@Article{info:doi/10.2196/67546, author="Pereira de Godoy, Carolina Ana and Bulgarelli Bestetti, Reinaldo", title="Hospitalization and Mortality in Brazilian Children and Adolescents Due to COVID-19: Retrospective Study", journal="JMIR Pediatr Parent", year="2025", month="May", day="20", volume="8", pages="e67546", keywords="COVID-19", keywords="children", keywords="mortality", keywords="Brazil", keywords="retrospective study", keywords="morbidity", keywords="hospitalization", abstract="Background: COVID-19 is currently one of the most important medical challenges as it affects the entire population, with children and adolescents being infected as easily as adults. Objective: The objective of this study was to evaluate the prevalence of mortality in children and adolescents aged <19 years, compared to that of adults. Methods: This retrospective, observational study analyzed the medical records of all patients diagnosed with COVID-19 by real-time reverse transcription--quantitative polymerase chain reaction who were hospitalized at Hospital de Base and the Infant and Maternal Hospital of S{\~a}o Jos{\'e} do Rio Preto, S{\~a}o Paulo, Brazil. Out of a total of 8986 hospitalized patients who were COVID-19 positive, 383 (4.26\%) were children and adolescents aged <19 years (group 1), and 8603 (95.74\%) were adults (group 2). Results: Overall, mortality was significantly higher (P<.001) in group 2 (2185/8603, 25.4\%) compared to group 1 (12/383, 3.1\%). A total of 11 (92\%) of the 12 patients in group 1 that died had associated diseases. The mortality rates by age group were as follows: infants aged <1 year, 1.6\% (2/123); children aged 1-4 years, 4\% (4/95); children aged 5-9 years, 2\% (1/47); adolescents aged 10-14 years, 2\% (1/40); and adolescents aged 15-19 years, 5\% (4/78). Conclusions: Mortality from COVID-19 in children and adolescents was significantly lower than that in adults and was associated with other comorbidities. ", doi="10.2196/67546", url="https://pediatrics.jmir.org/2025/1/e67546" } @Article{info:doi/10.2196/65751, author="Asan, Onur and Super, Ilse and Percy, Stephen and Clouser, N. Katharine", title="The Effect of COVID-19 on Health Care Utilization Among Children with Medical Complexity: Retrospective Chart Review Study", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="28", volume="8", pages="e65751", keywords="children with medical complexity", keywords="pediatric", keywords="children", keywords="health care utilization", keywords="telemedicine", keywords="telehealth", keywords="virtual care", keywords="virtual health", keywords="COVID-19", keywords="SARS-COV-2", keywords="coronavirus", keywords="respiratory", keywords="infectious", keywords="pulmonary", keywords="pandemic", keywords="chart review", keywords="chart review study", keywords="retrospective chart review", keywords="retrospective chart review study", doi="10.2196/65751", url="https://pediatrics.jmir.org/2025/1/e65751" } @Article{info:doi/10.2196/58566, author="Wallraf, Simon and Dierks, Marie-Luise and John, Cosima and Lander, Jonas", title="Patient Organizations' Digital Responses to the COVID-19 Pandemic: Scoping Review", journal="J Med Internet Res", year="2024", month="Dec", day="20", volume="26", pages="e58566", keywords="patient organizations", keywords="COVID-19", keywords="digital adaptation", keywords="digital transformation", keywords="scoping review", abstract="Background: Patient organizations (POs) play a crucial role in supporting individuals with health conditions. Their activities range from counseling to support groups to advocacy. The COVID-19 pandemic and its related public health measures prompted rapid digital transformation efforts across multiple sectors, including health care. Objective: This study aimed to explore how POs digitally responded to pandemic-related circumstances, focusing on aspects such as the technologies used, positive outcomes, and challenges encountered. Methods: This scoping review followed the methodological guidance of the JBI (Joanna Briggs Institute) Scoping Review Methodology Group and adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting guidelines. A systematic search of PubMed, the Web of Science Core Collection, and the WHO (World Health Organization) COVID-19 database, supplemented by a citation search approach, was conducted. The initial search was performed on November 10, 2022, and updated on November 8, 2023. Publications were eligible if they were published after November 30, 2019, and addressed pandemic-related digitalization efforts of POs, defined as nonprofit organizations with a focus on health-related support. A 2-step screening process was used to identify relevant literature. Data were extracted using a standardized table to capture aspects such as digital adaptation activities (eg, types of technologies implemented, positive outcomes, challenges, and facilitating factors) and coded inductively to identify similarities across included publications, and the findings were synthesized narratively. Results: The search and its subsequent update yielded 2212 records, with 13 articles included in this review. These articles revealed a range of PO services that were digitally adapted during the pandemic, with videoconferencing software emerging as the most commonly used tool (n=9 articles). The digital adaptation of group-based support activities was the most frequently reported transformation (n=9). Other adaptations included the digitalization of counseling services (n=3) and the delivery of information and education (n=3), including educational workshops, weekly webinars, and the dissemination of information through digital newsletters. While the use of digital formats, particularly for POs' group activities, often increased accessibility by breaking down preexisting barriers (n=5), they also created new barriers for certain groups, such as those lacking digital skills or resources (n=4). Some participants experienced a loss of interpersonal aspects, like a sense of community (n=3). However, further findings suggest that the digital delivery of such group activities preserved essential interpersonal aspects (n=7) and a preference among some participants to continue digital group activities (n=4), suggesting the potential for sustainability of such options post the COVID-19 pandemic. Conclusions: The rapid digitalization efforts of POs demonstrate their adaptability and the potential of digital technologies to improve support services, despite some challenges. Future digitalization strategies should focus, among other things, on promoting digital literacy to ensure the accessibility and inclusiveness of digital services. Trial Registration: OSF Registries, https://osf.io/anvf4 ", doi="10.2196/58566", url="https://www.jmir.org/2024/1/e58566", url="http://www.ncbi.nlm.nih.gov/pubmed/39705075" } @Article{info:doi/10.2196/63416, author="Sourander, Saana and Westerlund, Minja and Baumel, Amit and Hinkka-Yli-Salom{\"a}ki, Susanna and Ristkari, Terja and Kurki, Marjo and Sourander, Andre", title="Web-Based Parent Training With Telephone Coaching Aimed at Treating Child Disruptive Behaviors in a Clinical Setting During the COVID-19 Pandemic: Single-Group Study With 2-Year Follow-Up", journal="JMIR Pediatr Parent", year="2024", month="Dec", day="16", volume="7", pages="e63416", keywords="parent training", keywords="disruptive behavior", keywords="child psychopathology", keywords="child functioning", keywords="behaviors", keywords="behavioral", keywords="coaching", keywords="web-based", keywords="family counseling", keywords="child", keywords="disruptive", keywords="counseling", keywords="training", keywords="parents", keywords="parenting", keywords="telephone", keywords="telehealth", keywords="telemedicine", keywords="pediatrics", keywords="COVID-19", abstract="Background: There is a lack of studies examining the long-term outcomes of web-based parent training programs implemented in clinical settings during the COVID-19 pandemic. Objective: The aim is to study 2-year outcomes of families with 3? to 8-year-old children referred from family counseling centers to the Finnish Strongest Families Smart Website (SFSW), which provides digital parent training with telephone coaching aimed at treating child disruptive behaviors. Methods: Counseling centers in Helsinki identified fifty 3? to 8-year-old children with high levels of disruptive behavioral problems. Child psychopathology and functioning as well as parenting styles and parental mental health were collected from parents at baseline; posttreatment; and at 6-, 12-, and 24-month follow-ups. Results: The SFSW program had positive long-term changes in child psychopathology and parenting skills. Improvements in child psychopathology, including Strengths and Difficulties Questionnaire total score (Cohen d=0.47; P<.001), Strengths and Difficulties Questionnaire conduct scores (Cohen d=0.65; P<.001), and Affective Reactivity Index irritability scores (Cohen d=0.52; P<.001), were maintained until the 24-month follow-up. Similarly, changes in parenting skills measured with the Parenting Scale, including overreactivity (Cohen d=0.41; P=.001) and laxness (Cohen d=0.26; P=.02), were maintained until the 24-month follow-up. However, parental hostility changes were not maintained at long-term follow-up (Cohen d=?0.04; P=.70). Conclusions: The study shows that the SFSW parent training program can yield significant long-term benefits. Findings indicate that the benefits of the treatment may vary between different parenting styles, which is important to consider when developing more personalized parenting interventions. ", doi="10.2196/63416", url="https://pediatrics.jmir.org/2024/1/e63416" } @Article{info:doi/10.2196/59171, author="Lyzwinski, Lynnette and Zwicker, D. Jennifer and Mcdonald, Sheila and Tough, Suzanne", title="Psychological Interventions and Those With Elements of Positive Psychology for Child and Youth Mental Health During the COVID-19 Pandemic: Literature Review, Lessons Learned, and Areas for Future Knowledge Dissemination", journal="JMIR Pediatr Parent", year="2024", month="Sep", day="13", volume="7", pages="e59171", keywords="positive psychology", keywords="mindfulness", keywords="resilience", keywords="mental health", keywords="flourishing", keywords="knowledge translation", keywords="depression", keywords="anxiety", keywords="stress", abstract="Background: There was a marked decline in child and teenage mental health worldwide during the pandemic, with increasing prevalence of depression, anxiety, and suicide. Research indicates that positive psychological interventions may be beneficial for mental health. Objective: The aims of this review were to evaluate positive psychological interventions for child and youth mental health implemented during the COVID-19 pandemic and assess overall effectiveness for mental health and knowledge. Methods: We undertook a literature search of PubMed, MEDLINE, and Google Scholar for all eligible studies on digital and hybrid in-person psychological interventions for youth mental health during the COVID-19 pandemic. A particular emphasis was placed on positive psychological interventions or interventions that had components of positive psychology, including gratitude, acceptance, positive emotions, or resilience building. Results: A total of 41 interventions were included in this review. Most of the interventions were digital. Overall, most of the interventions assisted with one or more mental health or psychological indicators, such as depression, anxiety, posttraumatic stress disorder, stress, and resilience. However, findings were mixed when it came to targeting both depression and anxiety together. The interventions that promoted youth mental health most often had a range of diverse positive psychology components and were evidence based. Not all studies measured changes in mindfulness. Few studies examined knowledge acquired on mental health self-care, managing mental health problems, knowledge of positive psychological techniques, mindfulness knowledge, or mental health self-efficacy. Conclusions: Diverse multicomponent interventions appear to assist with youth mental health overall, although their effects on both depression and anxiety are less clear. There is also a need for more research on knowledge gains to determine whether the interventions improved knowledge on mental health--supportive behaviors, which may be sustained beyond the intervention. Finally, more studies need to evaluate whether the interventions assisted with increasing self-efficacy for practicing positive psychological techniques as well as changes in mindfulness levels. Future studies should not only assess effectiveness for mental health outcomes but also assess knowledge translation, with valid measures of knowledge and self-efficacy for mental health--supportive behaviors and positive psychological skills acquired (eg, the ability to practice mindfulness). ", doi="10.2196/59171", url="https://pediatrics.jmir.org/2024/1/e59171" } @Article{info:doi/10.2196/38236, author="Movahed, Mehrnoosh and Rue, Ishana and Yoo, Yejong Paul and Sogomonian, Tamara and Majnemer, Annette and Shikako, Keiko", title="Characteristics of Inclusive Web-Based Leisure Activities for Children With Disabilities: Qualitative Descriptive Study", journal="JMIR Pediatr Parent", year="2023", month="May", day="4", volume="6", pages="e38236", keywords="children with disabilities", keywords="social inclusion", keywords="participation", keywords="accessibility", keywords="leisure", keywords="web-based activities", keywords="pandemic", abstract="Background: The participation of children with disabilities in leisure activities is a key determinant of their physical and mental health. The COVID-19 pandemic has limited participation in leisure activities for all children, particularly those with disabilities. As a result, children with disabilities may be less active while feeling more isolated and stressed. Web-based communities and activities have become increasingly important. Understanding how web-based activities include or exclude children with disabilities can contribute to the development of inclusive communities that may support participation after the pandemic. Objective: This study aimed to identify factors that may facilitate or prevent the participation of children with disabilities in web-based leisure activities. Methods: We adopted a qualitative descriptive interpretative methodology and conducted interviews with 2 groups of participants: service providers offering inclusive web-based leisure activities and parents of children with disabilities who have engaged in web-based leisure activities during the COVID-19 pandemic. A semistructured interview format was created based on the Theoretical Domains Framework. The questions focused on the description of the web-based activities offered by the service provider (eg, age range, frequency, cost, target population, and type of activity offered) and any adaptations to make the web-based activity accessible to children and youth with disabilities, and their perceptions and beliefs about what supported or deterred participation in the activities. Results: A total of 17 participants described their experiences in participating in and creating web-based leisure programs and the factors preventing or facilitating children's participation in web-based activities. Environment and context factors included accommodations, the format of activities and the web-based setting, stakeholder involvement, and materials and resources available. Activities that had flexible schedules, both recorded and live options for joining, and that provided clear instructions and information were perceived as more accessible. Beliefs involved the characteristics of the child and the family environment, as well as the characteristics of the organizations providing the activity. Activity facilitators who were familiar with the web-based environment and knew the specific characteristics of the child facilitated their participation. Engagement in community champions and respect for children's individual preferences were perceived as positive. Access to technology, funding, and caregivers' ability to facilitate child engagement are crucial factors that must be considered when offering web-based programs. Conclusions: Web-based environments offer an accessible and safe option for leisure participation when public health conditions prevent children with disabilities from participating in in-person activities. However, to make web-based activities accessible to children with a variety of disabilities, there needs to be a clear plan toward universal web-based accessibility that accounts for individual needs and collective approaches to web-based leisure. Future work should consider developing and testing guidelines for web-based accessibility, equity, public policy, and programming considerations in offering these activities for all children. ", doi="10.2196/38236", url="https://pediatrics.jmir.org/2023/1/e38236", url="http://www.ncbi.nlm.nih.gov/pubmed/36668903" } @Article{info:doi/10.2196/41554, author="Kodjebacheva, Damianova Gergana and Culinski, Taylor and Kawser, Bushra and Coffer, Katelynn", title="Satisfaction With Telehealth Services Compared With Nontelehealth Services Among Pediatric Patients and Their Caregivers: Systematic Review of the Literature", journal="JMIR Pediatr Parent", year="2023", month="Apr", day="27", volume="6", pages="e41554", keywords="satisfaction", keywords="pediatrics", keywords="telehealth", keywords="telemedicine", keywords="virtual care", keywords="caregivers", keywords="patients", keywords="children", keywords="COVID-19", keywords="coronavirus", keywords="SARS-CoV-2", keywords="technology use", keywords="caregiver", keywords="adolescent", keywords="youth", keywords="satisfaction survey", keywords="health outcome", keywords="review methodology", keywords="systematic review", abstract="Background: Telehealth refers to the use of technology to deliver health care remotely. The COVID-19 pandemic has prompted an increase in telehealth services. Objective: This study aimed to review satisfaction with pediatric care in studies that had at least one group of pediatric patients and their caregivers receiving telehealth services during the COVID-19 pandemic and at least one comparison group of those receiving nontelehealth services. Methods: We searched for peer-reviewed studies published in the English language that compared the satisfaction with pediatric care between pediatric patients and their caregivers receiving telehealth services during the COVID-19 pandemic and those receiving nontelehealth services. Owing to stay-at-home orders, studies with comparison groups for nontelehealth services that took place either before or during the pandemic were eligible. We searched the PubMed, Embase, CINAHL, and PsycINFO databases on January 5, 2023. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 2 reviewers independently screened the titles and abstracts before reviewing the full text of the remaining articles. The following information was extracted from each eligible study: country, participant characteristics by comparison group, study design, telehealth approach, measurement tools to assess satisfaction, and findings by comparison group. Results: All 14 eligible studies assessed satisfaction among caregivers and pediatric patients participating in video or telephone visits during the COVID-19 pandemic compared with those having in-person appointments either before or during the pandemic. In 5 of the 14 studies, a comparison of nontelehealth services took place before the pandemic, and in the remaining 9 investigations, nontelehealth services took place during the pandemic. A total of 13 studies were observational investigations with different designs, and 1 study was a quasi-experimental intervention with 3 comparison groups for video, in-person, and hybrid visits. In 9 of the 14 studies, satisfaction with telehealth services was higher than during in-person visits. Caregivers were satisfied with video visits for the ease of use and reduced need for transportation. Reasons caregivers were not satisfied with remote care included limited personal interaction with the provider, technological challenges, and a lack of physical examination. Those participating in nontelehealth services expressed that in-person interactions promoted treatment adherence. Only 1 study assessed satisfaction where adolescent patients completed their own surveys; a higher percentage of adolescents using telehealth services reported effective communication with the provider compared with patients using in-person visits. Conclusions: In most studies, telehealth services received more favorable or comparable satisfaction ratings than in-person visits. Needed improvements in telehealth services included strategies to address technological challenges and develop better rapport among the patient, caregiver, and medical provider. Interventions may investigate the influence of telehealth services on access to and quality of care. ", doi="10.2196/41554", url="https://pediatrics.jmir.org/2023/1/e41554", url="http://www.ncbi.nlm.nih.gov/pubmed/37000504" } @Article{info:doi/10.2196/42378, author="Kahn, F. Nicole and Anan, H. Yomna and Bocek, M. Kevin and Christakis, A. Dimitri and Richardson, P. Laura and Pratt, Wanda and Sequeira, M. Gina", title="Understanding Transgender and Gender-Diverse Youth's Experiences Receiving Care via Telemedicine: Qualitative Interview Study", journal="JMIR Pediatr Parent", year="2023", month="Feb", day="14", volume="6", pages="e42378", keywords="transgender and gender diverse youth", keywords="adolescent", keywords="telemedicine", keywords="gender-affirming care", keywords="qualitative methods", keywords="COVID-19", keywords="pandemic", keywords="youth", keywords="gender", keywords="care", keywords="technical", keywords="implementation", keywords="transgender", keywords="gender diverse", keywords="complexity", abstract="Background: Access to virtual care has increased since the beginning of the COVID-19 pandemic, yet little is known about transgender and gender-diverse (TGD) youth's experiences and perspectives on receiving care via telemedicine. Objective: The purpose of this study was to explore these experiences to (1) inform necessary changes to the provision of pediatric gender-affirming care and (2) help providers and health systems determine if and how telemedicine should be made available post pandemic. Methods: Youth (aged 14-17 years) who completed a telemedicine visit in the Seattle Children's Gender Clinic were invited to participate in a semistructured interview exploring perceived advantages or disadvantages of telemedicine and preferred visit modalities. Interview transcriptions were analyzed by 2 research team members using an inductive thematic analysis framework. Results: A total of 15 TGD youth completed an interview. Commonly cited advantages of telemedicine were convenience and comfort with having visits in their own environments. Reported disadvantages included technical issues, discomfort with the impersonal nature, lack of familiarity with the platform, and privacy concerns. Overall, slightly more youth preferred in-person visits over telemedicine, referencing both specific characteristics of the clinical visit (ie, initial vs return and complexity) and proximity to the clinic as reasons for this preference. Although a plurality of TGD youth preferred in-person visits, they also recognized the value of telemedicine and the impact it may have in facilitating access to care. Conclusions: Given the variations in needs and visit complexity, our study supports the provision of both in-person and telemedicine modalities as options for pediatric gender-affirming care. ", doi="10.2196/42378", url="https://pediatrics.jmir.org/2023/1/e42378", url="http://www.ncbi.nlm.nih.gov/pubmed/36745775" } @Article{info:doi/10.2196/40940, author="Albayrak, Bilge and Cordier, Jane Larissa and Greve, Sandra and Teschler, Uta and Dathe, Anne-Kathrin and Felderhoff-M{\"u}ser, Ursula and H{\"u}ning, Maria Britta", title="Feasibility of Video Consultation for Preterm Neurodevelopmental Follow-up Care During the COVID-19 Pandemic: Cohort Study", journal="JMIR Pediatr Parent", year="2023", month="Jan", day="25", volume="6", pages="e40940", keywords="COVID-19", keywords="very preterm infant", keywords="video consultation", keywords="follow-up care", keywords="COVID-19 pandemic", keywords="neurodevelopmental outcome", abstract="Background: During the COVID-19 pandemic, parents of infants born very preterm or at risk were exceptionally worried about being infected. The only means of protection during the onset of the pandemic was social distancing. Video consultations for neurodevelopmental follow-up care were offered as an alternative way to stay in contact with patients and their families, to provide expert support, and to monitor and assess children's development. Objective: To assess the feasibility of and family satisfaction with video consultations, interviews were conducted after video and in-person consultations. Methods: An interview with 28 questions was created to evaluate parental satisfaction with the consultations (eg, their confidentiality and the children's behavior). A total of 93 interviews with parents were conducted between March 2020 and February 2021 and compared (58 after video consultations and 35 after in-person consultations). The interviews were conducted at the end of the consultations by a trained professional. The video consultations were conducted using a certified platform created by Zava Sprechstunde Online, maintaining data protection with end-to-end encryption. Follow-up consultations (video or in-person) were performed at corrected ages of 3, 6, and 12 months as well as 2, 3, 4, and 5 years. The rate of total follow-up appointments attended during the survey period was evaluated and compared with the previous year. Results: There were no significant differences between the video and in-person consultation groups in satisfaction, attitudes on the confidentiality of the consultation, or discussion of private and sensitive information. Following video consultations, parents were significantly more likely to report that they were avoiding contact with medical professionals during the pandemic (P=.045; Shapiro-Wilk W=1094.5, Cohen d=--0.1782146) than the in-person consultation group. Parents in the video-consultation group stated that performing a guided examination on their child was comfortable and helped them understand their child's development. In fact, they agreed to take advantage of future video consultations. The rate of total follow-up appointments increased compared to the previous year. Between March 2019 and February 2020, 782 of 984 (79.5\%) children born at Essen University Hospital attended a follow-up appointment. During the survey period, between March 2020 and February 2021, a total of 788 of 1086 children (73\%) attended a follow-up appointment, of which 117 (14.9\%) were video consultations. Conclusions: The feasibility of attending video consultations for follow-up care of very preterm or at-risk infants and parental satisfaction with these consultations were as high as for in-person consultations. Parents rated video consultations as being as confidential as in-person appointments. Telemedicine can be offered as an equivalent alternative to in-person consultations and is particularly useful under certain circumstances, such as for very sick children who require assistive devices or respiratory support and oxygen or for those living a long distance away. ", doi="10.2196/40940", url="https://pediatrics.jmir.org/2023/1/e40940", url="http://www.ncbi.nlm.nih.gov/pubmed/36409307" } @Article{info:doi/10.2196/40431, author="Nuss, Kayla and Coulter, Rebecca and DeSilva, Bianca and Buenafe, Jeann and Sheikhi, Ronak and Naylor, Patti-Jean and Liu, Sam", title="Evaluating the Effectiveness of a Family-Based Virtual Childhood Obesity Management Program Delivered During the COVID-19 Pandemic in Canada: Prospective Study", journal="JMIR Pediatr Parent", year="2022", month="Nov", day="3", volume="5", number="4", pages="e40431", keywords="childhood obesity management", keywords="virtual intervention", keywords="COVID-19 pandemic", keywords="COVID-19", keywords="children", keywords="healthy lifestyle", keywords="health promotion", keywords="virtual health", keywords="digital health intervention", keywords="parenting", keywords="obesity", keywords="childhood obesity", abstract="Background: Generation Health (GH) is a 10-week family-based lifestyle program designed to promote a healthy lifestyle for families with children who are off the healthy weight trajectory in British Columbia, Canada. GH uses a blended delivery format that involves 10 weekly in-person sessions, and self-guided lessons and activities on a web portal. The blended program was adapted to be delivered virtually due to the COVID-19 pandemic. Currently, the effectiveness of the virtual GH program compared with that of the blended GH program remains unclear. Objective: We aimed to (1) compare the effectiveness of the virtual GH program delivered during the COVID-19 pandemic with that of the blended GH program delivered prior to the pandemic for changing child physical activity, sedentary and dietary behaviors, screen time, and parental support--related behaviors for child physical activity and healthy eating, and (2) explore virtual GH program engagement and satisfaction. Methods: This study used a single-arm pre-post design. The blended GH program (n=102) was delivered from January 2019 to February 2020, and the virtual GH program (n=90) was delivered during the COVID-19 pandemic from April 2020 to March 2021. Families with children aged 8-12 years and considered overweight or obese (BMI ?85th percentile according to age and sex) were recruited. Participants completed preintervention and postintervention questionnaires to assess the children's physical activity, dietary and sedentary behaviors, and screen time, and the parent's support behaviors. Intervention feedback was obtained by interviews. Repeated measures ANOVA was used to evaluate the difference between the virtual and blended GH programs over time. Qualitative interviews were analyzed using thematic analyses. Results: Both the virtual and blended GH programs improved children's moderate-to-vigorous physical activity (F1,380=18.37; P<.001; $\eta$p2=0.07) and reduced screen time (F1,380=9.17; P=.003; $\eta$p2=0.06). However, vegetable intake was significantly greater in the virtual GH group than in the blended GH group at the 10-week follow-up (F1,380=15.19; P<.001; $\eta$p2=0.004). Parents in both groups showed significant improvements in support behaviors for children's physical activity (F1,380=5.55; P=.02; $\eta$p2=0.002) and healthy eating (F1,380=3.91; P<.001; $\eta$p2=0.01), as well as self-regulation of parental support for children's physical activity (F1,380=49.20; P<.001; $\eta$p2=0.16) and healthy eating (F1,380=91.13; P<.001; $\eta$p2=0.28). Families in both groups were satisfied with program delivery. There were no significant differences in attendance for the weekly in-person or group video chat sessions; however, portal usage was significantly greater in the virtual GH group (mean 50, SD 55.82 minutes) than in the blended GH group (mean 17, SD 15.3 minutes; P<.001). Conclusions: The study findings suggested that the virtual GH program was as effective as the blended program for improving child lifestyle behaviors and parental support--related behaviors. The virtual program has the potential to improve the flexibility and scalability of family-based childhood obesity management interventions. ", doi="10.2196/40431", url="https://pediatrics.jmir.org/2022/4/e40431", url="http://www.ncbi.nlm.nih.gov/pubmed/36054663" } @Article{info:doi/10.2196/40614, author="Sourander, Saana and Sourander, Andre and Hinkka-Yli-Salom{\"a}ki, Susanna and Ristkari, Terja and Kurki, Marjo", title="An Internet-Based Parent Training With Telephone Coaching on Managing Disruptive Behavior in Children at Special Family Counseling Centers During the COVID-19 Pandemic: Feasibility Study", journal="JMIR Pediatr Parent", year="2022", month="Nov", day="2", volume="5", number="4", pages="e40614", keywords="parent training", keywords="disruptive behavior", keywords="child psychopathology", keywords="child functioning", keywords="internet-based", keywords="COVID-19 pandemic", keywords="COVID-19", keywords="mental health", keywords="psychological well-being", keywords="digital health", keywords="parenting", keywords="telehealth", keywords="behavioral problem", keywords="psychopathology", abstract="Background: There is growing concern about the short- and long-term impacts that the COVID-19 pandemic will have on the mental health and psychosocial well-being of children and families. There are no existing studies about feasibility and outcomes using internet-based parent training programs with telephone coaching for disruptive behavioral problems in childhood during the COVID-19 pandemic in clinical settings. Objective: This study explored how the Strongest Families Smart Website (SFSW) parent training program, with telephone coaching, provided support during the COVID-19 pandemic at specialist family counseling centers in Helsinki, Finland, when restrictions made face-to-face counseling impossible. This study followed the success of a randomized controlled trial (RCT) and its implementation study of the SFSW parent training program by primary care child health clinics. The aim was to improve parenting skills, so that parents could tackle disruptive behavior by developing positive parent-child relationships. It started in May 2020, when the COVID-19 pandemic was at its height in Finland. Methods: In total, 8 family counseling centers in Helsinki identified 50 referrals aged 3-8 years with high levels of parent-reported disruptive behavioral problems. Child psychopathology and functioning and parental skills and well-being were measured at baseline, posttreatment, and 6 months later using a range of tools. The data were extracted from questionnaires completed by the parents. Results: We found that 44 (88\%) of the 50 families completed the whole 11-session parent training program. Most of the children (n=48, 96\%) had definitive or severe behavioral problems when they were initially screened by the centers, but with those assessed at the 6-month follow-up (n=45, 90\%), this dropped to 58\% (n=26). There were significant changes from baseline to 6-month follow-up in most of the child psychopathology measures, including the Child Behavior Checklist-Parent Report Form (CBCL) total score (mean change 16.3, SE 3.0, 95\% CI 10.2-22.3; P<.001) and externalizing score (mean change 7.0, SE 1.0, 95\% CI 4.9-9.0; P<.001). When parenting skills were measured with the Parenting Scale (PS), they showed significant changes from baseline to 6-month follow-up in total scores (mean change 0.5, SE 0.1, 95\% CI 0.4-0.7; P<.001). Parents showed significant change in the stress subscore (mean change 3.9, SE 0.8, 95\% CI 2.2-5.6; P<.001). Of the parents who filled in the satisfaction questionnaire (n=45, 90\%), 42 (93\%) reported high satisfaction in the skills and 44 (98\%) in the professionalism of the family coaches. Conclusions: The program proved to be an effective method for improving parenting skills and child psychopathology and functioning. The parents were satisfied with the program, and the dropout rate was exceptionally low. The study shows that the training program could be implemented in specialist clinical settings and during crisis conditions, such as the COVID-19 pandemic. ", doi="10.2196/40614", url="https://pediatrics.jmir.org/2022/4/e40614", url="http://www.ncbi.nlm.nih.gov/pubmed/36194895" } @Article{info:doi/10.2196/31579, author="Muthuka, John and Kiptoo, Michael and Oluoch, Kelly and Nzioki, Mativo Japheth and Nyamai, Musangi Everlyn", title="Association of Pregnancy With Coronavirus Cytokine Storm: Systematic Review and Meta-analysis", journal="JMIR Pediatr Parent", year="2022", month="Oct", day="4", volume="5", number="4", pages="e31579", keywords="COVID-19", keywords="pandemic", keywords="pregnancy", keywords="maternal health", keywords="cytokine", keywords="cytokine storm", keywords="immune response", keywords="infectious disease", keywords="coronavirus", keywords="respiratory", keywords="virus", keywords="pregnant", abstract="Background: COVID-19 was first identified in Wuhan, China, in December 2019, spreading to the rest of the globe, becoming a pandemic. Some studies have shown an association between pregnancy status and severe COVID-19 with a cytokine storm, whereas others have shown contrasting results. Objective: The aim of this study was to examine the relationship between pregnancy status and the clinical COVID-19 severity characterized by the cytokine storm through a systematic review and meta-analysis. Methods: We searched the Google Scholar, PubMed, Scopus, Web of Science, and Embase databases to identify clinical studies suitable for inclusion in this meta-analysis. Studies reporting pregnancy status and comparing the COVID-19 severity cytokine storm outcome were included. COVID-19 severity characterized by a cytokine storm was described using parameters such as intensive care unit admission, invasive mechanical ventilation, mechanical ventilation, hospital admission, pro- and anti-inflammatory cytokine levels, consolidation on chest computed tomography scan, pulmonary infiltration, extreme fevers as characteristic of a cytokine storm, syndromic severity, higher neutrophil count indicative of a cytokine storm, and severe COVID-19 presentation. Results: A total of 17 articles including data for 840,332 women with COVID-19 were included. This meta-analysis revealed a correlation between positive pregnancy status and severe COVID-19 with a cytokine storm (random-effects model odds ratio [OR] 2.47, 95\% CI 1.63-3.73; P<.001), with a cumulative incidence of 6432 (14.1\%) and 24,352 (3.1\%) among pregnant and nonpregnant women with COVID-19, respectively. The fixed-effects model also showed a correlation between pregnancy status and severe COVID-19 with a cytokine storm (OR 7.41, 95\% CI 7.02-7.83; P<.001). Considerable heterogeneity was found among all pooled studies (I{\texttwosuperior}=98\%, P<.001). Furthermore, the updated analysis showed substantially low heterogeneity (I{\texttwosuperior}=29 \%, P=.19), and the funnel plot revealed no publication bias. The subanalysis between single-center and multicenter studies demonstrated similar heterogeneity (I2=72\% and 98\%, respectively). Sensitivity analysis on each subgroup revealed that pregnancy was significantly related to severe COVID-19 with a cytokine storm from single-center studies (fixed-effects model OR 3.97, 95\% CI 2.26-6.95; P<.001) with very low heterogeneity (I{\texttwosuperior}=2\%, P=.42). Conclusions: Being pregnant is clearly associated with experiencing a severe course of COVID-19 characterized by a cytokine storm. The COVID-19 pandemic should serve as an impetus for further research on pregnant women diagnosed with COVID-19 to map out the salient risk factors associated with its severity. Trial Registration: PROSPERO CRD42021242011; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=242011. ", doi="10.2196/31579", url="https://pediatrics.jmir.org/2022/4/e31579", url="http://www.ncbi.nlm.nih.gov/pubmed/35319475" } @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/10.2196/35320, author="Parks, M. Amanda and Duffecy, Jennifer and McCabe, E. Jennifer and Blankstein Breman, Rachel and Milgrom, Jeannette and Hirshler, Yafit and Gemmill, W. Alan and Segre, S. Lisa and Felder, N. Jennifer and Uscher-Pines, Lori", title="Lessons Learned Recruiting and Retaining Pregnant and Postpartum Individuals in Digital Trials: Viewpoint", journal="JMIR Pediatr Parent", year="2022", month="Apr", day="20", volume="5", number="2", pages="e35320", keywords="digital trials", keywords="maternal and child health", keywords="pregnant and postpartum individuals", keywords="fraudulent enrollment", keywords="retention and recruitment", keywords="pediatrics", keywords="parenting", keywords="pregnant women", keywords="COVID-19", keywords="pandemic", keywords="postpartum", keywords="digital health", doi="10.2196/35320", url="https://pediatrics.jmir.org/2022/2/e35320", url="http://www.ncbi.nlm.nih.gov/pubmed/35107422" } @Article{info:doi/10.2196/32274, author="Yoo, Yejong Paul and Movahed, Mehrnoosh and Rue, Ishana and Santos, Dos Carlos Denner and Majnemer, Annette and Shikako, Keiko", title="Changes in Use of a Leisure Activity Mobile App for Children With Disabilities During the COVID-19 Pandemic: Retrospective Study", journal="JMIR Pediatr Parent", year="2022", month="Feb", day="25", volume="5", number="1", pages="e32274", keywords="COVID-19", keywords="participation", keywords="childhood disability", keywords="online leisure", keywords="app engagement", keywords="mHealth", keywords="children", keywords="parents", keywords="mobile apps", keywords="mobile health", keywords="digital health", keywords="pandemic", keywords="online leisure activities", keywords="user engagement", keywords="app usability", abstract="Background: Participation in leisure activities is essential for child development and a human right as per the United Nations Convention on the Rights of the Child. Children with disabilities face several restrictions when participating in leisure activities as compared to same age peers without disabilities. Access to information about accessible, inclusive leisure activities is one of the barriers limiting participation, and one potential health promotion strategy is to provide access to information to increase participation. The Jooay App is a mobile app listing such activities in Canada and Australia. With the COVID-19 global pandemic and subsequent public health measures, most community-based facilities providing the activities listed on Jooay were closed. The app therefore started listing online activities offered with the expectation of continuing to provide information for families and understanding the extent to which users relied on the mobile app as a tool to identify new safe leisure opportunities. Objective: This study aims to describe the engagement of the Jooay app before and during COVID-19, and to estimate the extent to which the listing of online activities was related to the engagement of the Jooay app. Methods: We conducted a retrospective study comparing Jooay app use between March 2020 and February 2021 to the engagement between March 2019 and February 2020 by Jooay users. Spearman rank correlations were carried out to identify associations between the activities listed and the users' engagement from May 2020 to February 2021. Results: Active engagement with the Jooay app from March 2020 to February 2021 dropped by an average of 135 engagements (64.2\%) compared to engagements in 2019-2020. The largest monthly drop in engagement was observed in May 2020 by 239 engagements (88.8\%). There was a strong positive correlation between the number of active users and the number of online activities listed on the app (rs=0.900). Conclusions: The engagement with the Jooay App presented an expected decrease during the first wave of the COVID-19 pandemic. The addition of online adapted leisure activities to the app's listings during the pandemic increased app use. Access to information about inclusive activities is a barrier for children with disabilities to engage in leisure. Mobile health solutions can be responsive to contextual factors and consider the social determinants of health such as socioeconomic and public health emergency issues that can impact the participation of vulnerable populations such as children with disabilities and help eliminate barriers to participation. The provision of online leisure opportunities during the pandemic could facilitate participation in these activities during the pandemic and beyond, which is essential and beneficial for the physical and mental well-being of children with disabilities and their families. ", doi="10.2196/32274", url="https://pediatrics.jmir.org/2022/1/e32274", url="http://www.ncbi.nlm.nih.gov/pubmed/35100129" } @Article{info:doi/10.2196/32708, author="Wood, M. Sarah and Pickel, Julia and Phillips, W. Alexis and Baber, Kari and Chuo, John and Maleki, Pegah and Faust, L. Haley and Petsis, Danielle and Apple, E. Danielle and Dowshen, Nadia and Schwartz, A. Lisa", title="Acceptability, Feasibility, and Quality of Telehealth for Adolescent Health Care Delivery During the COVID-19 Pandemic: Cross-sectional Study of Patient and Family Experiences", journal="JMIR Pediatr Parent", year="2021", month="Nov", day="15", volume="4", number="4", pages="e32708", keywords="telehealth", keywords="telemedicine", keywords="adolescent", keywords="COVID-19", keywords="acceptability", keywords="feasibility", keywords="young adult", keywords="teenager", keywords="cross-sectional", keywords="patient experience", keywords="experience", keywords="efficiency", keywords="equity", keywords="survey", abstract="Background: Data regarding the acceptability, feasibility, and quality of telehealth among adolescents and young adults (AYA) and their parents and caregivers (caregivers) are lacking. Objective: The aim of this study was to assess the noninferiority of telehealth versus in-person visits by comparing acceptability with respect to efficiency, effectiveness, equity, patient-centeredness, and confidentiality. Methods: Cross-sectional web-based surveys were sent to caregivers and AYA following video visits within an Adolescent Medicine subspecialty clinic in May-July 2020. Proportions of AYA and caregivers who rated telehealth as noninferior were compared using chi-squared tests. Feasibility was assessed via items measuring technical difficulties. Deductive thematic analysis using the Institute of Medicine dimensions of health care quality was used to code open-ended question responses. Results: Survey response rates were 20.5\% (55/268) for AYA and 21.8\% (123/563) for caregivers. The majority of the respondents were White cisgender females. Most AYA and caregivers rated telehealth as noninferior to in-person visits with respect to confidentiality, communication, medication management, and mental health care. A higher proportion of AYA compared to caregivers found telehealth inferior with respect to confidentiality (11/51, 22\% vs 3/118, 2.5\%, P<.001). One-quarter (14/55) of the AYA patients and 31.7\% (39/123) of the caregivers reported technical difficulties. The dominant themes in the qualitative data included advantages of telehealth for efficiency and equity of health care delivery. However, respondents' concerns included reduced safety and effectiveness of care, particularly for patients with eating disorders, owing to lack of hands-on examinations, collection of vital signs, and laboratory testing. Conclusions: Telehealth was highly acceptable among AYA and caregivers. Future optimization should include improving privacy, ameliorating technical difficulties, and standardizing at-home methods of obtaining patient data to assure patient safety. ", doi="10.2196/32708", url="https://pediatrics.jmir.org/2021/4/e32708", url="http://www.ncbi.nlm.nih.gov/pubmed/34779782" } @Article{info:doi/10.2196/27769, author="Noddin, Katie and Bradley, Dani and Wolfberg, Adam", title="Delivery Outcomes During the COVID-19 Pandemic as Reported in a Pregnancy Mobile App: Retrospective Cohort Study", journal="JMIR Pediatr Parent", year="2021", month="Oct", day="4", volume="4", number="4", pages="e27769", keywords="digital health", keywords="COVID-19", keywords="maternal health", keywords="obstetrics", keywords="COVID", keywords="pandemic", keywords="pregnant women", keywords="birth", keywords="hospital", keywords="delivery", keywords="women's health", keywords="Cesarean sections", abstract="Background: The COVID-19 pandemic has presented obstacles for providers and patients in the maternal health care setting, causing changes to many pregnant women's birth plans, as well as abrupt changes in hospital labor and delivery policies and procedures. Few data exist on the effects of the COVID-19 pandemic on the maternal health care landscape at the national level in the United States. Objective: The aim of this study is to assess the incidence of key obstetrics outcomes (preterm delivery, Cesarean sections, and home births) and length of hospital stay during the COVID-19 pandemic as compared to the 6 months prior. Methods: We conducted a retrospective cohort study of women aged 18-44 years in the United States who delivered between October 1, 2019, and September 30, 2020, had singleton deliveries, and completed a birth report in the Ovia Pregnancy mobile app. Women were assigned to the prepandemic cohort if they delivered between October 2019 and March 2020, and the pandemic cohort if they delivered between April and September 2020. Gestational age at delivery, delivery method, delivery facility type, and length of hospital stay were compared. Results: A total of 304,023 birth reports were collected, with 152,832 (50.26\%) in the prepandemic cohort and 151,191 (49.73\%) in the pandemic cohort. Compared to the prepandemic cohort, principal findings indicate a 5.67\% decrease in preterm delivery rates in the pandemic cohort (P<.001; odds ratio [OR] 0.94, 95\% CI 0.91-0.96), a 30.0\% increase in home birth rates (P<.001; OR 1.3, 95\% CI 1.23-1.4), and a 7.81\% decrease in the average hospital length of stay postdelivery (mean 2.48 days, SD 1.35). There were no overall changes in Cesarean section rates between cohorts, but differences were observed between age, race, and ethnicity subgroups. Conclusions: Results suggest a need for continuous monitoring of maternal health trends as the COVID-19 pandemic progresses and underline the important role of digital data collection, particularly during the pandemic. ", doi="10.2196/27769", url="https://pediatrics.jmir.org/2021/4/e27769", url="http://www.ncbi.nlm.nih.gov/pubmed/34509975" } @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/10.2196/28630, author="Eberle, Claudia and Stichling, Stefanie", title="Telemedical Approaches to Managing Gestational Diabetes Mellitus During COVID-19: Systematic Review", journal="JMIR Pediatr Parent", year="2021", month="Aug", day="5", volume="4", number="3", pages="e28630", keywords="gestational diabetes", keywords="telemedicine", keywords="mobile applications", keywords="COVID-19", keywords="systematic review", keywords="digital health", keywords="diabetes", abstract="Background: In 2019, a new coronavirus emerged in China, and the disease caused by the virus (COVID-19) was rapidly classified as a pandemic. Pregnant women with gestational diabetes mellitus (GDM) are considered to be at risk for severe COVID-19. In the context of the pandemic, there are serious concerns regarding adverse effects on maternal and neonatal outcomes for women with GDM. Effective treatments for patients with GDM are therefore particularly important. Due to contact restrictions and infection risks, digital approaches such as telemedicine are suitable alternatives. Objective: This systematic review aims to summarize currently available evidence on maternal and offspring outcomes of pregnant women with GDM and COVID-19 and to examine telemedical interventions to improve maternal glycemic control during the COVID-19 pandemic. Methods: Publications were systematically identified by searching the Cochrane Library, MEDLINE via PubMed, Web of Science Core Collection, Embase, and CINAHL databases for studies published up to March 2021. We sorted the COVID-19 studies by outcome and divided the telemedical intervention studies into web-based and app-based groups. We analyzed case reports (COVID-19) and both randomized and nonrandomized controlled clinical trials (telemedicine). To determine the change in glycated hemoglobin A1c (HbA1c), we pooled appropriate studies and calculated the differences in means, with 95\% CIs, for the intervention and control groups at the end of the interventions. Results: Regarding COVID-19 studies, we identified 11 case reports, 3 letters, 1 case series, and 1 retrospective single-center study. In total, 41 patients with GDM and COVID-19 were analyzed. The maternal and neonatal outcomes were extremely heterogeneous. We identified adverse outcomes for mother and child through the interaction of GDM and COVID-19, such as cesarean deliveries and low Apgar scores. Furthermore, we selected 9 telemedicine-related articles: 6 were randomized controlled trials, 2 were clinical controlled trials, and 1 was a quasi-experimental design. In total, we analyzed 480 patients with GDM in the intervention groups and 494 in the control groups. Regarding the quality of the 9 telemedical studies, 4 were rated as strong, 4 as moderate, and 1 as weak. Telemedical interventions can contribute to favorable impacts on HbA1c and fasting blood glucose values in the context of the COVID-19 pandemic. Meta-analysis revealed a mean difference in HbA1c of --0.19\% (95\% CI 0.34\% to 0.03\%) for all telemedical interventions, --0.138\% (95\% CI --0.24\% to --0.04\%) for the web-based interventions, and --0.305\% (96\% CI --0.88\% to 0.27\%) for the app-based interventions. Conclusions: Telemedicine is an effective approach in the context of COVID-19 and GDM because it enables social distancing and represents optimal care of patients with GDM, especially with regard to glycemic control, which is very important in view of the identified adverse maternal and neonatal outcomes. Further research is needed. ", doi="10.2196/28630", url="https://pediatrics.jmir.org/2021/3/e28630", url="http://www.ncbi.nlm.nih.gov/pubmed/34081604" } @Article{info:doi/10.2196/27733, author="Shirabe, Ritsuko and Okuhara, Tsuyoshi and Yokota, Rie and Okada, Hiroko and Goto, Eiko and Kiuchi, Takahiro", title="Changes in Anxiety and Stress Among Pregnant Women During the COVID-19 Pandemic: Content Analysis of a Japanese Social Question-and-Answer Website", journal="JMIR Pediatr Parent", year="2021", month="Jul", day="15", volume="4", number="3", pages="e27733", keywords="anxiety", keywords="content analysis", keywords="COVID-19", keywords="health communication", keywords="health information", keywords="mental health", keywords="pregnancy", keywords="social question-and-answer website", keywords="social support", keywords="stress", abstract="Background: The changing pattern of anxiety and stress experienced by pregnant women during the COVID-19 pandemic is unknown. Objective: We aimed to examine the sources of anxiety and stress in pregnant women in Japan during the COVID-19 pandemic. Methods: We performed content analysis of 1000 questions posted on the largest social website in Japan (Yahoo! Chiebukuro) from January 1 to May 25, 2020 (end date of the national state of emergency). The Gwet AC1 coefficient was used to verify interrater reliability. Results: A total 12 categories were identified. Throughout the study period, anxiety related to going outdoors appeared most frequent, followed by anxiety regarding employment and infection among family and friends. Following the declaration of the state of national emergency at the peak of the infection, infection-related anxiety decreased, whereas anxiety about social support and mood disorders increased. Stress regarding relationships appeared frequent throughout the pandemic. Conclusions: The sources of anxiety and stress in pregnant women in Japan changed during the pandemic. Our results suggest the need for rapid communications in the early phase of a pandemic as well as long-term psychosocial support to provide optimal support to pregnant women in Japan. Health care professionals should understand the changing pattern of requirements among pregnant women. ", doi="10.2196/27733", url="https://pediatrics.jmir.org/2021/3/e27733", url="http://www.ncbi.nlm.nih.gov/pubmed/34156962" } @Article{info:doi/10.2196/27974, author="Riem, E. Madelon M. and De Carli, Pietro and Guo, Jing and Bakermans-Kranenburg, J. Marian and van IJzendoorn, H. Marinus and Lodder, Paul", title="Internet Searches for Terms Related to Child Maltreatment During COVID-19: Infodemiology Approach", journal="JMIR Pediatr Parent", year="2021", month="Jul", day="13", volume="4", number="3", pages="e27974", keywords="child", keywords="maltreatment", keywords="COVID-19", keywords="pandemic", keywords="internet searches", keywords="information-seeking", keywords="internet", keywords="abuse", keywords="trend", keywords="Google trends", keywords="infodemiology", doi="10.2196/27974", url="https://pediatrics.jmir.org/2021/3/e27974", url="http://www.ncbi.nlm.nih.gov/pubmed/34174779" } @Article{info:doi/10.2196/29518, author="Herbst, Rachel and Rybak, Tiffany and Meisman, Andrea and Whitehead, Monica and Rosen, Brittany and Crosby, E. Lori and Klein, D. Melissa and Real, J. Francis", title="A Virtual Reality Resident Training Curriculum on Behavioral Health Anticipatory Guidance: Development and Usability Study", journal="JMIR Pediatr Parent", year="2021", month="Jun", day="29", volume="4", number="2", pages="e29518", keywords="resident education", keywords="virtual reality", keywords="behavioral health promotion", keywords="COVID-19", abstract="Background: Behavioral health disorders have steadily increased and been exacerbated by the COVID-19 pandemic. Though behavioral health disorders can be successfully mitigated with early implementation of evidence-based parent management strategies, education for pediatric residents on behavioral health anticipatory guidance has been limited to date, with training challenges compounded by the physical distancing requirements of the COVID-19 pandemic. Virtual reality (VR) simulations provide an opportunity to train residents on this complex competency by allowing deliberate practice of necessary skills while adhering to current social distancing guidelines. Objective: This study explored the usability of a VR-based behavioral health anticipatory guidance curriculum for pediatric residents. Methods: This mixed methods study included 14 postgraduate third-year pediatric residents who completed the behavioral health anticipatory guidance VR curriculum. Residents completed the MEC Spatial Presence Questionnaire to assess immersion in the virtual environment. Semistructured interviews were used to elucidate residents' perspectives on the curriculum's content and format. The interviews were analyzed using conventional content analysis. Results: Quantitatively, residents reported a high degree of immersion, spatial presence, and cognitive involvement. Most residents (11/14, 79\%) agreed or strongly agreed that it seemed as though they took part in the action of the simulation. Qualitatively, two themes emerged from the data: (1) the curriculum expands behavioral health anticipatory guidance and motivational interviewing knowledge and skills and (2) VR technology is uniquely positioned to develop competence. These themes revealed that the curriculum expanded their current level of knowledge and skill, addressed training gaps, and was applicable to all residents. Additionally, residents experienced VR as immersive, feasible, realistic to the clinic setting, and a safe space to practice and learn new skills. Conclusions: Pilot data indicates that VR may be an effective tool to teach pediatric residents behavioral health anticipatory guidance, meeting a current gap in medical education training. This VR curriculum is particularly relevant in the context of the COVID-19 pandemic given the increased behavioral health concerns of families. ", doi="10.2196/29518", url="https://pediatrics.jmir.org/2021/2/e29518", url="http://www.ncbi.nlm.nih.gov/pubmed/34081601" } @Article{info:doi/10.2196/26571, author="Richter, Marleine Linda and Naicker, Naomi Sara", title="A Data-Free Digital Platform to Reach Families With Young Children During the COVID-19 Pandemic: Online Survey Study", journal="JMIR Pediatr Parent", year="2021", month="Jun", day="28", volume="4", number="2", pages="e26571", keywords="families", keywords="parenting", keywords="children", keywords="COVID-19", keywords="digital", keywords="survey", keywords="data-free", abstract="Background: The COVID-19 pandemic and containment measures have severely affected families around the world. It is frequently assumed that digital technologies can supplement and perhaps even replace services for families. This is challenging in conditions of high device and data costs as well as poor internet provision and access, raising concerns about widening inequalities in availability of support and consequent effects on child and family outcomes. Very few studies have examined these issues, including in low- and middle-income countries. Objective: The study objectives were two-fold. The first objective was to gather data on the impact of the COVID-19 pandemic on families of young children using an online survey. The second objective was to assess the feasibility of using a data-free online platform to conduct regular surveys and, potentially, to provide support for parents and families of young children in South Africa. Methods: We used a data-free mobile messenger platform to conduct a short digital survey of the impact of the COVID-19 pandemic on caring for young children in South Africa. We report on the methodological processes and preliminary findings of the online survey. Results: More than 44,000 individuals accessed the survey link and 16,217 consented to the short survey within 96 hours of its launch. Respondents were predominantly from lower classes and lower-middle classes, representing the majority of the population, with urban residential locations roughly proportionate to national patterns and some underrepresentation of rural households. Mothers comprised 70.2\% (11,178/15,912) of respondents and fathers comprised 29.8\% (4734/15,912), representing 18,672 children 5 years of age and younger. Response rates per survey item ranged from 74.8\% (11,907/15,912) at the start of the survey to 50.3\% (8007/15,912) at completion. A total of 82.0\% (12,729/15,912) of parents experienced at least one challenge during the pandemic, and 32.4\% (2737/8441) did not receive help when needed from listed sources. Aggregate and individual findings in the form of bar graphs were made available to participants to view and download once they had completed the survey. Participants were also able to download contact details for support and referral services at no data cost. Conclusions: Data-free survey methodology breaks new ground and demonstrates potential not previously considered. Reach is greater than achieved through phone surveys and some social media platforms, men are not usually included in parent surveys, costs are lower than phone surveys, and the technology allows for immediate feedback to respondents. These factors suggest that zero-rated, or no-cost, services could provide a feasible, sustainable, and equitable basis for ongoing interactions with families of young children. ", doi="10.2196/26571", url="https://pediatrics.jmir.org/2021/2/e26571", url="http://www.ncbi.nlm.nih.gov/pubmed/33852414" } @Article{info:doi/10.2196/27958, author="Nicolaidou, Iolie and Stavrou, Evi and Leonidou, Georgia", title="Building Primary-School Children's Resilience through a Web-Based Interactive Learning Environment: Quasi-Experimental Pre-Post Study", journal="JMIR Pediatr Parent", year="2021", month="Jun", day="9", volume="4", number="2", pages="e27958", keywords="COVID-19", keywords="interactive learning environment", keywords="internet-based cognitive behavioral therapy", keywords="parents", keywords="prevention intervention", keywords="primary school children", keywords="psychological resilience", keywords="teachers", abstract="Background: Resilience is a person's mental ability to deal with challenging situations adaptively and is a crucial stress management skill. Psychological resilience and finding ways to cope in crises is a highly relevant topic considering the COVID-19 pandemic, which enforced quarantine, social distancing measures, and school closures worldwide. Parents and children are currently living with increased stress due to COVID-19. We need to respond with immediate ways to strengthen children's resilience. Internet-based cognitive behavioral therapy interventions for children's stress management overcome accessibility issues such as the inability to visit mental health experts owing to COVID-19 movement restrictions. An interactive learning environment was created, based on the preventive program ``Friends,'' to overcome accessibility issues associated with delivering cognitive behavioral therapy--based interventions in formal and informal education settings. Objective: This study aimed to examine the effectiveness of a web-based learning environment on resilience in (1) reducing anxiety symptoms and (2) increasing emotion recognition and recognition of stress management techniques among 9-10-year-old children. We also aimed to evaluate the learning environment's usability. Methods: A quasi-experimental pretest-posttest control group design was used. In total, 20 fourth graders in the experimental group interacted with the learning environment over 6 weekly 80-minute sessions. Further, 21 fourth graders constituted the control group. The main data sources were (1) a psychometric tool to measure children's anxiety symptoms, namely the Greek translation of the original Spence Children's Anxiety Scale, (2) 3 open-ended questions assessing emotion recognition and recognition of stress management techniques, and (3) the System Usability Scale to measure the usability of the learning environment. Results: In both groups, there was a small but nonsignificant postintervention reduction in reported anxiety symptoms, except for obsessive-compulsive disorder symptoms in the experimental group. A paired samples t test revealed that students' reported symptom scores of obsessive-compulsive disorder significantly decreased from 1.06 (SD 0.68) to 0.76 (SD 0.61) (t19= 5.16; P=.01). The experimental group revealed a significant increase in emotion recognition (t19=--6.99; P<.001), identification of somatic symptoms of stress (t19=--7.31; P<.001), and identification of stress management techniques (t19=--6.85; P<.001). The learning environment received a satisfactory usability score. The raw average system usability score was 76.75 (SD 8.28), which is in the 80th percentile rank and corresponds to grade B. Conclusions: This study shows that interactive learning environments might deliver resilience interventions in an accessible and cost-effective manner in formal education, potentially even in distance-learning conditions owing to the COVID-19 pandemic. Interactive learning environments on resilience are also valuable tools for parents who can use them with their children at home, for informal learning, using mobile devices. As such, they could be a promising first-step, low-intensity intervention that children and the youth can easily access. ", doi="10.2196/27958", url="https://pediatrics.jmir.org/2021/2/e27958", url="http://www.ncbi.nlm.nih.gov/pubmed/34106080" } @Article{info:doi/10.2196/29411, author="Hammons, J. Amber and Villegas, Elizabeth and Robart, Ryan", title="``It's Been Negative for Us Just All the Way Across the Board'': Focus Group Study Exploring Parent Perceptions of Child Screen Time During the COVID-19 Pandemic", journal="JMIR Pediatr Parent", year="2021", month="Jun", day="8", volume="4", number="2", pages="e29411", keywords="children", keywords="COVID-19", keywords="experiences", keywords="family", keywords="outcomes", keywords="pandemic", keywords="parenting", keywords="parents", keywords="screen time", abstract="Background: Child screen time (ST) has soared during the COVID-19 pandemic as lockdowns and restrictions have forced changes to regular family routines. It is important to investigate how families are navigating ST. Objective: This study aimed to explore families' experiences of ST during the COVID-19 pandemic. Methods: Virtual focus group sessions were conducted between December 2020 and February 2021 in English and Spanish. Transcripts were analyzed using reflexive thematic analysis. Results: In total, 48 parents (predominantly Hispanic) residing in California participated in 1 of 14 focus group sessions. Children were attending school remotely at the time of the study. A total of 6 themes and 1 subtheme were identified: (1) total ST has increased; (2) children are too attached to screens; (3) ST has advantages and disadvantages but parents perceive ST as mostly negative; (4) parents and children have limited options; (5) ST restrictions (subtheme: children react negatively when ST is restricted); and (6) parents are concerned that children are not getting enough exercise. Conclusions: This study provides a cross-sectional insight into how family life has changed with regard to ST during the COVID-19 pandemic. Parents expressed concerns about total ST, the addictive nature of it, and lack of physical activity. It is important that future studies examine the long-term effects of heavy ST and preemptively introduce ways to redirect children's ST habits as the country attempts to establish a new normal. ", doi="10.2196/29411", url="https://pediatrics.jmir.org/2021/2/e29411", url="http://www.ncbi.nlm.nih.gov/pubmed/34081606" } @Article{info:doi/10.2196/25106, author="Monzon, Alexandra and Kahhan, Nicole and Marker, Arwen and Patton, Susana", title="Challenges and Considerations for Reducing Diabetes Distress and Fear of Hypoglycemia in Parents of Youth With Type 1 Diabetes During the COVID-19 Pandemic", journal="JMIR Pediatr Parent", year="2021", month="Apr", day="23", volume="4", number="2", pages="e25106", keywords="type 1 diabetes", keywords="parents", keywords="children", keywords="diabetes distress", keywords="fear of hypoglycemia", keywords="COVID-19", keywords="telehealth", keywords="diabetes", keywords="challenge", keywords="youth", keywords="young adults", doi="10.2196/25106", url="https://pediatrics.jmir.org/2021/2/e25106", url="http://www.ncbi.nlm.nih.gov/pubmed/33848256" } @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" }