@Article{info:doi/10.2196/22696,
author="Shah, C. Aashaka
and Badawy, M. Sherif",
title="Telemedicine in Pediatrics: Systematic Review of Randomized Controlled Trials",
journal="JMIR Pediatr Parent",
year="2021",
month="Feb",
day="24",
volume="4",
number="1",
pages="e22696",
keywords="telemedicine",
keywords="telehealth",
keywords="pediatrics",
keywords="COVID-19",
keywords="coronavirus",
keywords="pandemic",
keywords="digital",
keywords="eHealth",
keywords="mHealth",
keywords="mobile health",
abstract="Background: Telemedicine modalities, such as videoconferencing, are used by health care providers to remotely deliver health care to patients. Telemedicine use in pediatrics has increased in recent years. This has resulted in improved health care access, optimized disease management, progress in the monitoring of health conditions, and fewer exposures to patients with illnesses during pandemics (eg, the COVID-19 pandemic). Objective: We aimed to systematically evaluate the most recent evidence on the feasibility and accessibility of telemedicine services, patients' and care providers' satisfaction with these services, and treatment outcomes related to telemedicine service use among pediatric populations with different health conditions. Methods: Studies were obtained from the PubMed database on May 10, 2020. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In this review, we included randomized controlled trials from the last 10 years that used a telemedicine approach as a study intervention or assessed telemedicine as a subspecialty of pediatric care. Titles and abstracts were independently screened based on the eligibility criteria. Afterward, full texts were retrieved and independently screened based on the eligibility criteria. A standardized form was used to extract the following data: publication title, first author's name, publication year, participants' characteristics, study design, the technology-based approach that was used, intervention characteristics, study goals, and study findings. Results: In total, 11 articles met the inclusion criteria and were included in this review. All studies were categorized as randomized controlled trials (8/11, 73\%) or cluster randomized trials (3/11, 27\%). The number of participants in each study ranged from 22 to 400. The health conditions that were assessed included obesity (3/11, 27\%), asthma (2/11, 18\%), mental health conditions (1/11, 9\%), otitis media (1/11, 9\%), skin conditions (1/11, 9\%), type 1 diabetes (1/11, 9\%), attention deficit hyperactivity disorder (1/11, 9\%), and cystic fibrosis--related pancreatic insufficiency (1/11). The telemedicine approaches that were used included patient and doctor videoconferencing visits (5/11, 45\%), smartphone-based interventions (3/11, 27\%), telephone counseling (2/11, 18\%), and telemedicine-based screening visits (1/11, 9\%). The telemedicine interventions in all included studies resulted in outcomes that were comparable to or better than the outcomes of control groups. These outcomes were related to symptom management, quality of life, satisfaction, medication adherence, visit completion rates, and disease progression. Conclusions: Although more research is needed, the evidence from this review suggests that telemedicine services for the general public and pediatric care are comparable to or better than in-person services. Patients, health care professionals, and caregivers may benefit from using both telemedicine services and traditional, in-person health care services. To maximize the potential of telemedicine, future research should focus on improving patients' access to care, increasing the cost-effectiveness of telemedicine services, and eliminating barriers to telemedicine use. ",
doi="10.2196/22696",
url="https://pediatrics.jmir.org/2021/1/e22696",
url="http://www.ncbi.nlm.nih.gov/pubmed/33556030"
}


@Article{info:doi/10.2196/25675,
author="Lam, Yan Joseph Hin
and Lee, Kit Stephen Man
and Tong, Xiuli",
title="Parents' and Students' Perceptions of Telepractice Services for Speech-Language Therapy During the COVID-19 Pandemic: Survey Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Jan",
day="28",
volume="4",
number="1",
pages="e25675",
keywords="eHealth",
keywords="telepractice",
keywords="speech and language pathology",
keywords="user satisfaction",
keywords="COVID-19",
keywords="school-based service",
abstract="Background: The ongoing COVID-19 pandemic has resulted in the suspension of face-to-face classes and a considerable increase in the use of telepractice services in speech-language pathology. However, little is known about parents' and students' satisfaction with telepractice services and their preferences for different service delivery modes. These factors may affect therapy effectiveness and the future adoption of telepractice. Objective: We evaluated students' and parents' perceptions of telepractice efficacy and their preferences for different service delivery modes (ie, on-site practice vs telepractice). We also identified factors that affect parents' and students' preferences for different service delivery modes during the COVID-19 pandemic. Methods: A 19-question survey on telepractice satisfaction and preferences was administered to 41 Hong Kong Chinese students and 85 parents who received telepractice services from school-based speech-language pathologists during the COVID-19 class suspension period. In addition to providing demographic information and data on the implementation of telepractice services, all participants were asked to rate their perceptions of the efficacy of telepractice services and compare on-site practices to telepractice on a 5-point Likert scale (ie, 1=strongly disagree/prefer the use of on-site speech-language therapy services and 5=strongly agree/prefer the use of telepractice services). Results: Despite the fact that telepractice efficacy was highly rated by parents (95\% CI 3.30-3.66) and students (95\% CI 3.21-3.76), both groups believed that telepractice was less effective than on-site practices (parents: 95\% CI 2.14-2.52; students: 95\% CI 2.08-2.65). Moreover, parents preferred on-site practices over telepractice (95\% CI 2.04-2.43), whereas students did not prefer one mode of practice over the other (95\% CI 2.74-3.41). A significant association between telepractice efficacy and a preference for telepractice services was found only among the students ($\tau$=.43, P<.001), not the parents ($\tau$=.07; P=.44). Conclusions: Although telepractice is an acceptable alternative service delivery option for providing speech and language therapy services to school-aged individuals, speech-language therapists and parents must play a more proactive role in telepractice services to facilitate effective communication between clinicians and parents. ",
doi="10.2196/25675",
url="http://pediatrics.jmir.org/2021/1/e25675/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33449909"
}


@Article{info:doi/10.2196/24827,
author="Zhang, Chun Ke
and Fang, Yuan
and Cao, He
and Chen, Hongbiao
and Hu, Tian
and Chen, Qi Ya
and Zhou, Xiaofeng
and Wang, Zixin",
title="Parental Acceptability of COVID-19 Vaccination for Children Under the Age of 18 Years: Cross-Sectional Online Survey",
journal="JMIR Pediatr Parent",
year="2020",
month="Dec",
day="30",
volume="3",
number="2",
pages="e24827",
keywords="parental acceptability",
keywords="COVID-19 vaccination",
keywords="children under the age of 18 years",
keywords="theory of planned behavior",
keywords="social media influence",
keywords="China",
abstract="Background: It is expected that COVID-19 vaccines will become available in China by the end of 2020. Vaccinating children against COVID-19 would contribute to the control of the pandemic and the recovery of the global economy. For children under the age of 18 years, parents are usually the decision makers regarding their children's vaccination. Objective: The goal of this study was to investigate parental acceptability of free COVID-19 vaccination for children under the age of 18 years in China. Methods: This is a secondary analysis of a cross-sectional, closed online survey among 2053 factory workers in Shenzhen, China, implemented from September 1 to 7, 2020.  Participants of the online survey were full-time employees aged 18 years or over who had resumed work in factories in Shenzhen. Factory workers in Shenzhen are required to receive physical examinations once a year. Eligible workers attending six designated physical examination sites were invited to complete an online survey. This study was based on a subsample of those who had at least one child under the age of 18 years (N=1052). After being briefed that COVID-19 vaccines developed by China are likely to be available by the end of 2020, participants were asked about their likelihood of having their children under the age of 18 years take up free COVID-19 vaccination provided by the government, if it existed. Multivariate logistic regression models were fitted to examine the associations of perceptions related to COVID-19 vaccination based on the theory of planned behavior (TPB) and exposure to information related to COVID-19 through social media with parental acceptability, after controlling for significant background characteristics. Results: The prevalence of parents' acceptability of COVID-19 vaccination for their children was 72.6\% (764/1052). After adjusting for significant background characteristics, positive attitudes toward COVID-19 vaccination (adjusted odds ratio [AOR] 1.70, 95\% CI 1.50-1.91), the perception that a family member would support them in having their children take up COVID-19 vaccination (ie, perceived subjective norm) (AOR 4.18, 95\% CI 3.21-5.43), and perceived behavioral control to have the children take up COVID-19 vaccination (AOR 1.84, 95\% CI 1.49-2.26) were associated with higher parental acceptability of COVID-19 vaccination. Regarding social media influence, higher exposure to positive information related to COVID-19 vaccination was associated with higher parental acceptability of COVID-19 vaccination (AOR 1.35, 95\% CI 1.17-1.56). Higher exposure to negative information related to COVID-19 vaccination was negatively associated with the dependent variable (AOR 0.85, 95\% CI 0.74-0.99). Conclusions: Parents' acceptability of COVID-19 vaccination for their children under 18 years of age was high in China. The TPB is a useful framework to guide the development of future campaigns promoting COVID-19 vaccination targeting parents. Transparency in communicating about the vaccine development process and vaccine safety testing is important. Public health authorities should also address misinformation in a timely manner. ",
doi="10.2196/24827",
url="http://pediatrics.jmir.org/2020/2/e24827/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33326406"
}


@Article{info:doi/10.2196/24345,
author="Schweiberger, Kelsey
and Hoberman, Alejandro
and Iagnemma, Jennifer
and Schoemer, Pamela
and Squire, Joseph
and Taormina, Jill
and Wolfson, David
and Ray, N. Kristin",
title="Practice-Level Variation in Telemedicine Use in a Pediatric Primary Care Network During the COVID-19 Pandemic: Retrospective Analysis and Survey Study",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="18",
volume="22",
number="12",
pages="e24345",
keywords="telehealth",
keywords="telemedicine",
keywords="ambulatory pediatrics",
keywords="health services research",
keywords="ambulatory",
keywords="pediatrics",
keywords="health services",
keywords="COVID-19",
abstract="Background: Telehealth, the delivery of health care through telecommunication technology, has potential to address multiple health system concerns. Despite this potential, only 15\% of pediatric primary care clinicians reported using telemedicine as of 2016, with the majority identifying inadequate payment for these services as the largest barrier to their adoption. The COVID-19 pandemic led to rapid changes in payment and regulations surrounding telehealth, enabling its integration into primary care pediatrics. Objective: Due to limited use of telemedicine in primary care pediatrics prior to the COVID-19 pandemic, much is unknown about the role of telemedicine in pediatric primary care. To address this gap in knowledge, we examined the association between practice-level telemedicine use within a large pediatric primary care network and practice characteristics, telemedicine visit diagnoses, in-person visit volumes, child-level variations in telemedicine use, and clinician attitudes toward telemedicine. Methods: We analyzed electronic health record data from 45 primary care practices and administered a clinician survey to practice clinicians. Practices were stratified into tertiles based on rates of telemedicine use (low, intermediate, high) per 1000 patients per week during a two-week period (April 19 to May 2, 2020). By practice tertile, we compared (1) practice characteristics, (2) telemedicine visit diagnoses, (3) rates of in-person visits to the office, urgent care, and the emergency department, (4) child-level variation in telemedicine use, and (5) clinician attitudes toward telemedicine across these practices. Results: Across pediatric primary care practices, telemedicine visit rates ranged from 5 to 23 telemedicine visits per 1000 patients per week. Across all tertiles, the most frequent telemedicine visit diagnoses were mental health (28\%-36\% of visits) and dermatologic (15\%-28\%). Compared to low telemedicine use practices, high telemedicine use practices had fewer in-person office visits (10 vs 16 visits per 1000 patients per week, P=.005) but more total encounters overall (in-office and telemedicine: 28 vs 22 visits per 1000 patients per week, P=.006). Telemedicine use varied with child age, race and ethnicity, and recent preventive care; however, no significant interactions existed between these characteristics and practice-level telemedicine use. Finally, clinician attitudes regarding the usability and impact of telemedicine did not vary significantly across tertiles. Conclusions: Across a network of pediatric practices, we identified significant practice-level variation in telemedicine use, with increased use associated with more varied telemedicine diagnoses, fewer in-person office visits, and increased overall primary care encounter volume. Thus, in the context of the pandemic, when underutilization of primary care was prevalent, higher practice-level telemedicine use supported pediatric primary care encounter volume closer to usual rates. Child-level telemedicine use differed by child age, race and ethnicity, and recent preventive care, building upon prior concerns about differences in access to telemedicine. However, increased practice-level use of telemedicine services was not associated with reduced or increased differences in use, suggesting that further work is needed to promote equitable access to primary care telemedicine. ",
doi="10.2196/24345",
url="http://www.jmir.org/2020/12/e24345/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33290244"
}


@Article{info:doi/10.2196/21644,
author="Biernesser, Candice
and Montano, Gerald
and Miller, Elizabeth
and Radovic, Ana",
title="Social Media Use and Monitoring for Adolescents With Depression and Implications for the COVID-19 Pandemic: Qualitative Study of Parent and Child Perspectives",
journal="JMIR Pediatr Parent",
year="2020",
month="Dec",
day="8",
volume="3",
number="2",
pages="e21644",
keywords="social media",
keywords="adolescent",
keywords="parents",
keywords="depression",
keywords="disclosure",
keywords="qualitative research",
keywords="COVID-19",
abstract="Background: Although youth report many positive experiences with social media (SM) use in their daily lives, adolescents with depression are more vulnerable to the risks of SM use than adolescents without depression. Parents protect adolescents with depression from the risks of SM use by monitoring their child's SM activity; however, this comes into conflict with the adolescent's need for autonomy in their web-based communication. The implications of SM use and monitoring for adolescents with depression and their parents are of particular relevance to the COVID-19 pandemic, as rates of SM use have increased in response to physical distancing measures. Objective: This study aims to explore parent and child perspectives regarding the use and function of SM in the daily lives of adolescents with depression and parents' perceptions of and experience with monitoring their child's SM use. Methods: We conducted qualitative interviews with adolescents with depression (n=23) and one parent of each adolescent (n=23) between July 2013 and September 2014. The adolescents were patients seeking treatment for depression in Pittsburgh, Pennsylvania. Data analysis included dyadic analysis of the adolescents' and parents' perspectives and qualitative descriptions of individual parent interviews to explore their experiences with SM use and monitoring. The construct of parental knowledge and factors hypothesized to contribute to parental knowledge, including adolescent disclosure, parental solicitation, and parental control, were used to guide the codebook and dyadic data analysis. Results: Dyadic analyses showed that parents and their children disagreed on the use and function of SM in the daily lives of adolescents with depression, with adolescents viewing SM as a forum for honest expression of their emotions, whereas parents felt that their children's posts were inconsequential and interfered with the adolescents' lives. Furthermore, parents reported using a wide range of strategies to gain knowledge of their child's SM use to monitor their safety on SM, including direct solicitation and indirect solicitation, such as keeping the child's passwords, asking friends or siblings about their child's SM use, and restricting SM behavior and access to devices. Conclusions: Clinicians should support adolescents with depression and their parents in finding common ground for an effective and acceptable monitoring approach. Resources are provided for clinicians navigating conversations about SM use and monitoring with adolescents with depression and their parents during the COVID-19 pandemic. ",
doi="10.2196/21644",
url="http://pediatrics.jmir.org/2020/2/e21644/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33289678"
}


@Article{info:doi/10.2196/23057,
author="Serlachius, Anna
and Badawy, M. Sherif
and Thabrew, Hiran",
title="Psychosocial Challenges and Opportunities for Youth With Chronic Health Conditions During the COVID-19 Pandemic",
journal="JMIR Pediatr Parent",
year="2020",
month="Oct",
day="12",
volume="3",
number="2",
pages="e23057",
keywords="COVID-19",
keywords="coronavirus",
keywords="pandemic",
keywords="chronic illness",
keywords="youth",
keywords="adolescents",
keywords="children",
keywords="psychosocial",
keywords="anxiety",
doi="10.2196/23057",
url="http://pediatrics.jmir.org/2020/2/e23057/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33001834"
}


@Article{info:doi/10.2196/23463,
author="Stull, W. Samuel
and McKnight, R. Erin
and Bonny, E. Andrea",
title="Patient and Clinician Perspectives on Adolescent Opioid Use Disorder Treatment During a Pandemic: One Step Back, but Two Forward?",
journal="JMIR Pediatr Parent",
year="2020",
month="Oct",
day="9",
volume="3",
number="2",
pages="e23463",
keywords="adolescent",
keywords="opioid use disorder",
keywords="treatment",
keywords="telehealth",
keywords="drug",
keywords="perspective",
keywords="opioid",
keywords="COVID-19",
keywords="young adult",
doi="10.2196/23463",
url="http://pediatrics.jmir.org/2020/2/e23463/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33016885"
}


@Article{info:doi/10.2196/19924,
author="Caze II, Todd
and Knell, P. Gregory
and Abt, John
and Burkhart, O. Scott",
title="Management and Treatment of Concussions via Tele-Concussion in a Pediatric Setting: Methodological Approach and Descriptive Analysis",
journal="JMIR Pediatr Parent",
year="2020",
month="Aug",
day="13",
volume="3",
number="2",
pages="e19924",
keywords="brain concussion",
keywords="athletic injuries",
keywords="sports injuries",
keywords="telemedicine",
keywords="eHealth",
keywords="mHealth",
keywords="telehealth",
keywords="mobile health",
keywords="adolescent",
keywords="child",
keywords="COVID-19",
abstract="Background: Approximately 2 million children in the United States sustain a concussion annually, resulting in an economic impact as high as US \$20 billion. Patients who receive treatment at concussion specialty clinics, versus primary care, experience faster recovery, thereby reducing patient burden and subsequent medical-related costs. Accessibility to specialty clinics is typically limited by the availability of in-office visits. This is particularly relevant in light of the severe acute respiratory syndrome coronavirus 2 pandemic and subsequent guidance to eliminate all non--medically necessary in-clinic visits. Telehealth has been used to effectively deliver in-clinic care across several disciplines including psychiatry, psychology, and neuropsychology. However, a model of telehealth delivered concussion assessment, treatment, and management has not been established. Objective: The purposes of this paper are to describe a pediatric concussion specialty clinic's experiences in delivering telehealth concussion services and to provide preliminary descriptive data on a sample of pediatric telehealth patients with concussions. Methods: The specialty pediatric concussion clinic described here began providing telehealth services in 2019 and is part of the largest and fastest-growing telehealth hospital network in the United States. The clinical care process will be described, including accessing the telehealth platform, assessment during the initial appointment, injury management including communication with relevant patient stakeholders (eg, parent or guardians, athletic trainers), dissemination of rehabilitation exercises, and nature of follow-up visits. Descriptive data will include patient demographics, the radius of care, the time between the date of injury and initial visit, the average number of follow-up visits, and days until medically cleared for return-to-learn and return-to-play. Results: The analytic sample included 18 patients with concussions who were seen for all of their visits via telehealth between August 2019 and April 2020. The mean age of the sample was 14.5 (SD 2.5) years. The radius of care was a median of 17 (IQR 11.0-31.0) miles from the clinic with a median time between injury and the first visit of 21 (IQR 6.0-41.5) days. The mean number of visits was 2.2 (SD 0.8) with a median days between visits of 5.4 (IQR 3.0-9.3) to manage and treat the concussion. Of the 18 patients, 55.6\% (n=10) were medically cleared for return-to-learn or -play in a median of 15.5 (IQR 11.0-29.0) days. Conclusions: Limited access to health care is a well-understood barrier for receiving quality care. Subsequently, there are increasing demands for flexibility in delivering concussion services remotely and in-clinic. This is the first paper to provide a clinically relevant framework for the assessment, management, and treatment of acute concussion via telehealth in a pediatric population. ",
doi="10.2196/19924",
url="https://pediatrics.jmir.org/2020/2/e19924",
url="http://www.ncbi.nlm.nih.gov/pubmed/32634106"
}


@Article{info:doi/10.2196/19867,
author="Ye, Jiancheng",
title="Pediatric Mental and Behavioral Health in the Period of Quarantine and Social Distancing With COVID-19",
journal="JMIR Pediatr Parent",
year="2020",
month="Jul",
day="28",
volume="3",
number="2",
pages="e19867",
keywords="pediatrics",
keywords="mental health",
keywords="stay-at-home orders",
keywords="health technology",
keywords="digital interventions",
keywords="social distancing",
keywords="COVID-19",
doi="10.2196/19867",
url="http://pediatrics.jmir.org/2020/2/e19867/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32634105"
}


@Article{info:doi/10.2196/20049,
author="Badawy, M. Sherif
and Radovic, Ana",
title="Digital Approaches to Remote Pediatric Health Care Delivery During the COVID-19 Pandemic: Existing Evidence and a Call for Further Research",
journal="JMIR Pediatr Parent",
year="2020",
month="Jun",
day="25",
volume="3",
number="1",
pages="e20049",
keywords="coronavirus",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="pandemic",
keywords="outbreak",
keywords="public health",
keywords="pediatric",
keywords="children",
keywords="adolescents",
keywords="telehealth",
keywords="telemedicine",
keywords="digital",
keywords="interventions",
keywords="digital health",
keywords="digital medicine",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="health care delivery",
doi="10.2196/20049",
url="http://pediatrics.jmir.org/2020/1/e20049/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32540841"
}


@Article{info:doi/10.2196/20712,
author="Berman, A. Claire
and Kacanek, Deborah
and Nichamin, Mindy
and Wilson, Dominique
and Davtyan, Mariam
and Salomon, Liz
and Patel, Kunjal
and Reznick, Megan
and Tassiopoulos, Katherine
and Lee, Sonia
and Bauermeister, Jose
and Paul, Mary
and Aldape, Theresa
and Seage III, R. George",
title="Using Social Media and Technology to Communicate in Pediatric HIV Research: Qualitative Study With Young Adults Living With or Exposed to Perinatal HIV",
journal="JMIR Pediatr Parent",
year="2020",
month="Jun",
day="23",
volume="3",
number="1",
pages="e20712",
keywords="pediatric HIV",
keywords="perinatal HIV",
keywords="youth",
keywords="young adults",
keywords="social media",
keywords="study retention",
keywords="COVID-19",
abstract="Background: As young adults living with perinatal HIV (PHIV) or perinatal HIV exposure but uninfected (PHEU) grow older and manage the challenges and competing demands of young adulthood, new approaches are needed to facilitate their retention in longitudinal research and clinical care beyond in-person clinic visits. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel virus that causes coronavirus disease (COVID-19), emerged in the United States in January 2020 and has underscored this need; studies are adapting to remote communication with and data collection from participants. However, there are limited data on communication preferences among young adults who are living with PHIV or PHEU. Objective: The objectives of this qualitative study were to describe participants' perceptions and use of social media and technology in their personal lives and in the context of participating in longitudinal pediatric HIV research and to describe the implications of the use of technology and social media for communication and retention purposes within a longitudinal pediatric study about HIV. Methods: We conducted 6 focus group discussions with 31 young adults living with PHIV and 13 in-depth interviews with 6 young adults living with PHIV and 7 living with PHEU. We asked about their preferences for the use of social media and digital technology in the Adolescent Master Protocol, a US-based longitudinal cohort study of youth affected by HIV. Results: Participants' willingness to use social media platforms, telephone calls, SMS text messages, and video calls within the context of HIV research varied due to fears of HIV stigma and inadvertent disclosure. However, trusting relationships with clinical staff positively impacted their willingness to use these platforms. Conclusions: Our findings offer insight into how pediatric studies and clinics can communicate with participants as they age, even as new technologies and social media platforms emerge and replace old ones. For optimal retention, pediatric clinical staff should consider communication approaches offering flexible and tailored options for young adults participating in HIV research. ",
doi="10.2196/20712",
url="http://pediatrics.jmir.org/2020/1/e20712/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32540839"
}