry. Objective: The objective of this study is to determine the efficacy and usability of digital tools integrated into a pediatric patient registry for ARI. Methods: Semistructured interviews and software interface usability testing were conducted with 11 parents and 8 emergency department physicians working at a tertiary pediatric hospital and research center in Perth, Western Australia, in 2019. Questions focused on experiences of discharge communication and clinical trial engagement. Responses were analyzed using the qualitative Framework Method. Participants were directly observed using digital interfaces as they attempted predetermined tasks that were then classified as success, failure, software failure, or not observed. Participants rated the interfaces using the System Usability Scale (SUS). Results: Most parents (9/11, 82%) indicated that they usually received verbal discharge advice, with some (5/11, 45%) recalling receiving preprinted resources from their physician. Most (8/11, 73%) would also like to receive discharge advice electronically. Most of the physicians (7/8, 88%) described their usual practice as verbal discharge instructions, with some (3/8, 38%) reporting time pressures associated with providing discharge instructions. The digital technology option was preferred for engaging in research by most parents (8/11, 73%). For the discharge communication digital tool, parents gave a mean SUS score of 94/100 (SD 4.3; A grade) for the mobile interface and physicians gave a mean usability score of 93/100 (SD 4.7; A grade) for the desktop interface. For the research data management tool (REDCap), parents gave a mean usability score of 78/100 (SD 11.0; C grade) for the mobile interface. Conclusions: Semistructured interviews allowed us to better understand parent and physician experiences of discharge communication and clinical research engagement. Software interface usability testing methods and use of the SUS helped us gauge the efficacy of our digital tools with both parent and physician users. This study demonstrates the feasibility of combining qualitative research methods with software industry interface usability testing methods to help determine the efficacy of digital tools in a pediatric clinical research setting. UR - https://formative.jmir.org/2022/1/e29889 UR - http://dx.doi.org/10.2196/29889 UR - http://www.ncbi.nlm.nih.gov/pubmed/35037889 ID - info:doi/10.2196/29889 ER - TY - JOUR AU - Rossi, Silvia AU - Santini, Junior Silvano AU - Di Genova, Daniela AU - Maggi, Gianpaolo AU - Verrotti, Alberto AU - Farello, Giovanni AU - Romualdi, Roberta AU - Alisi, Anna AU - Tozzi, Eugenio Alberto AU - Balsano, Clara PY - 2022/1/13 TI - Using the Social Robot NAO for Emotional Support to Children at a Pediatric Emergency Department: Randomized Clinical Trial JO - J Med Internet Res SP - e29656 VL - 24 IS - 1 KW - children KW - emotional health KW - emergency department KW - social robots KW - anxiety KW - stress N2 - Background: Social robots (SRs) have been used for improving anxiety in children in stressful clinical situations, such as during painful procedures. However, no studies have yet been performed to assess their effect in children while waiting for emergency room consultations. Objective: This study aims to assess the impact of SRs on managing stress in children waiting for an emergency room procedure through the assessment of salivary cortisol levels. Methods: This was an open randomized clinical trial in children attending a pediatric emergency department. Children accessing the emergency room were randomized to 1 of 3 groups: (1) playing with a NAO SR, (2) playing with a study nurse, or (3) waiting with parents. The salivary cortisol levels of all children were measured through a swab. Salivary cortisol levels before and after the intervention were compared in the 3 groups. We calculated the effect size of our interventions through the Cohen d-based effect size correlation (r). Results: A total of 109 children aged 3-10 years were enrolled in the study, and 94 (86.2%) had complete data for the analyses. Salivary cortisol levels significantly decreased more in the group exposed to robot interaction than in the other two groups (r=0.75). Cortisol levels decreased more in girls (r=0.92) than in boys (r=0.57). Conclusions: SRs are efficacious in decreasing stress in children accessing the emergency room and may be considered a tool for improving emotional perceptions of children and their families in such a critical setting. Trial Registration: ClinicalTrials.gov NCT04627909; https://clinicaltrials.gov/ct2/show/study/NCT04627909 UR - https://www.jmir.org/2022/1/e29656 UR - http://dx.doi.org/10.2196/29656 UR - http://www.ncbi.nlm.nih.gov/pubmed/34854814 ID - info:doi/10.2196/29656 ER - TY - JOUR AU - Ariff, Shabina AU - Maznani, Ikram AU - Bhura, Maria AU - Memon, Zahid AU - Arshad, Tayyaba AU - Samejo, Ahmed Tariq AU - Zaidi, Shujaat AU - Umer, Muhammad AU - Ahmed, Imran AU - Habib, Atif Muhammad AU - Soofi, Bashir Sajid AU - Bhutta, A. Zulfiqar PY - 2022/1/7 TI - Understanding Perceptions and Practices for Designing an Appropriate Community-Based Kangaroo Mother Care Implementation Package: Qualitative Exploratory Study JO - JMIR Form Res SP - e30663 VL - 6 IS - 1 KW - kangaroo mother care KW - low birth weight KW - neonatal mortality formative research KW - Pakistan KW - newborn care N2 - Background: Low birth weight (LBW) is a common outcome of preterm birth, which increases the risk of an infant?s morbidity and mortality. Approximately 20 million infants are born with LBW globally per year. Since a significant number of births in Pakistan take place at home, it is important to focus on the use of kangaroo mother care (KMC), the practice of skin-to-skin contact, in communities to prevent neonatal mortality and morbidity. Objective: We employed a formative research approach to understand the context of communities and facilities with regard to neonatal care and KMC practice. The broader aims were to inform the design and delivery of culturally appropriate platforms to introduce KMC in communities, and develop effective recruitment and retention strategies of KMC in rural areas of the Dadu district in the Sindh province of Pakistan. Methods: We conducted focus group discussions, in-depth interviews, and key informant interviews with families of LBW babies, community members, health care providers, and hospital administrators to identify barriers, enablers, and a knowledge base for KMC interventions. Results: Newborn care practices in communities were found to be suboptimal. The community was generally unaware of the KMC intervention for the care of LBW babies. However, facility health care providers, the community, and family members were willing to provide KMC to improve outcomes. We found significant support from the community members and health care providers for KMC practices. Mothers were also ready to provide intermittent KMC. The administrative staff at the hospitals accepted the introduction of KMC practices for LBW babies. Conclusions: KMC as a method of treating LBW babies is widely accepted in the community. This formative research provides strategically valuable information that will be helpful for developing effective implementation strategies by identifying common community practices for LBW babies, along with identifying the barriers and enablers to KMC practice. UR - https://formative.jmir.org/2022/1/e30663 UR - http://dx.doi.org/10.2196/30663 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994692 ID - info:doi/10.2196/30663 ER - TY - JOUR AU - Titgemeyer, Catrin Sarah AU - Schaaf, P. Christian PY - 2022/1/6 TI - Facebook Support Groups for Pediatric Rare Diseases: Cross-Sectional Study to Investigate Opportunities, Limitations, and Privacy Concerns JO - JMIR Pediatr Parent SP - e31411 VL - 5 IS - 1 KW - Facebook KW - support group KW - parental support KW - pediatric rare diseases KW - privacy paradox KW - children?s privacy N2 - Background: Because of the nature of rare diseases with affected individuals being widely geographically dispersed, finding an in-person/offline support group itself can be a challenge. Affected individuals therefore turn to social networking platforms such as Facebook for online support groups. Objective: We aim to put into perspective the opportunities Facebook offers as a tool for pediatric rare disease support groups by investigating its use, advantages, and limitations including privacy concerns. We analyze group accessibility and usage, advantages specific to rare diseases, perceived privacy, and views on using Facebook for communication between health professionals and parents, pharmaceutical companies, and study recruitment. Methods: We contacted 12 Facebook support groups for 12 respective rare diseases with pediatric onset and invited group members to participate in a cross-sectional online survey. Results: Of 231 respondents, 87.0% (n=201) of respondents were female, 12.6% (n=29) were male, and 0.4% reported another sex (n=1). Respondents? mean age was 41.56 years (SD 9.375); 91.3% (n=211) of respondents were parents (183 mothers, 27 fathers, 1 other sex); 59.7% (n=138) reported a self-initiated search for the Facebook group, 24.2% (n=56) received recommendations from their health professionals, and 12.6% (n=29) recommendations from someone else affected by the disease. On average, support group members visited Facebook at least once a day, visited and passively participated (read/liked posts) several times a week, and participated actively (commented/posted) once a month. As much as 79.2% (183/231) agreed that they would like to have health professionals as members of the respective Facebook group. Group members expressed more concern about privacy issues on Facebook in general than in their respective Facebook support groups, with concerns mostly related to Facebook itself and nongroup members. Conclusions: Our study confirmed that Facebook enhances support group accessibility for parents of children with rare diseases. Group participants perceive a reduction and elimination of distance, a common challenge in rare disease, and Facebook support groups create an environment of perceived privacy. The group?s privacy setting can be a critical factor for active support group participation. Sharing personal information and pictures on Facebook is very common among group participants, which shows the importance of discussing and protecting children?s privacy rights in this context. Trial Registration: German Clinical Trials Register DRKS00016067; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016067 UR - https://pediatrics.jmir.org/2022/1/e31411 UR - http://dx.doi.org/10.2196/31411 UR - http://www.ncbi.nlm.nih.gov/pubmed/34989690 ID - info:doi/10.2196/31411 ER - TY - JOUR AU - Mendonça, L. Fernanda AU - Regnault, Campli Fabiana Giuseppina Di AU - Di Leone, L. Camilla C. AU - Grizzo, C. Isabella AU - Bisaia, Aliny AU - Fragelli, Camila AU - Oliveira, M. Thais AU - Magalhães, C. Ana AU - Rios, Daniela PY - 2022/1/6 TI - Sensitivity Treatments for Teeth with Molar Incisor Hypomineralization: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e27843 VL - 11 IS - 1 KW - sensitivity KW - molar incisor hypomineralization KW - fluoride KW - dentistry KW - pediatric dentistry KW - dental care N2 - Background: The sensitivity of teeth with molar incisor hypomineralization (MIH) can affect children?s quality of life and is a challenging problem for dentists. Remineralizing agents such as sodium fluoride varnish seem to reduce the sensitivity of teeth with MIH, but long-term clinical trials with large samples are still needed for more evidence about its effectiveness as a desensitizing agent before its clinical recommendation. Objective: This randomized clinical trial aims to compare three treatment interventions for teeth with MIH and hypersensitivity. Methods: A total of 60 children aged 6-10 years presenting with at least one first permanent molar with sensitivity and no loss of enamel will be randomly assigned to three groups: the control group (sodium fluoride varnish; Duraphat, Colgate); experimental group I (4% titanium tetrafluoride varnish); and experimental group II (a coating resin containing surface prereacted glass-ionomer filler; PRG Barrier Coat, Shofu). The sodium fluoride varnish and 4% titanium tetrafluoride varnish will be applied once per week for 4 consecutive weeks and the PRG Barrier Coat resin will be applied in the first session and the application will be simulated the following 3 weeks to guarantee the blinding of the study. The primary outcome will be sensitivity level measured at different moments (before each material application, immediately after application or simulation, and 1, 2, 4, and 6 months after the last application/simulation) by one examiner using the Wong-Baker FACES Pain Rating Scale, the Schiff Cold Air Sensitivity Scale, and the FLACC (Face, Legs, Activity, Cry, Consolability) scale. As secondary outcomes, parental satisfaction and child self-reported discomfort after the treatment will be measured with a questionnaire prepared by the researcher. The data will undergo statistical analysis and the significance level will be set at 5%. Results: The project was funded in 2018, and enrollment was completed in November 2019. The recruitment of participants is currently underway and the first results are expected to be submitted for publication in 2022. Conclusions: If found effective in reducing the patient?s sensitivity long term, these agents can be considered as a treatment choice, and the findings will contribute to the development of a treatment protocol for teeth with sensitivity due to MIH. Trial Registration: Brazilian Registry of Clinical Trials Universal Trial Number U1111-1237-6720; https://tinyurl.com/mr4x82k9 International Registered Report Identifier (IRRID): DERR1-10.2196/27843 UR - https://www.researchprotocols.org/2022/1/e27843 UR - http://dx.doi.org/10.2196/27843 UR - http://www.ncbi.nlm.nih.gov/pubmed/34989687 ID - info:doi/10.2196/27843 ER - TY - JOUR AU - Gupta, Aarushi AU - Cafazzo, A. Joseph AU - IJzerman, J. Maarten AU - Swart, F. Joost AU - Vastert, Sebastiaan AU - Wulffraat, M. Nico AU - Benseler, Susanne AU - Marshall, Deborah AU - Yeung, Rae AU - Twilt, Marinka PY - 2021/12/24 TI - Genomic Health Literacy Interventions in Pediatrics: Scoping Review JO - J Med Internet Res SP - e26684 VL - 23 IS - 12 KW - pediatrics KW - patient education KW - genetics KW - genomics KW - mHealth KW - digital health KW - internet KW - genetic knowledge KW - genomic health literacy KW - children KW - adolescents N2 - Background: The emergence of genetic and genomic sequencing approaches for pediatric patients has raised questions about the genomic health literacy levels, attitudes toward receiving genomic information, and use of this information to inform treatment decisions by pediatric patients and their parents. However, the methods to educate pediatric patients and their parents about genomic concepts through digital health interventions have not been well-established. Objective: The primary objective of this scoping review is to investigate the current levels of genomic health literacy and the attitudes toward receiving genomic information among pediatric patients and their parents. The secondary aim is to investigate patient education interventions that aim to measure and increase genomic health literacy among pediatric patients and their parents. The findings from this review will be used to inform future digital health interventions for patient education. Methods: A scoping review using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and protocols was completed using the following databases: MEDLINE, Embase, CINAHL, and Scopus. Our search strategy included genomic information inclusive of all genetic and genomic terms, pediatrics, and patient education. Inclusion criteria included the following: the study included genetic, genomic, or a combination of genetic and genomic information; the study population was pediatric (children and adolescents <18 years) and parents of patients with pediatric illnesses or only parents of patients with pediatric illnesses; the study included an assessment of the knowledge, attitudes, and intervention regarding genomic information; the study was conducted in the last 12 years between 2008 and 2020; and the study was in the English language. Descriptive data regarding study design, methodology, disease population, and key findings were extracted. All the findings were collated, categorized, and reported thematically. Results: Of the 4618 studies, 14 studies (n=6, 43% qualitative, n=6, 43% mixed methods, and n=2, 14% quantitative) were included. Key findings were based on the following 6 themes: knowledge of genomic concepts, use of the internet and social media for genomic information, use of genomic information for decision-making, hopes and attitudes toward receiving genomic information, experiences with genetic counseling, and interventions to improve genomic knowledge. Conclusions: This review identified that older age is related to the capacity of understanding genomic concepts, increased genomic health literacy levels, and the perceived ability to participate in decision-making related to genomic information. In addition, internet-searching plays a major role in obtaining genomic information and filling gaps in communication with health care providers. However, little is known about the capacity of pediatric patients and their parents to understand genomic information and make informed decisions based on the genomic information obtained. More research is required to inform digital health interventions and to leverage the leading best practices to educate these genomic concepts. UR - https://www.jmir.org/2021/12/e26684 UR - http://dx.doi.org/10.2196/26684 UR - http://www.ncbi.nlm.nih.gov/pubmed/34951592 ID - info:doi/10.2196/26684 ER - TY - JOUR AU - Mörelius, Evalotte AU - Robinson, Suzanne AU - Arabiat, Diana AU - Whitehead, Lisa PY - 2021/12/22 TI - Digital Interventions to Improve Health Literacy Among Parents of Children Aged 0 to 12 Years With a Health Condition: Systematic Review JO - J Med Internet Res SP - e31665 VL - 23 IS - 12 KW - child KW - child health services KW - digital technology KW - health literacy KW - infant KW - internet-based intervention KW - parents KW - patient compliance KW - pediatric hospitals N2 - Background: Parental health literacy is associated with child health outcomes. Parents are increasingly turning to the internet to obtain health information. In response, health care providers are using digital interventions to communicate information to assist parents in managing their child?s health conditions. Despite the emergence of interventions to improve parental health literacy, to date, no systematic evaluation of the effectiveness of the interventions has been undertaken. Objective: The aim of this review is to examine the effect of digital health interventions on health literacy among parents of children aged 0-12 years with a health condition. This includes evaluating parents? engagement (use and satisfaction) with digital health interventions, the effect of these interventions on parental health knowledge and health behavior, and the subsequent impact on child health outcomes. Methods: This systematic review was registered a priori on PROSPERO (International Prospective Register of Systematic Reviews) and developed according to the Joanna Briggs Institute methodology for systematic reviews. The databases CINAHL, MEDLINE, and PsycINFO were searched for relevant literature published between January 2010 and April 2021. Studies were included if they were written in English. A total of 2 authors independently assessed the search results and performed a critical appraisal of the studies. Results: Following the review of 1351 abstracts, 31 (2.29%) studies were selected for full-text review. Of the 31 studies, 6 (19%) studies met the inclusion criteria. Of the 6 studies, 1 (17%) was excluded following the critical appraisal, and the 5 (83%) remaining studies were quantitative in design and included digital health interventions using web-based portals to improve parents? health knowledge and health behavior. Owing to heterogeneity in the reported outcomes, meta-analysis was not possible, and the findings were presented in narrative form. Of the 5 studies, satisfaction was measured in 3 (60%) studies, and all the studies reported high satisfaction with the digital intervention. All the studies reported improvement in parental health literacy at postintervention as either increase in disease-specific knowledge or changes in health behavior. Of the 5 studies, only 1 (20%) study included child health outcomes, and this study reported significant improvements related to increased parental health knowledge. Conclusions: In response to a pandemic such as COVID-19, there is an increased need for evidence-based digital health interventions for families of children living with health conditions. This review has shown the potential of digital health interventions to improve health knowledge and behavior among parents of young children with a health condition. However, few digital health interventions have been developed and evaluated for this population. Future studies with robust research designs are needed and should include the potential benefits of increased parent health literacy for the child. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020192386; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=192386 UR - https://www.jmir.org/2021/12/e31665 UR - http://dx.doi.org/10.2196/31665 UR - http://www.ncbi.nlm.nih.gov/pubmed/34941559 ID - info:doi/10.2196/31665 ER - TY - JOUR AU - Koldeweij, Charlotte AU - Clarke, Jonathan AU - Nijman, Joppe AU - Feather, Calandra AU - de Wildt, N. Saskia AU - Appelbaum, Nicholas PY - 2021/12/13 TI - CE Accreditation and Barriers to CE Marking of Pediatric Drug Calculators for Mobile Devices: Scoping Review and Qualitative Analysis JO - J Med Internet Res SP - e31333 VL - 23 IS - 12 KW - pediatric KW - drug dosage calculator KW - European regulations KW - safety KW - medical devices KW - medical errors KW - app KW - application KW - mobile health KW - pharmacy N2 - Background: Pediatric drug calculators (PDCs) intended for clinical use qualify as medical devices under the Medical Device Directive and the Medical Device Regulation. The extent to which they comply with European standards on quality and safety is unknown. Objective: This study determines the number of PDCs available as mobile apps for use in the Netherlands that bear a CE mark, and explore the factors influencing the CE marking of such devices among app developers. Methods: A scoping review of Google Play Store and Apple App Store was conducted to identify PDCs available for download in the Netherlands. CE accreditation of the sampled apps was determined by consulting the app landing pages on app stores, by screening the United Kingdom Medicines and Healthcare products Regulatory Agency?s online registry of medical devices, and by surveying app developers. The barriers to CE accreditation were also explored through a survey of app developers. Results: Of 632 screened apps, 74 were eligible, including 60 pediatric drug dosage calculators and 14 infusion rate calculators. One app was CE marked. Of the 20 (34%) respondents to the survey, 8 considered their apps not to be medical devices based on their intent of use or functionality. Three developers had not aimed to make their app available for use in Europe. Other barriers that may explain the limited CE accreditation of sampled PDC apps included poor awareness of European regulations among developers and a lack of restrictions when placing PDCs in app stores. Conclusions: The compliance of PDCs with European standards on medical devices is poor. This puts clinicians and their patients at risk of medical errors resulting from the largely unrestricted use of these apps. UR - https://www.jmir.org/2021/12/e31333 UR - http://dx.doi.org/10.2196/31333 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898456 ID - info:doi/10.2196/31333 ER - TY - JOUR AU - Finkelstein, B. Julia AU - Tremblay, S. Elise AU - Van Cain, Melissa AU - Farber-Chen, Aaron AU - Schumann, Caitlin AU - Brown, Christina AU - Shah, S. Ankoor AU - Rhodes, T. Erinn PY - 2021/12/2 TI - Pediatric Clinicians? Use of Telemedicine: Qualitative Interview Study JO - JMIR Hum Factors SP - e29941 VL - 8 IS - 4 KW - pediatrics KW - telemedicine KW - video visits KW - communication KW - webside manner N2 - Background: Bedside manner describes how clinicians relate to patients in person. Telemedicine allows clinicians to connect virtually with patients using digital tools. Effective virtual communication or webside manner may require modifications to traditional bedside manner. Objective: This study aims to understand the experiences of telemedicine providers with patient-to-provider virtual visits and communication with families at a single large-volume children?s hospital to inform program development and training for future clinicians. Methods: A total of 2 focus groups of pediatric clinicians (N=11) performing virtual visits before the COVID-19 pandemic, with a range of experiences and specialties, were engaged to discuss experiential, implementation, and practice-related issues. Focus groups were facilitated using a semistructured guide covering general experience, preparedness, rapport strategies, and suggestions. Sessions were digitally recorded, and the corresponding transcripts were reviewed for data analysis. The transcripts were coded based on the identified main themes and subthemes. On the basis of a higher-level analysis of these codes, the study authors generated a final set of key themes to describe the collected data. Results: Theme consistency was identified across diverse participants, although individual clinician experiences were influenced by their specialties and practices. A total of 3 key themes emerged regarding the development of best practices, barriers to scalability, and establishing patient rapport. Issues and concerns related to privacy were salient across all themes. Clinicians felt that telemedicine required new skills for patient interaction, and not all were comfortable with their training. Conclusions: Telemedicine provides benefits as well as challenges to health care delivery. In interprofessional focus groups, pediatric clinicians emphasized the importance of considering safety and privacy to promote rapport and webside manner when conducting virtual visits. The inclusion of webside manner instructions within training curricula is crucial as telemedicine becomes an established modality for providing health care. UR - https://humanfactors.jmir.org/2021/4/e29941 UR - http://dx.doi.org/10.2196/29941 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860669 ID - info:doi/10.2196/29941 ER - TY - JOUR AU - Claesdotter-Knutsson, Emma AU - André, Frida AU - Fridh, Maria AU - Delfin, Carl AU - Hakansson, Anders AU - Lindström, Martin PY - 2021/11/22 TI - Gender-Based Differences and Associated Factors Surrounding Excessive Smartphone Use Among Adolescents: Cross-sectional Study JO - JMIR Pediatr Parent SP - e30889 VL - 4 IS - 4 KW - smartphone KW - cell phone KW - adolescent KW - sleep KW - anxiety KW - substance use KW - nicotine KW - alcohol drinking KW - smartphone use KW - addiction KW - behavioral addiction KW - worry KW - pathology KW - internet N2 - Background: Excessive smartphone use is a new and debated phenomenon frequently mentioned in the context of behavioral addiction, showing both shared and distinct traits when compared to pathological gaming and gambling. Objective: The aim of this study is to describe excessive smartphone use and associated factors among adolescents, focusing on comparisons between boys and girls. Methods: This study was based on data collected through a large-scale public health survey distributed in 2016 to pupils in the 9th grade of primary school and those in the 2nd grade of secondary school. Bayesian binomial regression models, with weakly informative priors, were used to examine whether the frequency of associated factors differed between those who reported excessive smartphone use and those who did not. Results: The overall response rate was 77% (9143/11,868) among 9th grade pupils and 73.4% (7949/10,832) among 2nd grade pupils, resulting in a total of 17,092 responses. Based on the estimated median absolute percentage differences, along with associated odds ratios, we found that excessive smartphone use was associated with the use of cigarettes, alcohol, and other substances. The reporting of anxiety and worry along with feeling low more than once a week consistently increased the odds of excessive smartphone use among girls, whereas anxiety and worry elevated the odds of excessive smartphone use among boys. The reporting of less than 7 hours of sleep per night was associated with excessive smartphone use in all 4 study groups. Conclusions: The results varied across gender and grade in terms of robustness and the size of estimated difference. However, excessive smartphone use was associated with a higher frequency of multiple suspected associated factors, including ever having tried smoking, alcohol, or other substances; poor sleep; and often feeling low and feeling anxious. This study sheds light on some features and distinctions of a potentially problematic behavior among adolescents. UR - https://pediatrics.jmir.org/2021/4/e30889 UR - http://dx.doi.org/10.2196/30889 UR - http://www.ncbi.nlm.nih.gov/pubmed/34813492 ID - info:doi/10.2196/30889 ER - TY - JOUR AU - Ahlers-Schmidt, R. Carolyn AU - Schunn, Christy AU - Hervey, M. Ashley AU - Torres, Maria AU - Nelson, V. Jill Elizabeth PY - 2021/11/22 TI - Promoting Safe Sleep, Tobacco Cessation, and Breastfeeding to Rural Women During the COVID-19 Pandemic: Quasi-Experimental Study JO - JMIR Pediatr Parent SP - e31908 VL - 4 IS - 4 KW - COVID-19 KW - SIDS KW - sudden infant death syndrome KW - safe sleep KW - tobacco cessation KW - breastfeeding KW - virtual education N2 - Background: Safe Sleep Community Baby Showers address strategies to prevent sleep-related infant deaths. Due to the COVID-19 pandemic, these events transitioned from in-person to virtual. Objective: This study describes outcomes of transitioning Safe Sleep Community Baby Showers to a virtual format and compares outcomes to previous in-person events. Methods: Participants from four rural Kansas counties were emailed the presurvey, provided educational materials (videos, livestream, or digital documents), and completed a postsurvey. Those who completed both surveys received a portable crib and wearable blanket. Within-group comparisons were assessed between pre- and postsurveys; between-group comparisons (virtual vs in-person) were assessed by postsurveys. Results: Based on data from 145 in-person and 74 virtual participants, virtual participants were more likely to be married (P<.001) and have private insurance (P<.001), and were less likely to report tobacco use (P<.001). Both event formats significantly increased knowledge and intentions regarding safe sleep and avoidance of secondhand smoke (all P?.001). Breastfeeding intentions did not change. Differences were observed between in-person and virtual meetings regarding confidence in the ability to avoid secondhand smoke (in-person: 121/144, 84% vs virtual: 53/74, 72%; P=.03), intention to breastfeed ?6 months (in-person: 79/128, 62% vs virtual: 52/66, 79%; P=.008), and confidence in the ability to breastfeed ?6 months (in-person: 58/123, 47% vs virtual: 44/69, 64%; P=.02). Conclusions: Although both event formats demonstrated increased knowledge/intentions to follow safe sleep recommendations, virtual events may further marginalize groups who are at high risk for poor birth outcomes. Strategies to increase technology access, recruit priority populations, and ensure disparities are not exacerbated will be critical for the implementation of future virtual events. UR - https://pediatrics.jmir.org/2021/4/e31908 UR - http://dx.doi.org/10.2196/31908 UR - http://www.ncbi.nlm.nih.gov/pubmed/34550075 ID - info:doi/10.2196/31908 ER - TY - JOUR AU - Chin, Samuel AU - Carlin, Rebecca AU - Mathews, Anita AU - Moon, Rachel PY - 2021/11/15 TI - Infant Safe Sleep Practices as Portrayed on Instagram: Observational Study JO - JMIR Pediatr Parent SP - e27297 VL - 4 IS - 4 KW - sleep position KW - bed-sharing KW - social norms KW - social media KW - safe sleep KW - bedding N2 - Background: Parenting practices are highly influenced by perceived social norms. Social norms and American Academy of Pediatrics (AAP) guidelines for infant safe sleep practices are often inconsistent. Instagram has become one of the most popular social media websites among young adults (including many expectant and new parents). We hypothesized that the majority of Instagram images of infant sleep and sleep environments are inconsistent with AAP guidelines, and that the number of ?likes? for each image would not correlate with adherence of the image to these guidelines. Objective: The objective of this study was to determine the extent of adherence of Instagram images of infant sleep and sleep environments to safe infant sleep guidelines. Methods: We searched Instagram using hashtags that were relevant to infant sleeping practices and environments. We then used an open-source web scraper to collect images and the number of ?likes? for each image from 27 hashtags. Images were analyzed for adherence to AAP safe sleep guidelines. Results: A total of 1563 images (1134 of sleeping infant; 429 of infant sleep environment without sleeping infant) met inclusion criteria and were analyzed. Only 117 (7.49%) of the 1563 images were consistent with AAP guidelines. The most common reasons for inconsistency with AAP guidelines were presence of bedding (1173/1563, 75.05%) and nonrecommended sleep position (479/1134, 42.24%). The number of ?likes? was not correlated with adherence of the image to AAP guidelines. Conclusions: Although individuals who use Instagram and post pictures of sleeping infants or infant sleep environments may not actually use these practices regularly, the consistent portrayal of images inconsistent with AAP guidelines reinforces that these practices are normative and may influence the practice of young parents. UR - https://pediatrics.jmir.org/2021/4/e27297 UR - http://dx.doi.org/10.2196/27297 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779783 ID - info:doi/10.2196/27297 ER - TY - JOUR AU - Whale, Katie AU - Beasant, Lucy AU - Wright, J. Anne AU - Yardley, Lucy AU - Wallace, M. Louise AU - Moody, Louise AU - Joinson, Carol PY - 2021/11/15 TI - A Smartphone App for Supporting the Self-management of Daytime Urinary Incontinence in Adolescents: Development and Formative Evaluation Study of URApp JO - JMIR Pediatr Parent SP - e26212 VL - 4 IS - 4 KW - incontinence KW - urinary incontinence KW - digital intervention KW - child health KW - pediatric KW - pediatric incontinence KW - smartphone KW - intervention development KW - mobile phone N2 - Background: Daytime urinary incontinence (UI) is common in childhood and often persists into adolescence. UI in adolescence is associated with a range of adverse outcomes, including depressive symptoms, peer victimization, poor self-image, and problems with peer relationships. The first-line conservative treatment for UI is bladder training (standard urotherapy) that aims to establish a regular fluid intake and a timed schedule for toilet visits. The success of bladder training is strongly dependent on good concordance, which can be challenging for young people. Objective: This paper aims to describe the development of a smartphone app (URApp) that aims to improve concordance with bladder training in young people aged 11 to 19 years. Methods: URApp was designed by using participatory co-design methods and was guided by the person-based approach to intervention design. The core app functions were based on clinical guidance and included setting a daily drinking goal that records fluid intake and toilet visits, setting reminders to drink fluids and go to the toilet, and recording progress toward drinking goals. The development of URApp comprised the following four stages: a review of current smartphone apps for UI, participatory co-design workshops with young people with UI for gathering user requirements and developing wireframes, the development of a URApp prototype, and the user testing of the prototype through qualitative interviews with 23 young people with UI or urgency aged 10 to 19 years and 8 clinicians. The app functions and additional functionalities for supporting concordance and behavior change were iteratively optimized throughout the app development process. Results: Young people who tested URApp judged it to be a helpful way of supporting their concordance with a timed schedule for toilet visits and drinking. They reported high levels of acceptability and engagement. Preliminary findings indicated that some young people experienced improvements in their bladder symptoms, including a reduction in UI. Clinicians reported that URApp was clinically appropriate and aligned with the best practice guidelines for bladder training. URApp was deemed age appropriate, with all clinicians reporting that they would use it within their own clinics. Clinicians felt URApp would be of particular benefit to patients whose symptoms were not improving or those who were not engaging with their treatment plans. Conclusions: The next stage is to evaluate URApp in a range of settings, including pediatric continence clinics, primary care, and schools. This research is needed to test whether URApp is an effective (and cost-effective) solution for improving concordance with bladder training, reducing bladder symptoms, and improving the quality of life. UR - https://pediatrics.jmir.org/2021/4/e26212 UR - http://dx.doi.org/10.2196/26212 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779780 ID - info:doi/10.2196/26212 ER - TY - JOUR AU - Slovak, Petr AU - Ford, Q. Brett AU - Widen, Sherri AU - Daudén Roquet, Claudia AU - Theofanopoulou, Nikki AU - Gross, J. James AU - Hankin, Benjamin AU - Klasnja, Predrag PY - 2021/11/9 TI - An In Situ, Child-Led Intervention to Promote Emotion Regulation Competence in Middle Childhood: Protocol for an Exploratory Randomized Controlled Trial JO - JMIR Res Protoc SP - e28914 VL - 10 IS - 11 KW - randomized controlled trial KW - children KW - emotion regulation KW - in situ intervention KW - intervention KW - emotion KW - protocol KW - exploratory KW - efficacy KW - model KW - prevention KW - treatment KW - risk factor N2 - Background: Emotion regulation is a key transdiagnostic risk factor for a range of psychopathologies, making it a prime target for both prevention and treatment interventions in childhood. Existing interventions predominantly rely on workshops or in-person therapy-based approaches, limiting the ability to promote emotion regulation competence for children in everyday settings and at scale. Purrble is a newly developed, inexpensive, socially assistive robot?in the form of an interactive plush toy?that uses haptic feedback to support in-the-moment emotion regulation. It is accessible to children as needed in their daily lives, without the need for a priori training. Although qualitative data from previous studies show high engagement in situ and anecdotal evidence of the robot being incorporated into children?s emotion regulation routines, there is no quantitative evidence of the intervention?s impact on child outcomes. Objective: The aim of this study is to examine the efficacy of a new intervention model for child-led emotion regulation?Purrble?that can be deployed across prevention and treatment contexts. Methods: Overall, 134 children aged 8 to 10 years will be selected from an enriched nonclinical North American population; for inclusion, the cutoff for the parents? rating of child dysregulation will be ?10 points in the total difficulties score on the Strengths and Difficulties Questionnaire. This cutoff was selected to obtain a measurable, but not necessarily clinical, level of the child?s emotion regulatory difficulties. The selected families will be randomly assigned with .5 probability to receive either a Purrble or an active control (noninteractive plush toy). The primary outcome will be a daily ecological momentary assessment measure of child emotion regulation capability (as reported by parents) over a period of 4 weeks. Exploratory analyses will investigate the intervention impact on secondary outcomes of child emotion regulation, collected weekly over the same 4-week period, with follow-ups at 1 month and 6 months postdeployment. Quantitative data will be analyzed on an intent-to-treat basis. A proportion of families (approximately 30% of the sample) will be interviewed after deployment as part of the process analysis. Results: The study is funded by the UKRI Future Leaders Fellowship (MR/T041897/1) and an in-kind contribution from the Committee for Children. This study received ethical approval from the Pearl institutional review board (#18-CFC-101). Participant recruitment started in February 2021, with the 1-month deployment in April-May 2021. The results of this analysis will be published in 2022. Conclusions: This study will be the first quantitative evaluation of the efficacy of an innovative, proof-of-concept intervention model for an in situ, child-led emotion regulation intervention. Insights into the trajectory of daily changes, complemented with weekly questionnaire batteries and postdeployment interviews, will result in an in-depth understanding of whether and how the hypothesized intervention logic model works, leading to further intervention optimization. Trial Registration: ClinicalTrials.gov NCT04810455; http://clinicaltrials.gov/ct2/show/NCT04810455 International Registered Report Identifier (IRRID): PRR1-10.2196/28914 UR - https://www.researchprotocols.org/2021/11/e28914 UR - http://dx.doi.org/10.2196/28914 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751666 ID - info:doi/10.2196/28914 ER - TY - JOUR AU - Ennab, Farah AU - ElSaban, Mariam AU - Khalaf, Eman AU - Tabatabaei, Hanieh AU - Khamis, Hassan Amar AU - Devi, Radha Bindu AU - Hanif, Kashif AU - Elhassan, Hiba AU - Saravanan, Ketharanathan AU - Cremonesini, David AU - Popatia, Rizwana AU - Malik, Zainab AU - Ho, B. Samuel AU - Abusamra, Rania PY - 2021/11/5 TI - Clinical Characteristics of Children With COVID-19 in the United Arab Emirates: Cross-sectional Multicenter Study JO - JMIR Pediatr Parent SP - e29049 VL - 4 IS - 4 KW - pediatrics KW - children KW - COVID-19 KW - SARS-CoV-2 KW - United Arab Emirates KW - viral shedding KW - pandemic KW - treatment KW - outcomes KW - clinical KW - public heath N2 - Background: COVID-19 has infected over 123 million people globally. The first confirmed case in the United Arab Emirates (UAE)?was reported on January 29, 2020. According to studies conducted in the early epicenters of the pandemic, COVID-19 has fared mildly in the pediatric population. To date, there is a lack of published data about COVID-19 infection among children in the Arabian region. Objective: This study aims to investigate the clinical characteristics, laboratory findings, treatment, and outcomes of children with COVID-19. Methods: This cross-sectional, multicenter study included children with confirmed COVID-19 infection admitted to 3 large hospitals in Dubai, UAE, between March 1 and June 15, 2020. Serial COVID-19 polymerase chain reaction (PCR) testing data were collected, and patients? demographics, premorbid clinical characteristics, and inpatient hospital courses were examined. Results: In all, 111 children were included in our study and represented 22 nationalities. Of these, 59 (53.2%) were boys. The mean age of the participants was 7 (SD 5.3) years. About 15.3% of children were younger than 1 year. Only 4 (3.6%) of them had pre-existing asthma, all of whom had uneventful courses. At presentation, of the 111 children, 43 (38.7%) were asymptomatic, 68 (61.2%) had mild or moderate symptoms, and none (0%) had severe illness requiring intensive care. Fever (23/111, 20.7%), cough (22/111, 19.8%), and rhinorrhea (17/111, 15.3%) were the most common presenting symptoms, and most reported symptoms resolved by day 5 of hospitalization. Most patients had no abnormality on chest x-ray. The most common laboratory abnormalities on admission included variations in neutrophil count (22/111, 24.7%), aspartate transaminase (18/111, 22.5%), alkaline phosphatase (29/111, 36.7%), and lactate dehydrogenase (31/111, 42.5%). Children were infrequently prescribed targeted medications, with only 4 (3.6%) receiving antibiotics. None of the 52 patients tested for viral coinfections were positive. COVID-19 PCR testing turned negative at a median of 10 days (IQR: 6-14) after the first positive test. Overall, there was no significant difference of time to negative PCR results between symptomatic and asymptomatic children. Conclusions: This study of COVID-19 presentations and characteristics presents a first look into the burden of COVID-19 infection in the pediatric population in the UAE. We conclude that a large percentage of children experienced no symptoms and that severe COVID-19 disease is uncommon in the UAE. Various laboratory abnormalities were observed despite clinical stability. Ongoing surveillance, contact tracing, and public health measures will be important to contain future outbreaks. UR - https://pediatrics.jmir.org/2021/4/e29049 UR - http://dx.doi.org/10.2196/29049 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643535 ID - info:doi/10.2196/29049 ER - TY - JOUR AU - Mathur, Mala AU - Kerr, R. Bradley AU - Babal, C. Jessica AU - Eickhoff, C. Jens AU - Coller, J. Ryan AU - Moreno, A. Megan PY - 2021/11/2 TI - US Parents? Acceptance of Learning About Mindfulness Practices for Parents and Children: National Cross-sectional Survey JO - JMIR Pediatr Parent SP - e30242 VL - 4 IS - 4 KW - mindfulness KW - mental health KW - general pediatrics KW - pediatrics KW - children KW - parents KW - acceptability KW - well-being KW - parenting N2 - Background: Mindfulness practices are associated with improved health and well-being for children. Few studies have assessed parents? acceptance of learning about mindfulness practices. Objective: This study aims to assess parents? beliefs and interest in learning about mindfulness, including from their health care provider, and differences across demographic backgrounds. Methods: We conducted a national cross-sectional survey of parents with children aged 0-18 years in October 2018. Measures included beliefs and interest in learning about mindfulness. These measures were compared across demographic backgrounds using chi-square analysis. Multivariate linear and logistic regression analyses were used to perform adjusted comparisons between demographic backgrounds. Results: Participants (N=3000) were 87% (n=2621) female and 82.5% (n=2466) Caucasian. Most (n=1913, 64.2%) reported beliefs that mindfulness can be beneficial when parenting, 56.4% (n=1595) showed interest in learning about mindfulness to help their child stay healthy, and 40.8% (n=1214) reported interest in learning about mindfulness from their health care provider. Parents with a college degree 49.6% (n=444) were more likely to report interest in learning about mindfulness from a health care provider compared to those without 37.1% (n=768; P<.001). Parents interested in learning about mindfulness were more likely to be male 62.6% (n=223; P<.001). There was no significant difference in interest in learning about mindfulness from a health care provider based on race. Conclusions: This study indicates that many parents believe mindfulness can be beneficial while parenting and are interested in learning how mindfulness could help their child stay healthy. Findings suggest there is an opportunity to educate families about mindfulness practices. UR - https://pediatrics.jmir.org/2021/4/e30242 UR - http://dx.doi.org/10.2196/30242 UR - http://www.ncbi.nlm.nih.gov/pubmed/34726605 ID - info:doi/10.2196/30242 ER - TY - JOUR AU - Mannering, Hannah AU - Yan, Chao AU - Gong, Yang AU - Alrifai, Wael Mhd AU - France, Daniel AU - Chen, You PY - 2021/10/20 TI - Assessing Neonatal Intensive Care Unit Structures and Outcomes Before and During the COVID-19 Pandemic: Network Analysis Study JO - J Med Internet Res SP - e27261 VL - 23 IS - 10 KW - neonatal intensive care unit KW - collaboration KW - health care organization structures KW - intensive care KW - length of stay KW - discharge dispositions KW - electronic health records KW - network analysis KW - COVID-19 KW - temporal network analysis N2 - Background: Health care organizations (HCOs) adopt strategies (eg. physical distancing) to protect clinicians and patients in intensive care units (ICUs) during the COVID-19 pandemic. Many care activities physically performed before the COVID-19 pandemic have transitioned to virtual systems during the pandemic. These transitions can interfere with collaboration structures in the ICU, which may impact clinical outcomes. Understanding the differences can help HCOs identify challenges when transitioning physical collaboration to the virtual setting in the post?COVID-19 era. Objective: This study aims to leverage network analysis to determine the changes in neonatal ICU (NICU) collaboration structures from the pre? to the intra?COVID-19 era. Methods: In this retrospective study, we applied network analysis to the utilization of electronic health records (EHRs) of 712 critically ill neonates (pre?COVID-19, n=386; intra?COVID-19, n=326, excluding those with COVID-19) admitted to the NICU of Vanderbilt University Medical Center between September 1, 2019, and June 30, 2020, to assess collaboration between clinicians. We characterized pre?COVID-19 as the period of September-December 2019 and intra?COVID-19 as the period of March-June 2020. These 2 groups were compared using patients? clinical characteristics, including age, sex, race, length of stay (LOS), and discharge dispositions. We leveraged the clinicians? actions committed to the patients? EHRs to measure clinician-clinician connections. We characterized a collaboration relationship (tie) between 2 clinicians as actioning EHRs of the same patient within the same day. On defining collaboration relationship, we built pre? and intra?COVID-19 networks. We used 3 sociometric measurements, including eigenvector centrality, eccentricity, and betweenness, to quantify a clinician?s leadership, collaboration difficulty, and broad skill sets in a network, respectively. We assessed the extent to which the eigenvector centrality, eccentricity, and betweenness of clinicians in the 2 networks are statistically different, using Mann-Whitney U tests (95% CI). Results: Collaboration difficulty increased from the pre? to intra?COVID-19 periods (median eccentricity: 3 vs 4; P<.001). Nurses had reduced leadership (median eigenvector centrality: 0.183 vs 0.087; P<.001), and neonatologists with broader skill sets cared for more patients in the NICU structure during the pandemic (median betweenness centrality: 0.0001 vs 0.005; P<.001). The pre? and intra?COVID-19 patient groups shared similar distributions in sex (~0 difference), race (4% difference in White, and 3% difference in African American), LOS (interquartile range difference in 1.5 days), and discharge dispositions (~0 difference in home, 2% difference in expired, and 2% difference in others). There were no significant differences in the patient demographics and outcomes between the 2 groups. Conclusions: Management of NICU-admitted patients typically requires multidisciplinary care teams. Understanding collaboration structures can provide fine-grained evidence to potentially refine or optimize existing teamwork in the NICU. UR - https://www.jmir.org/2021/10/e27261 UR - http://dx.doi.org/10.2196/27261 UR - http://www.ncbi.nlm.nih.gov/pubmed/34637393 ID - info:doi/10.2196/27261 ER - TY - JOUR AU - Oppelaar, C. Martinus AU - van den Wijngaart, S. Lara AU - Merkus, M. Peter J. F. AU - Croonen, A. Ellen AU - Hugen, C. Cindy A. AU - Brouwer, L. Marianne AU - Boehmer, M. Annemie L. AU - Roukema, Jolt PY - 2021/10/20 TI - It Is Not Just the FEV1 That Matters, but the Personal Goals We Reach Along the Way: Qualitative, Multicenter, Prospective, Observational Study JO - J Med Internet Res SP - e29218 VL - 23 IS - 10 KW - eHealth KW - asthma KW - pediatrics KW - telemonitoring KW - lung function tests KW - lung function KW - spirometry KW - home monitoring KW - mHealth KW - app KW - smartphone KW - asthma control KW - child KW - outpatients KW - remote consultations KW - quality improvement KW - patient care management KW - telemetry KW - application KW - FEV1 KW - pulmonary care N2 - Background: The COVID-19 pandemic has boosted the use of forced expiratory volume in 1 second (FEV1) telemonitoring in pediatric asthma, but a consensus on its most efficient and effective implementation is still lacking. To find answers, it is important to study how such an intervention is perceived, experienced, and used by both patients and health care professionals (HCPs). Objective: The aim of this study was to provide perspectives on how FEV1 home monitoring should be used in pediatric asthma. Methods: This is a qualitative, multicenter, prospective, observational study which included patients with asthma aged 6-16 and HCPs. Primary outcomes were results of 2 surveys that were sent to all participants at study start and after 3-4 months. Secondary outcomes consisted of FEV1 device usage during 4 months after receiving the FEV1 device. Results: A total of 39 participants (26 patients and 13 HCPs) were included in this study. Survey response rates were 97% (38/39) at the start and 87% (34/39) at the end of the study. Both patients and HCPs were receptive toward online FEV1 home monitoring and found it contributive to asthma control, self-management, and disease perception. The main concerns were about reliability of the FEV1 device and validity of home-performed lung function maneuvers. FEV1 devices were used with a median frequency of 7.5 (IQR 3.3-25.5) during the 4-month study period. Conclusions: Patients and HCPs are receptive toward online FEV1 home monitoring. Frequency of measurements varied largely among individuals, yet perceived benefits remained similar. This emphasizes that online FEV1 home monitoring strategies should be used as a means to reach individual goals, rather than being a goal on their own. UR - https://www.jmir.org/2021/10/e29218 UR - http://dx.doi.org/10.2196/29218 UR - http://www.ncbi.nlm.nih.gov/pubmed/34668868 ID - info:doi/10.2196/29218 ER - TY - JOUR AU - Chirambo, Baxter Griphin AU - Thompson, Matthew AU - Hardy, Victoria AU - Ide, Nicole AU - Hwang, H. Phillip AU - Dharmayat, Kanika AU - Mastellos, Nikolaos AU - Heavin, Ciara AU - O'Connor, Yvonne AU - Muula, S. Adamson AU - Andersson, Bo AU - Carlsson, Sven AU - Tran, Tammy AU - Hsieh, Chen-Ling Jenny AU - Lee, Hsin-Yi AU - Fitzpatrick, Annette AU - Joseph Wu, Tsung-Shu AU - O'Donoghue, John PY - 2021/10/20 TI - Effectiveness of Smartphone-Based Community Case Management on the Urgent Referral, Reconsultation, and Hospitalization of Children Aged Under 5 Years in Malawi: Cluster-Randomized, Stepped-Wedge Trial JO - J Med Internet Res SP - e25777 VL - 23 IS - 10 KW - community case management KW - mobile health KW - pediatrics KW - childhood infection KW - mobile phone N2 - Background: Integrated community case management (CCM) has led to reductions in child mortality in Malawi resulting from illnesses such as malaria, pneumonia, and diarrhea. However, adherence to CCM guidelines is often poor, potentially leading to inappropriate clinical decisions and poor outcomes. We determined the impact of an e-CCM app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi. Objective: We determined the impact of an electronic version of a smartphone-based CCM (e-CCM) app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi. Methods: We used a stepped-wedge, cluster-randomized trial to compare paper-based CCM (control) with and without the use of an e-CCM app on smartphones from November 2016 to February 2017. A total of 102 village clinics from 2 districts in northern Malawi were assigned to 1 of 6 clusters, which were randomized on the sequencing of the crossover from the control phase to the intervention phase as well as the duration of exposure in each phase. Children aged ?2 months to <5 years who presented with acute illness were enrolled consecutively by health surveillance assistants. The primary outcome of urgent referrals to higher-level facilities was evaluated by using multilevel mixed effects models. A logistic regression model with the random effects of the cluster and the fixed effects for each step was fitted. The adjustment for potential confounders included baseline factors, such as patient age, sex, and the geographical location of the village clinics. Calendar time was adjusted for in the analysis. Results: A total of 6965 children were recruited?49.11% (3421/6965) in the control phase and 50.88% (3544/6965) in the intervention phase. After adjusting for calendar time, children in the intervention phase were more likely to be urgently referred to a higher-level health facility than children in the control phase (odds ratio [OR] 2.02, 95% CI 1.27-3.23; P=.003). Overall, children in the intervention arm had lower odds of attending a repeat health surveillance assistant consultation (OR 0.45, 95% CI 0.34-0.59; P<.001) or being admitted to a hospital (OR 0.75, 95% CI 0.62-0.90; P=.002), but after adjusting for time, these differences were not significant (P=.07 for consultation; P=.30 for hospital admission). Conclusions: The addition of e-CCM decision support by using smartphones led to a greater proportion of children being referred to higher-level facilities, with no apparent increase in hospital admissions or repeat consultations in village clinics. Our findings provide support for the implementation of e-CCM tools in Malawi and other low- and middle-income countries with a need for ongoing assessments of effectiveness and integration with national digital health strategies. Trial Registration: ClinicalTrials.gov NCT02763345; https://clinicaltrials.gov/ct2/show/NCT02763345 UR - https://www.jmir.org/2021/10/e25777 UR - http://dx.doi.org/10.2196/25777 UR - http://www.ncbi.nlm.nih.gov/pubmed/34668872 ID - info:doi/10.2196/25777 ER - TY - JOUR AU - Shrestha, Manisha AU - Bhandari, Gopal AU - Rathi, Kumar Suresh AU - Gudlavalleti, Gaurang Anirudh AU - Pandey, Binod AU - Ghimire, Ramesh AU - Ale, Daman AU - Kayastha, Sajani AU - Chaudhary, Shankar Daya AU - Byanju, Raghunandan AU - PY - 2021/10/8 TI - Improving the Follow-up Rate for Pediatric Patients (0-16 years) of an Eye Hospital in Nepal: Protocol for a Public Health Intervention Study JO - JMIR Res Protoc SP - e31578 VL - 10 IS - 10 KW - counseling KW - follow-up KW - intervention study KW - pediatric patients KW - ophthalmology KW - public health KW - Nepal N2 - Background: The follow-up of pediatric patients ensures regular ocular morbidity monitoring and better treatment outcome. Hiralal Santudevi Pradhan Institute of Ophthalmic Science (Bharatpur Eye Hospital [BEH]) noticed that the follow-up rate was only 22% among its pediatric patients. Several factors like lack of awareness and forgetfulness among patients may contribute to a lower number of follow-up visits. Therefore, BEH decided to find if counseling and reminders through SMS text messaging and phone calls would improve the follow-up rates. Objective: This study aims to evaluate the impact of interventions like counseling and reminder SMS text messaging and phone calls in improving the follow-up rate of pediatric patients. Methods: This is a public health intervention study being conducted using quantitative analysis. All children (0-16 years) with ocular conditions requiring at least 3 follow-up visits in the study period will be included. In all, 264 participants will be allocated to 3 groups: routine standard care, counseling, and reminders with SMS text messaging and phone calls. In counseling, patients will take part in 20-minute counseling sessions with trained counselors at each visit, and information leaflets will be provided to them. In the reminder SMS text messaging and phone call group, patients will receive an SMS text message 3 days prior and a phone call 1 day prior to their scheduled visits. Patients attending within 2 days of the scheduled date will be considered compliant to follow-up. The proportion of patients completing all the follow-up visits in each group will be assessed. Informed consent will be taken from parents and children. Univariate and multivariate analyses will be conducted. Results: The ethical approval for this study has been obtained from the Ethical Review Board (ERB) of Nepal Health Research Council (ERB protocol registration #761/2020 P). The data collection was initiated on January, 24, 2021, but due to the COVID-19 pandemic, as of September 2021, we have only been able to enroll 154 of the planned 264 participants (58.3% of the sample size). Conclusions: This study will reliably document not only the factors associated with follow-up rate through an intervention package (counseling and reminders through SMS text messaging and phone calls) but also the cost effectiveness of the intervention package, which can be applied in all the departments of the hospital. Trial Registration: ClinicalTrials.gov NCT04837534; https://clinicaltrials.gov/ct2/show/NCT04837534 International Registered Report Identifier (IRRID): DERR1-10.2196/31578 UR - https://www.researchprotocols.org/2021/10/e31578 UR - http://dx.doi.org/10.2196/31578 UR - http://www.ncbi.nlm.nih.gov/pubmed/34521615 ID - info:doi/10.2196/31578 ER - TY - JOUR AU - O'Dell, M. Sean AU - Fisher, R. Heidi AU - Schlieder, Victoria AU - Klinger, Tracey AU - Kininger, L. Rachel AU - Cosottile, McKenna AU - Cummings, Stacey AU - DeHart, Kathy PY - 2021/10/5 TI - Engaging Parents and Health Care Stakeholders to Inform Development of a Behavioral Intervention Technology to Promote Pediatric Behavioral Health: Mixed Methods Study JO - JMIR Pediatr Parent SP - e27551 VL - 4 IS - 4 KW - primary care KW - parenting KW - targeted prevention KW - behavioral intervention technology KW - behavioral health N2 - Background: Despite effective psychosocial interventions, gaps in access to care persist for youth and families in need. Behavioral intervention technologies (BITs) that apply psychosocial intervention strategies using technological features represent a modality for targeted prevention that is promising for the transformation of primary care behavioral health by empowering parents to take charge of the behavioral health care of their children. To realize the potential of BITs for parents, research is needed to understand the status quo of parental self-help and parent-provider collaboration to address behavioral health challenges and unmet parental needs that could be addressed by BITs. Objective: The aim of this study is to conduct foundational research with parents and health care stakeholders (HCS) to discover current practices and unmet needs related to common behavioral health challenges to inform the design, build, and testing of BITs to address these care gaps within a predominantly rural health system. Methods: We conducted a convergent mixed-parallel study within a large, predominantly rural health system in which the BITs will be developed and implemented. We analyzed data from parent surveys (N=385) on current practices and preferences related to behavioral health topics to be addressed in BITs along with focus group data of 48 HCS in 9 clinics regarding internal and external contextual factors contributing to unmet parental needs and current practices. By comparing and relating the findings, we formed interpretations that will inform subsequent BIT development activities. Results: Parents frequently endorsed several behavioral health topics, and several topics were relatively more or less frequently endorsed based on the child?s age. The HCS suggested that BITs may connect families with evidence-based guidance sooner and indicated that a web-based platform aligns with how parents already seek behavioral health guidance. Areas of divergence between parents and HCS were related to internalizing problems and cross-cutting issues such as parenting stress, which may be more difficult for health care HCS to detect or address because of the time constraints of routine medical visits. Conclusions: These findings provide a rich understanding of the complexity involved in meeting parents? needs for behavioral health guidance in a primary care setting using BITs. User testing studies for BIT prototypes are needed to successfully design, build, and test effective BITs to empower parents to take charge of promoting the behavioral health of their children. UR - https://pediatrics.jmir.org/2021/4/e27551 UR - http://dx.doi.org/10.2196/27551 UR - http://www.ncbi.nlm.nih.gov/pubmed/34609324 ID - info:doi/10.2196/27551 ER - TY - JOUR AU - Schmucker, Michael AU - Haag, Martin PY - 2021/9/20 TI - Automated Size Recognition in Pediatric Emergencies Using Machine Learning and Augmented Reality: Within-Group Comparative Study JO - JMIR Form Res SP - e28345 VL - 5 IS - 9 KW - resuscitation KW - emergency medicine KW - mobile applications KW - mobile phone KW - user-computer interface KW - augmented reality KW - machine learning N2 - Background: Pediatric emergencies involving children are rare events, and the experience of emergency physicians and the results of such emergencies are accordingly poor. Anatomical peculiarities and individual adjustments make treatment during pediatric emergency susceptible to error. Critical mistakes especially occur in the calculation of weight-based drug doses. Accordingly, the need for a ubiquitous assistance service that can, for example, automate dose calculation is high. However, few approaches exist due to the complexity of the problem. Objective: Technically, an assistance service is possible, among other approaches, with an app that uses a depth camera that is integrated in smartphones or head-mounted displays to provide a 3D understanding of the environment. The goal of this study was to automate this technology as much as possible to develop and statistically evaluate an assistance service that does not have significantly worse measurement performance than an emergency ruler (the state of the art). Methods: An assistance service was developed that uses machine learning to recognize patients and then automatically determines their size. Based on the size, the weight is automatically derived, and the dosages are calculated and presented to the physician. To evaluate the app, a small within-group design study was conducted with 17 children, who were each measured with the app installed on a smartphone with a built-in depth camera and a state-of-the-art emergency ruler. Results: According to the statistical results (one-sample t test; P=.42; ?=.05), there is no significant difference between the measurement performance of the app and an emergency ruler under the test conditions (indoor, daylight). The newly developed measurement method is thus not technically inferior to the established one in terms of accuracy. Conclusions: An assistance service with an integrated augmented reality emergency ruler is technically possible, although some groundwork is still needed. The results of this study clear the way for further research, for example, usability testing. UR - https://formative.jmir.org/2021/9/e28345 UR - http://dx.doi.org/10.2196/28345 UR - http://www.ncbi.nlm.nih.gov/pubmed/34542416 ID - info:doi/10.2196/28345 ER - TY - JOUR AU - Wharton-Smith, Alexandra AU - Baker, Kevin AU - Roca-Feltrer, Arantxa AU - Rodrigues, Maria AU - Richardson, Sol AU - Bonnington, A. Craig AU - Rassi, Christian AU - Marasciulo, Madeleine AU - Enosse, Sonia AU - Saute, Francisco AU - Aide, Pedro AU - Macete, Eusebio AU - Candrinho, Baltazar PY - 2021/9/15 TI - Assessment of the Feasibility, Acceptability, and Impact of Implementing Seasonal Malaria Chemoprevention in Nampula Province, Mozambique: Protocol for a Hybrid Effectiveness-Implementation Study JO - JMIR Res Protoc SP - e27855 VL - 10 IS - 9 KW - malaria KW - seasonal malaria chemoprevention KW - sulfadoxine-pyrimethamine amodiaquine KW - resistance KW - children under five KW - implementation research KW - Mozambique KW - Africa KW - mobile phone N2 - Background: Malaria is a significant cause of morbidity and mortality in children aged under 5 years in Mozambique. The World Health Organization recommends seasonal malaria chemoprevention (SMC), the administration of four monthly courses of sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ), to children aged 3-59 months during rainy season. However, as resistance to SP is widespread in East and Southern Africa, SMC has so far only been implemented across the Sahel in West Africa. Objective: This protocol describes the first phase of a pilot project that aims to assess the protective effect of SP and AQ when used for SMC and investigate the levels of molecular markers of resistance of Plasmodium falciparum to antimalarial medicines in the study districts. In addition, it is important to understand whether SMC is a feasible and acceptable intervention in the context of Nampula Province, Mozambique. Methods: This study will adopt a hybrid effectiveness-implementation design to conduct a mixed methods evaluation with six objectives: a molecular marker study, a nonrandomized controlled trial, an analysis of reported malaria morbidity indicators, a documentation exercise of the contextual SMC adaptation, an acceptability and feasibility assessment, and a coverage and quality assessment. Results: Ethical approval for this study was granted by the Mozambican Ministry of Health National Bioethics Committee on September 15, 2020. Data collection began in October 2020, and data analysis is expected to be completed by August 2021. Conclusions: This research will make a unique contribution to our understanding of whether the combination of SP and AQ, when used for SMC, can confer a protective effect against malaria in children aged 3-59 months in a region where malaria transmission is seasonal and SP resistance is expected to be high. If the project is successful, subsequent phases are expected to provide a more comprehensive assessment of the effectiveness and sustainability of SMCs. International Registered Report Identifier (IRRID): DERR1-10.2196/27855 UR - https://www.researchprotocols.org/2021/9/e27855 UR - http://dx.doi.org/10.2196/27855 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524109 ID - info:doi/10.2196/27855 ER - TY - JOUR AU - Liu, Lei AU - Ni, Yizhao AU - Beck, F. Andrew AU - Brokamp, Cole AU - Ramphul, C. Ryan AU - Highfield, D. Linda AU - Kanjia, Karkera Megha AU - Pratap, ?Nick? J. PY - 2021/9/10 TI - Understanding Pediatric Surgery Cancellation: Geospatial Analysis JO - J Med Internet Res SP - e26231 VL - 23 IS - 9 KW - surgery cancellation KW - socioeconomic factors KW - spatial regression models KW - machine learning N2 - Background: Day-of-surgery cancellation (DoSC) represents a substantial wastage of hospital resources and can cause significant inconvenience to patients and families. Cancellation is reported to impact between 2% and 20% of the 50 million procedures performed annually in American hospitals. Up to 85% of cancellations may be amenable to the modification of patients? and families? behaviors. However, the factors underlying DoSC and the barriers experienced by families are not well understood. Objective: This study aims to conduct a geospatial analysis of patient-specific variables from electronic health records (EHRs) of Cincinnati Children?s Hospital Medical Center (CCHMC) and of Texas Children?s Hospital (TCH), as well as linked socioeconomic factors measured at the census tract level, to understand potential underlying contributors to disparities in DoSC rates across neighborhoods. Methods: The study population included pediatric patients who underwent scheduled surgeries at CCHMC and TCH. A 5-year data set was extracted from the CCHMC EHR, and addresses were geocoded. An equivalent set of data >5.7 years was extracted from the TCH EHR. Case-based data related to patients? health care use were aggregated at the census tract level. Community-level variables were extracted from the American Community Survey as surrogates for patients? socioeconomic and minority status as well as markers of the surrounding context. Leveraging the selected variables, we built spatial models to understand the variation in DoSC rates across census tracts. The findings were compared to those of the nonspatial regression and deep learning models. Model performance was evaluated from the root mean squared error (RMSE) using nested 10-fold cross-validation. Feature importance was evaluated by computing the increment of the RMSE when a single variable was shuffled within the data set. Results: Data collection yielded sets of 463 census tracts at CCHMC (DoSC rates 1.2%-12.5%) and 1024 census tracts at TCH (DoSC rates 3%-12.2%). For CCHMC, an L2-normalized generalized linear regression model achieved the best performance in predicting all-cause DoSC rate (RMSE 1.299%, 95% CI 1.21%-1.387%); however, its improvement over others was marginal. For TCH, an L2-normalized generalized linear regression model also performed best (RMSE 1.305%, 95% CI 1.257%-1.352%). All-cause DoSC rate at CCHMC was predicted most strongly by previous no show. As for community-level data, the proportion of African American inhabitants per census tract was consistently an important predictor. In the Texas area, the proportion of overcrowded households was salient to DoSC rate. Conclusions: Our findings suggest that geospatial analysis offers potential for use in targeting interventions for census tracts at a higher risk of cancellation. Our study also demonstrates the importance of home location, socioeconomic disadvantage, and racial minority status on the DoSC of children?s surgery. The success of future efforts to reduce cancellation may benefit from taking social, economic, and cultural issues into account. UR - https://www.jmir.org/2021/9/e26231 UR - http://dx.doi.org/10.2196/26231 UR - http://www.ncbi.nlm.nih.gov/pubmed/34505837 ID - info:doi/10.2196/26231 ER - TY - JOUR AU - Khodyakov, Dmitry AU - Jilani, M. Shahla AU - Dellva, Stephanie AU - Faherty, J. Laura PY - 2021/9/7 TI - Informing the Development of a Standardized Clinical Definition of Neonatal Abstinence Syndrome: Protocol for a Modified-Delphi Expert Panel JO - JMIR Res Protoc SP - e25387 VL - 10 IS - 9 KW - Delphi KW - ExpertLens KW - expert panel KW - neonatal abstinence syndrome KW - neonatal opioid withdrawal syndrome KW - neonatal withdrawal KW - neonatal KW - neonates KW - opioid KW - opioids KW - withdrawal KW - infants KW - clinical KW - newborn KW - newborns KW - perinatal KW - postnatal N2 - Background: Neonatal abstinence syndrome (NAS) is a postnatal withdrawal syndrome that most commonly results from prenatal opioid exposure. Every 15 minutes, an infant is born in the United States with signs of NAS. The field lacks a standardized clinical definition of NAS, complicating discussions on programmatic and policy development to support opioid-exposed mothers and infants. Objective: The goal of this paper is to describe a protocol for a systematic expert panel process to inform the development of a clinical definition of NAS. Methods: We will conduct two three-round online modified-Delphi panels using the ExpertLens system and will follow the recommendations for Conducting and REporting of DElphi Studies (CREDES). One panel will focus on developing key components of a clinical definition of NAS, and the second panel will focus on neonatal opioid withdrawal syndrome (NOWS), which is a term that has come into use to differentiate opioid-exposed infants from infants exposed to other substances in utero. However, there is lack of agreement on the precise clinical definition of NOWS and how it is distinct from or overlaps with NAS. Each panel will complete two rating rounds and a discussion round using a similar protocol. We will analyze all rating data descriptively and determine the presence of agreement within and between the two panels. We will also perform thematic analysis of the qualitative comments to contextualize the panel findings. Results: The panels were convened between October 29 and December 17, 2020. Their results were disseminated and discussed at a national conference on NAS that took place on March 17-18, 2021. Conclusions: A standardized clinical definition of NAS will help to better characterize NAS incidence and to design effective clinical, public health, and policy interventions to support opioid-exposed mother-infant dyads. International Registered Report Identifier (IRRID): DERR1-10.2196/25387 UR - https://www.researchprotocols.org/2021/9/e25387 UR - http://dx.doi.org/10.2196/25387 UR - http://www.ncbi.nlm.nih.gov/pubmed/34491203 ID - info:doi/10.2196/25387 ER - TY - JOUR AU - Fang, Heping AU - Xian, Ruoling AU - Ma, Zhuoying AU - Lu, Mingyue AU - Hu, Yan PY - 2021/8/26 TI - Comparison of the Differences Between Web-Based and Traditional Questionnaire Surveys in Pediatrics: Comparative Survey Study JO - J Med Internet Res SP - e30861 VL - 23 IS - 8 KW - pediatrics KW - survey KW - questionnaire KW - web survey KW - comparative study N2 - Background: A web-based survey is a novel method for data capture. Some studies have applied web-based surveys in pediatrics, but few of them have reported data on the differences between web-based and traditional questionnaire surveys. Objective: The objective of our study was to evaluate the internal consistency of a web-based survey and compare it with a traditional questionnaire survey in pediatrics. Methods: A convenience sample of caregivers was invited to participate in the survey on feeding patterns and their children?s eating behaviors if their children were aged 2 to 7 years. A web-based survey and a traditional questionnaire survey were carried out between October 2018 and July 2019. A total of 1085 caregivers were involved in this study, and they were divided into the following three groups based on methods and sources: (1) web-based survey from a web source, (2) web-based survey from a hospital source, and (3) traditional questionnaire survey from a hospital source. The data were then compared and analyzed. Results: A total of 735 caregivers participated in the web-based survey and 350 caregivers participated in the traditional questionnaire survey, and 816 cases were then included in the analyses after data processing. The effective rate of the web-based survey was 70.1% (515/735), and the completeness rate of the traditional questionnaire survey was 86.0% (301/350). There were no significant differences between web-based surveys from different sources. However, demographic characteristics were significantly different between the web-based and traditional questionnaire surveys, mainly in terms of age and caregivers (?²4=16.509, P=.002 and ?²4=111.464, P<.001, respectively). Caregivers of children aged 2 to 3 years and grandparents were more likely to respond to the web-based survey. Age-specific stratified analysis showed that the score of ?monitoring? and the reporting rate of ?poor appetite? in children aged 2 to 3 years were significantly higher in the web-based survey compared to the traditional questionnaire survey after adjusting for demographic characteristics. Conclusions: A web-based survey could be a feasible tool in pediatric studies. However, differences in demographic characteristics and their possible impacts on the results should be considered in the analyses. UR - https://www.jmir.org/2021/8/e30861 UR - http://dx.doi.org/10.2196/30861 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319240 ID - info:doi/10.2196/30861 ER - TY - JOUR AU - Canares, Therese AU - Parrish, Carisa AU - Santos, Christine AU - Badawi, Alia AU - Stewart, Alyssa AU - Kleinman, Keith AU - Psoter, Kevin AU - McGuire, Joseph PY - 2021/7/28 TI - Pediatric Coping During Venipuncture With Virtual Reality: Pilot Randomized Controlled Trial JO - JMIR Pediatr Parent SP - e26040 VL - 4 IS - 3 KW - pediatrics KW - psychological distress KW - virtual reality KW - procedural pain KW - anxiety KW - phlebotomy N2 - Background: Virtual reality (VR) has shown promise in reducing children?s pain and anxiety during venipuncture, but studies on VR lack objective observations of pediatric coping. Notably, the process of capturing objective behavioral coping data can be labor- and personnel-intensive. Objective: The primary aims of this pilot trial were to assess the feasibility of conducting a trial of VR in a pediatric emergency department and the feasibility of documenting observed coping behaviors during pediatric procedures. Secondarily, this study examined whether VR affects child and caregiver coping and distress during venipuncture in the pediatric emergency department. Methods: This stratified, randomized, controlled pilot trial compared coping and distress between child life?supported VR engagement and child life specialist support without VR during painful procedures in children aged 7-22 years in the pediatric emergency department. An external control (reference group) received no standardized support. Primary feasibility outcomes included rates of recruitment, rates of withdrawal from VR, and rates of completed Child Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF) observations. Secondary clinical outcomes were applied to venipuncture procedures and included CAMPIS-SF coping and distress (range 0-1.0), pain and anxiety on a visual analog scale (range 0-10), and cybersickness symptoms. Results: Overall recruitment was 93% (66/71), VR withdrawal rate was 27% (4/15), and of the completed procedures, 100% (63/63) CAMPIS-SF observations were completed. A total of 55 patients undergoing venipuncture in the pediatric emergency department were included in the analyses of clinical outcomes: 15 patients (15 caregivers) randomized to VR, 20 patients (15 caregivers) randomized to child life specialist support, and 20 patients (17 caregivers) in the reference group. Patient coping differed across groups with higher coping in the VR group and child life specialist group than in the reference group (P=.046). There were no significant differences in the distress and pain ratings for patients and caregivers between the groups. Caregivers rated the lowest perceived anxiety in the child life specialist group (P=.03). There was no apparent change in cybersickness symptoms before and after VR use (P=.37). Conclusions: Real-time documentation of observed behaviors in patients and caregivers was feasible during medical procedures in which VR was utilized, particularly with the availability of research staff. VR and child life specialists improved coping in children during venipuncture procedures. Given the high participation rate, future studies to evaluate the efficacy of VR are recommended to determine whether an off-the-shelf VR headset can be a low-cost and low-risk tool to improve children?s coping during venipuncture or other related procedures. Trial Registration: ClinicalTrials.gov NCT03686176; https://clinicaltrials.gov/ct2/show/NCT03686176 UR - https://pediatrics.jmir.org/2021/3/e26040 UR - http://dx.doi.org/10.2196/26040 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319249 ID - info:doi/10.2196/26040 ER - TY - JOUR AU - Batra, Nikita AU - Colson, D. Cindy AU - Alberto, C. Emily AU - Burd, S. Randall PY - 2021/7/15 TI - Using Social Media for the Prevention of Pediatric Burn Injuries: Pilot Design and Usability Study JO - JMIR Form Res SP - e23242 VL - 5 IS - 7 KW - accident prevention KW - burns KW - pediatric KW - public health KW - social media N2 - Background: Most pediatric burn injuries are preventable. Social media is an effective method for delivering large-scale messaging and may be useful for injury prevention in this domain. Objective: This study evaluates the feasibility of creating a social media campaign for pediatric burn injury prevention. Methods: Ad spots containing a headline, short introduction, and video were created and posted on Facebook and Instagram over 4 months. Ad spots were targeted to parents and caregivers of children in our region with the highest number of burn injuries. We assessed the impact of each ad set using ThruPlays, reach, and video plays. Results: We created 55 ad spots, with an average length of 24.1 (range 10-44) seconds. We reached 26,496 people during the campaign. The total ThruPlays of the 55 ad spots were 14,460 at US $0.19 per ThruPlay. Ad spots related to home safety had a significantly higher daily ThruPlay rate than those related to fire safety (6.5 vs 0.5 per day; P<.001). Conclusions: Social media is a feasible modality for delivering public health messages focused on preventing pediatric burn injuries. Engagement with these ads is influenced by ad presentation and the focus of the underlying injury prevention message. UR - https://formative.jmir.org/2021/7/e23242 UR - http://dx.doi.org/10.2196/23242 UR - http://www.ncbi.nlm.nih.gov/pubmed/34264194 ID - info:doi/10.2196/23242 ER - TY - JOUR AU - Milne-Ives, Madison AU - Neill, Sarah AU - Bayes, Natasha AU - Blair, Mitch AU - Blewitt, Jane AU - Bray, Lucy AU - Carrol, D. Enitan AU - Carter, Bernie AU - Dawson, Rob AU - Dimitri, Paul AU - Lakhanpaul, Monica AU - Roland, Damian AU - Tavare, Alison AU - Meinert, Edward AU - PY - 2021/6/30 TI - Impact of Digital Educational Interventions to Support Parents Caring for Acutely Ill Children at Home and Factors That Affect Their Use: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e27504 VL - 10 IS - 6 KW - acute disease KW - telemedicine KW - child KW - pediatrics KW - childhood disease KW - childhood illness KW - health education KW - health literacy KW - help-seeking behavior KW - child health KW - digital intervention KW - mHealth KW - primary care KW - sick child N2 - Background: Urgent and emergency care health services are overburdened, and the use of these services by acutely ill infants and children is increasing. A large proportion of these visits could be sufficiently addressed by other health care professionals. Uncertainty about the severity of a child?s symptoms is one of many factors that play a role in parents? decisions to take their children to emergency services, demonstrating the need for improved support for health literacy. Digital interventions are a potential tool to improve parents? knowledge, confidence, and self-efficacy at managing acute childhood illness. However, existing systematic reviews related to this topic need to be updated and expanded to provide a contemporary review of the impact, usability, and limitations of these solutions. Objective: The purpose of this systematic review protocol is to present the method for an evaluation of the impact, usability, and limitations of different types of digital educational interventions to support parents caring for acutely ill children at home. Methods: The review will be structured using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and Population, Intervention, Comparator, and Outcome (PICO) frameworks. Five databases will be systematically searched for studies published in English during and after 2014: Medline, EMBASE, CINAHL, APA PsycNet, and Web of Science. Two reviewers will independently screen references? titles and abstracts, select studies for inclusion based on the eligibility criteria, and extract the data into a standardized form. Any disagreements will be discussed and resolved by a third reviewer if necessary. Risk of bias of all studies will be assessed using the Mixed-Methods Appraisal Tool (MMAT), and a descriptive analysis will be used to evaluate the outcomes reported. Results: The systematic review will commence during 2021. Conclusions: This systematic review will summarize the impact, usability, and limitations of digital interventions for parents with acutely ill children. It will provide an overview of the field; identify reported impacts on health and behavioral outcomes as well as parental knowledge, satisfaction, and decision making; and identify the factors that affect use to help inform the development of more effective and sustainable interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/27504 UR - https://www.researchprotocols.org/2021/6/e27504 UR - http://dx.doi.org/10.2196/27504 UR - http://www.ncbi.nlm.nih.gov/pubmed/34228628 ID - info:doi/10.2196/27504 ER - TY - JOUR AU - Pavuluri, Haritha AU - Grant, Alicia AU - Hartman, Alexander AU - Fowler, Lauren AU - Hudson, Jennifer AU - Springhart, Patrick AU - Kennedy, Blair Ann PY - 2021/6/15 TI - Implementation of iPads to Increase Compliance With Delivery of New Parent Education in the Mother?Baby Unit: Retrospective Study JO - JMIR Pediatr Parent SP - e18830 VL - 4 IS - 2 KW - technology KW - handheld computers KW - workflow KW - education KW - newborn KW - head trauma N2 - Background: Abusive head trauma (AHT) is a serious health problem affecting more than 3000 infants annually in the United States. The American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) recommend that health care providers counsel new parents about the dangers of AHT. Previous studies demonstrate that parental education is effective at reducing AHT events. South Carolina law requires hospitals to offer all new parents with the opportunity to watch an educational video about AHT. This mandate is addressed in different ways at the several delivery centers within a large South Carolina health care system with a range of viewing methods utilized, from DVD players to mobile workstations to personal devices. Frequent technical barriers and workflow inefficiencies resulted in low rates of compliance with this mandate at several campuses. To improve compliance of parent viewing of this educational video, the health care system standardized video viewing protocol across all campuses by implementing the use of iPads for parental education. Existing literature suggests that patient education can be improved in the hospital setting by utilizing tablet computers, but our literature search identified a gap in research around the education of parents and caregivers during hospitalization for childbirth. We used the implementation of an iPad-based parental education delivery protocol to evaluate whether tablet computers can improve compliance with delivering new parent education in the hospital setting. Objective: The objective of this study was to evaluate whether the standardized use of iPads to deliver education in the mother?baby unit resulted in improved rates of parents? acceptance of the opportunity to view an educational video about AHT. Methods: We interviewed physicians and nurses to determine what previous protocols were in place to educate new parents before a standardized iPad-based protocol was implemented across 6 campuses of a large South Carolina health care system. A retrospective study was conducted by review of 5231 records from across the 6 campuses to determine the pre- and postintervention compliance rates of viewing the AHT educational video by parents in the mother?baby unit. Results: Compliance increased overall (P<.001) across sites from an average of 41.93% (SD 46.24) to 99.73% (SD 0.26) (?=0.510). As much as 4 of 6 locations saw a significant increase in compliance rates after introducing the iPad intervention (P<.001). The remaining 2 locations that showed no significant difference (P>.05) had very high rates of preintervention compliance. Conclusions: Following the implementation of a standardized iPad-based protocol to deliver new parent education, there was a significant improvement in the percentage of new parents who viewed an educational video about AHT in the mother?baby unit. Based on these results, other health care providers should consider iPads to be a feasible and effective method for delivering hospital-based education to families in the mother?baby unit. UR - https://pediatrics.jmir.org/2021/2/e18830 UR - http://dx.doi.org/10.2196/18830 UR - http://www.ncbi.nlm.nih.gov/pubmed/34128809 ID - info:doi/10.2196/18830 ER - TY - JOUR AU - Lecomte, Fabienne AU - Thecua, Elise AU - Ziane, Laurine AU - Deleporte, Pascal AU - Duhamel, Alain AU - Vamour, Clémence AU - Mordon, Serge AU - Rakza, Thameur PY - 2021/5/25 TI - Phototherapy Using a Light-Emitting Fabric (BUBOLight) Device in the Treatment of Newborn Jaundice: Protocol for an Interventional Feasibility and Safety Study JO - JMIR Res Protoc SP - e24808 VL - 10 IS - 5 KW - jaundice KW - light emitting fabrics KW - light KW - neonate KW - newborn jaundice KW - perinatal KW - phototherapy N2 - Background: Neonatal jaundice is a common condition occurring in 60%-80% of all healthy-term and late-preterm neonates. In the majority of cases, neonatal jaundice resolves spontaneously and causes no harm; however, in some neonates, signi?cant hyperbilirubinemia can develop and lead to kernicterus jaundice, a serious neurological disease. Phototherapy (PT) is the preferred treatment for jaundice; however, to be effective, PT devices need to have a broad light emission surface to generate no or little heat and to provide an optimal wavelength and light intensity (420-490 nm and ?30 µW/cm²/nm, respectively). Objective: This study aimed to investigate the feasibility, safety, and level of satisfaction of parents and health care teams with the BUBOlight device, an innovative alternative to conventional hospital PT, in which luminous textiles have been incorporated in a sleeping bag. Methods: This interventional, exploratory, simple group, nonrandomized, single-center trial will be conducted at Lille Hospital. In total, 10-15 neonates and their parents will be included to obtain evaluable data from 10 parent-neonate pairs. Neonates weighing more than 2500 g at birth and born with ?37 weeks of amenorrhea that required PT in accordance with the guidelines of the National Institute For Health and Clinical Excellence will receive one 4-hour session of illumination. Total serum bilirubin and transcutaneous bilirubin levels were obtained at the start and 2 hours after the end of PT. Cutaneous and rectal temperatures, heart rate, and oxygen saturation will be measured at the beginning and during PT. The number of subjects is therefore not calculated on the basis of statistical assumptions. We aim to obtain a minimum proportion of 90% (ie, 9 of 10) of the neonates included, who have been able to undergo 4-hour PT without unacceptable and unexpected toxicities. We will calculate the mean, median, quartiles, minimum and maximum values of the quantitative parameters, and the frequency of the qualitative parameters. The rate of patients with no unacceptable and unexpected toxicities (ie, the primary endpoint) will be calculated. Results: The first patient is expected to be enrolled at the end of 2020, and clinical investigations are intended for up to June 2021. The final results of this study are expected to be available at the end of 2021. Conclusions: Our findings will provide insights into the safety and feasibility of a new PT device based on light-emitting fabrics for the treatment of newborn jaundice. This new system, if proven effective, will improve the humanization of neonatal care and help avoid mother-child separation. Trial Registration: ClinicalTrials.gov NCT04365998; https://clinicaltrials.gov/ct2/show/NCT04365998 International Registered Report Identifier (IRRID): PRR1-10.2196/24808 UR - https://www.researchprotocols.org/2021/5/e24808 UR - http://dx.doi.org/10.2196/24808 UR - http://www.ncbi.nlm.nih.gov/pubmed/34032584 ID - info:doi/10.2196/24808 ER - TY - JOUR AU - Wright, Lynn Amy AU - VanEvery, Rachel AU - Miller, Vicky PY - 2021/5/21 TI - Indigenous Mothers? Use of Web- and App-Based Information Sources to Support Healthy Parenting and Infant Health in Canada: Interpretive Description JO - JMIR Pediatr Parent SP - e16145 VL - 4 IS - 2 KW - Indigenous health KW - infant health KW - mothers KW - parenting KW - qualitative research KW - health education KW - health services accessibility KW - mobile phone N2 - Background: Web-based sources of health information are widely used by parents to support healthy parenting and aid in decision making about their infants? health. Although fraught with challenges such as misinformation, if used appropriately, web-based resources can improve access to health education and promote healthy choices. How Indigenous mothers use web-based information to support their parenting and infants? health has not yet been investigated; however, web-based modalities may be important methods for mitigating the reduced access to health care and negative health care interactions that many Indigenous people are known to experience. Objective: This study aims to understand the experience of Indigenous mothers who use web-based information to support the health of their infants. Methods: This interpretive description qualitative study used semistructured interviews and a discussion group to understand how Indigenous mothers living in Hamilton, Ontario and caring for an infant aged <2 years experienced meeting the health needs of their infants. The data presented reflect their experiences of using web-based sources of health information to support their infants? health. The Two-Eyed Seeing approach was applied to the study design, which ensured that both western and Indigenous worldviews were considered throughout. Results: A total of 19 Indigenous mothers participated in this study. The resulting 4 themes included distrusting information, staying anonymous, using visual information to support decision making, and accessing a world of experiences. Although fewer Indigenous mothers used web-based sources of information compared to mothers in the general population in other studies, tailoring web-based modalities to meet the unique needs of Indigenous mothers is an important opportunity for supporting the health and wellness of both mothers and infants. Conclusions: Web-based information sources are commonly used among parents, and ever-evolving web-based technologies make this information increasingly available and accessible. Tailoring web-based modalities to meet the unique preferences and needs of Indigenous mothers is an important method for improving their access to reliable and accurate health care information, thereby supporting healthy parenting and promoting infant health. UR - https://pediatrics.jmir.org/2021/2/e16145 UR - http://dx.doi.org/10.2196/16145 UR - http://www.ncbi.nlm.nih.gov/pubmed/34018489 ID - info:doi/10.2196/16145 ER - TY - JOUR AU - Maleki, Arash AU - Qoreishy, Mohammad Seyyed AU - Bahrami, Nabi Mohammad PY - 2021/5/3 TI - Surgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review JO - Interact J Med Res SP - e27075 VL - 10 IS - 2 KW - surgical treatment KW - Legg-Calvé-Perthes disease KW - pediatric KW - hip KW - treatment outcome N2 - Background: Legg-Calvé-Perthes disease (LCPD) is a common public health problem that usually occurs between the ages of 4 and 8 years, but it can occur between the ages of 2 and 15 years. This condition occurs due to the interruption of blood supply to the femoral head. Up to now, different surgical and nonsurgical treatments, including femoral varus osteotomy, innominate osteotomy, pelvic osteotomies, triple osteotomy, Chiari osteotomy, and shelf acetabuloplasty, have been suggested for noncontainable LCPD hips. Objective: The aim of this comprehensive review was to investigate the various surgical techniques used for LCPD. Methods: An advanced electronic search of the English-language literature was performed from October 8 to 14, 2020. The electronic databases PubMed, MEDLINE, Web of Science, Embase, Ovid, and Google scholar were searched using appropriate search terms. A manual search of references also was performed. After retrieving the studies, duplicates were removed, and the remining studies were screened based on the title, abstract, and full text. The quality of the selected articles was assessed, and the required data were extracted from eligible articles. Results: A total of 22 studies were included in the review. Based on the results of the reviewed studies, there are three main factors that influence the treatment outcomes in patients with Perthes disease. These factors are onset age, femoral head involvement severity, and treatment method. The disease has a poor prognosis in children over 8 years old, but this group of patients can also benefit from advanced surgical methods. In patients aged less than 6 years, the disease has a generally good prognosis, but in those aged between 6 and 8 years, its prognosis is variable. Thus, the need for surgical intervention requires close observation of signs. Once any head signs are observed, dynamic arthrography is beneficial before choosing the treatment approach. Conclusions: This review provides clinicians with a brief guideline for the treatment of patients with LCPD. UR - https://www.i-jmr.org/2021/2/e27075 UR - http://dx.doi.org/10.2196/27075 UR - http://www.ncbi.nlm.nih.gov/pubmed/33938444 ID - info:doi/10.2196/27075 ER - TY - JOUR AU - Alkureishi, A. Maria AU - Johnson, Tyrone AU - Nichols, Jacqueline AU - Dhodapkar, Meera AU - Czerwiec, K. M. AU - Wroblewski, Kristen AU - Arora, M. Vineet AU - Lee, Wei Wei PY - 2021/4/28 TI - Impact of an Educational Comic to Enhance Patient-Physician?Electronic Health Record Engagement: Prospective Observational Study JO - JMIR Hum Factors SP - e25054 VL - 8 IS - 2 KW - electronic health records KW - patient KW - comic KW - education KW - engagement N2 - Background: Electronic health record (EHR) use can impede or augment patient-physician communication. However, little research explores the use of an educational comic to improve patient-physician-EHR interactions. Objective: To evaluate the impact of an educational comic on patient EHR self-advocacy behaviors to promote patient engagement with the EHR during clinic visits. Methods: We conducted a prospective observational study with adult patients and parents of pediatric patients at the University of Chicago General Internal Medicine (GIM) and Pediatric Primary Care (PPC) clinics. We developed an educational comic highlighting EHR self-advocacy behaviors and distributed it to study participants during check-in for their primary care visits between May 2017 and May 2018. Participants completed a survey immediately after their visit, which included a question on whether they would be interested in a follow-up telephone interview. Of those who expressed interest, 50 participants each from the adult and pediatric parent cohorts were selected at random for follow-up telephone interviews 8 months (range 3-12 months) post visit. Results: Overall, 71.0% (115/162) of adult patients and 71.6% (224/313) of pediatric parents agreed the comic encouraged EHR involvement. African American and Hispanic participants were more likely to ask to see the screen and become involved in EHR use due to the comic (adult P=.01, P=.01; parent P=.02, P=.006, respectively). Lower educational attainment was associated with an increase in parents asking to see the screen and to be involved (?=?0.18, P=.003; ?=?0.19, P<.001, respectively) and in adults calling for physician attention (?=?0.17, P=.04), which was confirmed in multivariate analyses. Female GIM patients were more likely than males to ask to be involved (median 4 vs 3, P=.003). During follow-up phone interviews, 90% (45/50) of adult patients and all pediatric parents (50/50) remembered the comic. Almost half of all participants (GIM 23/50, 46%; PPC 21/50, 42%) recalled at least one best-practice behavior. At subsequent visits, adult patients reported increases in asking to see the screen (median 3 vs 4, P=.006), and pediatric parents reported increases in asking to see the screen and calling for physician attention (median 3 vs 4, Ps<.001 for both). Pediatric parents also felt that the comic had encouraged them to speak up and get more involved with physician computer use since the index visit (median 4 vs 4, P=.02) and that it made them feel more empowered to get involved with computer use at future visits (median 3 vs 4, P<.001). Conclusions: Our study found that an educational comic may improve patient advocacy for enhanced patient-physician-EHR engagement, with higher impacts on African American and Hispanic patients and patients with low educational attainment. UR - https://humanfactors.jmir.org/2021/2/e25054 UR - http://dx.doi.org/10.2196/25054 UR - http://www.ncbi.nlm.nih.gov/pubmed/33908891 ID - info:doi/10.2196/25054 ER - TY - JOUR AU - Namba, Fumihiko AU - Tanaka, Kosuke AU - Omori, Sayu AU - Ikeda, Kazushige AU - Kawabata, Ken AU - Sato, Hiroaki AU - Honda, Masakazu AU - Ichikawa, Tomonori AU - Minosaki, Yoshihiro AU - Michikawa, Takehiro AU - Oka, Shuntaro AU - Kabe, Kazuhiko PY - 2021/3/5 TI - Extreme Prematurity and Pulmonary Outcomes Program in Saitama: Protocol for a Prospective Multicenter Cohort Study in Japan JO - JMIR Res Protoc SP - e22948 VL - 10 IS - 3 KW - prematurity KW - preterm infant KW - bronchopulmonary dysplasia KW - respiratory outcome N2 - Background: Because of the improvements in survival rates for preterm infants, not only the rates of bronchopulmonary dysplasia (BPD) but also those of long-term respiratory complications of premature birth are increasing, resulting in financial and health burdens in developed countries. Thus far, the risk factors of respiratory morbidities in extremely preterm infants remain unknown. Furthermore, the definition and the predictive ability of BPD for long-term respiratory outcomes are yet to be determined. Objective: The objective of our study, Extreme Prematurity and Pulmonary Outcomes Program in Saitama, is to develop the diagnostic criteria for BPD and to determine the prognostic factors contributing to the long-term pulmonary outcomes manifesting in extremely preterm infants. Methods: The Extreme Prematurity and Pulmonary Outcomes Program in Saitama is an observational prospective cohort study performed by a consortium of six neonatal intensive care units (NICUs) in Saitama, Japan. The subjects included in this study are infants (from each clinical center) with gestational ages 22 to 27 weeks. The target is 400 subjects. This study aims to determine the definition of BPD and other perinatal factors that accurately predict the long-term pulmonary outcomes in survivors of extreme prematurity. Moreover, the association between BPD and postprematurity respiratory disease will be investigated using generalized linear models. Results: The protocol and consent forms were evaluated and approved on September 5, 2019, by the Ethics Committee of Saitama Medical Center, Saitama Medical University. Enrollment began on April 1, 2020. It is expected to end on March 31, 2023. The follow-up for 1 year corrected age is expected to continue through the middle of 2024. Conclusions: The Extreme Prematurity and Pulmonary Outcomes Program in Saitama incorporates aspects of neonatal care in secondary- and tertiary-level NICUs to develop existing research studies on the definition of BPD, objective biomarkers, and outcome measures of respiratory morbidity in extremely preterm infants beyond NICU hospitalization, thereby leading to a novel understanding of the nature and natural history of BPD and potential mechanistic and therapeutic targets in at-risk subjects. International Registered Report Identifier (IRRID): DERR1-10.2196/22948 UR - https://www.researchprotocols.org/2021/3/e22948 UR - http://dx.doi.org/10.2196/22948 UR - http://www.ncbi.nlm.nih.gov/pubmed/33666556 ID - info:doi/10.2196/22948 ER - TY - JOUR AU - Liu, Guihua AU - Wang, Shuo AU - Liao, Jinhua AU - Ou, Ping AU - Huang, Longsheng AU - Xie, Namei AU - He, Yingshuang AU - Lin, Jinling AU - He, Hong-Gu AU - Hu, Rongfang PY - 2021/2/10 TI - The Efficacy of WeChat-Based Parenting Training on the Psychological Well-being of Mothers With Children With Autism During the COVID-19 Pandemic: Quasi-Experimental Study JO - JMIR Ment Health SP - e23917 VL - 8 IS - 2 KW - coronavirus disease 2019 KW - autism spectrum disorder KW - parenting training KW - psychological well-being KW - social media KW - WeChat KW - COVID-19 KW - autism KW - parenting KW - mental health KW - well-being KW - anxiety KW - depression KW - stress N2 - Background: During the COVID-19 pandemic, special education schools for children in most areas of China were closed between the end of January and the beginning of June in 2020. The sudden interruption in schooling and the pandemic itself caused parents to be anxious and even to panic. Mobile-based parenting skills education has been demonstrated to be an effective method for improving the psychological well-being of mothers with children with autism. However, whether it can improve the psychological states of mothers in the context of the COVID-19 pandemic is a subject that should be urgently investigated. Objective: The aim of this study is to evaluate the efficacy of WeChat-based parenting training on anxiety, depression, parenting stress, and hope in mothers with children with autism, as well as the feasibility of the program during the COVID-19 pandemic. Methods: This was a quasi-experimental trial. A total of 125 mothers with preschool children with autism were recruited in January 2020. The participants were assigned to the control group (n=60), in which they received routine care, or the intervention group (n=65), in which they received the 12-week WeChat-based parenting training plus routine care, according to their preferences. Anxiety, depression, parenting stress, hope, satisfaction, and adherence to the intervention were measured at three timepoints: baseline (T0), postintervention (T1), and a 20-week follow-up (T2). Results: In total, 109 mothers completed the T1 assessment and 104 mothers completed the T2 assessment. The results of the linear mixed model analysis showed statistically significant group × time interaction effects for the intervention on anxiety (F=14.219, P<.001), depression (F=26.563, P<.001), parenting stress (F=68.572, P<.001), and hope (F=197.608, P<.001). Of all mothers in the intervention group, 90.4% (48.8/54) reported that they were extremely satisfied with the WeChat-based parenting training. In total, 40.0% (26/65) logged their progress in home training each week and 61.5% (40/65) logged their progress more than 80% of the time for all 20 weeks. Conclusions: The WeChat-based parenting training is acceptable and appears to be an effective approach for reducing anxiety, depression, and parenting stress, as well as increasing hope in mothers with children with autism during the global COVID-19 pandemic. Future studies with rigorous designs and longer follow-up periods are needed to further detect the effectiveness of the WeChat-based parenting training. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000031772; http://www.chictr.org.cn/showproj.aspx?proj=52165 UR - https://mental.jmir.org/2021/2/e23917 UR - http://dx.doi.org/10.2196/23917 UR - http://www.ncbi.nlm.nih.gov/pubmed/33481751 ID - info:doi/10.2196/23917 ER - TY - JOUR AU - Weijers, Miriam AU - Bastiaenen, Caroline AU - Feron, Frans AU - Schröder, Kay PY - 2021/2/9 TI - Designing a Personalized Health Dashboard: Interdisciplinary and Participatory Approach JO - JMIR Form Res SP - e24061 VL - 5 IS - 2 KW - visualization design model KW - dashboard KW - evaluation KW - personalized health care KW - International Classification of Functioning, Disability and Health (ICF) KW - patient access to records KW - human?computer interaction KW - health information visualization N2 - Background: Within the Dutch Child Health Care (CHC), an online tool (360° CHILD-profile) is designed to enhance prevention and transformation toward personalized health care. From a personalized preventive perspective, it is of fundamental importance to timely identify children with emerging health problems interrelated to multiple health determinants. While digitalization of children?s health data is now realized, the accessibility of data remains a major challenge for CHC professionals, let alone for parents/youth. Therefore, the idea was initiated from CHC practice to develop a novel approach to make relevant information accessible at a glance. Objective: This paper describes the stepwise development of a dashboard, as an example of using a design model to achieve visualization of a comprehensive overview of theoretically structured health data. Methods: Developmental process is based on the nested design model with involvement of relevant stakeholders in a real-life context. This model considers immediate upstream validation within 4 cascading design levels: Domain Problem and Data Characterization, Operation and Data Type Abstraction, Visual Encoding and Interaction Design, and Algorithm Design. This model also includes impact-oriented downstream validation, which can be initiated after delivering the prototype. Results: A comprehensible 360° CHILD-profile is developed: an online accessible visualization of CHC data based on the theoretical concept of the International Classification of Functioning, Disability and Health. This dashboard provides caregivers and parents/youth with a holistic view on children?s health and ?entry points? for preventive, individualized health plans. Conclusions: Describing this developmental process offers guidance on how to utilize the nested design model within a health care context. UR - https://formative.jmir.org/2021/2/e24061 UR - http://dx.doi.org/10.2196/24061 UR - http://www.ncbi.nlm.nih.gov/pubmed/33560229 ID - info:doi/10.2196/24061 ER - TY - JOUR AU - Chou, H. Joseph PY - 2020/10/29 TI - Predictive Models for Neonatal Follow-Up Serum Bilirubin: Model Development and Validation JO - JMIR Med Inform SP - e21222 VL - 8 IS - 10 KW - infant, newborn KW - neonatology KW - jaundice, neonatal KW - hyperbilirubinemia, neonatal KW - machine learning KW - supervised machine learning KW - data science KW - medical informatics KW - decision support techniques KW - models, statistical KW - predictive models N2 - Background: Hyperbilirubinemia affects many newborn infants and, if not treated appropriately, can lead to irreversible brain injury. Objective: This study aims to develop predictive models of follow-up total serum bilirubin measurement and to compare their accuracy with that of clinician predictions. Methods: Subjects were patients born between June 2015 and June 2019 at 4 hospitals in Massachusetts. The prediction target was a follow-up total serum bilirubin measurement obtained <72 hours after a previous measurement. Birth before versus after February 2019 was used to generate a training set (27,428 target measurements) and a held-out test set (3320 measurements), respectively. Multiple supervised learning models were trained. To further assess model performance, predictions on the held-out test set were also compared with corresponding predictions from clinicians. Results: The best predictive accuracy on the held-out test set was obtained with the multilayer perceptron (ie, neural network, mean absolute error [MAE] 1.05 mg/dL) and Xgboost (MAE 1.04 mg/dL) models. A limited number of predictors were sufficient for constructing models with the best performance and avoiding overfitting: current bilirubin measurement, last rate of rise, proportion of time under phototherapy, time to next measurement, gestational age at birth, current age, and fractional weight change from birth. Clinicians made a total of 210 prospective predictions. The neural network model accuracy on this subset of predictions had an MAE of 1.06 mg/dL compared with clinician predictions with an MAE of 1.38 mg/dL (P<.0001). In babies born at 35 weeks of gestation or later, this approach was also applied to predict the binary outcome of subsequently exceeding consensus guidelines for phototherapy initiation and achieved an area under the receiver operator characteristic curve of 0.94 (95% CI 0.91 to 0.97). Conclusions: This study developed predictive models for neonatal follow-up total serum bilirubin measurements that outperform clinicians. This may be the first report of models that predict specific bilirubin values, are not limited to near-term patients without risk factors, and take into account the effect of phototherapy. UR - http://medinform.jmir.org/2020/10/e21222/ UR - http://dx.doi.org/10.2196/21222 UR - http://www.ncbi.nlm.nih.gov/pubmed/33118947 ID - info:doi/10.2196/21222 ER - TY - JOUR AU - Baggett, M. Kathleen AU - Davis, Betsy AU - Landry, H. Susan AU - Feil, G. Edward AU - Whaley, Anna AU - Schnitz, Alana AU - Leve, Craig PY - 2020/9/22 TI - Understanding the Steps Toward Mobile Early Intervention for Mothers and Their Infants Exiting the Neonatal Intensive Care Unit: Descriptive Examination JO - J Med Internet Res SP - e18519 VL - 22 IS - 9 KW - early intervention KW - equity KW - NICU KW - low birthweight KW - transition KW - mobile internet intervention KW - infants KW - mothers N2 - Background: Neonatal intensive care unit (NICU) history, combined with systemic inequities for mothers of nondominant cultures and mothers who are socioeconomically disadvantaged, places infants at an extraordinary risk for poor developmental outcomes throughout life. Although receipt of early intervention (EI) is the best single predictor of developmental outcomes among children with and at risk for early developmental delays, mothers and infants with the greatest needs are least likely to receive EI. Mobile internet-based interventions afford substantial advantages for overcoming logistical challenges that often prevent mothers who are economically disadvantaged from accessing EI. However, the bridge from the NICU to a mobile internet intervention has been virtually unexplored. Objective: This study aims to examine progression flow from NICU exit referral to an early mobile internet intervention to increase EI access and promote parent mediation of infant social-emotional and communication development. Methods: Three NICUs serving the urban poor in a Midwestern city were provided support in establishing an electronic NICU exit referral mechanism into a randomized controlled trial of a mobile internet intervention for mothers and their infants. Measurement domains to reflect the bridge to service included each crucial gateway required for navigating the path into Part C EI, including referral, screening, assessment, and intervention access. An iterative process was used and documented to facilitate each NICU in establishing an individualized accountability plan for sharing referral materials with mothers before their NICU exit. Subsequent to the referral, progression flow was documented on the basis of a real-time electronic recording of service receipt and contact records. Mother and infant risk characteristics were also assessed. Descriptive analyses were conducted to summarize and characterize each measurement domain. Results: NICU referral rates for EI were 3 to 4 times higher for open-shared versus closed-single gatekeeper referral processes. Of 86 referred dyads, 67 (78%) were screened, and of those screened, 51 (76%) were eligible for assessment. Of the 51 assessment-eligible mothers and infants, 35 dyads (69%) completed the assessment and 31 (89%) went on to complete at least one remote coaching intervention session. The dyads who accessed and engaged in intervention were racially and ethnically diverse and experiencing substantial adversity. Conclusions: The transition from the NICU to home was fraught with missed opportunities for an EI referral. Beyond the referral, the most prominent reason for not participating in screening was that mothers could not be located after exiting the NICU. Stronger NICU referral mechanisms for EI are needed. It may be essential to initiate mobile interventions before exiting the NICU for maintaining post-NICU contact with some mothers. In contrast to a closed, single point of referral gatekeeper systems in NICUs, open, shared referral gating systems may be less stymied by individual service provider biases and disruptions. UR - http://www.jmir.org/2020/9/e18519/ UR - http://dx.doi.org/10.2196/18519 UR - http://www.ncbi.nlm.nih.gov/pubmed/32960178 ID - info:doi/10.2196/18519 ER - TY - JOUR AU - Schiro, Jessica AU - Pelayo, Sylvia AU - Martinot, Alain AU - Dubos, François AU - Beuscart-Zéphir, Marie-Catherine AU - Marcilly, Romaric PY - 2020/9/4 TI - Applying a Human-Centered Design to Develop a Patient Prioritization Tool for a Pediatric Emergency Department: Detailed Case Study of First Iterations JO - JMIR Hum Factors SP - e18427 VL - 7 IS - 3 KW - emergency department KW - triage systems KW - ergonomics KW - design KW - human-centered design KW - patients N2 - Background: Overcrowding in the emergency departments has become an increasingly significant problem. Patient triage strategies are acknowledged to help clinicians manage patient flow and reduce patients? waiting time. However, electronic patient triage systems are not developed so that they comply with clinicians? workflow. Objective: This case study presents the development of a patient prioritization tool (PPT) and of the related patient prioritization algorithm (PPA) for a pediatric emergency department (PED), relying on a human-centered design process. Methods: We followed a human-centered design process, wherein we (1) performed a work system analysis through observations and interviews in an academic hospital?s PED; (2) deduced design specifications; (3) designed a mock PPT and the related PPA; and (4) performed user testing to assess the intuitiveness of the icons, the effectiveness in communicating patient priority, the fit between the prioritization model implemented and the participants? prioritization rules, and the participants? satisfaction. Results: The workflow analysis identified that the PPT interface should meet the needs of physicians and nurses, represent the stages of patient care, and contain patient information such as waiting time, test status (eg, prescribed, in progress), age, and a suggestion for prioritization. The mock-up developed gives the status of patients progressing through the PED; a strip represents the patient and the patient?s characteristics, including a delay indicator that compares the patient?s waiting time to the average waiting time of patients with a comparable reason for emergency. User tests revealed issues with icon intuitiveness, information gaps, and possible refinements in the prioritization algorithm. Conclusions: The results of the user tests have led to modifications to improve the usability and usefulness of the PPT and its PPA. We discuss the value of integrating human factors into the design process for a PPT for PED. The PPT/PPA has been developed and installed in Lille University Hospital's PED. Studies are carried out to evaluate the use and impact of this tool on clinicians? situation awareness and prioritization-related cognitive load, prioritization of patients, waiting time, and patients? experience. UR - http://humanfactors.jmir.org/2020/3/e18427/ UR - http://dx.doi.org/10.2196/18427 UR - http://www.ncbi.nlm.nih.gov/pubmed/32886071 ID - info:doi/10.2196/18427 ER - TY - JOUR AU - Bustamante Loyola, Jorge AU - Perez Retamal, Marcela AU - Morgues Nudman, Isabel Monica AU - Maturana, Andres AU - Salinas Gonzalez, Ricardo AU - Cox, Horacio AU - González Mas, Miguel José AU - Muñoz, Lucia AU - Lopez, Lilian AU - Mendiburo-Seguel, Andrés AU - Simó, Sandra AU - Palau Subiela, Pascual AU - Guedeney, Antoine PY - 2020/6/26 TI - Interactive Guidance Intervention to Address Sustained Social Withdrawal in Preterm Infants in Chile: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e17943 VL - 9 IS - 6 KW - social withdrawal KW - preterm KW - early detection KW - interactive guidance KW - emotional stress KW - social development KW - postnatal depression KW - posttraumatic stress N2 - Background: Preterm newborns can be exposed early to significant perinatal stress, and this stress can increase the risk of altered socioemotional development. Sustained social withdrawal in infants is an early indicator of emotional distress which is expressed by low reactivity to the environment, and if persistent, is frequently associated with altered psychological development. Infants born prematurely have a higher probability of developing sustained social withdrawal (adjusted odds ratio 1.84, 95% CI 1.04-3.26) than infants born full term, and there is a correlation between weight at birth and sustained social withdrawal at 12 months of age. Objective: The aims of this study are to compare the effect of the interactive guidance intervention to that of routine pediatric care on sustained social withdrawal in infants born moderately or late preterm and to explore the relationship between sustained social withdrawal in these infants and factors such as neonatal intensive care unit hospitalization variables, parental depression, and posttraumatic stress symptoms. Methods: This study is designed as a multicenter randomized controlled trial. Moderate and late preterm newborns and their parents were recruited and randomized (1:1 allocation ratio) to control and experimental groups. During neonatal intensive care unit hospitalization, daily duration of skin-to-skin contact, breastfeeding, and parental visits were recorded. Also, a daily score for neonatal pain and painful invasive procedures were recorded. After discharge from neonatal intensive care, for the duration of the study, both groups will attend follow-up consultations with neonatologists at 2, 6, and 12 months of age (corrected for gestational age) and will receive routine pediatric care. Every consultation will be recorded and assessed with the Alarm Distress Baby Scale to detect sustained social withdrawal (indicated by a score of 5 or higher). The neonatologists will perform an interactive guidance intervention if an infant in the intervention group exhibits sustained social withdrawal. In each follow-up consultation, parents will fill out the Edinburgh Postnatal Depression Scale, the modified Perinatal Posttraumatic Stress Disorder Questionnaire, and the Impact of Event Scale?revised. Results: Recruitment for this trial started in September 2017. As of May 2020, we have completed enrollment (N=110 infants born moderately or late preterm). We aim to publish the results by mid-2021. Conclusions: This is the first randomized controlled trial with a sample of infants born moderately or late preterm infants who will attend pediatric follow-up consultations during their first year (corrected for gestational age at birth) with neonatologists trained in the Alarm Distress Baby Scale and who will receive this interactive guidance intervention. If successful, this early intervention will show significant potential to be implemented in both public and private health care, given its low cost of training staff and that the intervention takes place during routine pediatric follow-up. Trial Registration: ClinicalTrials.gov NCT03212547; https://clinicaltrials.gov/ct2/show/NCT03212547. International Registered Report Identifier (IRRID): DERR1-10.2196/17943 UR - http://www.researchprotocols.org/2020/6/e17943/ UR - http://dx.doi.org/10.2196/17943 UR - http://www.ncbi.nlm.nih.gov/pubmed/32589156 ID - info:doi/10.2196/17943 ER - TY - JOUR AU - Espinoza, Juan AU - Crown, Kelly AU - Kulkarni, Omkar PY - 2020/4/30 TI - A Guide to Chatbots for COVID-19 Screening at Pediatric Health Care Facilities JO - JMIR Public Health Surveill SP - e18808 VL - 6 IS - 2 KW - chatbots KW - COVID-19: pediatrics KW - digital health KW - screening UR - http://publichealth.jmir.org/2020/2/e18808/ UR - http://dx.doi.org/10.2196/18808 UR - http://www.ncbi.nlm.nih.gov/pubmed/32325425 ID - info:doi/10.2196/18808 ER - TY - JOUR AU - Holmen, Heidi AU - Riiser, Kirsti AU - Winger, Anette PY - 2020/2/28 TI - Home-Based Pediatric Palliative Care and Electronic Health: Systematic Mixed Methods Review JO - J Med Internet Res SP - e16248 VL - 22 IS - 2 KW - eHealth KW - home-based KW - pediatric palliative care KW - pediatric KW - children KW - family KW - communication KW - palliative care N2 - Background: Children and families in pediatric palliative care depend on close contact with health care personnel, and electronic health (eHealth) is suggested to support care at home by facilitating their remote interactions. Objective: This study aimed to identify and review the use of eHealth to communicate and support home-based pediatric palliative care and appraise the methodological quality of the published research. Methods: We conducted a convergent, systematic mixed methods review and searched Medical Literature Analysis and Retrieval System Online (Medline), EMBASE, PsycINFO, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Scopus for eligible papers. Studies evaluating 2-way communication technology for palliative care for children aged ?18 years and applying quantitative, qualitative, or mixed methods from 2012 to 2018 were eligible for inclusion. Quantitative and qualitative studies were equally valued during the search, screening, extraction, and analysis. Quantitative data were transformed into qualitative data and analyzed using a thematic analysis. Overall, 2 independent researchers methodologically appraised all included studies. Results: We identified 1277 citations. Only 7 papers were eligible for review. Evaluating eHealth interventions in pediatric palliative care poses specific methodological and ethical challenges. eHealth to facilitate remote pediatric palliative care was acknowledged both as an intrusion and as a support at home. Reluctance toward eHealth was mainly identified among professionals. Conclusions: The strengths of the conclusions are limited by the studies? methodological challenges. Despite the limitless possibilities held by new technologies, research on eHealth in home-based pediatric palliative care is scarce. The affected children and families appeared to hold positive attitudes toward eHealth, although their views were less apparent compared with those of the professionals. Trial Registration: PROSPERO CRD42018119051; https://tinyurl.com/rtsw5ky UR - http://www.jmir.org/2020/2/e16248/ UR - http://dx.doi.org/10.2196/16248 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130127 ID - info:doi/10.2196/16248 ER - TY - JOUR AU - Matin, B. Shababa AU - Wallingford, Allison AU - Xu, Shicheng AU - Ng, Natalie AU - Ho, Anthony AU - Vanosdoll, Madison AU - Waiswa, Peter AU - Labrique, B. Alain AU - Acharya, Soumyadipta PY - 2020/2/18 TI - Feasibility of a Mobile Health Tool for Mothers to Identify Neonatal Illness in Rural Uganda: Acceptability Study JO - JMIR Mhealth Uhealth SP - e16426 VL - 8 IS - 2 KW - newborn KW - neonatal health KW - community health workers KW - maternal behavior KW - Uganda KW - World Health Organization KW - mobile apps KW - telemedicine N2 - Background: A shortage of community health workers to triage sick neonates and poor recognition of neonatal illness by mothers contribute significantly toward neonatal deaths in low- and middle-income countries. Providing low-resource communities with the tools and knowledge to recognize signs of neonatal distress can lead to early care-seeking behavior. To empower and educate mothers to recognize signs of neonatal illness, we developed a neonatal health assessment device consisting of a smartphone app and a wearable sensor (the NeMo system). Objective: The aim of this study was to determine if mothers in rural Uganda were willing and able to use the NeMo system during the first week of their infant?s life. We also assessed mothers? responses to the device?s recommendation to seek care. Methods: A total of 20 mothers were enrolled in the study after giving birth in the Iganga District Hospital. Each mother was trained to use the NeMo system to assess her infant for signs of illness before leaving the hospital and was given the NeMo system to use at home for 1 week. Throughout the week, the smartphone tracked the mothers? usage of NeMo, and the study team visited twice to observe mothers? ability to use NeMo. Each mother was interviewed at the end of 1 week to gather qualitative feedback on her experience with the NeMo system. Results: In total, 18 mothers completed the study; 2 mothers were withdrawn during the week because of extenuating health circumstances. Moreover, 1 day after enrollment and training, 75% (15/20) of mothers used NeMo properly with no mistakes. Three days after enrollment and training, only 1 mother placed the wearable sensor improperly on her infant. On the final study day, only 1 mother connected the device improperly. Mothers used NeMo an average of 11.67 (SD 5.70) times on their own at home during the 5 full study days. Although the frequency of use per day decreased from day 1 to day 5 of the study (P=.04), 72% (13/18) of mothers used NeMo at least once per day. In total, 64% (9/14) of mothers who received an alert from the NeMo system to seek care for their infants either called the health care professional working with the study team or reused the system immediately and found no danger signs. All 18 mothers agreed or strongly agreed that the NeMo system was easy to use and helped them know when to seek care for their babies. Conclusions: NeMo is a feasible and acceptable tool to aid mothers in rural Uganda to assess their infant?s health. UR - https://mhealth.jmir.org/2020/2/e16426 UR - http://dx.doi.org/10.2196/16426 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130174 ID - info:doi/10.2196/16426 ER - TY - JOUR AU - Fernandez-Luque, Luis AU - Labarta, I. José AU - Palmer, Ella AU - Koledova, Ekaterina PY - 2020/2/18 TI - Content Analysis of Apps for Growth Monitoring and Growth Hormone Treatment: Systematic Search in the Android App Store JO - JMIR Mhealth Uhealth SP - e16208 VL - 8 IS - 2 KW - growth hormone KW - telemedicine KW - growth monitoring KW - mobile app KW - mobile health N2 - Background: The use of mobile apps for health is growing. This rapid growth in the number of health apps can make it hard to assess their quality and features. The increased demand for and availability of mobile health apps highlights the importance of regular publication of reviews to identify potential areas of unmet needs and concern. The focus of this review is mobile apps for monitoring growth for health care professionals, caregivers, and patients. Monitoring growth as a part of healthy physical development is important across different periods of childhood and adolescence. Objective: The goal of this content analysis is to map and understand the types of apps that currently exist that are related to growth monitoring and growth hormone treatment. Methods: A semiautomated search was undertaken using the app search engine 42Matters, complemented by a manual search for growth apps using the web search tool of Google Play (Android App Store). Apps were rated on their relevance to growth monitoring and categorized by independent raters. Results: In total, 76 apps were rated relevant to growth monitoring or growth hormone treatment. The level of agreement was measured for the semiautomated search and was very high (?=0.97). The target audience for 87% of the apps (66/76) was patients and relatives, followed by health care professionals (11%; 8/76) and both (3%; 2/76). Apps in the category ?growth tracking tools for children and babies? were retrieved most often (46%; 35/76) followed by ?general baby care apps? (32%; 24/76), ?nonpharmacological solutions for growth? (12%; 9/76) and ?growth hormone?related? (11%; 8/76). Overall, 19/76 apps (25%) tracked a precise location. Conclusions: This study mapped the type of apps currently available for growth monitoring or growth hormone treatment that can be used as a foundation for more detailed evaluations of app quality. The popularity of care apps for children and growth monitoring apps should provide a great channel for potential intervention in childhood health in the future. UR - http://mhealth.jmir.org/2020/2/e16208/ UR - http://dx.doi.org/10.2196/16208 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130162 ID - info:doi/10.2196/16208 ER - TY - JOUR AU - Chou, H. Joseph AU - Roumiantsev, Sergei AU - Singh, Rachana PY - 2020/1/30 TI - PediTools Electronic Growth Chart Calculators: Applications in Clinical Care, Research, and Quality Improvement JO - J Med Internet Res SP - e16204 VL - 22 IS - 1 KW - growth charts KW - pediatrics KW - infant, newborn KW - infant, premature KW - failure to thrive KW - internet KW - software N2 - Background: Parameterization of pediatric growth charts allows precise quantitation of growth metrics that would be difficult or impossible with traditional paper charts. However, limited availability of growth chart calculators for use by clinicians and clinical researchers currently restricts broader application. Objective: The aim of this study was to assess the deployment of electronic calculators for growth charts using the lambda-mu-sigma (LMS) parameterization method, with examples of their utilization for patient care delivery, clinical research, and quality improvement projects. Methods: The publicly accessible PediTools website of clinical calculators was developed to allow LMS-based calculations on anthropometric measurements of individual patients. Similar calculations were applied in a retrospective study of a population of patients from 7 Massachusetts neonatal intensive care units (NICUs) to compare interhospital growth outcomes (change in weight Z-score from birth to discharge [?Z weight]) and their association with gestational age at birth. At 1 hospital, a bundle of quality improvement interventions targeting improved growth was implemented, and the outcomes were assessed prospectively via monitoring of ?Z weight pre- and postintervention. Results: The PediTools website was launched in January 2012, and as of June 2019, it received over 500,000 page views per month, with users from over 21 countries. A retrospective analysis of 7975 patients at 7 Massachusetts NICUs, born between 2006 and 2011, at 23 to 34 completed weeks gestation identified an overall ?Z weight from birth to discharge of ?0.81 (P<.001). However, the degree of ?Z weight differed significantly by hospital, ranging from ?0.56 to ?1.05 (P<.001). Also identified was the association between inferior growth outcomes and lower gestational age at birth, as well as that the degree of association between ?Z weight and gestation at birth also differed by hospital. At 1 hospital, implementing a bundle of interventions targeting growth resulted in a significant and sustained reduction in loss of weight Z-score from birth to discharge. Conclusions: LMS-based anthropometric measurement calculation tools on a public website have been widely utilized. Application in a retrospective clinical study on a large dataset demonstrated inferior growth at lower gestational age and interhospital variation in growth outcomes. Change in weight Z-score has potential utility as an outcome measure for monitoring clinical quality improvement. We also announce the release of open-source computer code written in R to allow other clinicians and clinical researchers to easily perform similar analyses. UR - https://www.jmir.org/2020/1/e16204 UR - http://dx.doi.org/10.2196/16204 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012066 ID - info:doi/10.2196/16204 ER - TY - JOUR AU - Kinkar, Abdulelah AU - Alqarni, Dalya AU - Alghamdi, Abdulaziz AU - Wali, Sahal AU - Alghamdi, Nasser AU - Saloom, Saeed AU - Aashi, Mooataz PY - 2020/1/20 TI - Parental Knowledge, Attitudes, and Behaviors Toward Their Epileptic Children at King Abdulaziz University Hospital: Cross-Sectional Study JO - Interact J Med Res SP - e12697 VL - 9 IS - 1 KW - parenting KW - attitudes KW - behaviors KW - epilepsy KW - children KW - pediatrics N2 - Background: Epilepsy is a chronic disease characterized by periodic seizures that result from abnormal integrated firing impulses in the brain. It is one of the most common neurological disorders. Over the past few years, there has been increasing awareness about the effect that having a child with epilepsy has on parents and the reciprocal impact of parental knowledge and attitudes regarding epilepsy on the affected child. Objective: This study aimed to assess parental knowledge, attitudes, and behavior toward their epileptic children. Methods: A cross-sectional study was conducted in 2018 by the Pediatric Neurology Department of King Abdulaziz University Hospital, Jeddah, the Kingdom of Saudi Arabia. A sample size of 115 of 332 parents who have a child diagnosed with epilepsy and aged 18 years or younger were recruited for this study. Statistical analysis was performed using SPSS version 21. Data analysis was performed using an independent t test, a chi-square test, one-way analysis of variance, and correlation analysis. Results: A total of 115 participants answered the questionnaire; of these, 65 (56.5%) were men, with an average age of 40.3 years, and the mean age of the children was 9.0 years. Overall, 85 (85/115, 73.9%) children were taken care of by both of their parents. The mean parental knowledge score was 7.49 (SD 2.08) out of 12, and it was significantly related to the educational level of the parent (P=.004). The knowledge question that was most frequently answered incorrectly was ?Diagnosis of epilepsy is usually made based on at least two unprovoked seizures.? As only 28.7% (33/115) of participants chose the correct answer, mean parental attitude score was 26.51 (SD 4.284) out of 35, and there was no significant relation with the educational level of parents (P=.13); however, it was negatively correlated with the child?s age (P=.045). Mean parental behavioral score was 23.35 (SD 4.121) out of 35, and there was no significant relation with the educational level of the parents (P=.24). The most negatively answered question for the behavior section was ?I can leave my child without supervision,? with a mean score of 2.25 (SD 1.09) out of 5. Gender did not play a significant role in parental knowledge, attitudes, or behavior (P=.44, P=.77, and P=.99, respectively). Conclusions: Parental knowledge in our sample still needs improvement. Therefore, more awareness campaigns should be made for the community and for the parents of affected children to create a supportive environment for the children and help them thrive and develop. UR - http://www.i-jmr.org/2020/1/e12697/ UR - http://dx.doi.org/10.2196/12697 UR - http://www.ncbi.nlm.nih.gov/pubmed/31958065 ID - info:doi/10.2196/12697 ER - TY - JOUR AU - Rudolf, Isa AU - Pieper, Katharina AU - Nolte, Helga AU - Junge, Sibylle AU - Dopfer, Christian AU - Sauer-Heilborn, Annette AU - Ringshausen, C. Felix AU - Tümmler, Burkhard AU - von Jan, Ute AU - Albrecht, Urs-Vito AU - Fuge, Jan AU - Hansen, Gesine AU - Dittrich, Anna-Maria PY - 2019/11/21 TI - Assessment of a Mobile App by Adolescents and Young Adults With Cystic Fibrosis: Pilot Evaluation JO - JMIR Mhealth Uhealth SP - e12442 VL - 7 IS - 11 KW - mobile phone KW - mobile phone app KW - mHealth KW - self-management KW - adolescence KW - cystic fibrosis N2 - Background: Cystic fibrosis (CF) continues to be the most common life-limiting chronic pulmonary disease in adolescents and young adults. Treatment of CF demands a high treatment time investment to slow the progression of lung function decline, the most important contributor to morbidity and mortality. Adherence is challenging in CF due to the high treatment burden and the lack of immediate health consequences in case of nonadherence. Lung function decline is particularly pronounced in the transition phase between 12 and 24 years of age. The improvement of self-management and self-responsibility and independence from parents and desire for normalcy are conflicting aspects for many adolescents with CF, which influence adherence to the time-consuming pulmonary therapy. Mobile health (mHealth) care apps could help to support self-management and independence and thereby reconcile seemingly conflicting goals to improve adherence, quality of life, and ultimately CF life expectancy. Objective: This study aimed to (1) assess user behavior and satisfaction among adolescents and young adults with CF over an observation period of three months using an mHealth app; (2) identify areas of improvement for this mHealth app; and (3) compare overall and disease-specific satisfaction, lung function, and anthropometry before and after using the mHealth app. Methods: A total of 27 adolescents and young adults with CF (age range 12-24 years, mean age 16 years, SD 3 years; 14 females, 11 males) used a free mHealth app for three months of whom 25 provided questionnaire data for analysis at the end of the study. Data collection was carried out using questionnaires on usage characteristics and life satisfaction, and standardized assessment of lung function and anthropometry. Results: The use of the reminder function for medication declined from 70% (15/21) of the participants at week 4 to 65% (13/20) at week 8 of the observation period. At the end of the study, only 17% (4/23) of the participants wanted to continue using the app. Nevertheless, 56% (14/25) of participants saw the mobile app as a support for everyday life. Potential improvements targeting hedonistic qualities were identified to improve mHealth app adherence. Comparisons of satisfaction with different life aspects hinted at improvements or stabilization for the subitem respiration and the subitem lack of handicap by CF, suggesting that app use might stabilize certain CF-specific aspects of the weighted satisfaction with life. Lung function and anthropometry were not affected consistently. Conclusions: Most of the patients did not want to continue using the app after the study period. Only a few CF-specific aspects of weighted life satisfaction were possibly stabilized by the mHealth app; clinical parameters were not affected. Adaptation of the functions to adolescent-specific needs could improve the long-term use and thus positively affect the disease course. UR - https://mhealth.jmir.org/2019/11/e12442 UR - http://dx.doi.org/10.2196/12442 UR - http://www.ncbi.nlm.nih.gov/pubmed/31750841 ID - info:doi/10.2196/12442 ER - TY - JOUR AU - Svedberg, Petra AU - Arvidsson, Susann AU - Larsson, Ingrid AU - Carlsson, Ing-Marie AU - Nygren, M. Jens PY - 2019/11/15 TI - Barriers and Enablers Affecting Successful Implementation of the Electronic Health Service Sisom: Multicenter Study of Child Participation in Pediatric Care JO - J Med Internet Res SP - e14271 VL - 21 IS - 11 KW - children KW - pediatrics KW - eHealth KW - health care KW - quality improvement KW - diffusion of innovation KW - implementation science KW - participatory medicine N2 - Background: Children?s participation in health care is one of the most important components in the management of their disease. Electronic health (eHealth) services that are adapted to the needs of children have the potential for restructuring how children and professionals work together. Therefore, a digital interactive assessment and communication tool, Sisom, was developed to give children aged between 6 and 12 years a voice in their own health care. However, the implementation of eHealth services such as Sisom in daily practice in pediatric health care is rarely investigated. Objective: The aim of this study was to explore the process of implementing Sisom for children in pediatric care in Sweden. More specifically, the study aimed to (1) evaluate whether the implementation strategy was conducted as planned, (2) understand the barriers and facilitators of the implementation strategy in pediatric care settings, (3) gain insight into how professionals work with the specific intervention, and (4) gain insight into the usefulness and effects of the intervention from the professionals? perspectives. Methods: A process evaluation design was used to study the implementation of Sisom at 4 pediatric care centers in Sweden. An extensive amount of qualitative and quantitative data was collected before, during, and after the intervention through self-report checklists, memos, and interviews with professionals. In total, 46 children, aged between 6 and 13 years, participated. The children used Sisom on two occasions during 6 months. When they used Sisom, a printed report formed the basis for a forthcoming dialogue between professionals, children, and their parents. Results: To our knowledge, this is the first implementation study of an eHealth communication tool aimed at strengthening children?s participation in pediatric health care. Key factors for successful implementation were alignment of the solution with the values and goals of the organization, health care professionals? beliefs in the usefulness and usability of the solution, and health care professionals? willingness to change their professional roles guided by the solution. Conclusions: The results from the study show that it is possible to restructure health care delivery toward a child-centered approach, if there is a willingness and preparedness in the organization to implement an eHealth solution with the aim of restructuring the way of working with children?s participation. UR - https://www.jmir.org/2019/11/e14271 UR - http://dx.doi.org/10.2196/14271 UR - http://www.ncbi.nlm.nih.gov/pubmed/31730040 ID - info:doi/10.2196/14271 ER - TY - JOUR AU - Ponum, Mahvish AU - Hasan, Osman AU - Khan, Saadia PY - 2019/05/14 TI - EasyDetectDisease: An Android App for Early Symptom Detection and Prevention of Childhood Infectious Diseases JO - Interact J Med Res SP - e12664 VL - 8 IS - 2 KW - infectious diseases KW - mHealth KW - causes of death N2 - Background: Infectious diseases often lead to death among children under 5 years in many underdeveloped and developing countries. One of the main reasons behind this is an unawareness of disease symptoms among mothers and child caregivers. To overcome this, we propose the EasyDetectDisease mobile health app to educate mothers about the early symptoms of pediatric diseases and to provide them with practical advice for preventing the spread of such diseases in children under 5 years. The EasyDetectDisease app includes detailed knowledge of infectious diseases, including the corresponding symptoms, causes, incubation period, preventive measures, nutritional guidelines such as breastfeeding, video tutorials of child patients, and video guidelines by pediatric health experts to promote child health. It also provides information on the diagnosis of the infectious diseases based on symptoms. Objective: The objective of this study was to evaluate the usability (eg, ease of use, easy detection of disease, functionality, and navigation of interfaces) of the EasyDetectDisease app among mothers of children under 5 years of age. Methods: Two health sessions, held in Pakistan, were used to evaluate the usability of EasyDetectDisease by 30 mothers of children under 5 years. The app was evaluated based on various quantitative and qualitative measures. Results: The participating mothers confirmed that they were able to diagnose diseases accurately and that after following the instructions provided, their children recovered rapidly without any nutritional deficiency. All participating mothers showed an interest in using the EasyDetectDisease app if made available by governmental public health agencies, and they suggested its inclusion in all mobile phones as a built-in health app in the future. Conclusions: EasyDetectDisease was modified into a user-friendly app based on feedback collected during the usability sessions. All participants found it acceptable and easy to use, especially illiterate mothers. The EasyDetectDisease app proved to be a useful tool for child health care at home and for the treatment of infectious diseases and is expected to reduce the mortality rate of children under 5 years of age. UR - http://www.i-jmr.org/2019/2/e12664/ UR - http://dx.doi.org/10.2196/12664 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094329 ID - info:doi/10.2196/12664 ER - TY - JOUR AU - Khader, Yousef AU - Alyahya, Mohammad AU - Batieha, Anwar PY - 2019/03/06 TI - Barriers to Implementation of Perinatal Death Audit in Maternity and Pediatric Hospitals in Jordan: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e11653 VL - 5 IS - 1 KW - perinatal death KW - quality of health care KW - cause of death KW - Jordan N2 - Background: Perinatal death audit is a feasible and cost-effective quality improvement tool that helps to improve the quality of health care and reduce perinatal deaths. Perinatal death audit is not implemented in almost all hospitals in Jordan. Objective: This study aimed to assess health professionals? attitude toward perinatal death auditing and determine the main barriers for effective implementation of perinatal death auditing as perceived by health professionals in Jordanian hospitals. Methods: A cross-sectional study was conducted among health professionals in 4 hospitals in Jordan. All physicians (pediatricians and obstetricians) and nurses working in these hospitals were invited to participate in the study. The study questionnaire assessed the attitude of health professionals toward perinatal death audit and assessed barriers for implementation of perinatal death audit in their hospitals. Results: This study included a total of 84 physicians and 218 nurses working in the 4 selected maternity hospitals. Only 35% (29/84) of physicians and 36.2% (79/218) of nurses reported that perinatal death audit would help to improve the quality of prenatal health care services to a great or very great extent. Lack of time was the first-mentioned barrier for implementing perinatal death audit by both physicians (35/84, 42%) and nurses (80/218, 36.7%). Almost the same proportions of health professionals reported inadequate patient information being documented in hospital records as a barrier. Lack of a health information system was the third-mentioned barrier by health professionals. Fear of having conflicts with the family of the dead baby was reported by almost one-third of physicians and nurses. Only 28% (23/83) of physicians and 16.9% (36/213) of nurses reported that they would like to be involved in perinatal death audit in their health facilities. Conclusions: Health professionals in Jordan had poor attitude toward perinatal death audit. The main barriers for implementing perinatal death audit in Jordanian hospitals were lack of time, inadequate patient information being documented in hospital records, and lack of health information systems. UR - http://publichealth.jmir.org/2019/1/e11653/ UR - http://dx.doi.org/10.2196/11653 UR - http://www.ncbi.nlm.nih.gov/pubmed/30839277 ID - info:doi/10.2196/11653 ER - TY - JOUR AU - Pham, Quynh AU - Graham, Gary AU - Lalloo, Chitra AU - Morita, P. Plinio AU - Seto, Emily AU - Stinson, N. Jennifer AU - Cafazzo, A. Joseph PY - 2018/12/21 TI - An Analytics Platform to Evaluate Effective Engagement With Pediatric Mobile Health Apps: Design, Development, and Formative Evaluation JO - JMIR Mhealth Uhealth SP - e11447 VL - 6 IS - 12 KW - analytics KW - engagement KW - log data KW - mobile health KW - mobile apps KW - chronic disease N2 - Background: Mobile health (mHealth) apps for pediatric chronic conditions are growing in availability and challenge investigators to conduct rigorous evaluations that keep pace with mHealth innovation. Traditional research methods are poorly suited to operationalize the agile, iterative trials required to evidence and optimize these digitally mediated interventions. Objective: We sought to contribute a resource to support the quantification, analysis, and visualization of analytic indicators of effective engagement with mHealth apps for chronic conditions. Methods: We applied user-centered design methods to design and develop an Analytics Platform to Evaluate Effective Engagement (APEEE) with consumer mHealth apps for chronic conditions and implemented the platform to analyze both retrospective and prospective data generated from a smartphone-based pain self-management app called iCanCope for young people with chronic pain. Results: Through APEEE, we were able to automate the process of defining, operationalizing, and evaluating effective engagement with iCanCope. Configuring the platform to integrate with the app was feasible and provided investigators with a resource to consolidate, analyze, and visualize engagement data generated by participants in real time. Preliminary efforts to evaluate APEEE showed that investigators perceived the platform to be an acceptable evaluative resource and were satisfied with its design, functionality, and performance. Investigators saw potential in APEEE to accelerate and augment evidence generation and expressed enthusiasm for adopting the platform to support their evaluative practice once fully implemented. Conclusions: Dynamic, real-time analytic platforms may provide investigators with a powerful means to characterize the breadth and depth of mHealth app engagement required to achieve intended health outcomes. Successful implementation of APEEE into evaluative practice may contribute to the realization of effective and evidence-based mHealth care. UR - http://mhealth.jmir.org/2018/12/e11447/ UR - http://dx.doi.org/10.2196/11447 UR - http://www.ncbi.nlm.nih.gov/pubmed/30578179 ID - info:doi/10.2196/11447 ER - TY - JOUR AU - Sasangohar, Farzan AU - Davis, Elise AU - Kash, A. Bita AU - Shah, R. Sohail PY - 2018/12/20 TI - Remote Patient Monitoring and Telemedicine in Neonatal and Pediatric Settings: Scoping Literature Review JO - J Med Internet Res SP - e295 VL - 20 IS - 12 KW - neonatal KW - pediatric KW - remote patient monitoring KW - telehealth KW - telemedicine N2 - Background: Telemedicine and telehealth solutions are emerging rapidly in health care and have the potential to decrease costs for insurers, providers, and patients in various settings. Pediatric populations that require specialty care are disadvantaged socially or economically or have chronic health conditions that will greatly benefit from results of studies utilizing telemedicine technologies. This paper examines the emerging trends in pediatric populations as part of a systematic literature review and provides a scoping review of the type, extent, and quantity of research available. Objective: This paper aims to examine the role of remote patient monitoring (RPM) and telemedicine in neonatal and pediatric settings. Findings can be used to identify strengths, weaknesses, and gaps in the field. The identification of gaps will allow for interventions or research to improve health care quality and costs. Methods: A systematic literature review is being conducted to gather an adequate amount of relevant research for telehealth in pediatric populations. The fields of RPM and telemedicine are not yet very well established by the health care services sector, and definitions vary across health care systems; thus, the terms are not always defined similarly throughout the literature. Three databases were scoped for information for this specific review, and 56 papers were included for review. Results: Three major telemedicine trends emerged from the review of 45 relevant papers?RPM, teleconsultation, and monitoring patients within the hospital, but without contact?thus, decreasing the likelihood of infection or other adverse health effects. Conclusions: While the current telemedicine approaches show promise, limited studied conditions and small sample sizes affect generalizability, therefore, warranting further research. The information presented can inform health care providers of the most widely implemented, studied, and effective forms of telemedicine for patients and their families and the telemedicine initiatives that are most cost efficient for health systems. While the focus of this review is to summarize some telehealth applications in pediatrics, we have also presented research studies that can inform providers about the importance of data sharing of remote monitoring data between hospitals. Further reports will be developed to inform health systems as the systematic literature review continues. UR - http://www.jmir.org/2018/12/e295/ UR - http://dx.doi.org/10.2196/jmir.9403 UR - http://www.ncbi.nlm.nih.gov/pubmed/30573451 ID - info:doi/10.2196/jmir.9403 ER - TY - JOUR AU - Kaskinen, Anu AU - Ayeboa-Sallah, Benjamin AU - Teivaanmäki, Tiina AU - Wärnhjelm, Elina AU - Korhonen, Liisa AU - Helve, Otto PY - 2018/12/14 TI - Pediatric Web-Based Chat Services for Caregivers of Children: Descriptive Study JO - J Med Internet Res SP - e10165 VL - 20 IS - 12 KW - chat service KW - health information KW - internet KW - Web-based resources KW - pediatrics KW - social media N2 - Background: Pediatric physician-led Web-based chat services offer a novel, low-threshold communication channel between caregivers and physicians. Objective: Our aim was to describe chat conversations between caregivers and physicians in a Web-based chat service to determine the factors that should be considered when planning a similar chat service. We also aimed to evaluate whether caregivers considered the consultations helpful, whether physicians considered they could answer caregivers? questions, and whether further face-to-face medical contact was needed. Methods: In September 2015, a private medical center for children in the greater Helsinki area initiated a Web-based chat service, accessible via any device with an internet connection, open from 9 am to 9 pm local time. Four residents in pediatrics, who had performed at least 60% of their 6-year residency program, served as the physicians responsible for chat consultations with caregivers of children. Between October 2015 and March 2016, 343 consecutive consultations were immediately evaluated by a chat physician. On average, caregivers were followed up by email questionnaire 7-14 days later, which 98 caregivers answered a median of 11 (interquartile range, IQR, 7-20) days later. Results: The age of the children whose caregivers contacted the chat service was a median of 2.1 (IQR 0.83-4.69) years, and 29.8% (102/342) of the children were less than 1 year old. The majority (119/343, 34.7%) of the chat conversations took place from 9 am to noon, and infections were the most common concern in over half of cases (189/343, 55.1%). Chat physicians recommended a face-to-face appointment with a physician for that same day in 13.7% (47/343) of the cases. A face-to-face exam was recommended for that same day more often if the chat concerned infection (36/189, 19.0% cases) compared with other reasons (11/154, 7.1%, cases; P=.001). Physicians felt capable of answering caregivers? questions in 72.6% (249/343) of the cases, whereas 93% (91/98) of caregivers considered physicians? answers helpful. Whether caregivers had to take their children to see a physician that same day or whether caregivers? main concern was infection was not found to be associated with whether caregivers considered physicians? answers helpful or not. However, physicians felt more capable of answering caregivers? questions when the main concern was infection. Conclusions: Parental consultations via Web-based chat service often take place before noon and focus on infection-related issues as well as on the health and illness of very young children. These factors should be considered when planning or setting up such a service. Based on the high satisfaction with the chat service by both physicians and caregivers, Web-based chat services may be a useful way to help caregivers with concerns about their child?s health or illness. UR - https://www.jmir.org/2018/12/e10165/ UR - http://dx.doi.org/10.2196/10165 UR - http://www.ncbi.nlm.nih.gov/pubmed/30552087 ID - info:doi/10.2196/10165 ER - TY - JOUR AU - Bakker, Aafke AU - Janssen, Lindy AU - Noordam, Cees PY - 2018/12/13 TI - Home to Hospital Live Streaming With Virtual Reality Goggles: A Qualitative Study Exploring the Experiences of Hospitalized Children JO - JMIR Pediatr Parent SP - e10 VL - 1 IS - 2 KW - experiences KW - hospitalization KW - mobile phone KW - livestream KW - pediatrics KW - qualitative analysis KW - videoconferencing KW - virtual reality N2 - Background: Being separated from home and relatives is a major stressor for children and adolescents when hospitalized. Children long for a manner to be distracted, pleasured, and socially connected during hospitalization. Different technological devices have been applied in health care to answer those needs. Both virtual reality (VR) and videoconferencing have proven their value in hospital wards and pediatrics. VisitU combines these 2 technologies innovatively. VisitU is a recently launched VR product enabling users to be virtually at home during hospitalization. Objective: This study aims to explore the experiences of hospitalized patients with the VR intervention of VisitU in addition to standard care. Methods: Over a 3-month period, a purposive sample of 10 patients hospitalized in the Radboudumc Amalia Children?s Hospital was included in this qualitative study. Semistructured interviews were performed, one before and one after the use of the VR device. Patients were asked open-ended questions concerning their experiences with VisitU on practical, cognitive, emotional, and social domains. The interviews were audiorecorded and transcribed verbatim. Atlas.ti was used to support the qualitative analysis. Furthermore, the inductive thematic analysis was done according to the 6-step procedure described by Braun and Clarke. Results: The following 6 main themes were the result of the qualitative analysis: ?Being hospitalized,? ?Expectations of VisitU,? ?VisitU in use,? ?VisitU, the benefits,? ?The impact of VisitU,? and ?Barriers when using VisitU.? The way VisitU was used by patients varied. The main benefits of VisitU were being somewhere else, being at home, and facilitating social connection. Limitations were experienced on the technical abilities, physical side effects, and complexity of use. Despite that, patients were positive about VisitU and unanimous in the view that they would like to use it again and advise other patients to use it. Conclusions: This study shows the positive experiences of pediatric patients with VR live streaming. VisitU brings together the needs of patients and possibilities of VR and videoconferencing; it offers patients a way out of the hospital. Nevertheless, practical and technical obstacles must be overcome and side effects are an area of further research. UR - http://pediatrics.jmir.org/2018/2/e10/ UR - http://dx.doi.org/10.2196/pediatrics.9576 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518293 ID - info:doi/10.2196/pediatrics.9576 ER - TY - JOUR AU - Levac, Danielle AU - Dumas, M. Helene AU - Meleis, Waleed PY - 2018/11/26 TI - A Tablet-Based Interactive Movement Tool for Pediatric Rehabilitation: Development and Preliminary Usability Evaluation JO - JMIR Rehabil Assist Technol SP - e10307 VL - 5 IS - 2 KW - equipment design KW - rehabilitation KW - pediatrics KW - tablets KW - software N2 - Background: Motivating interactive tools may increase adherence to repetitive practice for children with disabilities, but many virtual reality and active video gaming systems are too challenging for children with significant needs. Objective: The objective of this study was to develop and conduct a usability evaluation of the Fun, Interactive Therapy Board (FITBoard), a movement toy bridging digital and physical interactions for children with disabilities. Methods: The FITBoard is a tablet app involving games controlled by hand, head, or foot touch of configurable, wired surfaces. Usability evaluation involved a cognitive walkthrough and think-aloud processes. Participants verbalized aloud while completing a series of 26 task actions involved in selecting a game and configuring the FITBoard to achieve the therapeutic goal. Therapists then responded to questions about usability perceptions. Unsuccessful actions were categorized as goal or action failures. Qualitative content analysis supported understanding of usability problems. Results: Participants included 5 pediatric physical therapists and 2 occupational therapists from 2 clinical sites. Goal failure was experienced by all participants in 2 tasks, and action failure was experienced by all participants in 2 tasks. For 14 additional tasks, 1 or more patients experienced goal or action failure, with an overall failure rate of 69% (18 of 26 tasks). Content analysis revealed 4 main categories: hardware usability, software usability, facilitators of therapy goals, and improvement suggestions. Conclusions: FITBoard hardware and software changes are needed to address goal and action failures to rectify identified usability issues. Results highlight potential FITBoard applications to address therapeutic goals and outline important practical considerations for product use by therapists. Subsequent research will evaluate therapist, parent, and child perspectives on FITBoard clinical utility when integrated within regular therapy interventions. UR - http://rehab.jmir.org/2018/2/e10307/ UR - http://dx.doi.org/10.2196/10307 UR - http://www.ncbi.nlm.nih.gov/pubmed/30478025 ID - info:doi/10.2196/10307 ER - TY - JOUR AU - Luo, Gang AU - Johnson, D. Michael AU - Nkoy, L. Flory AU - He, Shan AU - Stone, L. Bryan PY - 2018/11/05 TI - Appropriateness of Hospital Admission for Emergency Department Patients with Bronchiolitis: Secondary Analysis JO - JMIR Med Inform SP - e10498 VL - 6 IS - 4 KW - appropriate hospital admission KW - bronchiolitis KW - emergency department KW - operational definition N2 - Background: Bronchiolitis is the leading cause of hospitalization in children under 2 years of age. Each year in the United States, bronchiolitis results in 287,000 emergency department visits, 32%-40% of which end in hospitalization. Frequently, emergency department disposition decisions (to discharge or hospitalize) are made subjectively because of the lack of evidence and objective criteria for bronchiolitis management, leading to significant practice variation, wasted health care use, and suboptimal outcomes. At present, no operational definition of appropriate hospital admission for emergency department patients with bronchiolitis exists. Yet, such a definition is essential for assessing care quality and building a predictive model to guide and standardize disposition decisions. Our prior work provided a framework of such a definition using 2 concepts, one on safe versus unsafe discharge and another on necessary versus unnecessary hospitalization. Objective: The goal of this study was to determine the 2 threshold values used in the 2 concepts, with 1 value per concept. Methods: Using Intermountain Healthcare data from 2005-2014, we examined distributions of several relevant attributes of emergency department visits by children under 2 years of age for bronchiolitis. Via a data-driven approach, we determined the 2 threshold values. Results: We completed the first operational definition of appropriate hospital admission for emergency department patients with bronchiolitis. Appropriate hospital admissions include actual admissions with exposure to major medical interventions for more than 6 hours, as well as actual emergency department discharges, followed by an emergency department return within 12 hours ending in admission for bronchiolitis. Based on the definition, 0.96% (221/23,125) of the emergency department discharges were deemed unsafe. Moreover, 14.36% (432/3008) of the hospital admissions from the emergency department were deemed unnecessary. Conclusions: Our operational definition can define the prediction target for building a predictive model to guide and improve emergency department disposition decisions for bronchiolitis in the future. UR - http://medinform.jmir.org/2018/4/e10498/ UR - http://dx.doi.org/10.2196/10498 UR - http://www.ncbi.nlm.nih.gov/pubmed/30401659 ID - info:doi/10.2196/10498 ER - TY - JOUR AU - Hullmann, E. Stephanie AU - Keller, A. Stacy AU - Lynch, O. Dustin AU - Jenkins, Kelli AU - Moore, Courtney AU - Cockrum, Brandon AU - Wiehe, E. Sarah AU - Carroll, E. Aaron AU - Bennett Jr, E. William PY - 2018/09/10 TI - Phase I of the Detecting and Evaluating Childhood Anxiety and Depression Effectively in Subspecialties (DECADES) Study: Development of an Integrated Mental Health Care Model for Pediatric Gastroenterology JO - J Participat Med SP - e10655 VL - 10 IS - 3 KW - qualitative research KW - patient-reported outcomes KW - depression KW - anxiety N2 - Background: Children with gastrointestinal symptoms have a very high rate of anxiety and depression. Rapid identification of comorbid anxiety and depression is essential for effective treatment of a wide variety of functional gastrointestinal disorders. Objective: The objective of our study was to determine patient and parent attitudes toward depression, anxiety, and mental health screening during gastroenterology (GI) visits and to determine patient and parent preferences for communication of results and referral to mental health providers after a positive screen. Methods: We augmented standard qualitative group session methods with patient-centered design methods to assess patient and parent preferences. We used a variety of specific design methods in these sessions, including card sorting, projective methods, experience mapping, and constructive methods. Results: Overall, 11 families (11 patients and 14 parents) participated in 2 group sessions. Overall, patients and their parents found integrated mental health care to be acceptable in the subspecialty setting. Patients? primary concerns were for the privacy and confidentiality of their screening results. Patients and their parents emphasized the importance of mental health services not interfering with the GI visit and collaboration between the GI physician, psychologist, and primary care provider. Conclusions: Patients and their families are open to integrated mental health care in the pediatric subspecialty clinic. The next phase of the DECADES study will translate patient and parent preferences into an integrated mental health care system and test its efficacy in the pediatric GI office. UR - http://jopm.jmir.org/2018/3/e10655/ UR - http://dx.doi.org/10.2196/10655 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/10655 ER - TY - JOUR AU - Amawi, Omar Sami AU - Subki, Hussein Ahmed AU - Khatib, Abdulkarim Hazim AU - Alkhateeb, Sameer Omer AU - Fida, Hashim Rida AU - Saggaf, Mohammed Omar AU - Jan, Mohammed Mohammed PY - 2018/09/06 TI - Use of Electronic Entertainment and Communication Devices Among a Saudi Pediatric Population: Cross-Sectional Study JO - Interact J Med Res SP - e13 VL - 7 IS - 2 KW - television KW - tablet KW - mobile phone KW - computers KW - devices KW - entertainment KW - use KW - Saudi Arabia KW - children KW - population KW - behavior KW - parental impression N2 - Background: Excessive use of various electronic entertainment and communication devices, particularly among children, has been associated with increased behavioral problems. Despite children?s escalating use of these devices, parents? awareness about the impact thereof is still lacking. Objective: The objective of this study was to assess the use of electronic entertainment and communication devices among children attending a health care facility in Jeddah, Saudi Arabia, as well as the parental impression regarding the impact of electronic devices use on the behavior of their child. Methods: A focused 15-item questionnaire was designed for this cross-sectional study involving mothers of children attending the Well Baby Clinic of King Abdulaziz University Hospital, Jeddah, Saudi Arabia from July 1, 2016 to November 30, 2016. Results: This study included 190 mothers. The mean ages of the children, mothers, and fathers were 7.3 (SD 3.5), 35 (SD 6.5), and 43 (SD 8.3) years, respectively. Most children were of Saudi Arabian nationality (106/190, 55.8%). The most used device in this study was television (154/190, 81.0%), followed by mobile phones (134/190, 70.5%), and tablets (116/190, 61.0%). Computers were the least used device in this study (59/190, 31.0%). In total, 24.7% (47/190) of children in this study used electronic entertainment and communication devices for more than 4 hours per day. Most mothers (129/190, 67.9%) felt that their child spends too much time on electronic devices. Hyperactivity or behavioral problems were reported by 20.0% (38/190) of mothers in this study. Children spending longer hours on electronic devices were much more likely to be perceived to suffer from hyperactivity or behavioral problems (P=.01). Conclusions: Parental awareness is necessary to counteract the harmful effects of using electronic devices for a prolonged period. Parents require help to cope with this problem effectively. UR - http://www.i-jmr.org/2018/2/e13/ UR - http://dx.doi.org/10.2196/ijmr.9103 UR - http://www.ncbi.nlm.nih.gov/pubmed/30190254 ID - info:doi/10.2196/ijmr.9103 ER - TY - JOUR AU - Vahabzadeh, Arshya AU - Keshav, U. Neha AU - Salisbury, P. Joseph AU - Sahin, T. Ned PY - 2018/04/02 TI - Improvement of Attention-Deficit/Hyperactivity Disorder Symptoms in School-Aged Children, Adolescents, and Young Adults With Autism via a Digital Smartglasses-Based Socioemotional Coaching Aid: Short-Term, Uncontrolled Pilot Study JO - JMIR Ment Health SP - e25 VL - 5 IS - 2 KW - autism spectrum disorder KW - Asperger syndrome KW - augmented reality KW - virtual reality KW - artificial intelligence KW - affective computing KW - patient education as a topic KW - ADHD KW - attention deficit disorder with hyperactivity KW - attention KW - smartglasses N2 - Background: People with autism spectrum disorder (ASD) commonly experience symptoms related to attention-deficit/hyperactivity disorder (ADHD), including hyperactivity, inattention, and impulsivity. One-third of ASD cases may be complicated by the presence of ADHD. Individuals with dual diagnoses face greater barriers to accessing treatment for ADHD and respond less positively to primary pharmacologic interventions. Nonpharmacologic technology-aided tools for hyperactivity and inattention in people with ASD are being developed, although research into their efficacy and safety remains limited. Objective: The objective of this preliminary study was to describe the changes in ADHD-related symptoms in children, adolescents, and young adults with ASD immediately after use of the Empowered Brain system, a behavioral and social communication aid for ASD running on augmented reality smartglasses. Methods: We recruited 8 children, adolescents, and young adults with ASD (male to female ratio of 7:1, mean age 15 years, range 11.7-20.5 years) through a Web-based research signup form. The baseline score on the hyperactivity subscale of the Aberrant Behavioral Checklist (ABC-H), a measure of hyperactivity, inattention, and impulsivity, determined their classification into a high ADHD-related symptom group (n=4, ABC-H?13) and a low ADHD-related symptom group (n=4, ABC-H<13). All participants received an intervention with Empowered Brain, where they used smartglasses-based social communication and behavioral modules while interacting with their caregiver. We then calculated caregiver-reported ABC-H scores at 24 and 48 hours after the session. Results: All 8 participants were able to complete the intervention session. Postintervention ABC-H scores were lower for most participants at 24 hours (n=6, 75%) and for all participants at 48 hours (n=8, 100%). At 24 hours after the session, average participant ABC-H scores decreased by 54.9% in the high ADHD symptom group and by 20% in the low ADHD symptom group. At 48 hours after the session, ABC-H scores compared with baseline decreased by 56.4% in the high ADHD symptom group and by 66.3% in the low ADHD symptom group. Conclusions: This study provides initial evidence for the possible potential of the Empowered Brain system to reduce ADHD-related symptoms, such as hyperactivity, inattention, and impulsivity, in school-aged children, adolescents, and young adults with ASD. This digital smartglasses intervention can potentially be targeted at a broader array of mental health conditions that exhibit transdiagnostic attentional and social communication deficits, including schizophrenia and bipolar disorder. Further research is required to understand the clinical importance of these observed changes and to conduct longitudinal studies on this intervention with control groups and larger sample sizes. UR - http://mental.jmir.org/2018/2/e25/ UR - http://dx.doi.org/10.2196/mental.9631 UR - http://www.ncbi.nlm.nih.gov/pubmed/29610109 ID - info:doi/10.2196/mental.9631 ER - TY - JOUR AU - Lindsay, Cristina Ana AU - Wasserman, Minerva AU - Muñoz, A. Mario AU - Wallington, F. Sherrie AU - Greaney, L. Mary PY - 2018/01/30 TI - Examining Influences of Parenting Styles and Practices on Physical Activity and Sedentary Behaviors in Latino Children in the United States: Integrative Review JO - JMIR Public Health Surveill SP - e14 VL - 4 IS - 1 KW - parenting KW - styles KW - practices KW - physical activity KW - children KW - Hispanic KW - Latino N2 - Background: Research indicates that parents influence their children?s physical activity (PA) and sedentary behaviors (SB) through their parenting styles and practices. Objective: The objectives of this paper were to evaluate existing research examining the associations between parenting styles, parenting practices, and PA and SB among Latino children aged between 2 and 12 years, highlight limitations of the existing research, and generate suggestions for future research. Methods: The method of this integrative review was informed by methods developed by Whittemore and Knafl, which allow for the inclusion of qualitative, quantitative, and mixed-methods studies. Using the Preferred Reporting Items for Systematic Reviews Meta-Analyses guidelines, five electronic academic databases (PubMed, SPORTDiscus, PsycINFO, PsycARTICLES, and CINAHL) were searched for peer-reviewed, full-text papers published in English. Of the 641 unique citations identified, 67 full-text papers were retrieved, and 16 were selected for review. Results: The majority of the 16 reviewed studies were conducted with predominantly Mexican American or Mexican immigrant samples, and only 1 study examined the association between parenting styles and Latino children?s PA and SB. Most (n=15) reviewed studies assessed the influence of parenting practices on children?s PA and SB, and they provide good evidence that parenting practices such as offering verbal encouragement, prompting the child to be physically active, providing logistic support, engaging and being involved in PA, monitoring, and offering reinforcement and rewards encourage, facilitate, or increase children?s PA. The examined studies also provide evidence that parenting practices, such as setting rules and implementing PA restrictions due to safety concerns, weather, and using psychological control discourage, hinder, or decrease children?s PA. Conclusions: Because this review found a very small number of studies examining the relationship between parenting styles and Latino children?s PA and SB, additional research is needed. Given that the majority of reviewed studies were conducted with predominantly Mexican American or Mexican immigrant samples, additional research examining parenting styles, parenting practices, and PA and SB among multiethnic Latino groups is needed to design interventions tailored to the needs of this ethnically diverse population group. UR - http://publichealth.jmir.org/2018/1/e14/ UR - http://dx.doi.org/10.2196/publichealth.8159 UR - http://www.ncbi.nlm.nih.gov/pubmed/29382629 ID - info:doi/10.2196/publichealth.8159 ER - TY - JOUR AU - Wellner, Ben AU - Grand, Joan AU - Canzone, Elizabeth AU - Coarr, Matt AU - Brady, W. Patrick AU - Simmons, Jeffrey AU - Kirkendall, Eric AU - Dean, Nathan AU - Kleinman, Monica AU - Sylvester, Peter PY - 2017/11/22 TI - Predicting Unplanned Transfers to the Intensive Care Unit: A Machine Learning Approach Leveraging Diverse Clinical Elements JO - JMIR Med Inform SP - e45 VL - 5 IS - 4 KW - clinical deterioration KW - machine learning KW - data mining KW - electronic health record KW - patient acuity KW - vital signs KW - nursing assessment KW - clinical laboratory techniques N2 - Background: Early warning scores aid in the detection of pediatric clinical deteriorations but include limited data inputs, rarely include data trends over time, and have limited validation. Objective: Machine learning methods that make use of large numbers of predictor variables are now commonplace. This work examines how different types of predictor variables derived from the electronic health record affect the performance of predicting unplanned transfers to the intensive care unit (ICU) at three large children?s hospitals. Methods: We trained separate models with data from three different institutions from 2011 through 2013 and evaluated models with 2014 data. Cases consisted of patients who transferred from the floor to the ICU and met one or more of 5 different priori defined criteria for suspected unplanned transfers. Controls were patients who were never transferred to the ICU. Predictor variables for the models were derived from vitals, labs, acuity scores, and nursing assessments. Classification models consisted of L1 and L2 regularized logistic regression and neural network models. We evaluated model performance over prediction horizons ranging from 1 to 16 hours. Results: Across the three institutions, the c-statistic values for our best models were 0.892 (95% CI 0.875-0.904), 0.902 (95% CI 0.880-0.923), and 0.899 (95% CI 0.879-0.919) for the task of identifying unplanned ICU transfer 6 hours before its occurrence and achieved 0.871 (95% CI 0.855-0.888), 0.872 (95% CI 0.850-0.895), and 0.850 (95% CI 0.825-0.875) for a prediction horizon of 16 hours. For our first model at 80% sensitivity, this resulted in a specificity of 80.5% (95% CI 77.4-83.7) and a positive predictive value of 5.2% (95% CI 4.5-6.2). Conclusions: Feature-rich models with many predictor variables allow for patient deterioration to be predicted accurately, even up to 16 hours in advance. UR - http://medinform.jmir.org/2017/4/e45/ UR - http://dx.doi.org/10.2196/medinform.8680 UR - http://www.ncbi.nlm.nih.gov/pubmed/29167089 ID - info:doi/10.2196/medinform.8680 ER - TY - JOUR AU - Wennberg, Lena Anna AU - Jonsson, Sanna AU - Zadik Janke, Josefine AU - Hörnsten, Åsa PY - 2017/11/15 TI - Online Perceptions of Mothers About Breastfeeding and Introducing Formula: Qualitative Study JO - JMIR Public Health Surveill SP - e88 VL - 3 IS - 4 KW - breast feeding KW - bottle feeding KW - mothers KW - decision making KW - Internet KW - patient web portals N2 - Background: Although the benefits of breastfeeding are well established for babies and their mothers, many women give formula to their infants. Whether to breastfeed or to give infant formula is a complex decision to make. Many parents use the Internet to find information and support that relate to infant feeding decisions. Objective: The aim of this study was to analyze the perceptions of mothers, who are discussing the topic on Web forums, about introducing infant formula. Methods: This is a qualitative, descriptive, and cross-sectional study on online data from parenting Web forums. The text was analyzed using qualitative content analysis. Results: The analysis resulted in 1 main theme, ?balancing between social expectations and confidence in your parental ability,? which is further divided into 3 themes: ?striving to be a good mother,? ?striving for your own well-being,? and ?striving to discover your own path.? Conclusions: Breastfeeding is complex, and health care personnel can, with a more open approach toward formula, create better support for mothers by helping them to be more confident in their parental ability. UR - http://publichealth.jmir.org/2017/4/e88/ UR - http://dx.doi.org/10.2196/publichealth.8197 UR - http://www.ncbi.nlm.nih.gov/pubmed/29141838 ID - info:doi/10.2196/publichealth.8197 ER - TY - JOUR AU - Joshi, Rohan AU - van Pul, Carola AU - Sanders, Anouk AU - Weda, Hans AU - Bikker, Willem Jan AU - Feijs, Loe AU - Andriessen, Peter PY - 2017/10/20 TI - A Strategy to Reduce Critical Cardiorespiratory Alarms due to Intermittent Enteral Feeding of Preterm Neonates in Intensive Care JO - Interact J Med Res SP - e20 VL - 6 IS - 2 KW - preterm infants KW - enteral feeding KW - bradycardia KW - hypoxia KW - alarms N2 - Background: Many preterm infants require enteral feeding as they cannot coordinate sucking, swallowing, and breathing. In enteral feeding, milk feeds are delivered through a small feeding tube passed via the nose or mouth into the stomach. Intermittent milk feeds may either be administered using a syringe to gently push milk into the infant?s stomach (push feed) or milk can be poured into a syringe attached to the tube and allowed to drip in by gravity (gravity feed). This practice of enteral feeding is common in neonatal intensive care units. There is, however, no evidence in the literature to recommend the use of one method of feeding over the other. Objective: The aim of this study was to investigate which of the two methods of feeding is physiologically better tolerated by infants, as measured by the incidence of critical cardiorespiratory alarms during and immediately after feeding. Methods: We conducted a prospectively designed observational study with records of all feeding episodes in infants of gestational age less than 30 weeks at birth and with a minimum enteral intake of 100 mL/kg/day. In total, 2140 enteral feeding episodes were noted from 25 infants over 308 infant-days with records for several characteristics of the infants (eg, gestational age), feeding (eg, the position of infants), and of nursing-care events before feeding (eg, diapering). Logistic regression with mixed effects was used to model cardiorespiratory alarms for the push and gravity methods of feeding. Results: After adjustments were made for all confounding variables, the position of infants was found to be statistically significant in changing the outcome of critical alarms for the two methods of feeding (P=.02). For infants in the lateral position, push feeds led to 40% more instances of one or more critical cardiorespiratory alarms in comparison with the gravity method. Both methods of feeding created a statistically comparable number of alarms for infants in the prone position. Conclusions: This study provides objective data that may assist in optimizing enteral feeding protocols for premature infants. The incidence of critical cardiorespiratory alarms for infants in the lateral position can be lowered by the use of gravity instead of push feeding. No differences were observed between the two types of feeding when infants were in the prone position. UR - http://www.i-jmr.org/2017/2/e20/ UR - http://dx.doi.org/10.2196/ijmr.7756 UR - http://www.ncbi.nlm.nih.gov/pubmed/29054835 ID - info:doi/10.2196/ijmr.7756 ER - TY - JOUR AU - Shroff, L. Purvi AU - Hayes, W. Rebecca AU - Padmanabhan, Pradeep AU - Stevenson, D. Michelle PY - 2017/09/28 TI - Internet Usage by Parents Prior to Seeking Care at a Pediatric Emergency Department: Observational Study JO - Interact J Med Res SP - e17 VL - 6 IS - 2 KW - Internet KW - emergency department KW - decision making N2 - Background: Little is known about how parents utilize medical information on the Internet prior to an emergency department (ED) visit. Objective: The objective of the study was to determine the proportion of parents who accessed the Internet for medical information related to their child?s illness in the 24 hours prior to an ED visit (IPED), to identify the websites used, and to understand how the content contributed to the decision to visit the ED. Methods: A 40-question interview was conducted with parents presenting to an ED within a freestanding children?s hospital. If parents reported IPED, the number and names of websites were documented. Parents indicated the helpfulness of Web-based content using a 100-mm visual analog scale and the degree to which it contributed to the decision to visit the ED using 5-point Likert-type responses. Results: About 11.8 % (31/262) reported IPED (95% CI 7.3-5.3). Parents who reported IPED were more likely to have at least some college education (P=.04), higher annual household income (P=.001), and older children (P=.04) than those who did not report IPED. About 35% (11/31) could not name any websites used. Mean level of helpfulness of Web-based content was 62 mm (standard deviation, SD=25 mm). After Internet use, some parents (29%, 9/31) were more certain they needed to visit the ED, whereas 19% (6/31) were less certain. A majority (87%, 195/224) of parents who used the Internet stated that they would be somewhat likely or very likely to visit a website recommended by a physician. Conclusions: Nearly 1 out of 8 parents presenting to an urban pediatric ED reported using the Internet in the 24 hours prior to the ED visit. Among privately insured, at least one in 5 parents reported using the Internet prior to visiting the ED. Web-based medical information often influences decision making regarding ED utilization. Pediatric providers should provide parents with recommendations for high-quality sources of health information available on the Internet. UR - http://www.i-jmr.org/2017/2/e17/ UR - http://dx.doi.org/10.2196/ijmr.5075 UR - http://www.ncbi.nlm.nih.gov/pubmed/28958988 ID - info:doi/10.2196/ijmr.5075 ER - TY - JOUR AU - Chen, Jyu-Lin AU - Guedes, M. Claudia AU - Cooper, A. Bruce AU - Lung, E. Audrey PY - 2017/08/02 TI - Short-Term Efficacy of an Innovative Mobile Phone Technology-Based Intervention for Weight Management for Overweight and Obese Adolescents: Pilot Study JO - Interact J Med Res SP - e12 VL - 6 IS - 2 KW - adolescent KW - obesity KW - mobile phone technology KW - website KW - randomized clinical trial N2 - Background: In the United States, approximately one-third of adolescents are now overweight or obese, and one in six is obese. This financial cost and the larger nonfinancial costs of obesity make obesity prevention and management for adolescents imperative for the health of the nation. However, primary care visits are typically brief, and primary care providers may lack adequate resources to help overweight or obese adolescents to manage weight issues. To augment the efficacy of primary care visits for adolescent weight management, mobile phone technology can be used as an adjunct treatment that provides additional opportunities for encouraging improvement in lifestyle, attainment, and maintenance of healthy weight. Objective: The purposes of this study were to (1) measure effects of an innovative mobile phone technology-based intervention for overweight and obese adolescents and to (2) examine the intervention?s feasibility for use in primary care clinics. Methods: The mobile phone-based intervention had three components: use of the Fitbit Flex, participation in an online educational program, and receipt of biweekly text messages during the maintenance phase. A randomized controlled study design was utilized. Data regarding anthropometrics (body mass index [BMI] and waist-to-hip ratio), blood pressure, levels of physical and sedentary activity, diet, and self-efficacy regarding physical activity and diet were collected at baseline and at 3 and 6 months after the baseline assessment. Results: A total of 40 adolescents participated in the study. At the 6-month follow-up visit, compared to participants in the control group, the mobile phone-based intervention participants had significant improvement in BMI (z=?4.37, P=.001), diastolic blood pressure (z=?3.23, P=.001), physical activity days per week (z=2.58, P=.01), TV and computer time (z=?3.34, P=.001), servings of fruits and vegetables per day (z=2.74, P=.006), servings of soda and sweetened drinks (z=?3.19, P=.001), physical activity self-efficacy (z=2.75, P=.006), and dietary self-efficacy (z=5.05, P=.001). Medium to large effect sizes were found in these outcome variables. Conclusions: The use of mobile technologies may offer a practical, reliable adjunct to weight management for overweight and obese adolescents in busy primary care clinics serving adolescents. Trial Registration: Clinicaltrials.gov NCT 01693250; https://clinicaltrials.gov/ct2/show/NCT01693250? term=Adolescent+ obesity+AND+mhealth&rank=5 (Archived by WebCite at ) UR - http://www.i-jmr.org/2017/2/e12/ UR - http://dx.doi.org/10.2196/ijmr.7860 UR - http://www.ncbi.nlm.nih.gov/pubmed/28768612 ID - info:doi/10.2196/ijmr.7860 ER - TY - JOUR AU - Ben-Sasson, Ayelet AU - Yom-Tov, Elad PY - 2016/11/22 TI - Online Concerns of Parents Suspecting Autism Spectrum Disorder in Their Child: Content Analysis of Signs and Automated Prediction of Risk JO - J Med Internet Res SP - e300 VL - 18 IS - 11 KW - online queries KW - autistic disorders KW - parents KW - machine learning KW - early detection N2 - Background: Online communities are used as platforms by parents to verify developmental and health concerns related to their child. The increasing public awareness of autism spectrum disorders (ASD) leads more parents to suspect ASD in their child. Early identification of ASD is important for early intervention. Objective: To characterize the symptoms mentioned in online queries posed by parents who suspect that their child might have ASD and determine whether they are age-specific. To test the efficacy of machine learning tools in classifying the child?s risk of ASD based on the parent?s narrative. Methods: To this end, we analyzed online queries posed by parents who were concerned that their child might have ASD and categorized the warning signs they mentioned according to ASD-specific and non-ASD?specific domains. We then used the data to test the efficacy with which a trained machine learning tool classified the degree of ASD risk. Yahoo Answers, a social site for posting queries and finding answers, was mined for queries of parents asking the community whether their child has ASD. A total of 195 queries were sampled for this study (mean child age=38.0 months; 84.7% [160/189] boys). Content text analysis of the queries aimed to categorize the types of symptoms described and obtain clinical judgment of the child?s ASD-risk level. Results: Concerns related to repetitive and restricted behaviors and interests (RRBI) were the most prevalent (75.4%, 147/195), followed by concerns related to language (61.5%, 120/195) and emotional markers (50.3%, 98/195). Of the 195 queries, 18.5% (36/195) were rated by clinical experts as low-risk, 30.8% (60/195) as medium-risk, and 50.8% (99/195) as high-risk. Risk groups differed significantly (P<.001) in the rate of concerns in the language, social, communication, and RRBI domains. When testing whether an automatic classifier (decision tree) could predict if a query was medium- or high-risk based on the text of the query and the coded symptoms, performance reached an area under the receiver operating curve (ROC) curve of 0.67 (CI 95% 0.50-0.78), whereas predicting from the text and the coded signs resulted in an area under the curve of 0.82 (0.80-0.86). Conclusions: Findings call for health care providers to closely listen to parental ASD-related concerns, as recommended by screening guidelines. They also demonstrate the need for Internet-based screening systems that utilize parents? narratives using a decision tree questioning method. UR - http://www.jmir.org/2016/11/e300/ UR - http://dx.doi.org/10.2196/jmir.5439 UR - http://www.ncbi.nlm.nih.gov/pubmed/27876688 ID - info:doi/10.2196/jmir.5439 ER - TY - JOUR AU - Dinleyici, Meltem AU - Carman, Bora Kursat AU - Ozturk, Emel AU - Sahin-Dagli, Figen PY - 2016/06/07 TI - Media Use by Children, and Parents? Views on Children's Media Usage JO - Interact J Med Res SP - e18 VL - 5 IS - 2 KW - Internet KW - social media KW - children KW - parents KW - screen time N2 - Background: New (mobile phones, smartphones, tablets, and social media) and traditional media (television) have come to dominate the lives of many children and adolescents. Despite all of this media time and new technology, many parents seem to have few rules regarding the use of media by their children and adolescents. Objectives: The aim of this study was to evaluate media access/use of children and to evaluate beliefs and attitudes of parents concerning the use of old and new media in Turkey. Methods: This is a cross-sectional electronic survey of a national convenience sample in Turkey via SurveyMonkey, including 41 questions regarding topics relevant to television, computers, mobile phones, iPad/tablet use, and social media accounts. Results: The responses of the 333 participants (238 women, 95 men; 27-63 years) were evaluated. The average daily watching alone time was 0 to 2 hours among 53.4% (46/86), and daily coviewing time with parents of children was 0 to 2 hours among 62.7% (54/86) of children below 2 years of age. Regarding parents? monitoring their children?s computer use (n=178), 35.4% (63/178) of the parents prefer coviewing, 13.5% of the parents use a family filter (24/178), and 33.1% (59/178) of the parents prefer to check Web history. Approximately 71.2% (237/333) of the participants had an iPad/tablet in the house, 84.3% (200/333) of the parents give their children permission to use the iPad/tablet. Of the parents, 22.5% (45/200) noted that their children used the iPad/tablet at the table during lunch/dinner and 57.9% (26/45) of these children were aged 5 years and below. Of parents, 27.3% (91/333) agreed that the optimal age for owning a mobile phone was 12 years, and 18.0% (60/333) of the parents noted that their children (one-third was below 2 years) used the mobile phone at the table during meals. A total of 33.3% (111/333) children/adolescents have a Facebook profile, and 54.0% (60/111) were below 13 years of age. Approximately 89.2% (297/333) of the parents emphasized that the Internet is essential for their child?s education. Discussion: According to our study results, knowledge regarding the use of old and new media is limited among the parents in Turkey. Our study showed that screen time and mobile device use (including during meals) are common in children below 2 years of age, whereas no screen time was recommended for children below 2 years of age. We concluded that there is need for evidence-based guidelines regarding the use of the Internet and social media for parents and parents should ensure that there is a plan in place for the use of children?s media. UR - http://www.i-jmr.org/2016/2/e18/ UR - http://dx.doi.org/10.2196/ijmr.5668 UR - http://www.ncbi.nlm.nih.gov/pubmed/27267624 ID - info:doi/10.2196/ijmr.5668 ER - TY - JOUR AU - Fay, Michaela AU - Rapley, Tim AU - Foster, Helen AU - Pain, Clare AU - Gerrand, Craig PY - 2016/02/22 TI - Can Seeding in the Clinic Reach a Wide Audience? A Proof of Concept Study on Spreading a Health Message About Juvenile Idiopathic Arthritis Using a Shareable Online Video JO - Interact J Med Res SP - e6 VL - 5 IS - 1 KW - juvenile arthritis KW - video-audio media KW - patient education KW - Internet N2 - Background: Shareable online video offers the potential for spreading a health message across online and real world social networks. Seeding a message in a clinical setting may be advantageous. Objective: To investigate the potential of an online video to spread a health message about juvenile idiopathic arthritis (JIA) when delivered or seeded in a clinical setting and investigate factors that influence sharing behavior. Methods: Multimethod proof of concept study. Concepts for two different styles of video were developed using focus groups and interviews and reviewed by an online market research panel. We compared dissemination of the two videos from two specialist pediatric rheumatology clinics in NHS Hospitals. Participants were 15 patients, family members, and clinical staff with knowledge of JIA at concept stage; 300 market research panel members in development stage; and 38 patients and their parents or guardians in the seeding stage. Newly diagnosed patients with JIA and/or parents or guardians were invited to view and share an online video with a health message about JIA across real-life and electronic social networks. Main outcome measures were viewing statistics, sharing behavior and patterns, and participant feedback. Results: Of 38 patients and/or their parents or guardians given links, 26 visited the video webpage and shared the link, 2 visited and did not share, and 10 did not visit. Most links were viewed and shared within a few days. A total of 3314 pageviews were recorded with a mean of 89.6 pageviews per link (range 0-1245). Links were accessed from 26 countries, with most viewers in the United Kingdom (82.5%). Mothers were the most active group of sharers. Conclusions: Distribution of a video link in a clinical setting may be an effective way to spread a health message. Parents or guardians of children with JIA are more likely to share a link than young people. Dissemination depends on a small number of active sharers, the content of the video, and the willingness of participants to share health information about themselves. Trial Registration: UK Clinical Research Network Study Portfolio ID (UKCRN): 13747; http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=13747 (Archived by WebCite at http://www.webcitation.org/6eeXlMmM6). UR - http://www.i-jmr.org/2016/1/e6/ UR - http://dx.doi.org/10.2196/ijmr.4608 UR - http://www.ncbi.nlm.nih.gov/pubmed/26903485 ID - info:doi/10.2196/ijmr.4608 ER - TY - JOUR PY - 2013// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e4509 VL - 5 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v5i1.4509 ID - info:doi/10.5210/ojphi.v5i1.4509 ER - TY - JOUR AU - Beran, Tanya AU - Stanton, Lauren AU - Hetherington, Ross AU - Mishna, Faye AU - Shariff, Shaheen PY - 2012/11/09 TI - Development of the Bullying and Health Experiences Scale JO - Interact J Med Res SP - e13 VL - 1 IS - 2 KW - mental health KW - school bullying KW - cyberbullying KW - peer victimization KW - psychosocial impact KW - children N2 - Background: Until recently, researchers have studied forms of bullying separately. For 40 years, research has looked at the traditional forms of bullying, including physical (eg, hitting), verbal (eg, threats), and social (eg, exclusion). Attention focused on cyberbullying in the early 2000s. Although accumulating research suggests that bullying has multiple negative effects for children who are targeted, these effects excluded cyberbullying from the definition of bullying. Objective: This paper responds to the need for a multidimensional measure of the impact of various forms of bullying. We used a comprehensive definition of bullying, which includes all of its forms, to identify children who had been targeted or who had participated in bullying. We then examined various ways in which they were impacted. Methods: We used an online method to administer 37 impact items to 377 (277 female, 100 male) children and youth, to develop and test the Bullying and Health Experience Scale. Results: A principal components analysis of the bullying impact items with varimax rotation resulted in 8 factors with eigenvalues greater than one, explaining 68.0% of the variance. These scales include risk, relationships, anger, physical injury, drug use, anxiety, self-esteem, and eating problems, which represent many of the cognitive, psychological, and behavioral consequences of bullying. The Cronbach alpha coefficients for the 8 scales range from .73 to .90, indicating good inter-item consistency. Comparisons between the groups showed that children involved in bullying had significantly higher negative outcomes on all scales than children not involved in bullying. Conclusions: The high Cronbach alpha values indicate that the 8 impact scales provide reliable scores. In addition, comparisons between the groups indicate that the 8 scales provide accurate scores, with more negative outcomes reported by children involved in bullying compared to those who are not involved in bullying. This evidence of reliability and validity indicates that these scales are useful for research and clinical purposes to measure the multidimensional experiences of children who bully and are bullied. UR - http://www.i-jmr.org/2012/2/e13/ UR - http://dx.doi.org/10.2196/ijmr.1835 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612028 ID - info:doi/10.2196/ijmr.1835 ER -