@Article{info:doi/10.2196/66401, author="Ginsberg, Harrison Kristin and Alsweiler, Jane and Rogers, Jenny and Ross, Phoebe and Serlachius, Anna", title="Exploring Stress and Stress-Reduction With Caregivers and Clinicians in the Neonatal Intensive Care Unit to Inform Intervention Development: Qualitative Interview Study", journal="JMIR Pediatr Parent", year="2025", month="Apr", day="2", volume="8", pages="e66401", keywords="neonatal intensive care unit", keywords="NICU", keywords="parents", keywords="preterm infants", keywords="stress", keywords="stress reduction", keywords="intervention development", keywords="digital", keywords="neonatology", keywords="pediatric", keywords="infants", keywords="babies", keywords="neonatal", keywords="toddler", keywords="children", keywords="caregiver", keywords="telemedicine", keywords="telehealth", keywords="virtual care", keywords="virtual health", keywords="virtual medicine", keywords="remote consultation", keywords="qualitative study", abstract="Background: Parents and caregivers with preterm babies in the neonatal intensive care unit (NICU) experience high levels of distress and are at an increased risk of anxiety, depression, and acute stress disorders. Effective interventions to reduce this distress are well described in the literature, but this research has been conducted primarily in Europe and North America. To our knowledge, few interventions of this sort have been developed in Australasia, and none have been developed or tested in Aotearoa New Zealand. Objective: The primary aims of this study were to explore sources of stress with caregivers and clinicians in a NICU in Aotearoa New Zealand and gather participant ideas on ways to reduce caregiver stress to inform intervention development. Methods: This qualitative design used an essentialist and realist methodology to generate findings aimed at future intervention development. Overall, 10 NICU clinicians (neonatologists, nurses, and mental health clinicians) and 13 caregivers (mothers, fathers, and extended family members) of preterm babies, either currently admitted or discharged from the NICU within the last 12 months, were recruited to participate in interviews exploring stress and stress-reduction in the NICU. Results: The 23 participants included 10 clinicians (all female, with an average of 15 years of experience in the NICU) and 13 parents and caregivers (majority of them were female; 10/13, 77\%) of preterm babies. We identified 6 themes relevant to intervention development. Three themes focused on caregiver stress: the emotional ``rollercoaster'' of NICU; lack of support, both culturally and emotionally; and caregivers feeling ``left out'' and confused. Three themes focused on participant-proposed solutions to reduce stress: caregiver empowerment, improving emotional support, and communication on ``my'' terms (ie, digitally). Conclusions: Participants reported high levels of caregiver stress in the NICU, and they proposed a range of stress-reducing solutions, including increasing caregiver empowerment and improving emotional and cultural support. Clinicians and caregivers also strongly agreed on providing more information for caregivers in digital, mobile-friendly formats. ", doi="10.2196/66401", url="https://pediatrics.jmir.org/2025/1/e66401" } @Article{info:doi/10.2196/65107, author="Kahhan, A. Nicole and Fox, A. Larry and Benson, Matthew and Patton, R. Susana", title="Implementing Diabetes Distress Screening in a Pediatric Endocrinology Clinic Using a Digital Health Platform: Quantitative Secondary Data Analysis", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="6", volume="8", pages="e65107", keywords="type 1 diabetes", keywords="diabetes mellitus, type 1", keywords="pediatric", keywords="child", keywords="children", keywords="youth", keywords="parents", keywords="diabetes distress", keywords="eHealth", keywords="screening", keywords="digital health", keywords="diabetes", keywords="diabetic", keywords="type 1", keywords="DM", keywords="T1D", keywords="endocrinology", keywords="alert", keywords="best practice alert", keywords="BPA", keywords="patient education", abstract="Background: Type 1 diabetes (T1D) management requires following a complex and constant regimen relying on child or caregiver behaviors, skills, and knowledge. Psychological factors such as diabetes distress (DD), depression, and burnout are pertinent considerations in the treatment of pediatric T1D. Approximately 40\% of youth and 61\% of caregivers experience DD. Implementation of DD screening as part of clinical best practice is recommended and may facilitate treatment referral, perhaps leading to improved health or well-being for youth with T1D and their caregivers. By building on existing institutional infrastructure when available, screening via digital health platforms (applications, or ``apps'') may allow for timely screening of, and response to, DD. Objective: This work details the creation, implementation, and refinement of a process to screen for DD in youth and their caregivers in the context of routine T1D care using a digital health platform. Methods: DD screening was implemented in an outpatient endocrinology clinic over 1 year as part of a larger screen-to-treat trial for children aged 8?12.99 years and their caregivers. Validated measures were sent via digital health platform to be completed prior to the clinic visit. Results were initially reviewed manually, but a digital best practice alert (BPA) was later built to notify staff of elevated scores. Families experiencing DD received resources sent via the digital health platform. For this secondary analysis, child demographics and glycated hemoglobin A1c (HbA1c) were collected. Results: During the screening period, absolute completion rates were 36.78\% and 38.83\%, with adjusted screening rates at 52.02\% and 54.48\%, for children and caregivers, respectively. A total of 21 children (mean HbA1c 8.04\%, SD 1.39\%) and 26 caregivers (child mean HbA1c 8.04\%, SD 1.72\%) reported elevated DD. Prior to BPA development, resources were sent to all but 1 family. After BPA implementation, all families were sent resources. Conclusions: Early findings indicate that DD education, screening, and response can be integrated via digital platforms in a freestanding outpatient endocrinology clinic, thereby facilitating timely treatment referral and provision of resources for those identified with distress. Notably, in the observed 1-year screening period, screening rates were low, and barriers to implementation were identified. While some implementation challenges were iteratively addressed, there is a need for future quality improvement initiatives to improve screening rates and the identification of, or response to, DD in our pediatric patients and their families. Trial Registration: ClinicalTrials.gov NCT05268250; https://clinicaltrials.gov/study/NCT05268250 ", doi="10.2196/65107", url="https://pediatrics.jmir.org/2025/1/e65107" } @Article{info:doi/10.2196/56667, author="Khaksar, Sajjad and Jafari-Oori, Mehdi and Sarhangi, Forogh and Moayed, Sadat Malihe", title="Pediatric Sleep Quality and Parental Stress in Neuromuscular Disorders: Descriptive Analytical Study", journal="Asian Pac Isl Nurs J", year="2025", month="Jan", day="28", volume="9", pages="e56667", keywords="spinal muscular atrophy", keywords="neuromuscular disorders", keywords="sleep quality", keywords="pediatrics", keywords="parental stress", keywords="children", keywords="parents", keywords="muscular atrophy", keywords="muscular disorders", abstract="Background: Neuromuscular disorders (NMDs) constitute a heterogeneous group of disorders that affect motor neurons, neuromuscular junctions, and muscle fibers, resulting in symptoms such as muscle weakness, fatigue, and reduced mobility. These conditions significantly affect patients' quality of life and impose a substantial burden on caregivers. Spinal muscular atrophy (SMA) is a relatively common NMD in children that presents in various types with varying degrees of severity. Objective: This study aimed to evaluate the sleep quality of children with NMDs, particularly SMA types 1, 2, and 3 and assess the stress levels experienced by their parents. Methods: A descriptive analytical study was conducted from February to October 2023, in selected hospitals and dystrophy associations in Tehran and Isfahan, Iran. A total of 207 children aged 1?14 years with various NMDs were included in the study. Data were collected using a web-based questionnaire with 3 parts: demographic information, the Children's Sleep Habits Questionnaire to assess children's sleep, and the Stress Response Inventory to measure parental stress. Statistical analyses were performed using SPSS version 22, with an $\alpha$ level of .05. Results: Significant differences in sleep quality were found among SMA types, with mean scores of 74.76 (SD 7.48) for SMA type 1, 76.4 (SD 7.29) for SMA type 2, 72.88 (SD 6.73) for SMA type 3, and 75.87 (SD 5.74) for other NMDs (P=.02). A correlation was found between sleep and length of hospital stay (r=0.234, P<.001)and between sleep and the child's sex (r=?0.140, P=.04). Parental stress scores averaged 95.73 (SD 32.12). There was not a statistically significant difference in parental stress scores among the 4 groups (P=.78). This suggests that parental stress levels were similar across different NMD groups. Conclusions: Sleep disorders are prevalent among children with NMDs, especially SMA. Parents experience high levels of stress that can affect the care they provide. Therefore, interventions to improve children's sleep and address parental stress are crucial. Regular screening, counseling, and tailored support are recommended to enhance the well-being of children with NMDs and their families. ", doi="10.2196/56667", url="https://apinj.jmir.org/2025/1/e56667" } @Article{info:doi/10.2196/54862, author="Erika, Ayu Kadek and Fadilah, Nur and Latif, Insani Aulia and Hasbiah, Nurhikmawaty and Juliaty, Aidah and Achmad, Harun and Bustamin, Anugrayani", title="Stunting Super App as an Effort Toward Stunting Management in Indonesia: Delphi and Pilot Study", journal="JMIR Hum Factors", year="2024", month="Dec", day="17", volume="11", pages="e54862", keywords="stunting", keywords="stunting prevention", keywords="mobile app", abstract="Background: Currently, 30 million children are experiencing acute malnutrition, and 8 million children are severely underweight. Objective: This study aimed to develop a stunting super app, a one-stop app designed to prevent and manage stunting in Indonesia. Methods: This study consisted of three stages. Stage 1 used a 3-round Delphi study involving 12 experts. In stage 2, 4 experts and a parent of children with stunted growth created an Android app containing stunting educational materials. In stage 3, a pilot study involving a control group was conducted to evaluate parents' knowledge about stunting prevention through the app and standard interventions. Results: In the Delphi study, 11 consensus statements were extracted; arranged in three major themes, including maternal health education, child health education, and environmental education; and applied in the form of the Sistem Evaluasi Kesehatan Anak Tumbuh Ideal (SEHATI) app. This app was assessed using a content validity index, with a cumulative agreement of ?80\% among the 5 individuals. The pilot study showed an increase in the knowledge of mothers of toddlers with stunted growth before and after the educational intervention (P=.001). Conclusions: The SEHATI app provides educational content on stunting prevention that can increase the knowledge of mothers of toddlers with stunted growth. ", doi="10.2196/54862", url="https://humanfactors.jmir.org/2024/1/e54862" } @Article{info:doi/10.2196/64669, author="Sada, Fatos and Chivers, Paola and Cecelia, Sokol and Statovci, Sejdi and Ukperaj, Kujtim and Hughes, Jeffery and Hoti, Kreshnik", title="Parental Assessment of Postsurgical Pain in Infants at Home Using Artificial Intelligence--Enabled and Observer-Based Tools: Construct Validity and Clinical Utility Evaluation Study", journal="JMIR Pediatr Parent", year="2024", month="Dec", day="3", volume="7", pages="e64669", keywords="PainChek Infant", keywords="Observer-Administered Visual Analog Scale", keywords="parents", keywords="infant pain", keywords="pain assessment", keywords="circumcision", keywords="infant home assessment", keywords="clinical utility", keywords="construct validity", keywords="artificial intelligence", abstract="Background: Pain assessment in the infant population is challenging owing to their inability to verbalize and hence self-report pain. Currently, there is a paucity of data on how parents identify and manage this pain at home using standardized pain assessment tools. Objective: This study aimed to explore parents' assessment and intervention of pain in their infants at home following same-day surgery, using standardized pain assessment tools. Methods: This prospective study initially recruited 109 infant boys undergoing circumcision (same-day surgery). To assess pain at home over 3 days after surgery, parents using iOS devices were assigned to use the PainChek Infant tool, which is a point-of-care artificial intelligence--enabled tool, while parents using Android devices were assigned to use the Observer-Administered Visual Analog Scale (ObsVAS) tool. Chi-square analysis compared the intervention undertaken and pain presence. Generalized estimating equations were used to evaluate outcomes related to construct validity and clinical utility. Receiver operating characteristic analysis assessed pain score cutoffs in relation to the intervention used. Results: A total of 69 parents completed postsurgery pain assessments at home and returned their pain diaries. Of these 69 parents, 24 used ObsVAS and 45 used PainChek Infant. Feeding alone and feeding with medication were the most common pain interventions. Pain presence over time reduced. In the presence of pain, an intervention was likely to be administered ($\chi$22=21.4; P<.001), with a medicinal intervention being 12.6 (95\% CI 4.3-37.0; P<.001) times more likely and a nonmedicinal intervention being 5.2 (95\% CI 1.8-14.6; P=.002) times more likely than no intervention. In the presence of intervention, score cutoff values were ?2 for PainChek Infant and ?20 for ObsVAS. A significant effect between the use of the pain instrument ($\chi$21=7.2, P=.007) and intervention ($\chi$22=43.4, P<.001) was found, supporting the construct validity of both instruments. Standardized pain scores were the highest when a medicinal intervention was undertaken (estimated marginal mean [EMM]=34.2\%), followed by a nonmedicinal intervention (EMM=23.5\%) and no intervention (EMM=11.2\%). Similar trends were seen for both pain instruments. Pain was reduced in 94.5\% (224/237) of assessments where parents undertook an intervention. In 75.1\% (178/237) of assessments indicative of pain, the score changed from pain to no pain, with PainChek Infant assessments more likely to report this change (odds ratio 4.1, 95\% CI 1.4-12.3) compared with ObsVAS assessments. Conclusions: The use of standardized pain assessment instruments by parents at home to assess pain in their infants can inform their decision-making regarding pain identification and management, including determining the effectiveness of the chosen intervention. In addition to the construct validity and clinical utility of PainChek Infant and ObsVAS in this setting, feeding alone and a combination of feeding with medication use were the key pain intervention strategies used by parents. ", doi="10.2196/64669", url="https://pediatrics.jmir.org/2024/1/e64669" } @Article{info:doi/10.2196/62878, author="Garikipati, Anurag and Ciobanu, Madalina and Singh, Preet Navan and Barnes, Gina and Dinenno, A. Frank and Geisel, Jennifer and Mao, Qingqing and Das, Ritankar", title="Parent-Led Applied Behavior Analysis to Impact Clinical Outcomes for Individuals on the Autism Spectrum: Retrospective Chart Review", journal="JMIR Pediatr Parent", year="2024", month="Oct", day="30", volume="7", pages="e62878", keywords="applied behavior analysis", keywords="autism spectrum disorder", keywords="parent training", keywords="patient outcomes", keywords="skill acquisition", keywords="pediatrics", abstract="Background: Autism spectrum disorder (ASD) can have traits that impact multiple domains of functioning and quality of life, which can persevere throughout life. To mitigate the impact of ASD on the long-term trajectory of an individual's life, it is imperative to seek early and adequate treatment via scientifically validated approaches, of which applied behavior analysis (ABA) is the gold standard. ABA treatment must be delivered via a behavior technician with oversight from a board-certified behavior analyst. However, shortages in certified ABA therapists create treatment access barriers for individuals on the autism spectrum. Increased ASD prevalence demands innovations for treatment delivery. Parent-led treatment models for neurodevelopmental conditions are effective yet underutilized and may be used to fill this care gap. Objective: This study reports findings from a retrospective chart review of clinical outcomes for children that received parent-led ABA treatment and intends to examine the sustained impact that modifications to ABA delivery have had on a subset of patients of Montera, Inc. dba Forta (``Forta''), as measured by progress toward skill acquisition within multiple focus areas (FAs). Methods: Parents received ?40 hours of training in ABA prior to initiating treatment, and patients were prescribed focused (<25 hours/week) or comprehensive (>25?40 hours/week) treatment plans. Retrospective data were evaluated over ?90 days for 30 patients. The clinical outcomes of patients were additionally assessed by age (2-5 years, 6-12 years, 13?22 years) and utilization of prescribed treatment. Treatment encompassed skill acquisition goals; to facilitate data collection consistency, successful attempts were logged within a software application built in-house. Results: Improved goal achievement success between weeks 1?20 was observed for older age, all utilization, and both treatment plan type cohorts. Success rates increased over time for most FAs, with the exception of executive functioning in the youngest cohort and comprehensive plan cohort. Goal achievement experienced peaks and declines from week to week, as expected for ABA treatment; however, overall trends indicated increased skill acquisition success rates. Of 40 unique combinations of analysis cohorts and FAs, 20 showed statistically significant positive linear relationships (P<.05). Statistically significant positive linear relationships were observed in the high utilization cohort (communication with P=.04, social skills with P=.02); in the fair and full utilization cohorts (overall success with P=.03 for the fair utilization cohort and P=.001 for the full utilization cohort, and success in emotional regulation with P<.001 for the fair utilization cohort and P<.001 for the full utilization cohort); and in the comprehensive treatment cohort (communication with P=.001, emotional regulation with P=.045). Conclusions: Parent-led ABA can lead to goal achievement and improved clinical outcomes and may be a viable solution to overcome treatment access barriers that delay initiation or continuation of care. ", doi="10.2196/62878", url="https://pediatrics.jmir.org/2024/1/e62878" } @Article{info:doi/10.2196/53151, author="Sahyouni, Amal and Zoukar, Imad and Dashash, Mayssoon", title="Evaluating the Effectiveness of an Online Course on Pediatric Malnutrition for Syrian Health Professionals: Qualitative Delphi Study", journal="JMIR Med Educ", year="2024", month="Oct", day="28", volume="10", pages="e53151", keywords="effectiveness", keywords="online course", keywords="pediatric", keywords="malnutrition", keywords="essential competencies", keywords="e-learning", keywords="health professional", keywords="Syria", keywords="pilot study", keywords="acquisition knowledge", abstract="Background: There is a shortage of competent health professionals in managing malnutrition. Online education may be a practical and flexible approach to address this gap. Objective: This study aimed to identify essential competencies and assess the effectiveness of an online course on pediatric malnutrition in improving the knowledge of pediatricians and health professionals. Methods: A focus group (n=5) and Delphi technique (n=21 health professionals) were used to identify 68 essential competencies. An online course consisting of 4 educational modules in Microsoft PowerPoint (Microsoft Corp) slide form with visual aids (photos and videos) was designed and published on the Syrian Virtual University platform website using an asynchronous e-learning system. The course covered definition, classification, epidemiology, anthropometrics, treatment, and consequences. Participants (n=10) completed a pretest of 40 multiple-choice questions, accessed the course, completed a posttest after a specified period, and filled out a questionnaire to measure their attitude and assess their satisfaction. Results: A total of 68 essential competencies were identified, categorized into 3 domains: knowledge (24 competencies), skills (29 competencies), and attitudes (15 competencies). These competencies were further classified based on their focus area: etiology (10 competencies), assessment and diagnosis (21 competencies), and management (37 competencies). Further, 10 volunteers, consisting of 5 pediatricians and 5 health professionals, participated in this study over a 2-week period. A statistically significant increase in knowledge was observed among participants following completion of the online course (pretest mean 24.2, SD 6.1, and posttest mean 35.2, SD 3.3; P<.001). Pediatricians demonstrated higher pre- and posttest scores compared to other health care professionals (all P values were <.05). Prior malnutrition training within the past year positively impacted pretest scores (P=.03). Participants highly rated the course (mean satisfaction score >3.0 on a 5-point Likert scale), with 60\% (6/10) favoring a blended learning approach. Conclusions: In total, 68 essential competencies are required for pediatricians to manage children who are malnourished. The online course effectively improved knowledge acquisition among health care professionals, with high participant satisfaction and approval of the e-learning environment. ", doi="10.2196/53151", url="https://mededu.jmir.org/2024/1/e53151" } @Article{info:doi/10.2196/60626, author="Kvestad, Ingrid and Adolfsen, Frode and Angeles, Corinne Renira and Brandseth, Lekve Oda and Breivik, Kyrre and Evertsen, Grete Janne and Foer, Kv{\aa}le Irene and Haaland, Morten and Homola, Millerjord Birgit and Hoseth, Elisabeth Gro and Jonsson, Josefine and Kjerstad, Egil and Kyrrestad, Henriette and Martinussen, Monica and Moberg, Annelene and Moberg, Karianne and Skogstrand, Anita and Solberg, Remme Line and Aasheim, Merete", title="Effectiveness of a Bullying Intervention (Be-Prox) in Norwegian Early Childhood and Education Care Centers: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Oct", day="24", volume="13", pages="e60626", keywords="peer bullying in early childhood education and care", keywords="The Bernese Program", keywords="cluster randomized controlled trial", keywords="bullying", keywords="child", keywords="preschool", keywords="program evaluation", abstract="Background: A new and growing body of research has studied bullying among children in early childhood education and care centers (ECECs). The Bernese Program (Be-Prox) is designed to systematically prevent and handle bullying between children in Swiss ECECs. However, the effectiveness of the Be-Prox intervention has not yet been explored in a Norwegian ECEC setting. Objective: This study aims to evaluate the effectiveness of Be-Prox in preventing and handling bullying among peers in Norwegian ECECs. Methods: ECECs from 2 Norwegian municipalities were invited to participate in a cluster randomized controlled trial (RCT) to evaluate the effectiveness of the Be-Prox intervention on peer bullying in Norwegian ECECs. After baseline measures were taken, project ECECs were randomized to either an intervention or a control arm. The Be-Prox intervention was introduced to ECECs in the intervention arm through 6 modules over a 9-month period immediately after the randomization. ECECs in the control arm participated in the data collection and were offered the Be-Prox intervention the following year. The primary outcome of the effect evaluation is the mean sum of negative behavior between peers after the Be-Prox training is completed in the intervention arm. Secondary outcomes include child bystander behavior, teacher self-efficacy, and ECEC's authoritative climate. An extensive implementation and process evaluation, as well as cost-effectiveness analyses, will be conducted alongside the RCT. Results: Baseline data collection was conducted in September 2023, and the postintervention data collection started in May 2024. At baseline, we collected data on 708 children and 413 personnel from 38 project ECECs in the 2 Norwegian municipalities. The results from the study will be available in late 2024 at the earliest. Conclusions: The proposed project includes a comprehensive evaluation of the effectiveness of Be-Prox in Norwegian ECECs directly targeting the prevention and handling of bullying, including implementation and cost-effectiveness evaluations. The results from the project have the potential to fill in identified knowledge gaps in the understanding of negative behavior and bullying between peers in ECECs, and how these may be prevented. If proven efficient, our ambition is to offer Be-Prox to Norwegian ECECs as an evidence-based practice to prevent and handle bullying among preschool children. Trial Registration: ClinicalTrials.gov NCT06040437; https://clinicaltrials.gov/study/NCT06040437 International Registered Report Identifier (IRRID): DERR1-10.2196/60626 ", doi="10.2196/60626", url="https://www.researchprotocols.org/2024/1/e60626" } @Article{info:doi/10.2196/54914, author="Deribe, Leul and Girma, Eshetu and Lindstr{\"o}m, Nataliya and Gidey, Abdulkadir and Teferra, Solomon and Addissie, Adamu", title="Parent Education and Counseling (PairEd-C) Intervention to Improve Family-Centered Care: Protocol for a Prospective Acceptability Study Using the Theoretical Framework of Acceptability", journal="JMIR Res Protoc", year="2024", month="Oct", day="4", volume="13", pages="e54914", keywords="family-centered care", keywords="child cancer", keywords="theoretical framework of acceptability", keywords="education and counseling", keywords="acceptability", keywords="parent education", keywords="family centered", keywords="care service", keywords="theoretical framework", keywords="study protocol", keywords="family", keywords="health care", keywords="well-being", keywords="children", keywords="implementation", keywords="design intervention", abstract="Background: Family-centered care (FCC) is an intervention approach based on a respectful relationship between family and health care providers (HCPs) to ensure the health and well-being of children and their families. Although HCPs have a better perception of FCC, the level of its implementation is low. Reasons for low implementation include limited understanding, lack of training, and lack of implementation guidelines and tools to support implementation. Thus, we developed the Parent Education and Counseling (PairEd-C) intervention to improve FCC in pediatric oncology settings and assess its acceptability. Objective: The objective of this study is to assess the prospective acceptability of the PairEd-C intervention using the theoretical framework of acceptability (TFA) in the pediatric oncology department in a tertiary hospital in Ethiopia. Methods: The study was conducted using an exploratory qualitative study design. We aimed to recruit 10 to 15 participants for the in-depth interview. The study participants were health service leaders working in child cancer, HCPs, social workers, and parents of children with cancer. The intervention was developed using the integration of the first phase of the Medical Research Council (MRC) framework for developing and testing complex interventions and the behavior change wheel (BCW) framework. The main PairEd-C intervention components align with the intervention functions of education, persuasion, training, environmental restructuring, modeling, and enablement, which were intended to improve FCC in the pediatric oncology unit by providing structured and comprehensive education and counseling of parents of children with cancer. The intervention was implemented by providing training for the health care team, facilitating discussion among HCPs and setting a shared plan, improving the commitment of the health care team, providing education for parents, improving parents' capacity to attend the intervention sessions, arranging discussion among parents of children with cancer, and provision of education and counseling on distress. The HCPs working in the unit received training on the designed intervention. The trained educators and the health care provider delivered the intervention. Data will be analyzed using deductive thematic coding with a framework analysis technique based on the 7 TFA constructs. Atlas ti. version 9 will be used for data analysis. Results: Funding was acquired in 2017, and ethical clearance for conducting the study was obtained. We conducted the interviews with the study participants from December 2023 to January 2024. As of the acceptance of this protocol (June 2024), 12 study participants were interviewed. The data analysis process was started subsequently, and the manuscript will be completed and submitted for publication in early 2025. Conclusions: This acceptability study is expected to show that the designed intervention is acceptable to study participants, and the findings will be used to improve the intervention before progressing to the next step of our project. International Registered Report Identifier (IRRID): DERR1-10.2196/54914 ", doi="10.2196/54914", url="https://www.researchprotocols.org/2024/1/e54914", url="http://www.ncbi.nlm.nih.gov/pubmed/39365661" } @Article{info:doi/10.2196/64216, author="Taylor, Marin and Bondi, Christina Bianca and Andrade, F. Brendan and Au-Young, H. Stephanie and Chau, Vann and Danguecan, Ashley and D{\'e}sir{\'e}, Naddley and Guo, Ting and Ostojic-Aitkens, Dragana and Wade, Shari and Miller, Steven and Williams, Samantha Tricia", title="Stepped-Care Web-Based Parent Support Following Congenital Heart Disease: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Oct", day="4", volume="13", pages="e64216", keywords="congenital heart disease", keywords="neurodevelopmental outcomes", keywords="web-based mental health care", keywords="stepped care", keywords="positive parenting", keywords="family well-being", keywords="mental health", keywords="I-InTERACT-North", abstract="Background: Early neurodevelopmental risks, compounded with traumatic medical experiences, contribute to emotional and behavioral challenges in as many as 1 in 2 children with congenital heart disease (CHD). Parents report a strong need for supports; yet, there remains a lack of accessible, evidence-based behavioral interventions available for children with CHD and their families. I-InTERACT-North is a web-based stepped-care mental health program designed to support family well-being and reduce behavioral concerns through positive parenting for children with early medical complexity. In previous pilot studies, the program was effective in increasing positive parenting skills and decreasing child behavior problems, with high parent-reported acceptability. This paper presents the protocol for the first randomized study of stepped-care parent support for families of children with CHD. Objective: This study will involve a single-site, 2-arm, single-blind randomized controlled trial to evaluate (1) the feasibility and acceptability of a web-based stepped-care parent support program (I-InTERACT-North) and (2) the effectiveness of the program in enhancing positive parenting skills and reducing behavioral concerns among families of children with CHD. Methods: Families will be randomized (1:1) to either receive treatment or continue with care as usual for 12 months. Randomization will be stratified by child's sex assigned at birth and baseline parent-reported child behavior intensity. Primary outcomes include positive parenting skills and child behavior at baseline, 3 months, 6 months, and 12 months. Secondary outcomes include parental mental health, quality of life, service usage, and feasibility including program reach and adherence. A sample size of 244 families will provide >95\% power to detect an effect size of d=0.64. Based on attrition data from pilot studies, a target of 382 families will be enrolled. Parent reports of acceptability, adoption, and suggested adaptability of the program will be examined using cross-case thematic analyses. Primary efficacy analysis will be conducted using an intent-to-treat approach. Generalized estimating equations will be used to examine changes in positive parenting. Child behavior, quality of life, and parent mental health will be tested with repeated-measures analyses. Additional sensitivity and replication analyses will also be carried out. Results: Recruitment began in February 2024, and recruitment and follow-up will continue until January 2029. We anticipate results in late 2029. Conclusions: This study aims to test the effectiveness of I-InTERACT-North web-based stepped-care parent support in improving positive parenting skills and reducing child behavior problems in families of children with CHD compared with a care as usual control group. Results will inform future clinical implementation and expansion of this program among families of children with early medical conditions. Trial Registration: ClinicalTrials.gov NCT06075251; https://clinicaltrials.gov/study/NCT06075251 International Registered Report Identifier (IRRID): DERR1-10.2196/64216 ", doi="10.2196/64216", url="https://www.researchprotocols.org/2024/1/e64216", url="http://www.ncbi.nlm.nih.gov/pubmed/39365658" } @Article{info:doi/10.2196/51606, author="Marelli, Ariane and Rozenblum, Ronen and Bolster-Foucault, Clara and Via-Dufresne Ley, Alicia and Maynard, Noemie and Amaria, Khush and Galuppi, Barb and Strohm, Sonya and Nguyen, Linda and Dawe-McCord, Claire and Putterman, Connie and Kovacs, H. Adrienne and Gorter, Willem Jan", title="Development of MyREADY Transition BBD Mobile App, a Health Intervention Technology Platform, to Improve Care Transition for Youth With Brain-Based Disabilities: User-Centered Design Approach", journal="JMIR Pediatr Parent", year="2024", month="Oct", day="1", volume="7", pages="e51606", keywords="patient-centered care", keywords="patient engagement", keywords="mobile app", keywords="health IT", keywords="health care transition", keywords="mobile phone", abstract="Background: Transition from pediatric to adult health care varies and is resource intensive. Patient-centered health information technology (HIT) interventions are increasingly being developed in partnership with patients. Objective: This study aims to develop an internet-based mobile app intervention for patients with brain-based disabilities to improve transition in care readiness. Methods: The app was designed for patients aged 15 to 17 years with brain-based disabilities having the ability to use a mobile app. A multidisciplinary team, an industry partner, and a patient and family advisory council was assembled. We hypothesized that existing tools could be migrated into the app to address education, empowerment, and navigation. We used cognitive learning theory to support chapters targeting transition in care skill sets. We used the agile iterative methodology to engage stakeholders. Results: We developed a novel MyREADY Transition HIT platform. An electronic mentor supported cognitive learning with messaging, quizzes, rewards, and videos. We used gaming to guide navigation through a fictitious health care city. Adapting existing tools was achieved by the patient and family advisory council requesting personalization. Our iterative design required time-consuming back-end technology management. Developing the platform took 24 months instead of our grant-approved 12 months, impacting the onset of the planned trial within the allotted budget. Conclusions: A novel patient-centered HIT platform to improve health care transition was successfully developed in partnership with patients and industry. Careful resource management was needed to achieve timely delivery of the end product, flagging the cautious planning required to deliver HIT tools in time for the much-needed trials informing their clinical application. Trial Registration: ClinicalTrials.gov NCT03852550; https://clinicaltrials.gov/study/NCT03852550 ", doi="10.2196/51606", url="https://pediatrics.jmir.org/2024/1/e51606" } @Article{info:doi/10.2196/60330, author="Wang, Xiaoling and Rao, Rui and Li, Hua and Lei, Xiaoping and Dong, Wenbin", title="Red Blood Cell Transfusion for Incidence of Retinopathy of Prematurity: Prospective Multicenter Cohort Study", journal="JMIR Pediatr Parent", year="2024", month="Sep", day="18", volume="7", pages="e60330", keywords="red blood cell transfusion", keywords="retinopathy of prematurity", keywords="VPI", keywords="very preterm infants", keywords="ROP", keywords="visual impairment", keywords="blindness", keywords="RBC", keywords="red blood cell", abstract="Background: Retinopathy of prematurity (ROP) is a leading cause of visual impairment and blindness in preterm infants. Objective: This study sought to investigate the association between red blood cell (RBC) transfusion and ROP in very preterm infants (VPIs) to inform clinical strategies for ROP prevention and treatment. Methods: We designed a prospective multicenter cohort study that included VPIs and follow-up data from January 2017 to December 2022 at 3 neonatal clinical medicine centers. They were categorized into a transfusion group (infants who received an RBC transfusion within 4 wk) and a nontransfusion group. The relationship between RBC transfusion and ROP incidence was assessed using binary logistic regression, with subgroup analyses based on gestational age, birth weight, sex, and sepsis status. Inverse probability of treatment weighting and propensity score matching were applied to account for all potential confounding factors that could affect ROP development, followed by sensitivity analysis. Results: The study included 832 VPIs, including 327 in the nontransfusion group and 505 in the transfusion group. The transfusion group had a lower average birth weight and gestational age and a greater incidence of ROP, ?stage 2 ROP, and severe ROP. Logistic regression analysis revealed that the transfusion group had a significantly greater risk of ROP (adjusted odds ratio [aOR] 1.70, 95\% CI 1.14?2.53, P=.009) and ?stage 2 ROP (aOR 1.68, 95\% CI 1.02?2.78, P=.04) but not severe ROP (aOR 1.75, 95\% CI 0.61?5.02, P=.30). The trend analysis also revealed an increased risk of ROP with an increasing number of transfusions and a larger volume of blood transfused (P for trend<.001). Subgroup analyses confirmed a consistent trend, with the transfusion group at a higher risk for ROP across all subgroups. Inverse probability of treatment weighting and propensity score matching analyses supported the initial findings. Conclusions: For VPIs, RBC transfusion significantly increases the risk of ROP, and the risk increases with an increasing number of transfusions and volume of blood transfused. ", doi="10.2196/60330", url="https://pediatrics.jmir.org/2024/1/e60330" } @Article{info:doi/10.2196/59636, author="Murgueitio, Nicolas and Tate, Maresa and Lurie, Lucy and Priddy, Zoe and Boda, Sneha and Shipkova, Michelle and Rodriguez, Micaela and Machlin, Laura and Furlong, Sarah and Mitchell, Amanda and McLaughlin, Katie and Sheridan, Margaret", title="Testing a Conceptual Model of Early Adversity, Neural Function, and Psychopathology: Protocol for a Retrospective Observational Cohort Study", journal="JMIR Res Protoc", year="2024", month="Sep", day="17", volume="13", pages="e59636", keywords="early adversity", keywords="psychopathology", keywords="neurodevelopment", keywords="adverse childhood events", keywords="child development", abstract="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 ", doi="10.2196/59636", url="https://www.researchprotocols.org/2024/1/e59636" } @Article{info:doi/10.2196/63505, author="Braddock, Amy and Ghosh, Parijat and Montgomery, Emma and Lim, Crystal and Ghosh, Jaya and Henry, Nicole and Popescu, Mihail and Kimchi, Kimberly and Guo, Congyu and Bosworth, Taylor K. and Koopman, J. Richelle", title="Effectiveness of an mHealth App That Uses Financial Incentives and Gamification to Promote Health Behavior Change in Adolescents and Caregivers: Protocol for a Clinic-Based Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Sep", day="10", volume="13", pages="e63505", keywords="mHealth", keywords="adolescents", keywords="apps", keywords="caregivers", keywords="obesity", keywords="healthy lifestyle", keywords="CommitFit", keywords="mobile health", abstract="Background: Adolescent and adult obesity continues to be a public health epidemic in the United States. Despite the popularity of mHealth apps with gamification among adolescents, there are insufficient studies to evaluate the efficacy of gamified mHealth apps and financial incentives to motivate sustained health behavior change in adolescents or their adult caregivers. Objective: This study aims to evaluate the effectiveness of gamification techniques and financial incentives used in the novel ``CommitFit'' mHealth app to motivate health behavior change and improve various mental and physical health metrics in adolescents and their caregivers. Methods: This study is a 3-month randomized controlled trial (RCT) with 30 adolescents (aged 13-15 years) and their adult caregivers (N=60). It evaluates ``CommitFit,'' which uses gamification including points and leaderboards to motivate logging and achievement of self-selected health behavior goals (eg, more water, sleep, physical activity, fruits, or vegetables or fewer sugary beverages). The RCT had three arms, each with 10 dyads: (1) CommitFit-only users; (2) CommitFit\$, where adolescents were paid US \$0.05 for each point they earned; and (3) waitlist control. Intervention dyads used the app for 3 months and had the option to use it for the fourth month without prompts or extra financial incentives. User analytic software was used to evaluate the frequency of user logs and goal achievement. Monthly surveys evaluated self-reported change in the 5 CommitFit health behaviors. Changes in BMI and blood pressure were evaluated for all participants at 3 clinical visits. Mental health, gamification, and behavior economics surveys were completed during the clinical visits. Results: Recruitment began in August 2023 and was completed in 10 weeks. The research team successfully recruited and enrolled 30 dyads. Researchers emailed and called 89 caregivers on a physician-approved adolescent patient list, a 33\% recruitment rate. Data collection and analysis will be conducted in the spring and summer of 2024. The results of this study are anticipated to be published between late 2024 and early 2025. Conclusions: This RCT will expand knowledge of the effectiveness of gamification techniques, financial incentives, and mHealth apps to motivate sustained health behavior change among adolescents and caregivers. These results may offer new opportunities to caregivers, health insurers, health care systems, and clinicians to motivate health behavior change in adolescents and caregivers, with the ultimate goal of preventing or reducing obesity and obesity-related diseases. Additional gamification, mental health surveys, and app user analytics included in the study may provide further insight into the characteristics of adolescents or caregivers who would benefit the most from using a gamified mHealth app like CommitFit. International Registered Report Identifier (IRRID): DERR1-10.2196/63505 ", doi="10.2196/63505", url="https://www.researchprotocols.org/2024/1/e63505" } @Article{info:doi/10.2196/60621, author="Werner, E. Nicole and Morgen, Makenzie and Kooiman, Sophie and Jolliff, Anna and Warner, Gemma and Feinstein, James and Chui, Michelle and Katz, Barbara and Storhoff, Brittany and Sodergren, Kristan and Coller, Ryan", title="Effectiveness of a Mobile App (Meds@HOME) to Improve Medication Safety for Children With Medical Complexity: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Sep", day="9", volume="13", pages="e60621", keywords="medication safety", keywords="children with medical complexity", keywords="caregiving", keywords="polypharmacy", keywords="medication management", abstract="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 ", doi="10.2196/60621", url="https://www.researchprotocols.org/2024/1/e60621" } @Article{info:doi/10.2196/55411, author="Piris-Borregas, Salvador and Bell{\'o}n-Vaquerizo, Beatriz and Velasco-Echebur{\'u}a, Leticia and Ni{\~n}o-D{\'i}az, Lidia and S{\'a}nchez-Aparicio, Susana and L{\'o}pez-Maestro, Mar{\'i}a and Pall{\'a}s-Alonso, Rosa Carmen", title="Parental Autonomy in the Care of Premature Newborns and the Experience of a Neonatal Team: Observational Prospective Study", journal="JMIR Pediatr Parent", year="2024", month="Aug", day="30", volume="7", pages="e55411", keywords="family-centered care", keywords="neonatal intensive care unit", keywords="kangaroo mother care", keywords="mother", keywords="mothers", keywords="parent", keywords="parents", keywords="parental", keywords="ICU", keywords="intensive care", keywords="training", keywords="education", keywords="educational", keywords="premature", keywords="pediatric", keywords="pediatrics", keywords="paediatric", keywords="paediatrics", keywords="infant", keywords="infants", keywords="infancy", keywords="baby", keywords="babies", keywords="neonate", keywords="neonates", keywords="neonatal", keywords="newborn", keywords="newborns", keywords="intensive care unit", abstract="Background: The European Foundation for the Care of Newborn Infants (EFCNI) has promoted the importance of parental involvement in the care of children. Objective: The study aimed to examine how the time required by parents to achieve autonomy in the care of their very low--birth weight newborn infants was modified during the implementation of a training program. Methods: This was an observational prospective study in the context of a quality improvement initiative. The Cu{\'i}dame (meaning ``Take Care of Me'' in English) program was aimed at achieving parental autonomy. It was implemented over 2 periods: period 1, from September 1, 2020, to June 15, 2021; and period 2, from July 15, 2021, to May 31, 2022. The days required by parents to achieve autonomy in several areas of care were collected from the electronic health system. Results: A total of 54 and 43 families with newborn infants were recruited in periods 1 and 2, respectively. Less time was required to acheive autonomy in period 2 for participation in clinical rounds (median 10.5, IQR 5?20 vs 7, IQR 4?10.5 d; P<.001), feeding (median 53.5, IQR 34?68 vs 44.5, IQR 37?62 d; P=.049), and observation of neurobehavior (median 18, IQR 9?33 vs 11, IQR 7?16 d; P=.049). More time was required to achieve autonomy for kangaroo mother care (median 14, IQR 7?23 vs 21, IQR 10?31 d; P=.02), diaper change (median 9.5, IQR 4?20 vs 14.5, IQR 9?32 d; P=.04), and infection prevention (median 1, IQR 1?2 vs 6, IQR 3?12; P<.001). Conclusions: Parents required less time to achieve autonomy for participation in clinical rounds, feeding, and observation of neurobehavior during the implementation of the training program. Nevertheless, they required more time to achieve autonomy for kangaroo mother care, diaper change, and infection prevention. ", doi="10.2196/55411", url="https://pediatrics.jmir.org/2024/1/e55411" } @Article{info:doi/10.2196/56722, author="Kapp, M. Julie and Dicke, Rachel and Quinn, Kathleen", title="Online Delivery of Interprofessional Adverse Childhood Experiences Training to Rural Providers: Usability Study", journal="JMIR Pediatr Parent", year="2024", month="Aug", day="7", volume="7", pages="e56722", keywords="adverse childhood experiences", keywords="ACE", keywords="training", keywords="trauma-informed care", keywords="provider", keywords="rural", keywords="adverse", keywords="trauma", keywords="traumatic", keywords="providers", keywords="teaching", keywords="curriculum", keywords="curricula", keywords="education", keywords="educational", keywords="social work", keywords="social worker", keywords="social workers", keywords="psychologist", keywords="psychologists", keywords="counselor", keywords="counselors", keywords="interprofessional", keywords="pediatric", keywords="pediatrics", keywords="paediatric", keywords="paediatrics", keywords="child", keywords="children", keywords="experience", keywords="experiences", keywords="continuing education", abstract="Background: The population health burden of adverse childhood experiences (ACEs) reflects a critical need for evidence-based provider training. Rural children are also more likely than urban children to have any ACEs. A large proportion of providers are unaware of the detrimental effects of ACEs. There is a significant documented need for training providers about ACEs and trauma-informed care, in addition to a demand for that training. Objective: The objective was to develop, implement, and evaluate an online ACEs training curriculum tailored to Missouri providers, particularly those in rural areas given the higher prevalence of ACEs. Methods: From July 2021 to June 2022, we conducted literature reviews and environmental scans of training videos, partner organizations, clinical practice guidelines, and community-based resources to curate appropriate and tailored content for the course. We developed the ACEs training course in the Canvas learning platform (Instructure) with the assistance of an instructional designer and media designer. The course was certified for continuing medical education, as well as continuing education for licensed professional counselors, psychologists, and social workers. Recruitment occurred via key stakeholder email invitations and snowball recruitment. Results: Overall, 135 providers across Missouri requested enrollment, with 72.6\% (n=98) enrolling and accessing the training. Of the latter, 49\% (n=48) completed course requirements, with 100\% of respondents agreeing that the content was relevant to their work, life, or practice; they intend to apply the content to their work, life, or practice; they feel confident to do so; and they would recommend the course to others. Qualitative responses supported active intent to translate knowledge into practice. Conclusions: This study demonstrated the feasibility, acceptability, and effectiveness of interprofessional workforce ACEs training. Robust interest statewide reflects recognition of the topic's importance and intention to translate knowledge into practice. ", doi="10.2196/56722", url="https://pediatrics.jmir.org/2024/1/e56722" } @Article{info:doi/10.2196/57950, author="Lau, Nancy and Palermo, M. Tonya and Zhou, Chuan and Badillo, Isabel and Hong, Shannon and Aalfs, Homer and Yi-Frazier, P. Joyce and McCauley, Elizabeth and Chow, J. Eric and Weiner, J. Bryan and Ben-Zeev, Dror and Rosenberg, R. Abby", title="Mobile App Promoting Resilience in Stress Management for Adolescents and Young Adults With Cancer: Protocol for a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Jul", day="30", volume="13", pages="e57950", keywords="adolescents", keywords="young adult", keywords="cancer", keywords="mHealth", keywords="psychosocial intervention", keywords="stress management", keywords="coping", keywords="resilience", keywords="health-related quality of life", keywords="randomized controlled trial", keywords="mobile phone", abstract="Background: Adolescents and young adults (AYAs) with cancer are at risk of poor psychosocial outcomes. AYAs grew up with the internet and digital technology, and mobile Health (mHealth) psychosocial interventions have the potential to overcome care access barriers. Objective: This pilot randomized controlled trial (RCT) aimed to establish the feasibility, acceptability, and preliminary efficacy of a fully automated mobile app version of the Promoting Resilience in Stress Management intervention (mPRISM). Promoting Resilience in Stress Management is an evidence-based intervention developed in collaboration with AYAs, based on stress and coping theory, resilience theory, and evidence-based coping strategies. We hypothesized that mPRISM would be feasible, acceptable, and appropriate. Methods: This is a parallel, 2-arm, single-site pilot RCT with a waitlist control design. The study will recruit 80 AYAs with cancer from a clinic. Eligible AYAs are aged 12 to 25 years, within 12 months of a new cancer diagnosis, receiving chemotherapy or radiation therapy, speak, read, or write in English, and are cognitively able to participate in study procedures. Recruitment by clinical research coordinators will occur remotely by phone, video, or text. Participants will be randomized to psychosocial usual care (UC) alone or UC plus mPRISM for an 8-week intervention period, and will remain unblinded to study condition. Enrolled participants will complete surveys at baseline before randomization, 8 weeks, and 3-month follow-up. Using a waitlist design, the UC arm will receive mPRISM upon completion of 3-month follow-up surveys. Those in the UC arm will complete 2 additional measurement points at immediate posttreatment and 3 months later. The primary outcomes of interest are feasibility, defined as ?60\% enrollment and ?70\% retention (ie, percentage of participants who completed the study), and ``feasibility, acceptability, and appropriateness'' as defined by cut-off scores ?4/5 on 3 brief validated implementation outcome measures (feasibility of implementation measure, acceptability of intervention measure [AIM], intervention appropriateness measure [IAM]). We will apply top-box scoring for the implementation measures. Exploratory outcomes of interest include patient-reported health-related quality of life, resilience, distress, anxiety, depression, pain, and sleep. We will conduct an intention-to-treat analysis to compare the outcomes of the mPRISM arm versus the control arm with covariate-adjusted regression models. We will summarize individual digital usage metrics using descriptive statistics. Results: Since September 2023, we have enrolled 20 participants and recruitment is ongoing. Conclusions: Although our previous work suggests AYAs with cancer are interested in mHealth psychosocial interventions, such interventions have not yet been sufficiently evaluated or implemented among AYA oncology patients. mPRISM may serve as a potential mHealth intervention to fill this gap. In this study, we will test the feasibility, acceptability, and preliminary efficacy of mPRISM. This work will inform future larger-scale RCTs powered for efficacy outcomes. Trial Registration: ClinicalTrials.gov NCT05842902; https://clinicaltrials.gov/study/NCT05842902 International Registered Report Identifier (IRRID): DERR1-10.2196/57950 ", doi="10.2196/57950", url="https://www.researchprotocols.org/2024/1/e57950" } @Article{info:doi/10.2196/56447, author="Li, K. Brian S. and Fereday, Brendan and Wang, Ellen and Rodriguez, Samuel and Forssell, Karin and Bollaert, N. Andr{\'e} and Menendez, Maria and Caruso, J. Thomas", title="Enhancement of Immersive Technology Use in Pediatric Health Care With Accessible, Context-Specific Training: Descriptive Feasibility Study", journal="JMIR XR Spatial Comput", year="2024", month="Jul", day="30", volume="1", pages="e56447", keywords="immersive technology", keywords="implementation", keywords="adult learning", keywords="education", keywords="pediatric", keywords="accessibility", keywords="training", keywords="therapeutic", keywords="pediatric care", keywords="utilization", keywords="virtual reality", keywords="VR", keywords="monitoring", keywords="license", keywords="development", keywords="software", keywords="monitoring software", abstract="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. ", doi="10.2196/56447", url="https://xr.jmir.org/2024/1/e56447" } @Article{info:doi/10.2196/62775, author="Aldridge, Grace", title="Author's Reply: Mental Health Problems Among Children and Adolescents From a Sports Sociology Perspective", journal="J Med Internet Res", year="2024", month="Jul", day="3", volume="26", pages="e62775", keywords="parenting interventions", keywords="technology", keywords="sports sociology", keywords="child mental health", keywords="adolescent mental health", keywords="adverse childhood experiences", keywords="systematic review", keywords="intervention", keywords="digital technology, parenting", keywords="parenting program", keywords="engagement", keywords="support", doi="10.2196/62775", url="https://www.jmir.org/2024/1/e62775" } @Article{info:doi/10.2196/60513, author="Li, Yuan and Zhai, Qun and Peng, Weihang", title="Mental Health Problems Among Children and Adolescents From a Sports Sociology Perspective", journal="J Med Internet Res", year="2024", month="Jul", day="3", volume="26", pages="e60513", keywords="sociology of sport", keywords="children", keywords="adolescents", keywords="mental health", keywords="systematic review", keywords="intervention", keywords="digital technology, parenting", keywords="technology", keywords="parenting program", keywords="engagement", keywords="support", keywords="adverse childhood experiences", doi="10.2196/60513", url="https://www.jmir.org/2024/1/e60513" } @Article{info:doi/10.2196/51734, author="Cantarutti, Anna and Rescigno, Paola and Da Borso, Claudia and Gutierrez de Rubalcava Doblas, Joaquin and Bressan, Silvia and Barbieri, Elisa and Giaquinto, Carlo and Canova, Cristina", title="Association Between Early-Life Exposure to Antibiotics and Development of Child Obesity: Population-Based Study in Italy", journal="JMIR Public Health Surveill", year="2024", month="May", day="31", volume="10", pages="e51734", keywords="childhood obesity", keywords="BMI z score", keywords="pediatric population-based", keywords="antibiotics", keywords="real-world data", keywords="association", keywords="exposure", keywords="child obesity", keywords="obesity", keywords="population-based", keywords="gut microbiome", keywords="early life", keywords="pediatric", keywords="prescription", abstract="Background: Childhood obesity is a significant public health problem representing the most severe challenge in the world. Antibiotic exposure in early life has been identified as a potential factor that can disrupt the development of the gut microbiome, which may have implications for obesity. Objective: This study aims to evaluate the risk of developing obesity among children exposed to antibiotics early in life. Methods: An Italian retrospective pediatric population-based cohort study of children born between 2004 and 2018 was adopted using the Pedianet database. Children were required to be born at term, with normal weight, and without genetic diseases or congenital anomalies. We assessed the timing of the first antibiotic prescription from birth to 6, 12, and 24 months of life and the dose-response relationship via the number of antibiotic prescriptions recorded in the first year of life (none, 1, 2, and ?3 prescriptions). Obesity was defined as a BMI z score >3 for children aged ?5 years and >2 for children aged >5 years, using the World Health Organization growth references. The obese incidence rate (IR) {\texttimes} 100 person-years and the relative 95\% CI were computed using infant sex, area of residence, preschool and school age, and area deprivation index, which are the covariates of interest. A mixed-effect Cox proportional hazards model was used to estimate the hazard ratio and 95\% CI for the association between antibiotic exposure in early life and child obesity between 24 months and 14 years of age, considering the family pediatricians as a random factor. Several subgroup and sensitivity analyses were performed to assess the robustness of our results. Results: Among 121,540 children identified, 54,698 were prescribed at least an antibiotic within the first year of life and 26,990 were classified as obese during follow-up with an incidence rate of 4.05 cases (95\% CI 4.01-4.10) {\texttimes} 100 person-year. The risk of obesity remained consistent across different timings of antibiotic prescriptions at 6 months, 1 year, and 2 years (fully adjusted hazard ratio [aHR] 1.07, 95\% CI 1.04-1.10; aHR 1.06, 95\% CI 1.03-1.09; and aHR 1.07, 95\% CI 1.04-1.10, respectively). Increasing the number of antibiotic exposures increases the risk of obesity significantly (P trend<.001). The individual-specific age analysis showed that starting antibiotic therapy very early (between 0 and 5 months) had the greatest impact (aHR 1.12, 95\% CI 1.08-1.17) on childhood obesity with respect to what was observed among those who were first prescribed antibiotics after the fifth month of life. These results were consistent across subgroup and sensitivity analyses. Conclusions: The results from this large population-based study support the association between early exposure to antibiotics and an increased risk of childhood obesity. This association becomes progressively stronger with both increasing numbers of antibiotic prescriptions and younger age at the time of the first prescription. ", doi="10.2196/51734", url="https://publichealth.jmir.org/2024/1/e51734", url="http://www.ncbi.nlm.nih.gov/pubmed/38820573" } @Article{info:doi/10.2196/41567, author="Jain, Lovely and Pradhan, Sreya and Aggarwal, Arun and Padhi, Kumar Bijaya and Itumalla, Ramaiah and Khatib, Nazli Mahalaqua and Gaidhane, Shilpa and Zahiruddin, Syed Quazi and Santos, Guimar{\~a}es Celso Augusto and AL-Mugheed, Khalid and Alrahbeni, Tahani and Kukreti, Neelima and Satapathy, Prakasini and Rustagi, Sarvesh and Heidler, Petra and Marzo, Rillera Roy", title="Association of Child Growth Failure Indicators With Household Sanitation Practices in India (1998-2021): Spatiotemporal Observational Study", journal="JMIR Public Health Surveill", year="2024", month="May", day="24", volume="10", pages="e41567", keywords="undernutrition", keywords="malnutrition", keywords="stunting", keywords="wasting", keywords="underweight", keywords="sanitation", keywords="WaSH", keywords="LISA", keywords="NFHS", keywords="DHS", keywords="spatial epidemiology", keywords="epidemiology", keywords="children", keywords="child", keywords="India", keywords="intervention", abstract="Background: Undernutrition among children younger than 5 years is a subtle indicator of a country's health and economic status. Despite substantial macroeconomic progress in India, undernutrition remains a significant burden with geographical variations, compounded by poor access to water, sanitation, and hygiene services. Objective: This study aimed to explore the spatial trends of child growth failure (CGF) indicators and their association with household sanitation practices in India. Methods: We used data from the Indian Demographic and Health Surveys spanning 1998-2021. District-level CGF indicators (stunting, wasting, and underweight) were cross-referenced with sanitation and sociodemographic characteristics. Global Moran I and Local Indicator of Spatial Association were used to detect spatial clustering of the indicators. Spatial regression models were used to evaluate the significant determinants of CGF indicators. Results: Our study showed a decreasing trend in stunting (44.9\%-38.4\%) and underweight (46.7\%-35.7\%) but an increasing prevalence of wasting (15.7\%-21.0\%) over 15 years. The positive values of Moran I between 1998 and 2021 indicate the presence of spatial autocorrelation. Geographic clustering was consistently observed in the states of Madhya Pradesh, Jharkhand, Odisha, Uttar Pradesh, Chhattisgarh, West Bengal, Rajasthan, Bihar, and Gujarat. Improved sanitation facilities, a higher wealth index, and advanced maternal education status showed a significant association in reducing stunting. Relative risk maps identified hotspots of CGF health outcomes, which could be targeted for future interventions. Conclusions: Despite numerous policies and programs, malnutrition remains a concern. Its multifaceted causes demand coordinated and sustained interventions that go above and beyond the usual. Identifying hotspot locations will aid in developing control methods for achieving objectives in target areas. ", doi="10.2196/41567", url="https://publichealth.jmir.org/2024/1/e41567", url="http://www.ncbi.nlm.nih.gov/pubmed/38787607" } @Article{info:doi/10.2196/40796, author="Haeri Mazanderani, Ahmad and Radebe, Lebohang and Sherman, G. Gayle", title="Attrition Rates in HIV Viral Load Monitoring and Factors Associated With Overdue Testing Among Children Within South Africa's Antiretroviral Treatment Program: Retrospective Descriptive Analysis", journal="JMIR Public Health Surveill", year="2024", month="May", day="14", volume="10", pages="e40796", keywords="HIV", keywords="monitoring", keywords="viral load", keywords="suppression", keywords="overdue", keywords="retention", keywords="VL test", keywords="attrition", keywords="child", keywords="youth", keywords="pediatric", keywords="paediatric", keywords="sexually transmitted", keywords="sexual transmission", keywords="virological failure", keywords="South Africa", keywords="infant", keywords="adolescent", keywords="big data", keywords="descriptive analysis", keywords="laboratory data", abstract="Background: Numerous studies in South Africa have reported low HIV viral load (VL) suppression and high attrition rates within the pediatric HIV treatment program. Objective: Using routine laboratory data, we evaluated HIV VL monitoring, including mobility and overdue VL (OVL) testing, within 5 priority districts in South Africa. Methods: We performed a retrospective descriptive analysis of National Health Laboratory Service (NHLS) data for children and adolescents aged 1-15 years having undergone HIV VL testing between May 1, 2019, and April 30, 2020, from 152 facilities within the City of Johannesburg, City of Tshwane, eThekwini, uMgungundlovu, and Zululand. HIV VL test--level data were deduplicated to patient-level data using the NHLS CDW (Corporate Data Warehouse) probabilistic record-linking algorithm and then further manually deduplicated. An OVL was defined as no subsequent VL determined within 18 months of the last test. Variables associated with the last VL test, including age, sex, VL findings, district type, and facility type, are described. A multivariate logistic regression analysis was performed to identify variables associated with an OVL test. Results: Among 21,338 children and adolescents aged 1-15 years who had an HIV VL test, 72.70\% (n=15,512) had a follow-up VL test within 18 months. Furthermore, 13.33\% (n=2194) of them were followed up at a different facility, of whom 3.79\% (n=624) were in a different district and 1.71\% (n=281) were in a different province. Among patients with a VL of ?1000 RNA copies/mL of plasma, the median time to subsequent testing was 6 (IQR 4-10) months. The younger the age of the patient, the greater the proportion with an OVL, ranging from a peak of 52\% among 1-year-olds to a trough of 21\% among 14-year-olds. On multivariate analysis, 2 consecutive HIV VL findings of ?1000 RNA copies/mL of plasma were associated with an increased adjusted odds ratio (AOR) of having an OVL (AOR 2.07, 95\% CI 1.71-2.51). Conversely, patients examined at a hospital (AOR 0.86, 95\% CI 0.77-0.96), those with ?2 previous tests (AOR 0.78, 95\% CI 0.70-0.86), those examined in a rural district (AOR 0.63, 95\% CI 0.54-0.73), and older age groups of 5-9 years (AOR 0.56, 95\% CI 0.47-0.65) and 10-14 years (AOR 0.51, 95\% CI 0.44-0.59) compared to 1-4 years were associated with a significantly decreased odds of having an OVL test. Conclusions: Considerable attrition occurs within South Africa's pediatric HIV treatment program, with over one-fourth of children having an OVL test 18 months subsequent to their previous test. In particular, younger children and those with virological failure were found to be at increased risk of having an OVL test. Improved HIV VL monitoring is essential for improving outcomes within South Africa's pediatric antiretroviral treatment program. ", doi="10.2196/40796", url="https://publichealth.jmir.org/2024/1/e40796", url="http://www.ncbi.nlm.nih.gov/pubmed/38743934" } @Article{info:doi/10.2196/56188, author="Hrynyschyn, Robert and Guldager, Dalgaard Julie and Schulze, Daniel and Lyk, Bianca Patricia and Majgaard, Gunver and Stock, Christiane", title="Factors Associated With Risky Drinking Decisions in a Virtual Reality Alcohol Prevention Simulation: Structural Equation Model", journal="JMIR XR Spatial Comput", year="2024", month="May", day="6", volume="1", pages="e56188", keywords="alcohol", keywords="prevention", keywords="virtual reality", keywords="risk behavior", keywords="structural equation model", abstract="Background: Risky alcohol consumption among adolescents is a significant public health concern in most Western countries. Various motives and factors (eg, sensation seeking, gender, reduced self-efficacy) known in the literature are associated with risky drinking decisions in real life. Efforts to tackle risky drinking decisions in real life through skills training to deal with social pressures have been successful. However, interventions of this nature require significant resources. Technological solutions, such as virtual reality (VR), offer advantages, as they enable immersive experiences that replicate real-life scenarios. However, a question persists pertaining to the fidelity of real-world behaviors within virtual environments. Objective: This study is exploratory and aims to ascertain if the established drinking motives and factors for risky drinking decisions are transferrable to the virtual environment in the simulation game VR FestLab and to uncover determinants linked to risky drinking decisions within the simulation. Methods: The study analyzed data from the intervention arm of a cluster-randomized study of 161 Danish students aged 14-18 years who tested the virtual alcohol prevention simulation VR FestLab. At baseline and before playing VR FestLab, independent variables such as age, gender, alcohol consumption, use of other drugs, sensation seeking, drinking refusal skills, knowledge of blood alcohol concentration, and refusal communication skills were recorded. The dependent variable, virtual risk decisions, was measured immediately after the gameplay. Confirmatory factor analysis and structural equation modeling were used to examine the latent variables in relation to virtual risk decisions. Moderation analyses for age and gender in relation to the latent characteristics and the primary outcome were also conducted. Results: The data indicate that 73.9\% (119/161) of the participants engaged in binge drinking at least once in their lifetime. The confirmatory factor analysis demonstrated a good fit of the items for their respective constructs; therefore, they were adopted without modification in the structural equation model. The data suggest that individuals with prior alcohol experience are 4 times more likely to engage in virtual risk decisions within the simulated environment (odds ratio 4.31, 95\% CI 1.70-10.84; P=.01). Knowledge and awareness of blood alcohol concentration were associated with a lower chance to engage in virtual risk decisions (odds ratio 0.32, 95\% CI 0.11-0.93; P=.04). However, no significant associations were found between virtual risk decisions and other latent variables. Gender and age did not moderate the associations. Conclusions: The immersive and lifelike properties of VR partially reflected risk-related decisions. However, it remains unclear which factors favor the mapping of real-world behaviors in virtual simulations. Therefore, future research should address the mechanisms underlying behavioral dynamics in virtual simulations and explore the translation of virtual behaviors into real behaviors to gain a comprehensive understanding of the potential of virtual simulations for alcohol prevention. ", doi="10.2196/56188", url="https://xr.jmir.org/2024/1/e56188" } @Article{info:doi/10.2196/54610, author="Pretorius, Kelly and Kang, Sookja and Choi, Eunju", title="Photos Shared on Facebook in the Context of Safe Sleep Recommendations: Content Analysis of Images", journal="JMIR Pediatr Parent", year="2024", month="Apr", day="23", volume="7", pages="e54610", keywords="SUID", keywords="SIDS", keywords="parenting", keywords="safe sleep", keywords="photo analysis", keywords="pediatric", keywords="pediatrics", keywords="paediatric", keywords="paediatrics", keywords="infant", keywords="infants", keywords="infancy", keywords="baby", keywords="babies", keywords="neonate", keywords="neonates", keywords="neonatal", keywords="newborn", keywords="newborns", keywords="sleep", keywords="safety", keywords="death", keywords="mortality", keywords="social media", keywords="picture", keywords="pictures", keywords="photo", keywords="photos", keywords="photographs", keywords="image", keywords="images", keywords="Facebook", keywords="mother", keywords="mothers", keywords="parent", keywords="co-sleeping", keywords="sudden infant death", keywords="sudden unexpected infant death", keywords="adherence", keywords="parent education", keywords="parents' education", keywords="awareness", abstract="Background: Sudden unexpected infant death (SUID) remains a leading cause of infant mortality; therefore, understanding parental practices of infant sleep at home is essential. Since social media analyses yield invaluable patient perspectives, understanding sleep practices in the context of safe sleep recommendations via a Facebook mothers' group is instrumental for policy makers, health care providers, and researchers. Objective: This study aimed to identify photos shared by mothers discussing SUID and safe sleep online and assess their consistency with infant sleep guidelines per the American Academy of Pediatrics (AAP). We hypothesized the photos would not be consistent with guidelines based on prior research and increasing rates of accidental suffocation and strangulation in bed. Methods: Data were extracted from a Facebook mothers' group in May 2019. After trialing various search terms, searching for the term ``SIDS'' on the selected Facebook group resulted in the most relevant discussions on SUID and safe sleep. The resulting data, including 20 posts and 912 comments among 512 mothers, were extracted and underwent qualitative descriptive content analysis. In completing the extraction and subsequent analysis, 24 shared personal photos were identified among the discussions. Of the photos, 14 pertained to the infant sleep environment. Photos of the infant sleep environment were then assessed for consistency with safe sleep guidelines per the AAP standards by 2 separate reviewers. Results: Of the shared photos relating to the infant sleep environment, 86\% (12/14) were not consistent with AAP safe sleep guidelines. Specific inconsistencies included prone sleeping, foreign objects in the sleeping environment, and use of infant sleeping devices. Use of infant monitoring devices was also identified. Conclusions: This study is unique because the photos originated from the home setting, were in the context of SUID and safe sleep, and were obtained without researcher interference. Despite study limitations, the commonality of prone sleeping, foreign objects, and the use of both infant sleep and monitoring devices (ie, overall inconsistency regarding AAP safe sleep guidelines) sets the stage for future investigation regarding parental barriers to practicing safe infant sleep and has implications for policy makers, clinicians, and researchers. ", doi="10.2196/54610", url="https://pediatrics.jmir.org/2024/1/e54610" } @Article{info:doi/10.2196/54783, author="Avila-Montiel, Diana and Vilchis-Gil, Jenny and Miranda-Lora, Liliana Am{\'e}rica and Vel{\'a}zquez-L{\'o}pez, Lubia and Kl{\"u}nder-Kl{\"u}nder, Miguel", title="The Effects of an Educational Intervention About Front-of-Package Labeling on Food and Beverage Selection Among Children and Their Caregivers: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Apr", day="1", volume="13", pages="e54783", keywords="e-Health nutrition education", keywords="ultraprocessed foods", keywords="malnutrition", keywords="children", keywords="Mexico", keywords="intervention", keywords="obesity", keywords="food", keywords="food selection", keywords="labeling", keywords="package labeling", abstract="Background: Overweight and obesity pose a global public health challenge and have a multifactorial origin. One of these factors includes obesogenic environments, which promote ultraprocessed foods characterized by being high in calories, saturated fats, added sugars, and sodium. In Mexico, it has been estimated that 30\% of the total energy consumed comes from processed foods. The Modification to the Official Mexican Standards introduces nutritional information through black octagonal seals that alert consumers about products with excessive amounts of some components for a better food selection in the population. However, the effects of warning labels on processed food selection and purchases among children remain unknown. Objective: We aimed to evaluate the impact of a digital educational intervention focusing on front-of-package warning labels on the food selection and purchasing behavior of elementary schoolchildren and their caregivers. Methods: Children from 4 elementary schools in Mexico City, 2 public and 2 private schools, will participate in a randomized controlled trial. The schools will be chosen by simple random sampling. Schools will be randomized into 2 groups: intervention and control. In the control group, the dyads (caregiver-schoolchildren) will receive general nutritional education, and in the intervention group, they will receive guidance on reading labels and raising awareness about the impact of consuming ultraprocessed products on health. The educational intervention will be conducted via a website. Baseline measurements will be taken for both groups at 3 and 6 months. All participants will have access to an online store through the website, allowing them to engage in exercises for selecting and purchasing food and beverages. In addition, other measures will include a brief 5-question exam to evaluate theoretical understanding, a 24-hour reminder, a survey on food habits and consumption, application of a food preference scale, anthropometric measurements, and recording of school lunch choices. Results: Registration and funding were authorized in 2022, and we will begin data collection in September 2024. Recruitment has not yet taken place, but the status of data analysis and expected results will be published in April 2025. Conclusions: The study is expected to contribute to evaluating whether reinforcing front-of-package warning labels with education enhances its effects and makes them more sustainable. Conducting this study will allow us to propose whether or not it is necessary to develop new intervention strategies related to front-of-package labeling for a better understanding of the population, improved food choices, and better health outcomes. Trial Registration: ClinicalTrials.gov NCT06102473; https://clinicaltrials.gov/study/NCT06102473 International Registered Report Identifier (IRRID): PRR1-10.2196/54783 ", doi="10.2196/54783", url="https://www.researchprotocols.org/2024/1/e54783", url="http://www.ncbi.nlm.nih.gov/pubmed/38557591" } @Article{info:doi/10.2196/48682, author="Weidner, Jens and Glauche, Ingmar and Manuwald, Ulf and Kern, Ivana and Reinecke, Ines and Bathelt, Franziska and Amin, Makan and Dong, Fan and Rothe, Ulrike and Kugler, Joachim", title="Correlation of Socioeconomic and Environmental Factors With Incidence of Crohn Disease in Children and Adolescents: Systematic Review and Meta-Regression", journal="JMIR Public Health Surveill", year="2024", month="Mar", day="25", volume="10", pages="e48682", keywords="Crohn's disease", keywords="inflammatory bowel disease", keywords="pediatric", keywords="children", keywords="adolescents", keywords="environmental factors", keywords="Crohn disease", keywords="gastroenteritis", keywords="inflammatory bowel diseases", keywords="bowel disease", keywords="digestive system", keywords="gastrointestinal disease", abstract="Background: The worldwide incidence of Crohn disease (CD) in childhood and adolescence has an increasing trend, with significant differences between different geographic regions and individual countries. This includes an increase in the incidence of CD in countries and geographic regions where CD was not previously prevalent. In response to the increasing incidence, the pediatric care landscape is facing growing challenges. Objective: This systematic review and meta-analysis were undertaken to comprehensively delineate the incidence rates of CD in pediatric populations across different countries and to explore potential influencing factors. Methods: We performed a systematic review of PubMed and Embase (via Ovid) for studies from January 1, 1970, to December 31, 2019. In addition, a manual search was performed in relevant and previously published reviews. The results were evaluated quantitatively. For this purpose, random effects meta-analyses and meta-regressions were performed to investigate the overall incidence rate and possible factors influencing the incidence. Results: A qualitative synthesis of 74 studies was performed, with 72 studies included in the meta-analyses and 52 in the meta-regressions. The results of our meta-analysis showed significant heterogeneity between the individual studies, which cannot be explained by a sample effect alone. Our findings showed geographical differences in incidence rates, which increased with increasing distance from the equator, although no global temporal trend was apparent. The meta-regression analysis also identified geographic location, UV index, and Human Development Index as significant moderators associated with CD incidence. Conclusions: Our results suggest that pediatric CD incidence has increased in many countries since 1970 but varies widely with geographic location, which may pose challenges to the respective health care systems. We identified geographic, environmental, and socioeconomic factors that contribute to the observed heterogeneity in incidence rates. These results can serve as a basis for future research. To this end, implementations of internationally standardized and interoperable registries combined with the dissemination of health data through federated networks based on a common data model, such as the Observational Medical Outcomes Partnership, would be beneficial. This would deepen the understanding of CD and promote evidence-based approaches to preventive and interventional strategies as well as inform public health policies aimed at addressing the increasing burden of CD in children and adolescents. Trial Registration: PROSPERO International prospective register of systematic reviews CRD42020168644; https://www.crd.york.ac.uk/PROSPERO/display\_record.php?RecordID=168644 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-037669 ", doi="10.2196/48682", url="https://publichealth.jmir.org/2024/1/e48682", url="http://www.ncbi.nlm.nih.gov/pubmed/38526534" } @Article{info:doi/10.2196/51574, author="Secor, M. Andrew and C{\'e}lestin, Kemar and Jasmin, Margareth and Honor{\'e}, Guy Jean and Wagner, D. Anjuli and Beima-Sofie, Kristin and Pintye, Jillian and Puttkammer, Nancy", title="Electronic Medical Record Data Missingness and Interruption in Antiretroviral Therapy Among Adults and Children Living With HIV in Haiti: Retrospective Longitudinal Study", journal="JMIR Pediatr Parent", year="2024", month="Mar", day="6", volume="7", pages="e51574", keywords="HIV", keywords="Haiti", keywords="pediatrics", keywords="combination antiretroviral therapy", keywords="electronic medical record", keywords="data quality", keywords="child", keywords="children", keywords="antiretroviral", keywords="therapy", keywords="longitudinal study", keywords="HIV diagnosis", keywords="diagnosis", keywords="HIV care", keywords="patient records", keywords="quality of care", keywords="treatment", keywords="engagement", abstract="Background: Children (aged 0-14 years) living with HIV often experience lower rates of HIV diagnosis, treatment, and viral load suppression. In Haiti, only 63\% of children living with HIV know their HIV status (compared to 85\% overall), 63\% are on treatment (compared to 85\% overall), and 48\% are virally suppressed (compared to 73\% overall). Electronic medical records (EMRs) can improve HIV care and patient outcomes, but these benefits are largely dependent on providers having access to quality and nonmissing data. Objective: We sought to understand the associations between EMR data missingness and interruption in antiretroviral therapy treatment by age group (pediatric vs adult). Methods: We assessed associations between patient intake record data missingness and interruption in treatment (IIT) status at 6 and 12 months post antiretroviral therapy initiation using patient-level data drawn from iSant{\'e}, the most widely used EMR in Haiti. Missingness was assessed for tuberculosis diagnosis, World Health Organization HIV stage, and weight using a composite score indicator (ie, the number of indicators of interest missing). Risk ratios were estimated using marginal parameters from multilevel modified Poisson models with robust error variances and random intercepts for the facility to account for clustering. Results: Data were drawn from 50 facilities and comprised 31,457 patient records from people living with HIV, of which 1306 (4.2\%) were pediatric cases. Pediatric patients were more likely than adult patients to experience IIT (n=431, 33\% vs n=7477, 23.4\% at 6 months; P<.001). Additionally, pediatric patient records had higher data missingness, with 581 (44.5\%) pediatric records missing at least 1 indicator of interest, compared to 7812 (25.9\%) adult records (P<.001). Among pediatric patients, each additional indicator missing was associated with a 1.34 times greater likelihood of experiencing IIT at 6 months (95\% CI 1.08-1.66; P=.008) and 1.24 times greater likelihood of experiencing IIT at 12 months (95\% CI 1.05-1.46; P=.01). These relationships were not statistically significant for adult patients. Compared to pediatric patients with 0 missing indicators, pediatric patients with 1, 2, or 3 missing indicators were 1.59 (95\% CI 1.26-2.01; P<.001), 1.74 (95\% CI 1.02-2.97; P=.04), and 2.25 (95\% CI 1.43-3.56; P=.001) times more likely to experience IIT at 6 months, respectively. Among adult patients, compared to patients with 0 indicators missing, having all 3 indicators missing was associated with being 1.32 times more likely to experience IIT at 6 months (95\% CI 1.03-1.70; P=.03), while there was no association with IIT status for other levels of missingness. Conclusions: These findings suggest that both EMR data quality and quality of care are lower for children living with HIV in Haiti. This underscores the need for further research into the mechanisms by which EMR data quality impacts the quality of care and patient outcomes among this population. Efforts to improve both EMR data quality and quality of care should consider prioritizing pediatric patients. ", doi="10.2196/51574", url="https://pediatrics.jmir.org/2024/1/e51574" } @Article{info:doi/10.2196/53728, author="Alotaibi, Mansour and Almutairi, B. Anwar and Alhirsan, Saleh and Alkazemi, Afrah and Alharbi, Maha and Alrashdi, Naif and Taqi, Ahmad and Alamiri, Bibi and Vogtle, Laura and Alqahtani, M. Mohammed", title="Psychostimulant Medications for Physical Function and Spasticity in Children With Cerebral Palsy: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Mar", day="5", volume="13", pages="e53728", keywords="cerebral palsy", keywords="CNS stimulants", keywords="spasticity", keywords="motor performance", keywords="gross motor function", keywords="psychostimulant", keywords="medications", keywords="physical function", keywords="CP", keywords="children", keywords="child", keywords="pediatrics", keywords="pediatric", keywords="impairment", keywords="movement", keywords="central nervous system", keywords="safety", keywords="tolerability", keywords="efficacy", keywords="methylphenidate", keywords="modafinil", keywords="Kuwait", keywords="rehabilitation", keywords="physical therapy", abstract="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 ", doi="10.2196/53728", url="https://www.researchprotocols.org/2024/1/e53728", url="http://www.ncbi.nlm.nih.gov/pubmed/38441919" } @Article{info:doi/10.2196/55560, author="Lawrence-Sidebottom, Darian and Huffman, Goodgame Landry and Beam, Brenna Aislinn and Guerra, Rachael and Parikh, Amit and Roots, Monika and Huberty, Jennifer", title="Rates of Trauma Exposure and Posttraumatic Stress in a Pediatric Digital Mental Health Intervention: Retrospective Analysis of Associations With Anxiety and Depressive Symptom Improvement Over Time", journal="JMIR Pediatr Parent", year="2024", month="Feb", day="27", volume="7", pages="e55560", keywords="collaborative care model", keywords="telehealth", keywords="childhood trauma", keywords="DMHI", keywords="digital health", keywords="mental health", keywords="telemedicine", keywords="trauma", keywords="traumatic", keywords="pediatric", keywords="pediatrics", keywords="paediatric", keywords="paediatrics", keywords="child", keywords="children", keywords="youth", keywords="adolescent", keywords="adolescents", keywords="teen", keywords="teens", keywords="teenager", keywords="teenagers", keywords="retrospective", keywords="anxiety", keywords="depression", keywords="depressive", keywords="co-occurring", keywords="comorbid", keywords="comorbidity", keywords="comorbidities", keywords="association", keywords="associations", keywords="correlation", keywords="correlations", keywords="correlate", abstract="Background: More than 2 out of 3 children and adolescents in the United States experience trauma by the age of 16 years. Exposure to trauma in early life is linked to a range of negative mental health outcomes throughout the lifespan, particularly co-occurring symptoms of posttraumatic stress (PTS), anxiety, and depression. There has been an increasing uptake of digital mental health interventions (DMHIs) among youths, particularly for anxiety and depression. However, little is known regarding the incidence of trauma exposure and PTS symptoms among youths participating in DMHIs and whether PTS symptoms impact anxiety and depressive symptom treatment response. Moreover, it is unclear whether participation in a DMHI for anxiety and depressive symptoms is associated with secondary effects on PTS symptoms among trauma-exposed youths. Objective: This study aims to use retrospective data from youths participating in a DMHI to (1) characterize rates of trauma, PTS, and comorbid anxiety and depressive symptoms; (2) determine whether trauma exposure and elevated PTS symptoms impact the improvement of comorbid anxiety and depressive symptoms throughout participation in care; and (3) determine whether participation in a non--posttraumatic DMHI is linked to reductions in PTS symptoms. Methods: This study was conducted using retrospective data from members (children ages 6 to 12 years) involved in a pediatric collaborative care DMHI. Participating caregivers reported their children's trauma exposure. PTS, anxiety, and depressive symptom severity were measured monthly using validated assessments. Results: Among eligible participants (n=966), 30.2\% (n=292) reported at least 1 traumatic event. Of those with trauma exposure and elevated symptoms of PTS (n=119), 73\% (n=87) exhibited elevated anxiety symptoms and 50\% (n=59) exhibited elevated depressive symptoms. Compared to children with no trauma, children with elevated PTS symptoms showed smaller reductions per month in anxiety but not depressive symptoms (anxiety: F2,287=26.11; P<.001). PTS symptoms also decreased significantly throughout care, with 96\% (n=79) of participants showing symptom reductions. Conclusions: This study provides preliminary evidence for the frequency of trauma exposure and comorbid psychiatric symptoms, as well as variations in treatment response between trauma-exposed and nontrauma-exposed youths, among participants in a pediatric collaborative care DMHI. Youths with traumatic experiences may show increased psychiatric comorbidities and slower treatment responses than their peers with no history of trauma. These findings deliver compelling evidence that collaborative care DMHIs may be well-suited to address mental health symptoms in children with a history of trauma while also highlighting the critical need to assess symptoms of PTS in children seeking treatment. ", doi="10.2196/55560", url="https://pediatrics.jmir.org/2024/1/e55560", url="http://www.ncbi.nlm.nih.gov/pubmed/38412001" } @Article{info:doi/10.2196/53120, author="Wood, Michael and Gandhi, Kavi and Chapman, Andrea and Skippen, Peter and Krahn, Gordon and G{\"o}rges, Matthias and Stewart, Evelyn S.", title="Pediatric Delirium Educational Tool Development With Intensive Care Unit Clinicians and Caregivers in Canada: Focus Group Study", journal="JMIR Pediatr Parent", year="2023", month="Dec", day="11", volume="6", pages="e53120", keywords="pediatric delirium education", keywords="pediatric ICU", keywords="focus groups, prototyping", keywords="end users", keywords="users", keywords="education", keywords="educational", keywords="educational tool", keywords="tool", keywords="development", keywords="caregiver", keywords="Canada", keywords="PICU", keywords="pediatric intensive care unit", keywords="quality of life", keywords="child", keywords="children", keywords="family resource", keywords="cognition", keywords="clinical utility", keywords="intensive care unit", abstract="Background: Pediatric intensive care unit (PICU)--associated delirium contributes to a decline in postdischarge quality of life, with worse outcomes for individuals with delayed identification. As delirium screening rates remain low within PICUs, caregivers may be able to assist with early detection, for which they need more education, as awareness of pediatric delirium among caregivers remains limited. Objective: This study aimed to develop an educational tool for caregivers to identify potential delirium symptoms during their child's PICU stay, educate them on how to best support their child if they experience delirium, and guide them to relevant family resources. Methods: Web-based focus groups were conducted at a tertiary pediatric hospital with expected end users of the tool (ie, PICU health care professionals and caregivers of children with an expected PICU length of stay of over 48 h) to identify potential educational information for inclusion in a family resource guide and to identify strategies for effective implementation. Data were analyzed thematically to generate requirements to inform prototype development. Participants then provided critical feedback on the initial prototype, which guided the final design. Results: In all, 24 participants (18 health care professionals and 6 caregivers) attended 7 focus groups. Participants identified five informational sections for inclusion: (1) delirium definition, (2) key features of delirium (signs and symptoms), (3) postdischarge outcomes associated with delirium, (4) tips to inform family-centered care, and (5) education or supportive resources. Participants identified seven design requirements: information should (1) be presented in an order that resembles the structure of the clinical discussion around delirium; (2) increase accessibility, recall, and preparedness by providing multiple formats; (3) aim to reduce stress by implementing positive framing; (4) minimize cognitive load to ensure adequate information processing; (5) provide supplemental electronic resources via QR codes; (6) emphasize collaboration between caregivers and the health care team; and (7) use prompting questions to act as a call to action for caregivers. Conclusions: Key design requirements derived from end-user feedback were established and guided the development of a novel pediatric delirium education tool. Implementing this tool into regular practice has the potential to reduce distress and assist in the early recognition and treatment of delirium in the PICU domain. Future evaluation of its clinical utility is necessary. ", doi="10.2196/53120", url="https://pediatrics.jmir.org/2023/1/e53120" } @Article{info:doi/10.2196/48004, author="McMann, Tiana and Wenzel, Christine and Le, Nicolette and Li, Zhuoran and Xu, Qing and Cuomo, E. Raphael and Mackey, Tim", title="Detection and Characterization of Web-Based Pediatric COVID-19 Vaccine Discussions and Racial and Ethnic Minority Topics: Retrospective Analysis of Twitter Data", journal="JMIR Pediatr Parent", year="2023", month="Nov", day="30", volume="6", pages="e48004", keywords="COVID-19 vaccine", keywords="vaccine hesitancy", keywords="pediatric vaccine", keywords="pediatric COVID-19 vaccine", keywords="vaccine beliefs", keywords="vaccine-related concerns", keywords="vaccine-related confidence", keywords="vaccine barriers", keywords="vaccine facilitators", keywords="racial and ethnic minority", abstract="Background: Despite pediatric populations representing a smaller proportion of COVID-19 cases and having a less severe prognosis, those belonging to racial and ethnic minority groups are at an increased risk of developing more severe COVID-19--related outcomes. Vaccine coverage is crucial to pandemic mitigation efforts, yet since the start of the COVID-19 pandemic, vaccine hesitancy has increased and routine pediatric immunizations have decreased. Limited research exists on how vaccine hesitancy may contribute to low pediatric COVID-19 vaccine uptake among racial and ethnic minority populations. Objective: This study aimed to characterize COVID-19 vaccine--related discussion and sentiment among Twitter users, particularly among racial and ethnic minority users. Methods: We used the Twitter application programming interface to collect tweets and replies. Tweets were selected by filtering for keywords associated with COVID-19 vaccines and pediatric-related terms. From this corpus of tweets, we used the Biterm Topic Model to output topics and examined the top 200 retweeted tweets that were coded for pediatric COVID-19 vaccine relevance. Relevant tweets were analyzed using an inductive coding approach to characterize pediatric COVID-19 vaccine--related themes. Replies to relevant tweets were collected and coded. User metadata were assessed for self-reporting of race or ethnic group affiliation and verified account status. Results: A total of 863,007 tweets were collected from October 2020 to October 2021. After outputting Biterm Topic Model topics and reviewing the 200 most retweeted tweets, 208,666 tweets and 3905 replies were identified as being pediatric COVID-19 vaccine related. The majority (150,262/208,666, 72.01\%) of tweets expressed vaccine-related concerns. Among tweets discussing vaccine confidence, user replies expressing agreement were significantly outweighed by those expressing disagreement (1016/3106, 32.71\% vs 2090/3106, 67.29\%; P<.001). The main themes identified in the Twitter interactions were conversations regarding vaccine-related concerns including adverse side effects, concerns that the vaccine is experimental or needs more testing and should not be tested on pediatric populations, the perception that the vaccine is unnecessary given the perceived low risk of pediatric infection, and conversations associated with vaccine-related confidence (ie, the vaccine is protective). Among signal tweets and replies, we identified 418 users who self-identified as a racial minority individual and 40 who self-identified as an ethnic minority individual. Among the subcodes identified in this study, the vaccine being protective was the most discussed topic by racial and ethnic minority groups (305/444, 68.7\%). Conclusions: Vaccine-related concerns can have negative consequences on vaccine uptake and participation in vaccine-related clinical trials. This can impact the uptake and development of safe and effective vaccines, especially among racial and ethnic minority populations. ", doi="10.2196/48004", url="https://pediatrics.jmir.org/2023/1/e48004" } @Article{info:doi/10.2196/45358, author="Oh, Soyeon Sarah and Kang, Bada and Park, Jewel and Kim, SangMin and Park, Eun-Cheol and Lee, Hee Seung and Kawachi, Ichiro", title="Racial/Ethnic Disparity in Association Between Fetal Alcohol Syndrome and Alcohol Intake During Pregnancy: Multisite Retrospective Cohort Study", journal="JMIR Public Health Surveill", year="2023", month="Apr", day="21", volume="9", pages="e45358", keywords="fetal alcohol syndrome", keywords="ethnic disparity", keywords="alcohol intake", keywords="pregnancy", keywords="health disparity", keywords="public health", keywords="minority population", keywords="vulnerable population", keywords="women's health", keywords="pediatrics", keywords="fetal health", abstract="Background: Alcohol consumption during pregnancy is associated with a range of adverse birth-related outcomes, including stillbirth, low birth weight, preterm birth, and fetal alcohol syndrome (FAS). With more than 10\% of women consuming alcohol during pregnancy worldwide, it is increasingly important to understand how racial/ethnic variations affect FAS onset. However, whether race and ethnicity inform FAS risk assessment when daily ethanol intake is controlled for remains unknown. Objective: This study aimed to assess racial/ethnic disparities in FAS risk associated with alcohol consumption during pregnancy. Methods: We used data from a longitudinal cohort study (the Collaborative Initiative on Fetal Alcohol Spectrum Disorders) at 5 hospital sites around the United States of 595 women who consumed alcohol during pregnancy from 2007 to 2017. Questionnaires, in-person interviews, and reviews of medical, legal, and social service records were used to gather data on average alcoholic content (AAC) during pregnancy. Self-reports of maternal race (American Indian/Alaska Native [AI/AN], Asian, Native Hawaiian or other Pacific Islander, Black or African American, White, more than one race, and other) and ethnicity (Hispanic/Latino or not Hispanic/Latino), as well as FAS diagnoses based on standardized dysmorphological criteria, were used for analysis. Log-binomial regression was used to examine the risk of FAS associated with each 1-gram increase in ethanol consumption during pregnancy, stratified by race/ethnicity. Results: A total of 3.4\% (20/595) of women who reported consuming alcohol during pregnancy gave birth to a baby with FAS. Women who gave birth to a baby with FAS had a mean AAC of 32.06 (SD 9.09) grams, which was higher than that of women who did not give birth to a baby with FAS (mean 12.07, SD 15.87 grams). AI/AN mothers with FAS babies had the highest AAC (mean 42.62, SD 8.35 grams), followed by White (mean 30.13, SD 4.88 grams) and Black mothers (mean 27.05, SD 12.78 grams). White (prevalence ratio [PR] 1.10, 95\% CI 1.03-1.19), Black (PR 1.13, 95\% CI 1.04-1.23), and AI/AN (PR 1.10, 95\% CI 1.00-1.21) mothers had 10\% to 13\% increased odds of giving birth to a baby with FAS given the same exposure to alcohol during pregnancy. Regardless of race, a 1-gram increase in AAC resulted in a 4\% increase (PR 1.04, 95\% CI 1.02-1.07) in the chance of giving birth to a baby with ?2 facial anomalies (ie, short palpebral fissures, thin vermilion border of the upper lip, and smooth philtrum) and a 4\% increase (PR 1.04, 95\% CI 1.01-1.07) in the chance of deficient brain growth. Conclusions: The risk of delivering a baby with FAS was comparable among White, Black, and AI/AN women at similar levels of drinking during pregnancy. Regardless of race, a 1-gram increase in AAC resulted in increased odds of giving birth to a baby with facial anomalies or deficient brain growth. ", doi="10.2196/45358", url="https://publichealth.jmir.org/2023/1/e45358", url="http://www.ncbi.nlm.nih.gov/pubmed/37083819" } @Article{info:doi/10.2196/42680, author="Saiger, John Michael and Deterding, Sebastian and Gega, Lina", title="Children and Young People's Involvement in Designing Applied Games: Scoping Review", journal="JMIR Serious Games", year="2023", month="Mar", day="16", volume="11", pages="e42680", keywords="serious game", keywords="game design", keywords="end user", keywords="participatory design", keywords="co-design", keywords="user involvement method", keywords="interventions", keywords="game development", keywords="children", keywords="pediatric", keywords="young people", keywords="child", keywords="youth", keywords="review method", keywords="scoping", keywords="applied game", abstract="Background: User involvement is widely accepted as key for designing effective applied games for health. This especially holds true for children and young people as target audiences, whose abilities, needs, and preferences can diverge substantially from those of adult designers and players. Nevertheless, there is little shared knowledge about how concretely children and young people have been involved in the design of applied games, let alone consensus guidance on how to do so effectively. Objective: The aim of this scoping review was to describe which user involvement methods have been used in the design of applied games with children and young people, how these methods were implemented, and in what roles children and young people were involved as well as what factors affected their involvement. Methods: We conducted a systematic literature search and selection across the ACM Digital Library, IEEE Xplore, Scopus, and Web of Science databases using State of the Art through Systematic Review software for screening, selection, and data extraction. We then conducted a qualitative content analysis on the extracted data using NVivo. Results: We retrieved 1085 records, of which 47 (4.33\%) met the eligibility criteria. The chief involvement methods were participatory design (20/47, 43\%) and co-design (16/47, 37\%), spanning a wide range of 45 concrete activities with paper prototyping, group discussions, and playtesting being the most frequent. In only half of the studies (24/47, 51\%), children and young people participated as true design partners. Our qualitative content analysis suggested 5 factors that affect their successful involvement: comprehension, cohesion, confidence, accessibility, and time constraints. Conclusions: Co-design, participatory design, and similar high-level labels that are currently used in the field gloss over very uneven degrees of participation in design and a wide variety of implementations that greatly affect actual user involvement. This field would benefit from more careful consideration and documentation of the reason of user involvement. Future research should explore concrete activities and configurations that can address the common challenges of involving children and young people, such as comprehension, cohesion, confidence, and accessibility. ", doi="10.2196/42680", url="https://games.jmir.org/2023/1/e42680", url="http://www.ncbi.nlm.nih.gov/pubmed/36928258" } @Article{info:doi/10.2196/34588, author="Johnson, W. Rowan and White, K. Becky and Gucciardi, F. Daniel and Gibson, Noula and Williams, A. Sian", title="Intervention Mapping of a Gamified Therapy Prescription App for Children With Disabilities: User-Centered Design Approach", journal="JMIR Pediatr Parent", year="2022", month="Aug", day="9", volume="5", number="3", pages="e34588", keywords="neurodevelopmental disability", keywords="mobile health", keywords="self-determination theory", keywords="gamification", keywords="physiotherapy", keywords="occupational therapy", keywords="speech pathology", keywords="behavior change", keywords="mobile phone", abstract="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. ", doi="10.2196/34588", url="https://pediatrics.jmir.org/2022/3/e34588", url="http://www.ncbi.nlm.nih.gov/pubmed/35943782" } @Article{info:doi/10.2196/36756, author="Sadaka, Yair and Horwitz, Dana and Wolff, Leor and Sela, Tomer and Meyerovitch, Joseph and Peleg, Assaf and Bachmat, Eitan and Benis, Arriel", title="Trends in the Prevalence of Chronic Medication Use Among Children in Israel Between 2010 and 2019: Protocol for a Retrospective Cohort Study", journal="JMIR Res Protoc", year="2022", month="Aug", day="5", volume="11", number="8", pages="e36756", keywords="psychotropic drugs", keywords="central nervous system stimulants", keywords="mental health", keywords="medication therapy management", keywords="drug prescriptions", keywords="attention deficit hyperactivity disorder", keywords="ADHD, Israel", keywords="children", keywords="data mining", keywords="machine learning", keywords="electronic medical records", keywords="pediatrics", keywords="chronic disease", keywords="epidemiology", abstract="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 ", doi="10.2196/36756", url="https://www.researchprotocols.org/2022/8/e36756", url="http://www.ncbi.nlm.nih.gov/pubmed/35775233" } @Article{info:doi/10.2196/33981, author="Zachrison, S. Kori and Hayden, M. Emily and Boggs, M. Krislyn and Boyle, P. Tehnaz and Gao, Jingya and Samuels-Kalow, E. Margaret and Marcin, P. James and Camargo Jr, A. Carlos", title="Emergency Departments' Uptake of Telehealth for Stroke Versus Pediatric Care: Observational Study", journal="J Med Internet Res", year="2022", month="Jun", day="20", volume="24", number="6", pages="e33981", keywords="telehealth", keywords="telemedicine", keywords="emergency care", keywords="stroke", keywords="pediatric care", abstract="Background: Telehealth for emergency stroke care delivery (telestroke) has had widespread adoption, enabling many hospitals to obtain stroke center certification. Telehealth for pediatric emergency care has been less widely adopted. Objective: Our primary objective was to determine whether differences in policy or certification requirements contributed to differential uptake of telestroke versus pediatric telehealth. We hypothesized that differences in financial incentives, based on differences in patient volume, prehospital routing policy, and certification requirements, contributed to differential emergency department (ED) adoption of telestroke versus pediatric telehealth. Methods: We used the 2016 National Emergency Department Inventory--USA to identify EDs that were using telestroke and pediatric telehealth services. We surveyed all EDs using pediatric telehealth services (n=339) and a convenience sample of the 1758 EDs with telestroke services (n=366). The surveys characterized ED staffing, transfer patterns, reasons for adoption, and frequency of use. We used bivariate comparisons to examine differences in reasons for adoption and use between EDs with only telestroke services, only pediatric telehealth services, or both. Results: Of the 442 EDs surveyed, 378 (85.5\%) indicated use of telestroke, pediatric telehealth, or both. EDs with both services were smaller in bed size, volume, and ED attending coverage than those with only telestroke services or only pediatric telehealth services. EDs with telestroke services reported more frequent use, overall, than EDs with pediatric telehealth services: 14.1\% (45/320) of EDs with telestroke services reported weekly use versus 2.9\% (8/272) of EDs with pediatric telehealth services (P<.001). In addition, 37 out of 272 (13.6\%) EDs with pediatric telehealth services reported no consults in the past year. Across applications, the most frequently selected reason for adoption was ``improving level of clinical care.'' Policy-related reasons (ie, for compliance with outside certification or standards or for improving ED performance on quality metrics) were rarely indicated as the most important, but these reasons were indicated slightly more often for telestroke adoption (12/320, 3.8\%) than for pediatric telehealth adoption (1/272, 0.4\%; P=.003). Conclusions: In 2016, more US EDs had telestroke services than pediatric telehealth services; among EDs with the technology, consults were more frequently made for stroke than for pediatric patients. The most frequently indicated reason for adoption among all EDs was related to clinical care. ", doi="10.2196/33981", url="https://www.jmir.org/2022/6/e33981", url="http://www.ncbi.nlm.nih.gov/pubmed/35723927" } @Article{info:doi/10.2196/34115, author="McCrady, Emma and Strychowsky, E. Julie and Woolfson, P. Jessica", title="Experience of Pediatricians and Pediatric Surgeons With Virtual Care During the COVID-19 Pandemic: Descriptive Study", journal="JMIR Pediatr Parent", year="2022", month="Jun", day="15", volume="5", number="2", pages="e34115", keywords="virtual care", keywords="web-based care", keywords="COVID-19", keywords="pediatrics", keywords="pandemic", keywords="physicians", keywords="digital health", keywords="pediatricians", keywords="telehealth", abstract="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. ", doi="10.2196/34115", url="https://pediatrics.jmir.org/2022/2/e34115", url="http://www.ncbi.nlm.nih.gov/pubmed/35666938" } @Article{info:doi/10.2196/34969, author="Gustafsson, M. Berit and Korhonen, Laura", title="A Multiprofessional and Intersectoral Working Model to Detect and Support Preschool Children With Neurodevelopmental Difficulties (PLUSS Model): Protocol for an Evaluation Study", journal="JMIR Res Protoc", year="2022", month="Jun", day="15", volume="11", number="6", pages="e34969", keywords="early detection", keywords="early intervention", keywords="preschool children", keywords="multiprofessional", keywords="neurodevelopmental difficulties", keywords="parental support", keywords="preschool support", keywords="mental health", keywords="neurological", keywords="behavioural", keywords="emotional", keywords="paediatrics", keywords="pediatrics", keywords="parenting", keywords="children", keywords="neurodevelopmental", keywords="developmental", abstract="Background: Neurodevelopmental difficulties with various emotional and behavioral symptoms increase the risk of mental health problems later in life. Although we know that early detection and interventions are effective, there is a lack of intersectoral, integrative, and evidence-based working models to provide these services for preschool children and their parents. PLUSS (Psykisk h{\"a}lsa L{\"a}rande Utveckling Samverkan kring Sm{\aa} barn; English translation: mental health, learning, development, collaboration around preschool children) is a collaborative ``one way in'' model involving parents, health care providers, preschools, social services, and researchers. PLUSS provides coordinated services to screen, evaluate, and support toddlers with neurodevelopmental problems. It also offers parental interventions and education for preschool teachers. Objective: The model will be studied in a research project that aims to investigate (1) using a quasi-experimental study on longitudinal trajectories of neurodevelopmental difficulties and ability to function among participating preschoolers, (2) user satisfaction, and (3) implementation of the model and its effectiveness. The long-term goal is to provide evidence-based, coordinated services to reduce problems related to neurodevelopmental difficulties among preschool children and promote well-being and functioning in everyday life. Methods: The population of interest is children aged 1.5-5 years, whom the child health care nurse refers for further assessment due to suspected neurodevelopmental problems. Data are collected using questionnaires and semistructured interviews. Measures include sociodemographic data, longitudinal data on neurodevelopmental problems, parental well-being and satisfaction, the effectiveness of parental and preschool teacher training and implementation of the model, and fostered multisectoral collaborations. Data will be analyzed with qualitative and quantitative methods. Results: The PLUSS model has been approved by the National Ethics Review Board (2019--04839). This study was supported by FUTURUM grants 910161 and 910441. Data collection started in April 2019, with the data collection period planned to end in May 2024. Conclusions: PLUSS is an integrative working model with multiprofessional competence and intersectoral collaboration capacity to help preschool children with neurodevelopmental problems and their parents. It will be studied using quasi-experimental cross-sectional and longitudinal study designs. Data will be collected from parents, health care providers, and preschool teachers, and will be analyzed using quantitative and qualitative methods. The study will run in one Swedish county, and generalizability needs to be studied separately. Loss of follow-up could impact the longitudinal analysis. Trial Registration: ClinicalTrials.gov NCT04815889; https://clinicaltrials.gov/ct2/show/NCT04815889 International Registered Report Identifier (IRRID): DERR1-10.2196/34969 ", doi="10.2196/34969", url="https://www.researchprotocols.org/2022/6/e34969", url="http://www.ncbi.nlm.nih.gov/pubmed/35704376" } @Article{info:doi/10.2196/33170, author="Kelly, Jennifer Katherine and Doucet, Shelley and Luke, Alison and Azar, Rima and Montelpare, William", title="Exploring the Use of a Facebook-Based Support Group for Caregivers of Children and Youth With Complex Care Needs: Qualitative Descriptive Study", journal="JMIR Pediatr Parent", year="2022", month="Jun", day="7", volume="5", number="2", pages="e33170", keywords="peer-to-peer support", keywords="children", keywords="youth", keywords="complex care needs", keywords="social media", keywords="social support", abstract="Background: Caregivers of children and youth with complex care needs (CCN) require substantial support to ensure the well-being of their families. Web-based peer-to-peer (P2P) support groups present an opportunity for caregivers to seek and provide timely informational and emotional support. Despite the widespread use of social media for health-related support across diverse patient and caregiver populations, it is unclear how caregivers of children and youth with CCN use and potentially benefit from these groups. Objective: The aim of this study is to explore the use of a web-based P2P support group for caregivers of children and youth with CCN in New Brunswick, Canada, and investigate factors related to its use by members. Methods: The study sample consisted of individuals who joined a closed Facebook group and an analysis of content published to the group. In phase 1, a Facebook group was developed in consultation with a patient and family advisory council, and members were recruited to the group. Phase 2 of this study consisted of an observation period during which posts and related interactions (ie, likes, loves, and comments) by members were collected. In phase 3, a web-based survey was distributed, and semistructured interviews were conducted with a subsample of group members. Survey and interview data were analyzed using thematic analysis. Results: A total of 108 caregivers joined the Facebook group between October 2020 and March 2021. There were 93 posts with 405 comments and 542 associated interactions (448/542, 82.7\% likes and 94/542, 17.3\% loves). Of these 93 posts, 37 (40\%) were made by group members, and 56 (60\%) were made by moderators. Of the 108 members, a subsample of 39 (36.1\%) completed a web-based survey, and 14 (13\%) participated in the interviews. Content analyses of posts by members revealed that inquiry (17/37, 46\%), informational (15/37, 41\%), and emotional posts (4/37, 11\%) were the most common. Emotional posts received the highest number of interactions (median 24.5). In total, 5 themes emerged from the interviews related to the use of the group and mediating factors of interactions between group members: resource for information, altruistic contribution, varying level of engagement, perceived barriers to and facilitators of group activity, and moderators as contributing members. Conclusions: These findings demonstrate that caregivers of children and youth with CCN seek geography-specific P2P support groups to meet informational and social support needs. This study contributes to the knowledge on how caregivers use Facebook groups to meet their support needs through moderate and passive engagement. ", doi="10.2196/33170", url="https://pediatrics.jmir.org/2022/2/e33170", url="http://www.ncbi.nlm.nih.gov/pubmed/35671082" } @Article{info:doi/10.2196/32490, author="Zapolski, Tamika and Whitener, MacKenzie and Khazvand, Shirin and Crichlow, Queenisha and Revilla, Rebecca and Salgado, F. Eduardo and Aalsma, Matthew and Cyders, Melissa and Salyers, Michelle and Wu, Wei", title="Implementation of a Brief Dialectical Behavioral Therapy Skills Group in High Schools for At-Risk Youth: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2022", month="May", day="12", volume="11", number="5", pages="e32490", keywords="dialectical behavioral therapy", keywords="adolescents", keywords="high school", keywords="intervention", keywords="teenagers", keywords="risk-taking behavior", keywords="impulsivity", keywords="emotion dysregulation", keywords="social and emotional learning", keywords="youth", abstract="Background: Adolescence is a developmental period marked by engagement in risk-taking behaviors, especially among impulsive or emotionally dysregulated youth. Thus, interventions that teach skills to reduce the risk of negative outcomes associated with emotional dysregulation are required. Social and emotional learning (SEL) programs have been developed to address both adolescent emotional dysregulation and risk-taking behaviors; however, current programs have mostly been implemented among younger youth and are used as a tier 1 universal intervention rather than a targeted tier 2 intervention for youth identified with emotional regulation difficulties. Objective: This study aimed to address the need for SEL programming that can be delivered in schools, particularly for older youth who have difficulties with emotional or behavioral dysregulation, to reduce the risk of health-risk behaviors among this population. Methods: Here, we outline the implementation of an SEL intervention titled Going 4 Goals, a 9-session adaptation of the Dialectical Behavioral Therapy for Adolescents (DBT-A) program delivered to at-risk high school students in a school setting. The primary objectives of the study are to test whether participating in the skills group intervention produces significant increases in the core DBT-A skills of mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness, while also producing significant decreases in substance use and risky behaviors. These primary outcomes are based on changes in participant scores between baseline and after the intervention and follow-ups at 1, 3, and 6 months compared with a control group of youth participating in the school's health curriculum at the same time points. Qualitative interviews will also be conducted with intervention participants and school staff to examine acceptability and facilitators of and barriers to the intervention. Results: A total of 171 participants across 13 groups had been enrolled in the intervention, with data collection ending December 2021. Data analysis will begin in the spring of 2022, with expected results to be published in the spring of 2023. Conclusions: This paper describes the protocol of the 9-session school-based adaptation of the DBT-A intervention and discusses the strengths and limitations of the study and future directions. International Registered Report Identifier (IRRID): DERR1-10.2196/32490 ", doi="10.2196/32490", url="https://www.researchprotocols.org/2022/5/e32490", url="http://www.ncbi.nlm.nih.gov/pubmed/35551054" } @Article{info:doi/10.2196/37126, author="Grimes, Amanda and Lightner, S. Joseph and Eighmy, Katlyn and Wray, D. Bridget and Valleroy, Ella and Baughn, Maya", title="Physical Activity and Nutrition Intervention for Middle Schoolers (Move More, Get More): Protocol for a Quasi-Experimental Study", journal="JMIR Res Protoc", year="2022", month="May", day="4", volume="11", number="5", pages="e37126", keywords="intervention protocol", keywords="physical activity", keywords="food intake", keywords="nutrition", keywords="healthy eating", keywords="middle schoolers", keywords="youth", keywords="school", keywords="student", keywords="fitness", keywords="exercise", keywords="food consumption", keywords="diet", keywords="fruit consumption", keywords="vegetable consumption", abstract="Background: Physical activity and nutrition behaviors are important to reducing the prevalence of childhood obesity. Previous research has identified school-based interventions as effective strategies to improve physical activity and nutrition. However, the results are often mixed, and middle schoolers are an under-studied population. Objective: Our study aims to fill this gap by developing an after-school intervention to increase physical activity and fruit and vegetable consumption that is influenced by national guidelines and formative research. Methods: This study was an after-school, quasi-experimental study spanning 9 months. Enrollment began in September 2021 and continued on a rolling basis through February 2022. Weekly, middle schoolers were offered 2-3 physical activity sessions and 1 produce kit. Physical activity was measured using accelerometers and questionnaires. Nutrition behaviors were assessed using questionnaires, and physical literacy was assessed using researcher observations. Follow-up data collection occurred in December 2021 and in April 2022. Difference scores will be calculated and analyzed for each outcome variable. Results: The intervention started in September 2021 and will conclude in May 2022. Published study results are expected in late 2022. Conclusions: An increase in physical literacy, physical activity, and fruit and vegetable consumption is expected. If successful, future studies will focus on reach and sustainability. Lastly, this study may serve as a model for improving health outcomes in middle schools. International Registered Report Identifier (IRRID): DERR1-10.2196/37126 ", doi="10.2196/37126", url="https://www.researchprotocols.org/2022/5/e37126", url="http://www.ncbi.nlm.nih.gov/pubmed/35507392" } @Article{info:doi/10.2196/30260, author="Hoag, A. Jennifer and Karst, Jeffrey and Bingen, Kristin and Palou-Torres, Akasha and Yan, Ke", title="Distracting Through Procedural Pain and Distress Using Virtual Reality and Guided Imagery in Pediatric, Adolescent, and Young Adult Patients: Randomized Controlled Trial", journal="J Med Internet Res", year="2022", month="Apr", day="18", volume="24", number="4", pages="e30260", keywords="virtual reality", keywords="procedural", keywords="pain", keywords="anxiety", keywords="pediatric", keywords="guided imagery", abstract="Background: Children with acute and chronic illness undergo frequent, painful, and distressing procedures. Objective: This randomized controlled trial was used to evaluate the effectiveness of guided imagery (GI) versus virtual reality (VR) on the procedural pain and state anxiety of children and young adults undergoing unsedated procedures. We explored the role of trait anxiety and pain catastrophizing in intervention response. Methods: Children and young adults were recruited from the hematology, oncology, and blood and marrow transplant clinics at a children's hospital. Each study participant completed the GI and VR intervention during separate but consecutive unsedated procedures. Self-report measures of pain and anxiety were completed before and after the procedures. Results: A total of 50 participants (median age 13 years) completed both interventions. GI and VR performed similarly in the management of procedural pain. Those with high pain catastrophizing reported experiencing less nervousness about pain during procedures that used VR than those using GI. State anxiety declined pre- to postprocedure in both interventions; however, the decrease reached the level of significance during the VR intervention only. Those with high trait anxiety had less pain during GI. Conclusions: In our sample, VR worked as well as GI to manage the pain and distress associated with common procedures experienced by children with acute or chronic illnesses. Children who are primed for pain based on beliefs about pain or because of their history of chronic pain had a better response to VR. GI was a better intervention for those with high trait anxiety. Trial Registration: ClinicalTrials.gov NCT04892160; https://clinicaltrials.gov/ct2/show/NCT04892160 ", doi="10.2196/30260", url="https://www.jmir.org/2022/4/e30260", url="http://www.ncbi.nlm.nih.gov/pubmed/35436209" } @Article{info:doi/10.2196/33394, author="Huo, Shutong and Wang, Kai and Liu, Zongchao and Yang, Yuao and Hee, Yi Jia and He, Qiwei and Takesue, Rie and Tang, Kun", title="Influence of Maternal Exposure to Mass Media on Growth Stunting Among Children Under Five: Mediation Analysis Through the Water, Sanitation, and Hygiene Program", journal="JMIR Public Health Surveill", year="2022", month="Apr", day="6", volume="8", number="4", pages="e33394", keywords="water, sanitation and hygiene", keywords="mass media", keywords="malnutrition", keywords="Democratic Republic of Congo", keywords="DRC", keywords="mediation analysis", keywords="children", keywords="pediatric", keywords="stunting", keywords="television", keywords="internet", keywords="sanitation", keywords="hygiene", abstract="Background: The issue of malnutrition in the Democratic Republic of Congo is severe. Meanwhile, the Water, Sanitation, and Hygiene program has been demonstrated to be effective in reducing the rates of growth stunting among children. Objective: We aimed to explore the association between maternal exposure to mass media and stunting in children through water, sanitation, and hygiene behaviors. Methods: Mediation analysis was conducted using data from the 2018 Multiple Indicators Cluster Surveys. Results: Mothers' exposures to television and the internet in the Democratic Republic of Congo significantly decreases the risk of stunting in children by 5\% and 10\%, respectively, mediated by household water, sanitation, and hygiene facilities and practices. Conclusions: These findings could inform interventions and policies to reduce the rate of stunting rate children by promoting water, sanitation, and hygiene through mass media, especially through the internet and television. ", doi="10.2196/33394", url="https://publichealth.jmir.org/2022/4/e33394", url="http://www.ncbi.nlm.nih.gov/pubmed/35384848" } @Article{info:doi/10.2196/34822, author="Shore, Josh and Nalder, Emily and Hutchison, Michael and Reed, Nick and Hunt, Anne", title="Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development", journal="JMIR Pediatr Parent", year="2022", month="Apr", day="4", volume="5", number="2", pages="e34822", keywords="concussion", keywords="pediatrics", keywords="active rehabilitation", keywords="telehealth", keywords="exercise", keywords="mobile phone", abstract="Background: Active rehabilitation involving subsymptom threshold exercise combined with education and support promotes recovery in youth with concussion but is typically delivered in person, which may limit accessibility for families because of a lack of services in their communities or logistical challenges to attending in-person sessions. Objective: This paper describes the evidence-based and theory-informed development of the Tele-Active Rehabilitation (Tele-AR) intervention for pediatric concussion, which was specifically designed for remote service delivery. Methods: The intervention was designed by clinician-researchers with experience in pediatric concussion rehabilitation following the Medical Research Council guidance for developing complex interventions. Development involved a critical review of the literature to identify existing evidence, the expansion of the theoretical basis for active rehabilitation, and the modeling of the intervention process and outcomes. Results: Tele-AR is a 6-week home exercise and education and support program facilitated through weekly videoconferencing appointments with a clinician. Exercise consists of low- to moderate-intensity subsymptom threshold aerobic activity and coordination drills that are individualized to participant needs and interests (prescribed for 3 days per week). Education includes the evidence-supported Concussion \& You self-management program, which covers topics related to energy management, nutrition, hydration, sleep hygiene, and return to activity. Elements of self-determination theory are incorporated to support motivation and engagement. We present a logic model describing predicted intervention effects using a biopsychosocial conceptualization of outcomes after concussion. Conclusions: The Tele-AR intervention may help to increase access to care that improves recovery and promotes a timely return to activity in youth with concussion. Future research is needed to evaluate the feasibility and efficacy of this approach. ", doi="10.2196/34822", url="https://pediatrics.jmir.org/2022/2/e34822", url="http://www.ncbi.nlm.nih.gov/pubmed/35377326" } @Article{info:doi/10.2196/33614, author="Boch, Samantha and Hussain, Syed-Amad and Bambach, Sven and DeShetler, Cameron and Chisolm, Deena and Linwood, Simon", title="Locating Youth Exposed to Parental Justice Involvement in the Electronic Health Record: Development of a Natural Language Processing Model", journal="JMIR Pediatr Parent", year="2022", month="Mar", day="21", volume="5", number="1", pages="e33614", keywords="parental incarceration", keywords="machine learning", keywords="natural language processing", keywords="parental justice involvement", keywords="adverse childhood experiences", keywords="pediatrics", keywords="pediatric health", keywords="parenting", keywords="digital health", keywords="electronic health record", keywords="eHealth", abstract="Background: Parental justice involvement (eg, prison, jail, parole, or probation) is an unfortunately common and disruptive household adversity for many US youths, disproportionately affecting families of color and rural families. Data on this adversity has not been captured routinely in pediatric health care settings, and if it is, it is not discrete nor able to be readily analyzed for purposes of research. Objective: In this study, we outline our process training a state-of-the-art natural language processing model using unstructured clinician notes of one large pediatric health system to identify patients who have experienced a justice-involved parent. Methods: Using the electronic health record database of a large Midwestern pediatric hospital-based institution from 2011-2019, we located clinician notes (of any type and written by any type of provider) that were likely to contain such evidence of family justice involvement via a justice-keyword search (eg, prison and jail). To train and validate the model, we used a labeled data set of 7500 clinician notes identifying whether the patient was ever exposed to parental justice involvement. We calculated the precision and recall of the model and compared those rates to the keyword search. Results: The development of the machine learning model increased the precision (positive predictive value) of locating children affected by parental justice involvement in the electronic health record from 61\% (a simple keyword search) to 92\%. Conclusions: The use of machine learning may be a feasible approach to addressing the gaps in our understanding of the health and health services of underrepresented youth who encounter childhood adversities not routinely captured---particularly for children of justice-involved parents. ", doi="10.2196/33614", url="https://pediatrics.jmir.org/2022/1/e33614", url="http://www.ncbi.nlm.nih.gov/pubmed/35311681" } @Article{info:doi/10.2196/27760, author="Pearson, Nicole and Finch, Meghan and Sutherland, Rachel and Kingsland, Melanie and Wolfenden, Luke and Wedesweiler, Taya and Herrmann, Vanessa and Yoong, Lin Sze", title="An mHealth Intervention to Reduce the Packing of Discretionary Foods in Children's Lunch Boxes in Early Childhood Education and Care Services: Cluster Randomized Controlled Trial", journal="J Med Internet Res", year="2022", month="Mar", day="17", volume="24", number="3", pages="e27760", keywords="nutrition", keywords="mHealth", keywords="child", keywords="preschool", keywords="parents", abstract="Background: Interventions in early childhood education and care (ECEC) services have the potential to improve children's diet at the population level. Objective: This study aims to test the efficacy of a mobile health intervention in ECEC services to reduce parent packing of foods high in saturated fat, sugar, and sodium (discretionary foods) in children's (aged 3-6 years) lunch boxes. Methods: A cluster randomized controlled trial was undertaken with 355 parent and child dyads recruited by phone and in person from 17 ECEC services (8 [47\%] intervention and 9 [53\%] control services). Parents in the intervention group received a 10-week fully automated program targeting barriers to packing healthy lunch boxes delivered via an existing service communication app. The program included weekly push notifications, within-app messages, and links to further resources, including websites and videos. The control group did not receive any intervention. The primary outcomes were kilojoules from discretionary foods and associated nutrients (saturated fat, free sugars, and sodium) packed in children's lunch boxes. Secondary outcomes included consumption of kilojoules from discretionary foods and related nutrients and the packing and consumption of serves of discretionary foods and core food groups. Photography and weights of foods in children's lunch boxes were recorded by trained researchers before and after the trial to assess primary and secondary outcomes. Outcome assessors were blinded to service allocation. Feasibility, appropriateness, and acceptability were assessed via an ECEC service manager survey and a parent web-based survey. Use of the app was assessed via app analytics. Results: Data on packed lunch box contents were collected for 88.8\% (355/400) of consenting children at baseline and 84.3\% (337/400) of children after the intervention. There was no significant difference between groups in kilojoule from discretionary foods packed (77.84 kJ, 95\% CI ?163.49 to 319.18; P=.53) or the other primary or secondary outcomes. The per-protocol analysis, including only data from children of parents who downloaded the app, also did not find any statistically significant change in primary (?1.98 kJ, 95\% CI ?343.87 to 339.90; P=.86) or secondary outcomes. Approximately 61.8\% (102/165) of parents in the intervention group downloaded the app, and the mean service viewing rate of weekly within-app messages was 26\% (SD 14.9). Parents who responded to the survey and participating services agreed that it was appropriate to receive lunch box information via the app (40/50, 80\% and 6/8, 75\%, respectively). Conclusions: The intervention was unable to demonstrate an impact on kilojoules or associated nutrients from discretionary foods packed in children's lunch boxes. Low app downloads and program message views indicate a need to explore how to improve factors related to implementation before further testing similar mobile health interventions in this setting. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000133235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374379 ", doi="10.2196/27760", url="https://www.jmir.org/2022/3/e27760", url="http://www.ncbi.nlm.nih.gov/pubmed/35297768" } @Article{info:doi/10.2196/31820, author="Man, Alice and van Ballegooie, Courtney", title="Assessment of the Readability of Web-Based Patient Education Material From Major Canadian Pediatric Associations: Cross-sectional Study", journal="JMIR Pediatr Parent", year="2022", month="Mar", day="16", volume="5", number="1", pages="e31820", keywords="health literacy", keywords="accessibility", keywords="online health information", keywords="pediatrics", keywords="patient education", abstract="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. ", doi="10.2196/31820", url="https://pediatrics.jmir.org/2022/1/e31820", url="http://www.ncbi.nlm.nih.gov/pubmed/35293875" } @Article{info:doi/10.2196/29656, author="Rossi, Silvia and Santini, Junior Silvano and Di Genova, Daniela and Maggi, Gianpaolo and Verrotti, Alberto and Farello, Giovanni and Romualdi, Roberta and Alisi, Anna and Tozzi, Eugenio Alberto and Balsano, Clara", title="Using the Social Robot NAO for Emotional Support to Children at a Pediatric Emergency Department: Randomized Clinical Trial", journal="J Med Internet Res", year="2022", month="Jan", day="13", volume="24", number="1", pages="e29656", keywords="children", keywords="emotional health", keywords="emergency department", keywords="social robots", keywords="anxiety", keywords="stress", abstract="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 ", doi="10.2196/29656", url="https://www.jmir.org/2022/1/e29656", url="http://www.ncbi.nlm.nih.gov/pubmed/34854814" } @Article{info:doi/10.2196/25466, author="Medina, Rafael and Bouhaben, Jaime and de Ram{\'o}n, Ignacio and Cuesta, Pablo and Ant{\'o}n-Toro, Luis and Pacios, Javier and Quintero, Javier and Ramos-Quiroga, Antoni Josep and Maest{\'u}, Fernando", title="Electrophysiological Brain Changes Associated With Cognitive Improvement in a Pediatric Attention Deficit Hyperactivity Disorder Digital Artificial Intelligence-Driven Intervention: Randomized Controlled Trial", journal="J Med Internet Res", year="2021", month="Nov", day="26", volume="23", number="11", pages="e25466", keywords="ADHD", keywords="cognitive stimulation", keywords="magnetoencephalography", keywords="artificial intelligence", keywords="Conners continuous performance test", keywords="KAD\_SCL\_01", keywords="AI", keywords="cognitive impairment", keywords="attention deficit hyperactivity disorder", keywords="pediatrics", keywords="children", keywords="rehabilitation", abstract="Background: Cognitive stimulation therapy appears to show promising results in the rehabilitation of impaired cognitive processes in attention deficit hyperactivity disorder. Objective: Encouraged by this evidence and the ever-increasing use of technology and artificial intelligence for therapeutic purposes, we examined whether cognitive stimulation therapy implemented on a mobile device and controlled by an artificial intelligence engine can be effective in the neurocognitive rehabilitation of these patients. Methods: In this randomized study, 29 child participants (25 males) underwent training with a smart, digital, cognitive stimulation program (KAD\_SCL\_01) or with 3 commercial video games for 12 weeks, 3 days a week, 15 minutes a day. Participants completed a neuropsychological assessment and a preintervention and postintervention magnetoencephalography study in a resting state with their eyes closed. In addition, information on clinical symptoms was collected from the child{\textasciiacute}s legal guardians. Results: In line with our main hypothesis, we found evidence that smart, digital, cognitive treatment results in improvements in inhibitory control performance. Improvements were also found in visuospatial working memory performance and in the cognitive flexibility, working memory, and behavior and general executive functioning behavioral clinical indexes in this group of participants. Finally, the improvements found in inhibitory control were related to increases in alpha-band power in all participants in the posterior regions, including 2 default mode network regions of the interest: the bilateral precuneus and the bilateral posterior cingulate cortex. However, only the participants who underwent cognitive stimulation intervention (KAD\_SCL\_01) showed a significant increase in this relationship. Conclusions: The results seem to indicate that smart, digital treatment can be effective in the inhibitory control and visuospatial working memory rehabilitation in patients with attention deficit hyperactivity disorder. Furthermore, the relation of the inhibitory control with alpha-band power changes could mean that these changes are a product of plasticity mechanisms or changes in the neuromodulatory dynamics. Trial Registration: ISRCTN Registry ISRCTN71041318; https://www.isrctn.com/ISRCTN71041318 ", doi="10.2196/25466", url="https://www.jmir.org/2021/11/e25466", url="http://www.ncbi.nlm.nih.gov/pubmed/34842533" } @Article{info:doi/10.2196/29049, author="Ennab, Farah and ElSaban, Mariam and Khalaf, Eman and Tabatabaei, Hanieh and Khamis, Hassan Amar and Devi, Radha Bindu and Hanif, Kashif and Elhassan, Hiba and Saravanan, Ketharanathan and Cremonesini, David and Popatia, Rizwana and Malik, Zainab and Ho, B. Samuel and Abusamra, Rania", title="Clinical Characteristics of Children With COVID-19 in the United Arab Emirates: Cross-sectional Multicenter Study", journal="JMIR Pediatr Parent", year="2021", month="Nov", day="5", volume="4", number="4", pages="e29049", keywords="pediatrics", keywords="children", keywords="COVID-19", keywords="SARS-CoV-2", keywords="United Arab Emirates", keywords="viral shedding", keywords="pandemic", keywords="treatment", keywords="outcomes", keywords="clinical", keywords="public heath", abstract="Background: COVID-19 has infected over 123 million people globally. The first confirmed case in the United Arab Emirates (UAE)\thinspacewas 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. ", doi="10.2196/29049", url="https://pediatrics.jmir.org/2021/4/e29049", url="http://www.ncbi.nlm.nih.gov/pubmed/34643535" } @Article{info:doi/10.2196/25745, author="Kaelin, C. Vera and Valizadeh, Mina and Salgado, Zurisadai and Parde, Natalie and Khetani, A. Mary", title="Artificial Intelligence in Rehabilitation Targeting the Participation of Children and Youth With Disabilities: Scoping Review", journal="J Med Internet Res", year="2021", month="Nov", day="4", volume="23", number="11", pages="e25745", keywords="health care", keywords="pediatric rehabilitation", keywords="technology", keywords="young persons", keywords="robotics", keywords="human-machine interaction", keywords="personalization", keywords="customization", keywords="goal-setting", keywords="natural language processing", keywords="machine learning", abstract="Background: In the last decade, there has been a rapid increase in research on the use of artificial intelligence (AI) to improve child and youth participation in daily life activities, which is a key rehabilitation outcome. However, existing reviews place variable focus on participation, are narrow in scope, and are restricted to select diagnoses, hindering interpretability regarding the existing scope of AI applications that target the participation of children and youth in a pediatric rehabilitation setting. Objective: The aim of this scoping review is to examine how AI is integrated into pediatric rehabilitation interventions targeting the participation of children and youth with disabilities or other diagnosed health conditions in valued activities. Methods: We conducted a comprehensive literature search using established Applied Health Sciences and Computer Science databases. Two independent researchers screened and selected the studies based on a systematic procedure. Inclusion criteria were as follows: participation was an explicit study aim or outcome or the targeted focus of the AI application; AI was applied as part of the provided and tested intervention; children or youth with a disability or other diagnosed health conditions were the focus of either the study or AI application or both; and the study was published in English. Data were mapped according to the types of AI, the mode of delivery, the type of personalization, and whether the intervention addressed individual goal-setting. Results: The literature search identified 3029 documents, of which 94 met the inclusion criteria. Most of the included studies used multiple applications of AI with the highest prevalence of robotics (72/94, 77\%) and human-machine interaction (51/94, 54\%). Regarding mode of delivery, most of the included studies described an intervention delivered in-person (84/94, 89\%), and only 11\% (10/94) were delivered remotely. Most interventions were tailored to groups of individuals (93/94, 99\%). Only 1\% (1/94) of interventions was tailored to patients' individually reported participation needs, and only one intervention (1/94, 1\%) described individual goal-setting as part of their therapy process or intervention planning. Conclusions: There is an increasing amount of research on interventions using AI to target the participation of children and youth with disabilities or other diagnosed health conditions, supporting the potential of using AI in pediatric rehabilitation. On the basis of our results, 3 major gaps for further research and development were identified: a lack of remotely delivered participation-focused interventions using AI; a lack of individual goal-setting integrated in interventions; and a lack of interventions tailored to individually reported participation needs of children, youth, or families. ", doi="10.2196/25745", url="https://www.jmir.org/2021/11/e25745", url="http://www.ncbi.nlm.nih.gov/pubmed/34734833" } @Article{info:doi/10.2196/26957, author="Worth, Chris and Harper, Simon and Salomon-Estebanez, Maria and O'Shea, Elaine and Nutter, W. Paul and Dunne, J. Mark and Banerjee, Indraneel", title="Clustering of Hypoglycemia Events in Patients With Hyperinsulinism: Extension of the Digital Phenotype Through Retrospective Data Analysis", journal="J Med Internet Res", year="2021", month="Oct", day="29", volume="23", number="10", pages="e26957", keywords="hyperinsulinism", keywords="continuous glucose monitoring", keywords="digital phenotype", keywords="hypoglycemia", keywords="nocturnal hypoglycemia", abstract="Background: Hyperinsulinism (HI) due to excess and dysregulated insulin secretion is the most common cause of severe and recurrent hypoglycemia in childhood. High cerebral glucose use in the early hours results in a high risk of hypoglycemia in people with diabetes and carries a significant risk of brain injury. Prevention of hypoglycemia is the cornerstone of the management of HI, but the risk of hypoglycemia at night or the timing of hypoglycemia in children with HI has not been studied; thus, the digital phenotype remains incomplete and management suboptimal. Objective: This study aims to quantify the timing of hypoglycemia in patients with HI to describe glycemic variability and to extend the digital phenotype. This will facilitate future work using computational modeling to enable behavior change and reduce exposure of patients with HI to injurious hypoglycemic events. Methods: Patients underwent continuous glucose monitoring (CGM) with a Dexcom G4 or G6 CGM device as part of their clinical assessment for either HI (N=23) or idiopathic ketotic hypoglycemia (IKH; N=24). The CGM data were analyzed for temporal trends. Hypoglycemia was defined as glucose levels <3.5 mmol/L. Results: A total of 449 hypoglycemic events totaling 15,610 minutes were captured over 237 days from 47 patients (29 males; mean age 70 months, SD 53). The mean length of hypoglycemic events was 35 minutes. There was a clear tendency for hypoglycemia in the early hours (3-7 AM), particularly for patients with HI older than 10 months who experienced hypoglycemia 7.6\% (1480/19,370 minutes) of time in this period compared with 2.6\% (2405/92,840 minutes) of time outside this period (P<.001). This tendency was less pronounced in patients with HI who were younger than 10 months, patients with a negative genetic test result, and patients with IKH. Despite real-time CGM, there were 42 hypoglycemic events from 13 separate patients with HI lasting >30 minutes. Conclusions: This is the first study to have taken the first step in extending the digital phenotype of HI by describing the glycemic trends and identifying the timing of hypoglycemia measured by CGM. We have identified the early hours as a time of high hypoglycemia risk for patients with HI and demonstrated that simple provision of CGM data to patients is not sufficient to eliminate hypoglycemia. Future work in HI should concentrate on the early hours as a period of high risk for hypoglycemia and must target personalized hypoglycemia predictions. Focus must move to the human-computer interaction as an aspect of the digital phenotype that is susceptible to change rather than simple mathematical modeling to produce small improvements in hypoglycemia prediction accuracy. ", doi="10.2196/26957", url="https://www.jmir.org/2021/10/e26957", url="http://www.ncbi.nlm.nih.gov/pubmed/34435596" } @Article{info:doi/10.2196/29899, author="Toto, L. Regina and Vorel, S. Ethan and Tay, E. Khoon-Yen and Good, L. Grace and Berdinka, M. Jesse and Peled, Adam and Leary, Marion and Chang, P. Todd and Weiss, K. Anna and Balamuth, B. Frances", title="Augmented Reality in Pediatric Septic Shock Simulation: Randomized Controlled Feasibility Trial", journal="JMIR Med Educ", year="2021", month="Oct", day="6", volume="7", number="4", pages="e29899", keywords="augmented reality", keywords="simulation", keywords="septic shock", keywords="children", keywords="pediatrics", keywords="simulation-based education", keywords="application", keywords="fluid administration", abstract="Background: Septic shock is a low-frequency but high-stakes condition in children requiring prompt resuscitation, which makes it an important target for simulation-based education. Objective: In this study, we aimed to design and implement an augmented reality app (PediSepsisAR) for septic shock simulation, test the feasibility of measuring the timing and volume of fluid administration during septic shock simulation with and without PediSepsisAR, and describe PediSepsisAR as an educational tool. We hypothesized that we could feasibly measure our desired data during the simulation in 90\% of the participants in each group. With regard to using PediSepsisAR as an educational tool, we hypothesized that the PediSepsisAR group would report that it enhanced their awareness of simulated patient blood flow and would more rapidly verbalize recognition of abnormal patient status and desired management steps. Methods: We performed a randomized controlled feasibility trial with a convenience sample of pediatric care providers at a large tertiary care pediatric center. Participants completed a prestudy questionnaire and were randomized to either the PediSepsisAR or control (traditional simulation) arms. We measured the participants' time to administer 20, 40, and 60 cc/kg of intravenous fluids during a septic shock simulation using each modality. In addition, facilitators timed how long participants took to verbalize they had recognized tachycardia, hypotension, or septic shock and desired to initiate the sepsis pathway and administer antibiotics. Participants in the PediSepsisAR arm completed a poststudy questionnaire. We analyzed data using descriptive statistics and a Wilcoxon rank-sum test to compare the median time with event variables between groups. Results: We enrolled 50 participants (n=25 in each arm). The timing and volume of fluid administration were captured in all the participants in each group. There was no statistically significant difference regarding time to administration of intravenous fluids between the two groups. Similarly, there was no statistically significant difference between the groups regarding time to verbalized recognition of patient status or desired management steps. Most participants in the PediSepsisAR group reported that PediSepsisAR enhanced their awareness of the patient's perfusion. Conclusions: We developed an augmented reality app for use in pediatric septic shock simulations and demonstrated the feasibility of measuring the volume and timing of fluid administration during simulation using this modality. In addition, our findings suggest that PediSepsisAR may enhance participants' awareness of abnormal perfusion. ", doi="10.2196/29899", url="https://mededu.jmir.org/2021/4/e29899", url="http://www.ncbi.nlm.nih.gov/pubmed/34612836" } @Article{info:doi/10.2196/27855, author="Wharton-Smith, Alexandra and Baker, Kevin and Roca-Feltrer, Arantxa and Rodrigues, Maria and Richardson, Sol and Bonnington, A. Craig and Rassi, Christian and Marasciulo, Madeleine and Enosse, Sonia and Saute, Francisco and Aide, Pedro and Macete, Eusebio and Candrinho, Baltazar", title="Assessment of the Feasibility, Acceptability, and Impact of Implementing Seasonal Malaria Chemoprevention in Nampula Province, Mozambique: Protocol for a Hybrid Effectiveness-Implementation Study", journal="JMIR Res Protoc", year="2021", month="Sep", day="15", volume="10", number="9", pages="e27855", keywords="malaria", keywords="seasonal malaria chemoprevention", keywords="sulfadoxine-pyrimethamine amodiaquine", keywords="resistance", keywords="children under five", keywords="implementation research", keywords="Mozambique", keywords="Africa", keywords="mobile phone", abstract="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 ", doi="10.2196/27855", url="https://www.researchprotocols.org/2021/9/e27855", url="http://www.ncbi.nlm.nih.gov/pubmed/34524109" } @Article{info:doi/10.2196/25873, author="Khairat, Saif and McDaniel, Phillip and Jansen, Matthew and Francis, Tia and Edson, Barbara and Gianforcaro, Robert", title="Analysis of Social Determinants and the Utilization of Pediatric Tele--Urgent Care During the COVID-19 Pandemic: Cross-sectional Study", journal="JMIR Pediatr Parent", year="2021", month="Aug", day="30", volume="4", number="3", pages="e25873", keywords="telehealth", keywords="pediatrics", keywords="social", keywords="determinants", keywords="COVID-19", keywords="use", keywords="children", keywords="infant", keywords="consultation", keywords="telemedicine", keywords="urgent care", keywords="vulnerable population", keywords="cross-sectional", keywords="minority", abstract="Background: Telehealth is increasingly used to provide specialty consultations to infants and children receiving care. However, there is uncertainty if the COVID-19 pandemic has influenced the use of telehealth among vulnerable populations. Objective: This research aims to compare the overall use of tele--urgent care visits for pediatric patients before and after the pandemic, especially among vulnerable populations. Methods: We conducted a cross-sectional analysis of pediatric tele--urgent care visits at a virtual care center at a southeastern health care center. The main outcome of this study was the use of pediatrics tele--urgent visits across geographical regions with different levels of social disparities and between 2019 and 2020. Results: Of 584 tele--urgent care visits, 388 (66.4\%) visits occurred in 2020 during the pandemic compared to 196 (33.6\%) visits in 2019. Among 808 North Carolina zip codes, 181 (22\%) consisted of a high concentration of vulnerable populations, where 17.7\% (56/317) of the tele--urgent care visits originated from. The majority (215/317, 67.8\%) of tele--urgent care visits originated from zip codes with a low concentration of vulnerable populations. There was a significant association between the rate of COVID-19 cases and the concentration level of social factors in a given Zip Code Tabulation Area. Conclusions: The use of tele--urgent care visits for pediatric care doubled during the COVID-19 pandemic. The majority of the tele--urgent care visits after COVID-19 originated from regions where there is a low presence of vulnerable populations. In addition, our geospatial analysis found that geographic regions with a high concentration of vulnerable populations had a significantly higher rate of COVID-19--confirmed cases and deaths compared to regions with a low concentration of vulnerable populations. ", doi="10.2196/25873", url="https://pediatrics.jmir.org/2021/3/e25873", url="http://www.ncbi.nlm.nih.gov/pubmed/34459742" } @Article{info:doi/10.2196/24791, author="Monzani, Alice and Tagliaferri, Francesco and Bellone, Simonetta and Genoni, Giulia and Rabbone, Ivana", title="A Global Overview of COVID-19 Research in the Pediatric Field: Bibliometric Review", journal="JMIR Pediatr Parent", year="2021", month="Jul", day="23", volume="4", number="3", pages="e24791", keywords="COVID-19", keywords="SARS-CoV-2", keywords="children", keywords="pediatrics", keywords="bibliometric review", keywords="publications", keywords="research", keywords="literature", keywords="review", abstract="Background: Since the beginning of the COVID-19 pandemic, a great number of papers have been published in the pediatric field. Objective: We aimed to assess research around the globe on COVID-19 in the pediatric field by bibliometric analysis, identifying publication trends and topic dissemination and showing the relevance of publishing authors, institutions, and countries. Methods: The Scopus database was comprehensively searched for all indexed documents published between January 1, 2020, and June 11, 2020, dealing with COVID-19 in the pediatric population (0-18 years). A machine learning bibliometric methodology was applied to evaluate the total number of papers and citations, journal and publication types, the top productive institutions and countries and their scientific collaboration, and core keywords. Results: A total of 2301 papers were retrieved, with an average of 4.8 citations per article. Of this, 1078 (46.9\%) were research articles, 436 (18.9\%) were reviews, 363 (15.8\%) were letters, 186 (8.1\%) were editorials, 7 (0.3\%) were conference papers, and 231 (10\%) were categorized as others. The studies were published in 969 different journals, headed by The Lancet. The retrieved papers were published by a total of 12,657 authors from 114 countries. The most productive countries were the United States, China, and Italy. The four main clusters of keywords were pathogenesis and clinical characteristics (keyword occurrences: n=2240), public health issues (n=352), mental health (n=82), and therapeutic aspects (n=70). Conclusions: In the pediatric field, a large number of articles were published within a limited period on COVID-19, testifying to the rush to spread new findings on the topic in a timely manner. The leading authors, countries, and institutions evidently belonged to the most impacted geographical areas. A focus on the pediatric population was often included in general articles, and pediatric research about COVID-19 mainly focused on the clinical features, public health issues, and psychological impact of the disease. ", doi="10.2196/24791", url="https://pediatrics.jmir.org/2021/3/e24791", url="http://www.ncbi.nlm.nih.gov/pubmed/34081597" } @Article{info:doi/10.2196/23242, author="Batra, Nikita and Colson, D. Cindy and Alberto, C. Emily and Burd, S. Randall", title="Using Social Media for the Prevention of Pediatric Burn Injuries: Pilot Design and Usability Study", journal="JMIR Form Res", year="2021", month="Jul", day="15", volume="5", number="7", pages="e23242", keywords="accident prevention", keywords="burns", keywords="pediatric", keywords="public health", keywords="social media", abstract="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. ", doi="10.2196/23242", url="https://formative.jmir.org/2021/7/e23242", url="http://www.ncbi.nlm.nih.gov/pubmed/34264194" } @Article{info:doi/10.2196/16426, author="Matin, B. Shababa and Wallingford, Allison and Xu, Shicheng and Ng, Natalie and Ho, Anthony and Vanosdoll, Madison and Waiswa, Peter and Labrique, B. Alain and Acharya, Soumyadipta", title="Feasibility of a Mobile Health Tool for Mothers to Identify Neonatal Illness in Rural Uganda: Acceptability Study", journal="JMIR Mhealth Uhealth", year="2020", month="Feb", day="18", volume="8", number="2", pages="e16426", keywords="newborn", keywords="neonatal health", keywords="community health workers", keywords="maternal behavior", keywords="Uganda", keywords="World Health Organization", keywords="mobile apps", keywords="telemedicine", abstract="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. ", doi="10.2196/16426", url="https://mhealth.jmir.org/2020/2/e16426", url="http://www.ncbi.nlm.nih.gov/pubmed/32130174" } @Article{info:doi/10.2196/16208, author="Fernandez-Luque, Luis and Labarta, I. Jos{\'e} and Palmer, Ella and Koledova, Ekaterina", title="Content Analysis of Apps for Growth Monitoring and Growth Hormone Treatment: Systematic Search in the Android App Store", journal="JMIR Mhealth Uhealth", year="2020", month="Feb", day="18", volume="8", number="2", pages="e16208", keywords="growth hormone", keywords="telemedicine", keywords="growth monitoring", keywords="mobile app", keywords="mobile health", abstract="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 ($\Kappa$=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. ", doi="10.2196/16208", url="http://mhealth.jmir.org/2020/2/e16208/", url="http://www.ncbi.nlm.nih.gov/pubmed/32130162" } @Article{info:doi/10.2196/13400, author="Gibson, Kim and Al-Naji, Ali and Fleet, Julie-Anne and Steen, Mary and Chahl, Javaan and Huynh, Jasmine and Morris, Scott", title="Noncontact Heart and Respiratory Rate Monitoring of Preterm Infants Based on a Computer Vision System: Protocol for a Method Comparison Study", journal="JMIR Res Protoc", year="2019", month="Aug", day="29", volume="8", number="8", pages="e13400", keywords="heart rate", keywords="respiratory rate", keywords="infant", keywords="electrocardiography", keywords="computers", abstract="Background: Biomedical research in the application of noncontact methods to measure heart rate (HR) and respiratory rate (RR) in the neonatal population has produced mixed results. This paper describes and discusses a protocol for conducting a method comparison study, which aims to determine the accuracy of a proposed noncontact computer vision system to detect HR and RR relative to the HR and RR obtained by 3-lead electrocardiogram (ECG) in preterm infants in the neonatal unit. Objective: The aim of this preliminary study is to determine the accuracy of a proposed noncontact computer vision system to detect HR and RR relative to the HR and RR obtained by 3-lead ECG in preterm infants in the neonatal unit. Methods: A single-center cross-sectional study was planned to be conducted in the neonatal unit at Flinders Medical Centre, South Australia, in May 2018. A total of 10 neonates and their ECG monitors will be filmed concurrently for 10 min using digital cameras. Advanced image processing techniques are to be applied later to determine their physiological data at 3 intervals. These data will then be compared with the ECG readings at the same points in time. Results: Study enrolment began in May 2018. Results of this study were published in July 2019. Conclusions: The study will analyze the data obtained by the noncontact system in comparison to data obtained by ECG, identify factors that may influence data extraction and accuracy when filming infants, and provide recommendations for how this noncontact system may be implemented into clinical applications. International Registered Report Identifier (IRRID): RR1-10.2196/13400 ", doi="10.2196/13400", url="https://www.researchprotocols.org/2019/8/e13400", url="http://www.ncbi.nlm.nih.gov/pubmed/31469077" } @Article{info:doi/10.2196/14540, author="Vanosdoll, Madison and Ng, Natalie and Ho, Anthony and Wallingford, Allison and Xu, Shicheng and Matin, Binte Shababa and Verma, Neha and Farzin, Azadeh and Golden, Christopher W. and Yazdi, Youseph and Waiswa, Peter and Labrique, Alain and Acharya, Soumyadipta", title="A Novel Mobile Health Tool for Home-Based Identification of Neonatal Illness in Uganda: Formative Usability Study", journal="JMIR Mhealth Uhealth", year="2019", month="Aug", day="15", volume="7", number="8", pages="e14540", keywords="neonatal", keywords="community health workers", keywords="maternal", keywords="Uganda", keywords="World Health Organization", keywords="smartphone app", keywords="digital health", keywords="mobile health", keywords="telemedicine", abstract="Background: While early identification of neonatal illness can impact neonatal mortality rates and reduce the burden of treatment, identifying subtle clinical signs and symptoms of possible severe illness is especially challenging in neonates. The World Health Organization and the United Nations Children's Fund developed the Integrated Management of Neonatal Childhood Illness guidelines, an evidence-based tool highlighting seven danger signs to assess neonatal health. Currently, many mothers in low-resource settings rely on home visits from community health workers (CHWs) to determine if their baby is sick. However, CHWs visit infrequently, and illness is often detected too late to impact survival. Thus, delays in illness identification pose a significant barrier to providing expedient and effective care. Neonatal Monitoring (NeMo), a novel neonatal assessment tool, seeks to increase the frequency of neonatal screening by task-shifting identification of neonatal danger signs from CHWs to mothers. Objective: This study aimed to explore the usability and acceptability of the NeMo system among target users and volunteer CHWs by assessing ease of use and learnability. Methods: Simulated device use and semistructured interviews were conducted with 32 women in the Iganga-Mayuge districts in eastern Uganda to evaluate the usability of the NeMo system, which involves a smartphone app paired with a low cost, wearable band to aid in identification of neonatal illness. Two versions of the app were evaluated using a mixed methods approach, and version II of the app contained modifications based on observations of the first cohort's use of the system. During the posed scenario simulations, participants were offered limited guidance from the study team in order to probe the intuitiveness of the NeMo system. The ability to complete a set of tasks with the system was tested and recorded for each participant and closed- and open-ended questions were used to elicit user feedback. Additionally, focus groups with 12 CHWs were conducted to lend additional context and insight to the usability and feasibility assessment. Results: A total of 13/22 subjects (59\%) using app version I and 9/10 subjects (90\%) using app version II were able to use the phone and app with no difficulty, despite varying levels of smartphone experience. Following modifications to the app's audio instructions in version II, participants' ability to accurately answer qualitative questions concerning neonatal danger signs improved by at least 200\% for each qualitative danger sign. All participants agreed they would trust and use the NeMo system to assess the health of their babies. Furthermore, CHWs emphasized the importance of community sensitization towards the system to encourage its adoption and regular use, as well as the decision to seek care based on its recommendations. Conclusions: The NeMo system is an intuitive platform for neonatal assessment in a home setting and was found to be acceptable to women in rural Uganda. ", doi="10.2196/14540", url="http://mhealth.jmir.org/2019/8/e14540/", url="http://www.ncbi.nlm.nih.gov/pubmed/31418428" } @Article{info:doi/10.2196/11684, author="Ashmore, Jonathan and Di Pietro, Jerome and Williams, Kelly and Stokes, Euan and Symons, Anna and Smith, Martina and Clegg, Louise and McGrath, Cormac", title="A Free Virtual Reality Experience to Prepare Pediatric Patients for Magnetic Resonance Imaging: Cross-Sectional Questionnaire Study", journal="JMIR Pediatr Parent", year="2019", month="Apr", day="18", volume="2", number="1", pages="e11684", keywords="virtual reality", keywords="MRI", keywords="anxiety", abstract="Background: A magnetic resonance image (MRI) is a diagnostic test that requires patients to lie still for prolonged periods within a claustrophobic and noisy environment. This can be difficult for children to tolerate, and often general anesthetic (GA) is required at considerable cost and detriment to patient safety. Virtual reality (VR) is a newly emerging technology that can be implemented at low cost within a health care setting. It has been shown to reduce fear associated with a number of high-anxiety situations and medical procedures. Objective: The goal of the research was to develop a VR resource to prepare pediatric patients for MRI, helping to reduce anxieties in children undergoing the procedure. Methods: A freely accessible VR preparation resource was developed to prepare pediatric patients for their upcoming MRI. The resource consists of an app and supporting preparation book and used a series of panoramic 360 degree videos of the entire MRI journey, including footage from within the bore of the scanner. The app, deployed via the Android Play Store and iOS App Store, can be viewed on most mobile phones, allowing a child to experience an MRI in VR using an inexpensive Google Cardboard headset. The app contains 360 degree videos within an animated, interactive VR interface designed for 4 to 12-year-olds. The resource was evaluated as part of a clinical audit on 23 patients (aged 4 to 12 years), and feedback was obtained from 10 staff members. In 5 patients, the resource was evaluated as a tool to prepare patients for an awake MRI who 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 to 10, the VR resource was rated with a median score of 8.5 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. When considering their experiences using the resource with pediatric patients, on a scale of 1 to 10, the staff members rated the VR resource a median score of 8.5 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 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 VR resource has the potential to relieve anxieties and better prepare patients for an awake MRI. The resource has potential to avoid GA through educating the child about the MRI process. ", doi="10.2196/11684", url="http://pediatrics.jmir.org/2019/1/e11684/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518319" } @Article{info:doi/10.2196/11653, author="Khader, Yousef and Alyahya, Mohammad and Batieha, Anwar", title="Barriers to Implementation of Perinatal Death Audit in Maternity and Pediatric Hospitals in Jordan: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2019", month="Mar", day="06", volume="5", number="1", pages="e11653", keywords="perinatal death", keywords="quality of health care", keywords="cause of death", keywords="Jordan", abstract="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. ", doi="10.2196/11653", url="http://publichealth.jmir.org/2019/1/e11653/", url="http://www.ncbi.nlm.nih.gov/pubmed/30839277" } @Article{info:doi/10.2196/10804, author="Kakarmath, S. Sujay and de Redon, Emily and Centi, Jayne Amanda and Palacholla, Ramya and Kvedar, Joseph and Jethwani, Kamal and Agboola, Stephen", title="Assessing the Usability of an Automated Continuous Temperature Monitoring Device (iThermonitor) in Pediatric Patients: Non-Randomized Pilot Study", journal="JMIR Pediatr Parent", year="2018", month="Dec", day="21", volume="1", number="2", pages="e10804", keywords="connected health", keywords="continuous monitoring", keywords="mobile phone", keywords="pediatric", keywords="temperature", abstract="Background: Fever is an important vital sign and often the first one to be assessed in a sick child. In acutely ill children, caregivers are expected to monitor a child's body temperature at home after an initial medical consult. Fever literacy of many caregivers is known to be poor, leading to fever phobia. In children with a serious illness, the responsibility of periodically monitoring temperature can add substantially to the already stressful experience of caring for a sick child. Objective: The objective of this pilot study was to assess the feasibility of using the iThermonitor, an automated temperature measurement device, for continuous temperature monitoring in postoperative and postchemotherapy pediatric patients. Methods: We recruited 25 patient-caregiver dyads from the Pediatric Surgery Department at the Massachusetts General Hospital (MGH) and the Pediatric Cancer Centers at the MGH and the Dana Farber Cancer Institute. Enrolled dyads were asked to use the iThermonitor device for continuous temperature monitoring over a 2-week period. Surveys were administered to caregivers at enrollment and at study closeout. Caregivers were also asked to complete a daily event-monitoring log. The Generalized Anxiety Disorder-7 item questionnaire was also used to assess caregiver anxiety at enrollment and closeout. Results: Overall, 19 participant dyads completed the study. All 19 caregivers reported to have viewed temperature data on the study-provided iPad tablet at least once per day, and more than a third caregivers did so six or more times per day. Of all participants, 74\% (14/19) reported experiencing an out-of-range temperature alert at least once during the study. Majority of caregivers reported that it was easy to learn how to use the device and that they felt confident about monitoring their child's temperature with it. Only 21\% (4/9) of caregivers reported concurrently using a device other than the iThermonitor to monitor their child's temperature during the study. Continuous temperature monitoring was not associated with an increase in caregiver anxiety. Conclusions: The study results reveal that the iThermonitor is a highly feasible and easy-to-use device for continuous temperature monitoring in pediatric oncology and surgery patients. Trial Registration: ClinicalTrials.gov NCT02410252; https://clinicaltrials.gov/ct2/show/NCT02410252 (Archived by WebCite at http://www.webcitation.org/73LnO7hel) ", doi="10.2196/10804", url="http://pediatrics.jmir.org/2018/2/e10804/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518304" } @Article{info:doi/10.2196/10363, author="Burstein, Brett and Bretholz, Adam", title="A Novel Smartphone App to Support Learning and Maintaining Competency With Bier Blocks for Pediatric Forearm Fracture Reductions: Protocol for a Mixed-Methods Study", journal="JMIR Res Protoc", year="2018", month="Dec", day="21", volume="7", number="12", pages="e10363", keywords="intravenous regional anesthesia", keywords="lidocaine", keywords="procedural sedation", keywords="mobile phone", abstract="Background: Distal forearm fractures are among the most common injuries presenting to the pediatric emergency department (PED). Bier block (BB), or intravenous regional anesthesia, is a safe and effective alternative to procedural sedation for closed reduction of forearm fractures; it is associated with fewer adverse events, a shorter length of stay, and reduced costs. BB has long remained relatively underutilized; however, with an increasing emphasis on efficient resource use and patient-centered care, there is renewed interest in this technique. Objective: Our tertiary PED recently became the first in Canada to successfully implement an active BB program. Subsequently, we developed a mobile BB smartphone app designed to support the sustained departmental use of BB. The app can be used for training and maintenance of competency and incorporates instructional material, as well as our institutional BB protocol, printable medication order sheets, and monitoring forms. The present report describes the development and functionality of the BB smartphone app. Methods: We have described app development and content. App dissemination metrics will be tracked, and user feedback will be analyzed using a self-administered electronic survey. Additionally, app utilization in our PED will be compared with real-world clinical use of BB for fracture reductions. Results: The first iteration of the BB app was launched in 2015, with the most recent update in September 2018. App metric tracking is planned for January 2020 until December 2021. Conclusions: We have highlighted how the BB app serves as a paradigm of an educational tool designed not only for individual users but also for supporting the department-wide implementation and dissemination of a new technique. App dissemination and use metrics will be tracked and correlated with clinical use of BB in the PED. International Registered Report Identifier (IRRID): PRR1-10.2196/10363 ", doi="10.2196/10363", url="http://www.researchprotocols.org/2018/12/e10363/", url="http://www.ncbi.nlm.nih.gov/pubmed/30578214" } @Article{info:doi/10.2196/11447, author="Pham, Quynh and Graham, Gary and Lalloo, Chitra and Morita, P. Plinio and Seto, Emily and Stinson, N. Jennifer and Cafazzo, A. Joseph", title="An Analytics Platform to Evaluate Effective Engagement With Pediatric Mobile Health Apps: Design, Development, and Formative Evaluation", journal="JMIR Mhealth Uhealth", year="2018", month="Dec", day="21", volume="6", number="12", pages="e11447", keywords="analytics", keywords="engagement", keywords="log data", keywords="mobile health", keywords="mobile apps", keywords="chronic disease", abstract="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. ", doi="10.2196/11447", url="http://mhealth.jmir.org/2018/12/e11447/", url="http://www.ncbi.nlm.nih.gov/pubmed/30578179" } @Article{info:doi/10.2196/10165, author="Kaskinen, Anu and Ayeboa-Sallah, Benjamin and Teivaanm{\"a}ki, Tiina and W{\"a}rnhjelm, Elina and Korhonen, Liisa and Helve, Otto", title="Pediatric Web-Based Chat Services for Caregivers of Children: Descriptive Study", journal="J Med Internet Res", year="2018", month="Dec", day="14", volume="20", number="12", pages="e10165", keywords="chat service", keywords="health information", keywords="internet", keywords="Web-based resources", keywords="pediatrics", keywords="social media", abstract="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. ", doi="10.2196/10165", url="https://www.jmir.org/2018/12/e10165/", url="http://www.ncbi.nlm.nih.gov/pubmed/30552087" } @Article{info:doi/10.2196/11402, author="Alkhalifah, Shahad and Aldhalaan, Hesham", title="Telehealth Services for Children With Autism Spectrum Disorders in Rural Areas of the Kingdom of Saudi Arabia: Overview and Recommendations", journal="JMIR Pediatr Parent", year="2018", month="Nov", day="15", volume="1", number="2", pages="e11402", keywords="autism spectrum disorders", keywords="intervention", keywords="Saudi Arabia", keywords="telehealth", doi="10.2196/11402", url="http://pediatrics.jmir.org/2018/2/e11402/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518306" } @Article{info:doi/10.2196/10498, author="Luo, Gang and Johnson, D. Michael and Nkoy, L. Flory and He, Shan and Stone, L. Bryan", title="Appropriateness of Hospital Admission for Emergency Department Patients with Bronchiolitis: Secondary Analysis", journal="JMIR Med Inform", year="2018", month="Nov", day="05", volume="6", number="4", pages="e10498", keywords="appropriate hospital admission", keywords="bronchiolitis", keywords="emergency department", keywords="operational definition", abstract="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. ", doi="10.2196/10498", url="http://medinform.jmir.org/2018/4/e10498/", url="http://www.ncbi.nlm.nih.gov/pubmed/30401659" } @Article{info:doi/10.2196/mhealth.9560, author="Yimtae, Kwanchanok and Israsena, Pasin and Thanawirattananit, Panida and Seesutas, Sangvorn and Saibua, Siwat and Kasemsiri, Pornthep and Noymai, Anukool and Soonrach, Tharapong", title="A Tablet-Based Mobile Hearing Screening System for Preschoolers: Design and Validation Study", journal="JMIR Mhealth Uhealth", year="2018", month="Oct", day="23", volume="6", number="10", pages="e186", keywords="hearing screening", keywords="mobile health", keywords="speech audiometry", keywords="hearing loss", abstract="Background: Hearing ability is important for children to develop speech and language skills as they grow. After a mandatory newborn hearing screening, group or mass screening of children at later ages, such as at preschool age, is often practiced. For this practice to be effective and accessible in low-resource countries such as Thailand, innovative enabling tools that make use of pervasive mobile and smartphone technology should be considered. Objective: This study aims to develop a cost-effective, tablet-based hearing screening system that can perform a rapid minimal speech recognition level test. Methods: An Android-based screening app was developed. The screening protocol involved asking children to choose pictures corresponding to a set of predefined words heard at various sound levels offered in a specifically designed sequence. For the app, the set of words was validated, and their corresponding speech power levels were calibrated. We recruited 122 children, aged 4-5 years, during the development phase. Another 63 children of the same age were screened for their hearing abilities using the app in version 2. The results in terms of the sensitivity and specificity were compared with those measured using the conventional audiometric equipment. Results: For screening purposes, the sensitivity of the developed screening system version 2 was 76.67\% (95\% CI 59.07-88.21), and the specificity was 95.83\% (95\% CI 89.77-98.37) for screening children with mild hearing loss (pure-tone average threshold at 1, 2, and 4 kHz, >20 dB). The time taken for the screening of each child was 150.52 (SD 19.07) seconds (95\% CI 145.71-155.32 seconds). The average time used for conventional play audiometry was 11.79 (SD 3.66) minutes (95\% CI 10.85-12.71 minutes). Conclusions: This study shows the potential use of a tablet-based system for rapid and mobile hearing screening. The system was shown to have good overall sensitivity and specificity. Overall, the idea can be easily adopted for systems based on other languages. ", doi="10.2196/mhealth.9560", url="http://mhealth.jmir.org/2018/10/e186/", url="http://www.ncbi.nlm.nih.gov/pubmed/30355558" } @Article{info:doi/10.2196/mhealth.9725, author="Wexler, Catherine and Brown, Melinda and Hurley, A. Emily and Ochieng, Martin and Goggin, Kathy and Gautney, Brad and Maloba, May and Lwembe, Raphael and Khamadi, Samoel and Finocchario-Kessler, Sarah", title="Implementing eHealth Technology to Address Gaps in Early Infant Diagnosis Services: Qualitative Assessment of Kenyan Provider Experiences", journal="JMIR Mhealth Uhealth", year="2018", month="Aug", day="22", volume="6", number="8", pages="e169", keywords="early infant diagnosis (EID)", keywords="HIV/AIDS", keywords="eHealth", keywords="mHealth", keywords="implementation science", keywords="Kenya", abstract="Background: Literature suggests that electronic health (eHealth) interventions can improve the efficiency and accuracy of health service delivery and improve health outcomes and are generally well received by patients; however, there are limited data on provider experiences using eHealth interventions in resource-limited settings. The HIV Infant Tracking System (HITSystem) is an eHealth intervention designed to improve early infant diagnosis (EID) outcomes among HIV-exposed infants. Objective: We aimed to compare provider experiences with standard EID and HITSystem implementation at 6 Kenyan hospitals and 3 laboratories. The objective of this study was to better understand provider experiences implementing and using the HITSystem in order to assess facilitators and barriers that may impact adoption and sustainability of this eHealth intervention. Methods: As part of a randomized controlled trial to evaluate the HITSystem, we conducted semistructured interviews with 17 EID providers at participating intervention and control hospitals and laboratories. Results: Providers emphasized the perceived usefulness of the HITSystem, including improved efficiency in sample tracking and patient follow-up, strengthened communication networks among key stakeholders, and improved capacity to meet patient needs compared to standard EID. These advantages were realized from an intervention that providers saw as easy to use and largely compatible with workflow. However, supply stock outs and patient psychosocial factors (including fear of HIV status disclosure and poverty) provided ongoing challenges to EID service provision. Furthermore, slow or sporadic internet access and heavy workload prevented real-time HITSystem data entry for some clinicians. Conclusions: Provider experiences with the HITSystem indicate that the usefulness of the HITSystem, along with the ease with which it is able to be incorporated into hospital workflows, contributes to its sustained adoption and use in Kenyan hospitals. To maximize implementation success, care should be taken in intervention design and implementation to ensure that end users see clear advantages to using the technology and to account for variations in workflows, patient populations, and resource levels by allowing flexibility to suit user needs. Trial Registration: ClinicalTrials.gov NCT02072603; https://clinicaltrials.gov/ct2/show/NCT02072603 (Archived by WebCite at http://www.webcitation.org/71NgMCrAm) ", doi="10.2196/mhealth.9725", url="http://mhealth.jmir.org/2018/8/e169/", url="http://www.ncbi.nlm.nih.gov/pubmed/30135052" } @Article{info:doi/10.2196/jmir.9596, author="O'Sullivan, Benjamin and Alam, Fahad and Matava, Clyde", title="Creating Low-Cost 360-Degree Virtual Reality Videos for Hospitals: A Technical Paper on the Dos and Don'ts", journal="J Med Internet Res", year="2018", month="Jul", day="16", volume="20", number="7", pages="e239", keywords="360-degree video", keywords="VR", keywords="virtual reality", keywords="video production", keywords="anesthetic preparation", keywords="preoperative anxiety", keywords="preoperative preparation", doi="10.2196/jmir.9596", url="http://www.jmir.org/2018/7/e239/", url="http://www.ncbi.nlm.nih.gov/pubmed/30012545" } @Article{info:doi/10.2196/10958, author="Breakey, R. Vicky and Bouskill, Vanessa and Nguyen, Cynthia and Luca, Stephanie and Stinson, N. Jennifer and Ahola Kohut, Sara", title="Online Peer-to-Peer Mentoring Support for Youth with Hemophilia: Qualitative Needs Assessment", journal="JMIR Pediatr Parent", year="2018", month="Jul", day="10", volume="1", number="2", pages="e10958", keywords="hemophilia", keywords="adolescents", keywords="transition", keywords="self-management", keywords="education", keywords="internet", keywords="mentoring", abstract="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. ", doi="10.2196/10958", url="http://pediatrics.jmir.org/2018/2/e10958/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518296" } @Article{info:doi/10.2196/mhealth.8849, author="McWilliams, Andrew and Reeves, Kelly and Shade, Lindsay and Burton, Elizabeth and Tapp, Hazel and Courtlandt, Cheryl and Gunter, Andrew and Dulin, F. Michael", title="Patient and Family Engagement in the Design of a Mobile Health Solution for Pediatric Asthma: Development and Feasibility Study", journal="JMIR Mhealth Uhealth", year="2018", month="Mar", day="22", volume="6", number="3", pages="e68", keywords="engagement", keywords="pediatric asthma", keywords="shared decision-making", keywords="health information technology", abstract="Background: Asthma is a highly prevalent, chronic disease with significant morbidity, cost, and disparities in health outcomes. While adherence to asthma treatment guidelines can improve symptoms and decrease exacerbations, most patients receive care that is not guideline-based. New approaches that incorporate shared decision-making (SDM) and health information technology (IT) are needed to positively impact asthma management. Despite the promise of health IT to improve efficiency and outcomes in health care, new IT solutions frequently suffer from a lack of widespread adoption and do not achieve desired results, as a consequence of not involving end-users in design. Objective: To describe a case study of a pediatric asthma SDM health IT solution's development and demonstrate a methodology for engaging actual patients and families in IT development. Perspectives are shared from the vantage point of the research team and a parent of a child with asthma, who participated on the development team. Methods: We adapted user-centric design principles to engage actual users across three main development phases: project initiation, ideation, and usability testing. To facilitate the necessary level of user engagement, our approach included: (1) a Development Workgroup consisting of patients, caregivers, and providers who met regularly with the research team; and (2) ``real-world users'' consisting of patients, caregivers, and providers recruited from a variety of care locations, including safety-net clinics. Results: Using this methodology, we successful partnered with asthma patients and families to create an interactive, digital solution called Carolinas Asthma Coach. Carolinas Asthma Coach incorporates SDM principles to elicit patient information, including goals and preferences, and provides health-literate, tailored education with specific guideline-based recommendations for patients and their providers. Of the patients, caregivers, and providers surveyed, 100\% (n=60) said they would recommend Carolinas Asthma Coach to a friend or colleague. Qualitative feedback from users provided support for the usability and engaging nature of the app. Conclusions: This project demonstrates the feasibility and benefits of deploying user-centric design methods that engage real patients and caregivers throughout the health IT design process. ", doi="10.2196/mhealth.8849", url="http://mhealth.jmir.org/2018/3/e68/", url="http://www.ncbi.nlm.nih.gov/pubmed/29567637" }