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Journal Description

JMIR Pediatrics and Parenting (JPP) is a new sister journal of JMIR (the leading open-access journal in health informatics (Impact Factor 2017: 4.671), with a unique focus on technologies, medical devices, apps, engineering, informatics applications for patient/parent education in pediatrics, training/counselling and behavioral interventions, preventative interventions and clinical care for children and adolescent populations or child-parent dyads. JPP recognizing that pediatrics in the 21st century should be a participatory process, involving parents and informal caregivers, and using information and communication technologies.

As an open access journal, we are read by clinicians and patients alike and have (as all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews).

During a limited period of time, there are no fees to publish in this journal. Articles are carfully copyedited and XML-tagged, ready for submission in PubMed Central.

Be a founding author of this new journal and submit your paper today!


Recent Articles:

  • Source: Image created by the Authors; Copyright: Kelly Pretorius; URL:; License: Licensed by JMIR.

    Sudden Infant Death Syndrome and Safe Sleep on Twitter: Analysis of Influences and Themes to Guide Health Promotion Efforts


    Background: In the United States, sudden infant death syndrome (SIDS) is the leading cause of death in infants aged 1 month to 1 year. Approximately 3500 infants die from SIDS and sleep-related reasons on a yearly basis. Unintentional sleep-related deaths and bed sharing, a known risk factor for SIDS, are on the rise. Furthermore, ethnic disparities exist among those most affected by SIDS. Despite public health campaigns, infant mortality persists. Given the popularity of social media, understanding social media conversations around SIDS and safe sleep may assist the medical and public health communities with information needed to spread, reinforce, or counteract false information regarding SIDS and safe sleep. Objective: The objective of our study was to investigate the social media conversation around SIDS and safe sleep to understand the possible influences and guide health promotion efforts and public health research as well as enable health professionals to engage in directed communication regarding this topic. Methods: We used textual analytics to identify topics and extract meanings contained in unstructured textual data. Twitter messages were captured during September, October, and November in 2017. Tweets and retweets were collected using NUVI software in conjunction with Twitter’s search API using the keywords: “sids,” “infant death syndrome,” “sudden infant death syndrome,” and “safe sleep.” This returned a total of 41,358 messages, which were analyzed using text mining and social media monitoring software. Results: Multiple themes were identified, including recommendations for safe sleep to prevent SIDS, safe sleep devices, the potential causes of SIDS, and how breastfeeding reduces SIDS. Compared with September and November, more personal and specific stories of infant loss were demonstrated in October (Pregnancy and Infant Loss Awareness Month). The top influencers were news organizations, universities, and health-related organizations. Conclusions: We identified valuable topics discussed and shared on Twitter regarding SIDS and safe sleep. The study results highlight the contradicting information a subset of the population is exposed to regarding SIDS and the continued controversy over vaccines. In addition, this analysis emphasizes the lack of public health organizations’ presence on Twitter compared with the influence of universities and news media organizations. The results also demonstrate the prevalence of safe sleep products that are embedded in safe sleep messaging. These findings can assist providers in speaking about relevant topics when engaging in conversations about the prevention of SIDS and the promotion of safe sleep. Furthermore, public health agencies and advocates should utilize social media and Twitter to better communicate accurate health information as well as continue to combat the spread of false information.

  • Men's pregnancy playbook (montage). Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Engaging Men in Prenatal Health via eHealth: Findings From a National Survey


    Background: Pregnancy outcomes in the United States rank among the worst of countries with a developed health care system. Although traditional prenatal health primarily focuses on women, promising findings have emerged in international research that suggest the potential of including men in prenatal health interventions in the United States. eHealth apps present a promising avenue to reach new and expectant fathers with crucial parenting knowledge and healthy, supportive behaviors. Objective: The aim was to explore the perceived role of men in prenatal health, acceptability of eHealth to positively engage men during pregnancy, and participant-suggested ways of improving a prenatal health app designed for new and expectant fathers. Methods: A nationally representative sample of adult males (N=962) was recruited through an online survey panel. A third-party market research and digital data collection agency managed the recruitment. The sample had a mean age of 30.2 (SD 6.3) years and included both fathers (413/962, 42.9%) and non-fathers (549/962, 57.1%). Nearly 12.0% (115/962) of participants had a partner who was pregnant at the time of the survey. Results: Despite perceived barriers, such as time constraints, financial burdens, and an unclear role, men believe it is important to be involved in pregnancy health. The majority of participants (770/944, 81.6%) found the site to contain useful and interesting information. Most substantially, more than three-quarters (738/962, 76.7%) of the sample said they would share the site with others who would benefit from the information. Participants recommended the addition of interactive modules, such as a financial planning tool and videos, to make the site stronger. Conclusions: We explored the use of targeted eHealth to introduce men to prenatal education. Results indicate men are favorable to this intervention. Additional refinement should include interactive tools to further engage men in this important issue. Reaching men at the prenatal phase is an early “teachable moment”—where new/expectant fathers are open to information on how to help their partners have a healthy pregnancy and promote the health of their unborn children. Findings will further inform best practices for engaging men in pregnancy, which is crucial for improving maternal and child health outcomes in the United States.

  • Source: Flickr; Copyright: moodboard; URL:; License: Creative Commons Attribution (CC-BY).

    Online Peer-to-Peer Mentoring Support for Youth with Hemophilia: Qualitative Needs Assessment


    Background: To support adolescents through transition from pediatrics to adult care, health care providers and families help teens gain knowledge and develop self-management skills. Peer mentoring can provide meaningful support and has been associated with improved health outcomes in patients with other chronic conditions. Peer mentoring is an appealing way to provide support, but it is imperative to consider the unique needs of adolescents to ensure its success. Objective: The objective of our study was to identify the peer mentoring wants and needs of youth with hemophilia in order to guide the development of a new program. Methods: In this qualitative study, we interviewed a convenience sample of youth with hemophilia from 2 Canadian hemophilia treatment centers. Two iterative cycles of audiorecorded, semistructured individual interviews were conducted. Descriptive statistics and content analyses were used to organize data into categories that reflected emerging themes. Results: In total, we recruited 23 participants aged 12-20 years, with a mean age of 14.91 (2.57) years. When asked about program design, participants weighed the importance of flexibility in delivery (eg, Web-based, in person, text messaging [short message service]), content (eg, structured vs unstructured), frequency of sessions, and length of the program. Participants identified some potential challenges such as scheduling issues, comfort level for disease discussion, and discordant mentor-mentee personality types. The program was viewed as a positive medium for connecting peers with hemophilia. Conclusions: Adolescents with hemophilia expressed interest in a peer mentoring program and provided valuable insight that will be applied in the development of a peer mentoring program for youth with hemophilia.

  • Source: Freepik; Copyright: Freepik; URL:; License: Licensed by JMIR.

    Maternal and Child Acceptability of a Proposed Guided Imagery Therapy Mobile App Designed to Treat Functional Abdominal Pain Disorders in Children:...


    Background: Functional abdominal pain disorders are chronic abdominal pain conditions, which affect up to 20% of children worldwide. Of the various functional abdominal pain disorder treatment modalities, psychological therapies such as guided imagery therapy appear most effective. However, there are significant barriers to receiving psychological therapies, including access to trained therapists. Alternatively, remotely delivered psychological therapies for functional abdominal pain disorders have been efficacious. Objective: The objective of our study was to assess acceptability of a proposed guided imagery therapy app designed to treat functional abdominal pain disorders through remote delivery of prerecorded audio sessions and to evaluate user preferences for using such an app. Methods: Using a mixed-methods approach, we conducted a predevelopment formative study among children aged 7 to 12 years with a functional abdominal pain disorder and their parents. The parents completed our modified Technology Acceptance Model (TAM) questionnaire, which quantified behavioral intention and related factors for using a guided imagery therapy app. Dyads participated in separate in-person semistructured interviews to assess their attitudes toward and preferences for a guided imagery therapy app. Questionnaire and interview findings were collected concurrently, analyzed separately, and then integrated through methods triangulation. Results: Among the 15 participating parent-child dyads, 5 (33%) children were Hispanic and 11 (73%) had irritable bowel syndrome. They had diverse socioeconomic status. All parent participants were mothers. The TAM questionnaire indicated that mothers scored favorably on behavioral intention to use a guided imagery therapy app (mean score 12.0, SD 2.6, possible range 3-15). Scores for the TAM factors perceived usefulness, perceived ease of use, hedonic motivation, compatibility, and habit also were favorable. Maternal interviews confirmed positive attitudes toward the proposed app. They advocated a visual component to hold their child’s attention during the guided imagery therapy sessions; recommended incorporating background sounds into the sessions; favored session reminder notifications from the app; and thought the best time for their child to listen to the sessions would be in the evening or before bed. The child interviews also confirmed positive attitudes toward the proposed app. They suggested guided imagery therapy session topics such as sports and adventures; listening to sessions in their bedroom; and the need for parental supervision to install the app on their mobile device. Integration of the quantitative and qualitative methods findings complimented one another on acceptability. The favorable behavioral intention TAM score aligned well with expressed positive maternal and child attitudes toward the app and can be explained by the desire to avoid medications. The questionnaire and interviews also confirmed therapeutic benefit as an intrinsic motivator to promote routine use. Conclusions: A guided imagery therapy app designed to treat pediatric patients with functional abdominal pain disorders appears to be acceptable to both mothers and children. Incorporating parent and child preferences into a guided imagery therapy app could promote therapeutic compliance and increase access to optimal care.

  • Source: Freepik; Copyright: Yanalya; URL:; License: Licensed by JMIR.

    eHealth Interventions for Anxiety Management Targeting Young Children and Adolescents: Exploratory Review


    Background: Advances in technology are progressively more relevant to the clinical practice of psychology and mental health services generally. Studies indicate that technology facilitates the delivery of interventions, such as cognitive behavioral therapy, in the treatment of psychological disorders in adults, such as depression, anxiety, obsessive-compulsive disorder, panic symptoms, and eating disorders. Fewer data exist for computer-based (stand-alone, self-help) and computer-assisted (in combination with face-to-face therapy, or therapist guided) programs for youth. Objective: Our objective was to summarize and critically review the literature evaluating the acceptability and efficacy of using technology with treatment and prevention programs for anxiety in young children and adolescents. The aim was to improve the understanding of what would be critical for future development of effective technology-based interventions. Methods: We conducted an exploratory review of the literature through searches in 3 scientific electronic databases (PsycINFO, ScienceDirect, and PubMed). We used keywords in various combinations: child or children, adolescent, preschool children, anxiety, intervention or treatment or program, smartphone applications or apps, online or Web-based tool, computer-based tool, internet-based tool, serious games, cognitive behavioral therapy or CBT, biofeedback, and mindfulness. For inclusion, articles had to (1) employ a technological therapeutic tool with or without the guidance of a therapist; (2) be specific for treatment or prevention of anxiety disorders in children or adolescents; (3) be published between 2000 and 2018; and (4) be published in English and in scientific peer-reviewed journals. Results: We identified and examined 197 articles deemed to be relevant. Of these, we excluded 164 because they did not satisfy 1 or more of the requirements. The final review comprised 19 programs. Published studies demonstrated promising results in reducing anxiety, especially relative to the application of cognitive behavioral therapy with technology. For those programs demonstrating efficacy, no difference was noted when compared with traditional interventions. Other approaches have been applied to technology-based interventions with inconclusive results. Most programs were developed to be used concurrently with traditional treatments and lacked long-term evaluation. Very little has been done in terms of prevention interventions. Conclusions: Future development of eHealth programs for anxiety management in children will have to address several unmet needs and overcome key challenges. Although developmental stages may limit the applicability to preschool children, prevention should start in early ages. Self-help formats and personalization are highly relevant for large-scale dissemination. Automated data collection should be built in for program evaluation and effectiveness assessment. And finally, a strategy to stimulate motivation to play and maintain high adherence should be carefully considered.

  • Source: Image created by the Authors; Copyright: The Authors; URL:; License: Licensed by JMIR.

    The Rise of New Alcoholic Games Among Adolescents and the Consequences in the Emergency Department: Observational Retrospective Study


    Background: The links between the internet and teenager behavior are difficult situations to control and may lead to the development of new and excessive methods of drinking alcohol during alcoholic games. Findings indicate that reported cases are very useful sources for better understanding of alcoholic games, yielding successful measures promoting health among adolescents. Admittance of adolescents to hospital emergency departments (EDs) after consumption of excessive amounts of alcohol has become the norm in developed countries. The harmful effects of acute alcohol abuse are reported in this paper. Objective: The aim of this work was to investigate the close connections between new drinking behaviors among adolescents and study the increase in new alcoholic games, together with the challenges that cause acute alcohol intoxication, the influence of the internet and social networks, and their consequences for public health services. Methods: Data came from prehospital and intrahospital admissions attributable to alcohol consumption. From 2013 to 2015, 3742 patients were admitted to EDs due to acute alcohol intoxication: 830 of them were aged 15 to 30 years, and 225 were adolescents and young adults between 15 and 20 years who had been playing alcoholic games. Retrospectively, diagnostic data associated with extrahospital anamneses were selected by one of the hospital management information systems, Qlik. As a result of our previous experience, questionnaires and face-to-face interviews were performed at a later stage, when a clinical audit for intoxicated adolescent patients was described, with the overall goal of establishing a potential methodological workflow and adding important information to research carried out so far. Results: Between 2013 and 2015, 830 young patients aged 15 to 30 years were admitted to EDs for acute alcohol intoxication. About 20% (166/830) of the sample confirmed that they had drunk more than 5 alcoholic units within 2 hours twice during the past 30 days as a result of binge drinking. Referring to new alcoholic games, 41% of the sample stated that they knew what neknomination is and also that at least one of their friends had accepted this challenge, describing symptoms such as vomiting, headache, altered behavior, increased talkativeness, and sociability. The median value of the weighted average cost of the diagnosis-related group relating to interventions provided by hospitals was the same for both genders, €46,091 (US $56,497; minimum €17,349 and maximum €46,091). Conclusions: Drinking games encourage young people to consume large quantities of alcohol within a short period of time putting them at risk of alcohol poisoning, which can potentially lead to accidental injuries, unsafe sex, suicide, sexual assault, and traffic accidents. The spread of these games through the internet and social networks is becoming a serious health problem facing physicians and medical professionals every day, especially in the ED; for this reason, it is necessary to be aware of the risks represented by such behaviors in order to recognize and identify preliminary symptoms and develop useful prevention programs. The strategic role of emergency services is to monitor and define the problem right from the start in order to control the epidemic, support planning, coordinate the delivery of assistance in the emergency phase, and provide medical education. Hospital-based interdisciplinary health care researchers collected specific data on hazardous drinking practices linked to evaluation of increased alcohol-related consequences and cases admitted to the ED.

  • Mom and child baking in kitchen. Source: Pixabay; Copyright: Anna Prosekova; URL:; License: Public Domain (CC0).

    Clustering of Obesity-Related Risk Behaviors Among Families With Preschool Children Using a Socioecological Approach: Cross-Sectional Study

    Authors List:


    Background: Limited attention has been given to assessing home environments of parents with preschool-aged children using a socioecological approach to better understand potential influencers of obesity risk. Objective: The purpose of this cross-sectional study was to examine the clustering of obesity-related risk behaviors among mothers with preschool children. Methods: Mothers with preschool-aged children (ages 2 to 5 years) who participated in the online Home Obesogenic Measure of Environments (HOMES) survey were examined in clustering of four healthy recommended behaviors (ie, mother’s fruit and vegetable intake ≥5 per day, sedentary screen time <4 hours per day, sugar-sweetened beverage intake <1 time/day, and increased physical activity level). Frequencies and percents of the clustering variables were conducted along with Spearman rank order correlations to determine significant associations. Ward’s method with squared Euclidean distances were performed for the cluster analysis using the four standardized continuous variables. Identification of total cluster number was determined by visually inspecting the dendogram. Sociodemographic, intrapersonal, social environment, and home physical environment characteristic differences between cluster groups were further examined by independent t tests and chi-square analysis to validate findings. Results: Of the 496 participants (72.6%, 360/496 white; age mean 32.36, SD 5.68 years), only a third (37.1%, 184/496) consumed five or more servings of fruits/vegetables daily, had low sedentary screen time of <4 hours/day, and reported moderate to high levels of physical activity (34.1%, 169/496). More than half (57.7%, 286/496) consumed <1 sugar-sweetened beverage serving daily. A positive correlation (r=.34, P<.001) between physical activity level and fruit/vegetable intake (≥5 servings/day), and a positive correlation (r=.15, P=.001) between low sedentary screen time (<4 hours/day) and low sugar-sweetened beverage intake (<1 serving/day) were found. Ward’s hierarchical analysis revealed a two-cluster solution: less healthy/inactive moms (n=280) and health conscious/active moms (n=216). Health conscious/active moms were significantly (P<.010) likely to be more physically active, have lower sedentary screen time, lower daily intake of sugar-sweetened beverages, and greater daily intake of fruits and vegetables compared to less healthy/inactive moms. Less healthy/inactive moms were significantly more likely to have a higher body mass index and waist circumference compared to the other cluster; however, there were no significant sociodemographic differences. There were many intrapersonal (eg, importance of physical activity for child and self) and home physical environment (eg, home availability of fruits/vegetables and salty/fatty snacks) characteristic differences between clusters, but few significant differences emerged for social environment characteristics (eg, family meals, family cohesion). Conclusions: Findings may have implications in tailoring future obesity prevention interventions among families with young children.

  • Source:; Copyright:; URL:; License: Public Domain (CC0).

    Combining Activity Trackers With Motivational Interviewing and Mutual Support to Increase Physical Activity in Parent-Adolescent Dyads: Longitudinal...


    Background: An essential component of any effective adolescent weight management program is physical activity (PA). PA levels drop dramatically in adolescence, contributing to the rising prevalence of adolescent obesity. Therefore, finding innovative interventions to address this decline in PA may help adolescents struggling with weight issues. The growing field of health technology provides potential solutions for addressing chronic health issues and lifestyle change, such as adolescent obesity. Activity trackers, used in conjunction with smartphone apps, can engage, motivate, and foster support among users while simultaneously providing feedback on their PA progress. Objective: The objective of our study was to evaluate the effect of a 10-week pilot study using smartphone-enabled activity tracker data to tailor motivation and goal setting on PA for overweight and obese adolescents and their parents. Methods: We queried enrolled adolescents, aged 14 to 16 years, with a body mass index at or above the 85th percentile, and 1 of their parents as to behaviors, barriers to change, and perceptions about exercise and health before and after the intervention. We captured daily step count and active minutes via activity trackers. Staff made phone calls to dyads at weeks 1, 2, 4, and 8 after enrollment to set daily personalized step-count and minutes goals based on their prior data and age-specific US national guidelines. We evaluated dyad correlations using nonparametric Spearman rank order correlations. Results: We enrolled 9 parent-adolescent dyads. Mean adolescent age was 15 (SD 0.9) years (range 14-16 years; 4 female and 5 male participants); mean parent age was 47 (SD 8.0) years (range 36-66 years). On average, adolescents met their personalized daily step-count goals on 35% (range 11%-62%) of the days they wore their trackers; parents did so on 39% (range 3%-68%) of the days they wore their trackers. Adolescents met their active-minutes goals on 55% (range 27%-85%) of the days they wore their trackers; parents did so on 83% (range 52%-97%) of the days. Parent and adolescent success was strongly correlated (step count: r=.36, P=.001; active minutes: r=.30, P=.007). Parental age was inversely correlated with step-count success (r=–.78, P=.01). Conclusions: Our findings illustrate that parent-adolescent dyads have highly correlated PA success rates. This supports further investigation of family-centered weight management interventions for adolescents, particularly those that involve the parent and the adolescent working together.

  • Source: Flickr; Copyright: Royalty-Free/Corbis; URL:; License: Creative Commons Attribution + Noncommercial + ShareAlike (CC-BY-NC-SA).

    Adolescents’ Perspectives on Using Technology for Health: Qualitative Study


    Background: Adolescents’ wide use of technology opens up opportunities to integrate technology into health visits and health care. In particular, technology has the potential to influence adolescent behavior change by offering new avenues for provider communication and support for healthy choices through many different platforms. However, little information exists to guide the integration of technology into adolescent health care, especially adolescents’ perspectives and preferences for what they find useful. Objective: This qualitative study aimed to take a broad approach to understanding adolescents’ use of technology for supporting their overall health and to understand whether and how adolescents envision using technology to enhance their health and clinical care, particularly in communicating with their provider. Methods: Adolescents (13-18 years) were recruited to participate in semi-structured, in-depth individual interviews. Potential participants were approached in-person through the Seattle Children's Hospital Adolescent Medicine Clinic while they were waiting for consultation appointments, through outreach to youth who expressed interest in other local research study activities, and via flyers in waiting rooms. Interviews were recorded, transcribed, and analyzed using a thematic analysis approach. Results: Thirty-one adolescents (58% female, mean age 15.2 years) were interviewed and described 3 main uses of technology: (1) to gather information, (2a) to share their own experiences and (2b) view others’ experiences in order to gain social support or inspiration, and (3) to track behaviors and health goals. Perceived benefits and potential downsides were identified for technology use. Teens desired to use technology with their provider for 3 main reasons: (1) have questions answered outside of visits, (2) have greater access to providers as a way to build relationship/rapport, and (3) share data regarding behaviors in between visits. Social media was not a preferred method for communicating with providers for any of the youth due to concerns about privacy and intrusiveness. Conclusions: Although youth are avid users of technology in general, in regard to technology for health, they display specific use preferences especially in how they wish to use it to communicate with their primary care provider. Health care providers should offer guidance to youth with regard to how they have used and plan to use technology and how to balance potential positives and negatives of use. Technology developers should take youth preferences into account when designing new health technology and incorporate ways they can use it to communicate with their health care provider.

  • Source: Flickr; Copyright: Metropolitan Transportation Authority of the State of New York; URL:; License: Creative Commons Attribution (CC-BY).

    Theoretically-Based Emotion Regulation Strategies Using a Mobile App and Wearable Sensor Among Homeless Adolescent Mothers: Acceptability and Feasibility Study


    Background: Many adolescent mothers are parenting young children under highly stressful conditions as they are managing first-time parenthood, poverty, lack of housing, school and work, and challenging peer and familial relationships. Mobile health (mHealth) technology has the potential to intervene at various points in the emotion regulation process of adolescent mothers to provide them support for more adaptive emotional and behavioral regulation in the course of their daily life. Objective: The goal of this study was to examine the acceptability, feasibility, use patterns, and mechanisms by which a mobile technology used as an adjunct to in-person, provider-delivered sessions fostered adolescent mothers’ adaptive emotion regulation strategies under real-life conditions. Methods: Participants (N=49) were enrolled in the intervention condition of a larger pilot study of homeless adolescent mothers living in group-based shelters. The mHealth technology, Calm Mom, consisted of a mobile app and a wrist-worn sensorband for the ambulatory measurement and alerting of increased electrodermal activity (EDA), a physiological measurement of stress. We examined logs of mobile app activity and conducted semistructured qualitative interviews with a subsample (N=10) of participants. Qualitative data analysis was guided by the theoretical frames of the intervention and a technology acceptance model and included an analysis of emerging themes and concepts. Results: Overall, participants indicated that one or more of the elements of Calm Mom supported their ability to effectively regulate their emotions in the course of their daily life in ways that were consonant with the intervention’s theoretical model. For many adolescent mothers, the app became an integral tool for managing stress. Due to technical challenges, fewer participants received sensorband alerts; however, those who received alerts reported high levels of acceptability as the technology helped them to identify their emotions and supported them in engaging in more adaptive behaviors during real-life stressful situations with their children, peers, and family members. Conclusions: Calm Mom is a promising technology for providing theoretically driven behavioral intervention strategies during real-life stressful moments among a highly vulnerable population. Future research efforts will involve addressing technology challenges and refining tailoring algorithms for implementation in larger-scale studies.

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  • How Women Evaluate Birth Challenges: An Analysis of Online Birth Stories

    Date Submitted: Sep 15, 2018

    Open Peer Review Period: Sep 19, 2018 - Nov 14, 2018

    Background: Birth stories provide an intimate glimpse into women’s birth experiences, in their own words. Understanding the emotions elicited in women by certain types of behaviors during labor and...

    Background: Birth stories provide an intimate glimpse into women’s birth experiences, in their own words. Understanding the emotions elicited in women by certain types of behaviors during labor and delivery could help those in the healthcare community provide better emotional care for laboring women. Objective: The objective of the study was to understand which supportive reactions and behaviors contributed to negative or positive emotions among women in regards to their labor and delivery experience. Methods: We sampled ten women’s stories from a popular blog that described births that strayed from the plan. Ninety challenging events that occurred during labor and delivery were identified. Each challenge had an emotionally positive, negative, or neutral evaluation by the woman. We classified supportive and unsupportive behaviors in response to these challenges and examined their association with the woman’s emotional appraisal of the challenges. Results: Four types of behaviors were identified: informational inclusion, decisional inclusion (mostly by healthcare providers), practical support, and emotional support (mostly by partners). Supportive reactions were not associated with emotional appraisal; however, unsupportive reactions were associated with women appraising the challenge negatively (Fisher Exact Test, P = .02). Conclusions: While supportive behaviors did not elicit any particular emotion, unsupportive behaviors did cause women to view challenges negatively. Patients should be encouraged to express their needs at every opportunity, particularly when challenges present themselves during labor, and healthcare professionals should strive to cater to them.

  • A pilot feasibility randomized controlled trial of a 12-week e-mentoring employment intervention for youth with physical disabilities

    Date Submitted: Sep 7, 2018

    Open Peer Review Period: Sep 12, 2018 - Nov 7, 2018

    Background: Youth with disabilities are at high risk of unemployment compared to youth without disabilities. They often encounter challenges in accessing vocational programs that meet their needs. One...

    Background: Youth with disabilities are at high risk of unemployment compared to youth without disabilities. They often encounter challenges in accessing vocational programs that meet their needs. One promising approach that could help to address barriers that youth encounter while also enhancing social support is through electronic mentoring (e-mentoring). Although there is an increase in e-mentoring for youth with disabilities, little is known about their impact for youth with physical disabilities. Objective: This study assessed the acceptability and initial impact of an online peer e-mentor employment intervention for youth with physical disabilities. Methods: The ‘Empowering youth towards employment’ intervention was evaluated using a pilot randomized controlled trial. Youth, aged 15-21 with physical disabilities were randomly assigned to an experimental (i.e., mentored) or control (i.e., non-mentored) group. Trained mentors (i.e., near peers) with a physical disability led the online discussion forums and provided peer support and resources for 12 modules (1 topic per week over 12 weeks). Primary outcomes focused on self-determination, career maturity and social support. Results: Thirteen youth (mean age 17.3  1.88 (SD), 54% female) completed in the RCT (intervention n= 9, control n=4). Participants reported satisfaction with the program and that it was feasible and acceptable. Participants mean engagement level with the program was 5.22/10 (SD 2.48) for the experimental group and 5.40 (SD 4.56) for controls. Participants in the intervention demonstrated significant improvements in self-determination, t 2.49 (p<0.04) compared to the control group. No adverse events were reported. Conclusions: The ‘Empowering youth towards employment’ is a promising intervention that enhances self-determination among youth with physical disabilities. Clinical Trial: NCT02522507; (Archived by WebCite at

  • Qualitative and Quantitative Evaluation of the Make Safe Happen® app – a mobile technology-based safety behavior change intervention

    Date Submitted: Aug 28, 2018

    Open Peer Review Period: Aug 29, 2018 - Oct 25, 2018

    Background: Background: Nearly half of the unintentional injuries in children happen in and around the home; many of these injuries are preventable. Providing parents and caregivers with the proper in...

    Background: Background: Nearly half of the unintentional injuries in children happen in and around the home; many of these injuries are preventable. Providing parents and caregivers with the proper injury prevention information that is easily accessible may help them make their homes safer for children. Objective: Objective: The objective of this study was to evaluate parental injury prevention awareness and home safety behaviors, motivations for and challenges to taking injury prevention and safety actions for parents as well as user experience following the use of the Make Safe Happen® mobile app. Methods: Methods: Forty parents of children 0-12 years of age living in Columbus, Ohio participated in one of five focus group discussions following the completion of a pretest survey, use of the Make Safe Happen® app, and a posttest survey. Results: Results: Following the use of the Make Safe Happen® app, parents reported a significant increase in injury prevention awareness and completed 45% more home safety behaviors in and around their homes. Nearly all of the parents felt the app provided them with the information needed to make their home safer for their children; the great majority of parents intended to make such changes in the future. Conclusions: Conclusions: The combination of the qualitative and quantitative data collection allowed for a rich data capture and provided a deeper understanding of parent’s safety knowledge, behaviors, app use, and decision making regarding child injury prevention in and around the home. The Make Safe Happen® app provides the information and motivation parents and caregivers need to help them take steps to prevent child injuries that may in and around their homes.

  • Preparing paediatric patients for MRI with a free and accessible Virtual Reality experience

    Date Submitted: Aug 11, 2018

    Open Peer Review Period: Aug 15, 2018 - Oct 10, 2018

    Background: An MRI is a diagnostic test which requires patients to sit still for prolonged periods within a claustrophobic and noisy environment. This can be difficult for children to tolerate and oft...

    Background: An MRI is a diagnostic test which requires patients to sit still for prolonged periods within a claustrophobic and noisy environment. This can be difficult for children to tolerate and often general anaesthetic (GA) is required at considerable cost and detriment to patient safety. Virtual reality (VR) is a newly emerging technology which can be implemented at low cost within a healthcare setting. It has been shown to reduce fear associated with a number of high anxiety situations and medical procedures. Objective: To develop a virtual reality resource to prepare paediatric patients for MRI helping to reduce anxieties in children undergoing the procedure. Methods: A free VR app was developed to prepare paediatric patients for their upcoming MRI. The app displays a series of panoramic 360 videos of the entire MRI journey, including footage from within the bore of the scanner. Deployed to the Android play store and iOS app store it can be viewed on most mobile phones allowing a child to experience an MRI in VR using an inexpensive Google Cardboard headset. The 360 videos are contained within an animated, interactive virtual reality interface designed for 7-12yr olds. For younger children a preparation book was developed to be used in conjunction with the app. The resource was evaluated on 23 patients (4-12yrs) and feedback was obtained from 10 staff. In 5 patients the app was evaluated as a tool to prepare patients for an awake MRI whom otherwise were booked to have an MRI under GA. Results: The VR preparation resource has been successfully implemented at 3 UK institutions. Of the 23 patients surveyed, on a scale of 1-10 the VR resource was rated with a median score of 9 for “enjoyment”, 8 for “helpfulness” and 10 for “ease of use”. All patients agreed that it made them feel more positive about their MRI and all suggested they would recommend the resource to other children. Of the 10 staff surveyed, when considering their experiences of using the resource with paediatric patients, on a scale of 1-10 they rated the VR resource with a median score of 9 for “enjoyment”, 9 for “helpfulness” and 9 for “ease of use”. All staff believed it could help prepare children for an awake MRI, thus avoiding general anesthetic (GA). A successful awake MRI was achieved in 4 of the 5 children for whom routine care would have resulted in an MRI under GA. Conclusions: Our Virtual reality resource was able to relieve anxieties and better prepare patients for an awake MRI. The resource has potential to avoid general anesthetic through educating the child about the MRI process.

  • “If you let them, they will be on it 24 hours a day”: a qualitative study conducted in the United States exploring Brazilian immigrant mothers’ beliefs, attitudes, and practices related to screen time behaviors of their preschool-aged children

    Date Submitted: Aug 2, 2018

    Open Peer Review Period: Aug 10, 2018 - Oct 6, 2018

    Background: The increasing prevalence of excessive screen time (ST) among children is a growing public health concern due the associated risk of overweight and obesity in children. Increasing ST among...

    Background: The increasing prevalence of excessive screen time (ST) among children is a growing public health concern due the associated risk of overweight and obesity in children. Increasing ST among preschool-age children (2-5 years of age) has prompted several countries including the United States (US) to develop ST guidelines. In 2016, the American Academy of Pediatrics (AAP) released updated guidelines that encourage parents of preschool-age children to limit ST to < 1 hour per day. Objective: To explore the beliefs, attitudes, and practices of Brazilian-born immigrant mothers’ living in the US related to their preschool-aged children’s ST. Methods: Qualitative study with seven focus group discussions (FGDs) conducted with Brazilian immigrant mothers to gain an in-depth understanding of the research topics. All FGDs were audio-recorded and professionally transcribed verbatim. The Portuguese transcripts were analyzed using thematic analysis. Results: In total, 37 women participated in the FGDs. Analyses revealed that although most mothers expressed concerns for their children’s ST, nearly all viewed ST as an acceptable part of children’s daily lives. Furthermore, mothers perceived more benefits than disadvantages associated with ST. Mothers’ positive beliefs (e.g., educational purposes, entertainment) and their perceived functional benefits of ST (e.g., ability to keep children occupied so tasks can be completed, regular communication with family outside the US) contributed to their acceptance of ST for their young children. Nevertheless, most mothers spoke of the need to find a balance between their children’s ST and other activities, and reported using several parenting practices to manage ST including monitoring time and content, setting limits and rules, and prompting their children to do something else. Conclusions: The present study provides new information on the beliefs, attitudes, and practices of Brazilian immigrant mothers living in the US related to their preschool-aged children’s ST. Study findings revealed several potentially modifiable maternal beliefs and parenting practices that may provide important targets for parenting- and family-based interventions aimed at promoting adequate preschool-age children’s ST. Clinical Trial: n/a

  • Dipstick urinalysis in children; reviewing a valuable but an underutilized diagnostic tool in developing countries

    Date Submitted: Aug 1, 2018

    Open Peer Review Period: Aug 6, 2018 - Oct 2, 2018

    Background: Dipstick urinalysis (DU) utilizes a reagent strip as a diagnostic chemical examination of the urine to determine the pathological changes in the urine that may result from a systemic and/o...

    Background: Dipstick urinalysis (DU) utilizes a reagent strip as a diagnostic chemical examination of the urine to determine the pathological changes in the urine that may result from a systemic and/or a metabolic disease and/or the diseases of the kidney and the urinary tract. DU is cheap, non-invasive, easy and quick to perform, widely available, and can be done by the bed-side. Objective: Unfortunately, DU is undervalued in sub-Saharan Africa because clinicians are ignorant of its diagnostic values and the broadness of its usefulness Methods: For each of the common ten (pH, specific gravity, glucose, ketone, protein, blood, nitrite, leucocyte esterase, bilirubin and urobilinogen) analytes detectable by DU, this article reviews the pathophysiology of each analyte; it describes the principle of the chemical reaction for each analyte; it summarizes the interpretation of the test result and the possible causes of false positives and false negatives for each test. In addition, the article underscores the usefulness of DU in aiding the management of prematurity, pneumonia, diarrhoea, sepsis and malaria, the common childhood killer diseases in sub-Saharan Africa. Results: This article should arouse the interest of clinicians working in developing countries to see DU as an invaluable diagnostic tool in resource-constrained settings of the world Conclusions: It is expected that the clinicians working in developing countries will see this article as a quick reference guide when interpreting DU results of the child under their care