@Article{info:doi/10.2196/25388,
author="Donelle, Lorie
and Hall, Jodi
and Hiebert, Bradley
and Jackson, Kimberley
and Stoyanovich, Ewelina
and LaChance, Jessica
and Facca, Danica",
title="Investigation of Digital Technology Use in the Transition to Parenting: Qualitative Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Feb",
day="17",
volume="4",
number="1",
pages="e25388",
keywords="parenting",
keywords="digital health",
keywords="technology",
keywords="health literacy",
keywords="information seeking",
abstract="Background: The transition to parenting---that is, the journey from preconception through pregnancy and postpartum periods---is one of the most emotionally charged and information-intense times for individuals and families. While there is a developing body of literature on the use and impact of digital technology on the information behaviors of children, adolescents, and young adults, personal use of digital technology during the transition to parenting and in support of infants to 2 years of age is relatively understudied. Objective: The purpose of this study was to enhance our understanding of the ways digital technologies contribute to the experience of the transition to parenting, particularly the role these technologies play in organizing and structuring emerging pregnancy and early parenting practices. Methods: A qualitative descriptive study was conducted to understand new parents' experiences with and uses of digital technology during 4 stages---prenatal, pregnancy, labor, and postpartum---of their transition to becoming a new parent. A purposive sampling strategy was implemented using snowball sampling techniques to recruit participants who had become a parent within the previous 24 months. Focus groups and follow-up interviews were conducted using semistructured interview guides that inquired about parents' type and use of technologies for self and family health. Transcribed audio recordings were thematically analyzed. Results: A total of 10 focus groups and 3 individual interviews were completed with 26 participants. While recruitment efforts targeted parents of all genders and sexual orientations, all participants identified as heterosexual women. Participants reported prolific use of digital technologies to direct fertility (eg, ovulation timing), for information seeking regarding development of their fetus, to prepare for labor and delivery, and in searching for a sense of community during postpartum. Participants expressed their need for these technologies to assist them in the day-to-day demands of preparing for and undertaking parenting, yet expressed concerns about their personal patterns of use and the potential negative impacts of their use. The 3 themes generated from the data included: ``Is this normal; is this happening to you?!'', ``Am I having a heart attack; what is this?'', and ``Anyone can put anything on Wikipedia'': Managing the Negative Impacts of Digital Information. Conclusions: Digital technologies were used by mothers to track menstrual cycles during preconception; monitor, document, and announce a pregnancy during the prenatal stage; prepare for delivery during labor/birth stage; and to help babies sleep, document/announce their birth, and connect to parenting resources during the postpartum stage. Mothers used digital technologies to reassure themselves that their experiences were normal or to seek help when they were abnormal. Digital technologies provided mothers with convenient means to access health information from a range of sources, yet mothers were apprehensive about the credibility and trustworthiness of the information they retrieved. Further research should seek to understand how men and fathers use digital technologies during their transition to parenting. Additionally, further research should critically examine how constant access to information affects mothers' perceived need to self-monitor and further understand the unintended health consequences of constant surveillance on new parents. ",
doi="10.2196/25388",
url="https://pediatrics.jmir.org/2021/1/e25388",
url="http://www.ncbi.nlm.nih.gov/pubmed/33595440"
}


@Article{info:doi/10.2196/23842,
author="Hentschel, Austen
and Hsiao, J. Chu
and Chen, Y. Lynn
and Wright, Lauren
and Shaw, Jennifer
and Du, Xinsong
and Flood-Grady, Elizabeth
and Harle, A. Christopher
and Reeder, F. Callie
and Francois, Magda
and Louis-Jacques, Adetola
and Shenkman, Elizabeth
and Krieger, L. Janice
and Lemas, J. Dominick",
title="Perspectives of Pregnant and Breastfeeding Women on Participating in Longitudinal Mother-Baby Studies Involving Electronic Health Records: Qualitative Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Mar",
day="5",
volume="4",
number="1",
pages="e23842",
keywords="electronic health records",
keywords="pregnancy",
keywords="breastfeeding",
keywords="maternal-child health",
keywords="research engagement",
keywords="mother-infant medical record linkage",
abstract="Background: Electronic health records (EHRs) hold great potential for longitudinal mother-baby studies, ranging from assessing study feasibility to facilitating patient recruitment to streamlining study visits and data collection. Existing studies on the perspectives of pregnant and breastfeeding women on EHR use have been limited to the use of EHRs to engage in health care rather than to participate in research. Objective: The aim of this study is to explore the perspectives of pregnant and breastfeeding women on releasing their own and their infants' EHR data for longitudinal research to identify factors affecting their willingness to participate in research. Methods: We conducted semistructured interviews with pregnant or breastfeeding women from Alachua County, Florida. Participants were asked about their familiarity with EHRs and EHR patient portals, their comfort with releasing maternal and infant EHR data to researchers, the length of time of the data release, and whether individual research test results should be included in the EHR. The interviews were transcribed verbatim. Transcripts were organized and coded using the NVivo 12 software (QSR International), and coded data were thematically analyzed using constant comparison. Results: Participants included 29 pregnant or breastfeeding women aged between 22 and 39 years. More than half of the sample had at least an associate degree or higher. Nearly all participants (27/29, 93\%) were familiar with EHRs and had experience accessing an EHR patient portal. Less than half of the participants (12/29, 41\%) were willing to make EHR data available to researchers for the duration of a study or longer. Participants' concerns about sharing EHRs for research purposes emerged in 3 thematic domains: privacy and confidentiality, transparency by the research team, and surrogate decision-making on behalf of infants. The potential release of sensitive or stigmatizing information, such as mental or sexual health history, was considered in the decisions to release EHRs. Some participants viewed the simultaneous use of their EHRs for both health care and research as potentially beneficial, whereas others expressed concerns about mixing their health care with research. Conclusions: This exploratory study indicates that pregnant and breastfeeding women may be willing to release EHR data to researchers if researchers adequately address their concerns regarding the study design, communication, and data management. Pregnant and breastfeeding women should be included in EHR-based research as long as researchers are prepared to address their concerns. ",
doi="10.2196/23842",
url="https://pediatrics.jmir.org/2021/1/e23842",
url="http://www.ncbi.nlm.nih.gov/pubmed/33666558"
}


@Article{info:doi/10.2196/24714,
author="Staiano, E. Amanda
and Shanley, R. Jenelle
and Kihm, Holly
and Hawkins, R. Keely
and Self-Brown, Shannon
and H{\"o}chsmann, Christoph
and Osborne, C. Melissa
and LeBlanc, M. Monique
and Apolzan, W. John
and Martin, K. Corby",
title="Digital Tools to Support Family-Based Weight Management for Children: Mixed Methods Pilot and Feasibility Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Jan",
day="7",
volume="4",
number="1",
pages="e24714",
keywords="parent training",
keywords="weight loss",
keywords="telehealth",
keywords="obesity",
keywords="SafeCare",
abstract="Background: Family-based behavioral therapy is an efficacious approach to deliver weight management counseling to children and their parents. However, most families do not have access to in-person, evidence-based treatment. We previously developed and tested DRIVE (Developing Relationships that Include Values of Eating and Exercise), a home-based parent training program to maintain body weight among children at risk for obesity, with the intent to eventually disseminate it nationally alongside SafeCare, a parent support program that focuses on parent-child interactions. Currently the DRIVE program has only been tested independently of SafeCare. This study created the ``mHealth DRIVE'' program by further adapting DRIVE to incorporate digital and mobile health tools, including remotely delivered sessions, a wireless scale that enabled a child-tailored weight graph, and a pedometer. Telehealth delivery via mHealth platforms and other digital tools can improve program cost-effectiveness, deliver long-term care, and directly support both families and care providers. Objective: The objective of this study was to examine preliminary acceptability and effectiveness of the mHealth DRIVE program among children and parents who received it and among SafeCare providers who potentially could deliver it. Methods: Study 1 was a 13-week pilot study of a remotely delivered mHealth family-based weight management program. Satisfaction surveys were administered, and height and weight were measured pre- and post-study. Study 2 was a feasibility/acceptability survey administered to SafeCare providers. Results: Parental and child satisfaction (mean of 4.9/6.0 and 3.8/5.0, respectively) were high, and children's (N=10) BMI z-scores significantly decreased (mean --0.14, SD 0.17; P=.025). Over 90\% of SafeCare providers (N=74) indicated that SafeCare families would benefit from learning how to eat healthily and be more active, and 80\% of providers reported that they and the families would benefit from digital tools to support child weight management. Conclusions: Pediatric mHealth weight management interventions show promise for effectiveness and acceptability by families and providers. Trial Registration: Clinicaltrials.gov NCT03297541, https://clinicaltrials.gov/ct2/show/NCT03297541. ",
doi="10.2196/24714",
url="https://pediatrics.jmir.org/2021/1/e24714",
url="http://www.ncbi.nlm.nih.gov/pubmed/33410760"
}


@Article{info:doi/10.2196/22541,
author="Tate, Allan
and Trofholz, Amanda
and Miner, Michael
and Berge, Jerica",
title="Days Needed to Characterize the Healthfulness of a Typical Dinner Meal in Direct Observational Research: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Mar",
day="24",
volume="4",
number="1",
pages="e22541",
keywords="meal healthfulness",
keywords="direct observation",
keywords="family meals",
keywords="well-being",
keywords="diet",
keywords="food",
abstract="Background: Prior research around the home meal environment has demonstrated that family meals are associated with positive health outcomes for children and adolescents. Researchers have begun using direct observational methods to understand key aspects of family meals such as meal healthfulness and family meal frequency to explain the protective nature of family meals. Direct observational research, however, can be resource intensive and also burdensome for participants. Information about the number of days needed to sufficiently characterize typical meal healthfulness using direct observational research methods is needed. Objective: The current study aimed to produce guidance about the number of meals necessary to approximate typical meal healthfulness at the family dinner meal occasion in a direct observational, mixed methods study of the home food environment. Methods: Families were recruited between 2012-2013 from primary care clinics in the Minneapolis--St Paul metropolitan area (N=120). A total of 800 meals were collected as part of the Family Meals LIVE! mixed methods study. The Healthfulness of Meal Index was used to evaluate meal dietary healthfulness of foods served at 8 family meal occasions. Participating families were provided an iPad (Apple Inc) and asked to video-record 8 consecutive days of family dinner meals with a minimum of two weekend meals. After the meal, families completed a meal screener, which is a self-reported, open-ended measure of the foods served at the meal. Results: Weekend and weekday meals differed in their measurement of meal healthfulness, indicating that at least one weekday and one weekend day are necessary to approximate meal healthfulness. Single-day measurement mischaracterized the strength of the relationship between the quality of what was served and intake by almost 50\%, and 3 to 4 observation days were sufficient to characterize typical weekly meal healthfulness (r=0.94; P<.001). Conclusions: Relatively few direct observational days of family meals data appear to be needed to approximate the healthfulness of meals across 1 week. Specifically, 1 weekday and 1 weekend observation are needed, including a total of 3 to 4 days of direct observational meal data. These findings may inform future direct observational study designs to reduce both research costs and participant burden in assessing features of the meal environment. ",
doi="10.2196/22541",
url="https://pediatrics.jmir.org/2021/1/e22541",
url="http://www.ncbi.nlm.nih.gov/pubmed/33759788"
}


@Article{info:doi/10.2196/24851,
author="Thompson, P. Alison
and MacDonald, E. Shannon
and Wine, Eytan
and Scott, D. Shannon",
title="Understanding Parents' Experiences When Caring for a Child With Functional Constipation: Interpretive Description Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Jan",
day="20",
volume="4",
number="1",
pages="e24851",
keywords="constipation",
keywords="child",
keywords="parents",
keywords="caregivers",
keywords="qualitative research",
abstract="Background: Pediatric functional constipation (FC) is a common but serious medical condition. Despite significant effects on children, families, and the health care system, the condition is typically undertreated. Parents carry the primary responsibility for complex treatment programs; therefore, understanding their experiences and needs may offer a critical perspective toward improving clinical care. Objective: The aim of this study is to understand and give voice to parents' experiences and information needs when caring for a child with FC. The ultimate objective is to build an evidence base suitable for creating a digital knowledge translation tool to better support parents caring for a child with FC. Methods: This qualitative design used an interpretive description methodology to generate findings aimed at improving clinical care. One-on-one, in-depth interviews were completed either in person or through web-based teleconferencing to explore parents' perspectives. Data collection and analysis occurred concurrently. Results: Analysis of 16 interviews generated 4 major themes: living in the shadows; not taken seriously, with a subtheme of persevering and advocating; missing information and misinformation; and self-doubt and strained relationships. One minor theme of affirmative influences that foster resilience and hope was identified. Conclusions: Parents have unmet needs for support and information related to pediatric FC. To address gaps in current care provision, decision makers may consider interventions for clinicians, resources for parents, and shifting care models to better meet parents' needs. ",
doi="10.2196/24851",
url="http://pediatrics.jmir.org/2021/1/e24851/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33470939"
}


@Article{info:doi/10.2196/23193,
author="Hanley, Terry
and Sefi, Aaron
and Grauberg, Janet
and Prescott, Julie
and Etchebarne, Andre",
title="A Theory of Change for Web-Based Therapy and Support Services for Children and Young People: Collaborative Qualitative Exploration",
journal="JMIR Pediatr Parent",
year="2021",
month="Mar",
day="22",
volume="4",
number="1",
pages="e23193",
keywords="telepsychology",
keywords="digital mental health",
keywords="online therapy",
keywords="young people",
keywords="Kooth",
keywords="Theory of Change",
keywords="positive virtual ecosystems",
abstract="Background: Web-based counseling and support has become increasingly commonplace for children and young people (CYP). Currently, there is limited research that focuses on the mechanisms of change within complex telepsychology platforms, a factor that makes designing and implementing outcome measures challenging. Objective: This project aims to articulate a theory of change (ToC) for Kooth, a web-based therapy and support platform for CYP. Methods: A collaborative qualitative research design involving professional staff, academic partners, and young people was used to develop the ToC. The following three major reflective phases were engaged: a scoping workshop involving professional staff and academic partners, a series of explorative projects were completed to inform the development of the ToC, and the draft ToC was reviewed for coherence by key stakeholders (young people, online professionals, and service managers). Results: A collaboratively developed ToC was presented. This was divided into the conditions that lead to individuals wanting to access web-based therapy and support (eg, individuals wanting support there and then or quickly), the mode of service delivery (eg, skilled and experienced professionals able to build empathetic relationships with CYP), and the observed and reported changes that occur as a consequence of using the service (eg, individuals being better able to manage current and future situations). Conclusions: Developing the ToC helps to shed light on how web-based therapy and support services aid the mental health and well-being of CYP. Furthermore, it helps to understand the development of positive virtual ecosystems and can be used to devise evaluative tools for CYP telepsychology providers. ",
doi="10.2196/23193",
url="https://pediatrics.jmir.org/2021/1/e23193",
url="http://www.ncbi.nlm.nih.gov/pubmed/33749615"
}


@Article{info:doi/10.2196/24988,
author="Khasawneh, Amro
and Chalil Madathil, Kapil
and Zinzow, Heidi
and Rosopa, Patrick
and Natarajan, Gitanjali
and Achuthan, Krishnashree
and Narasimhan, Meera",
title="Factors Contributing to Adolescents' and Young Adults' Participation in Web-Based Challenges: Survey Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Feb",
day="17",
volume="4",
number="1",
pages="e24988",
keywords="web-based challenges",
keywords="self-injurious behavior",
keywords="behavior",
keywords="integrated behavioral model",
keywords="social media",
keywords="challenge",
keywords="adolescent",
keywords="young adult",
keywords="participation",
keywords="survey",
abstract="Background: Web-based challenges, phenomena that are familiar to adolescents and young adults who spend large amounts of time on social media, range from minimally harmful behaviors intended to support philanthropic endeavors to significantly harmful behaviors that may culminate in injury or death. Objective: This study aims to investigate the beliefs that lead adolescents and young adults to participate in these activities by analyzing the amyotrophic lateral sclerosis (ALS) ice bucket challenge, representing nonharmful behaviors associated with web-based challenges, and the cinnamon challenge, representing web-based challenges that lead to harmful behaviors. Methods: A retrospective quantitative study was conducted with a total of 471 participants aged between 13 and 35 years who either had participated in the ALS ice bucket challenge or the cinnamon challenge, or had never participated in any web-based challenge. Binomial logistic regression models were used to classify those who participated in the ALS ice bucket challenge or cinnamon challenge versus those who did not engage in either challenge using the integrated behavioral model's beliefs as predictors. Results: The findings showed that participants of both the cinnamon challenge and the ALS ice bucket challenge had significantly greater expectations from the public to participate in the challenge they completed in comparison with individuals who never participated in any challenge (P=.01 for the cinnamon challenge and P=.003 for the ALS ice bucket challenge). Cinnamon challenge participants had greater value for the outcomes of the challenge (P<.001) and perceived positive public opinion about the challenge (P<.001), in comparison with individuals who never participated in any challenge. In contrast, ALS ice bucket challenge participants had significantly greater positive emotional responses than individuals who never participated in any challenge (P<.001). Conclusions: The constructs that contribute to the spread of web-based challenges vary based on the level of self-harm involved in the challenge and its purpose. Intervention efforts could be tailored to address the beliefs associated with different types of web-based challenges. ",
doi="10.2196/24988",
url="http://pediatrics.jmir.org/2021/1/e24988/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33595450"
}


@Article{info:doi/10.2196/25991,
author="Kowalski, L. Rebecca
and Lee, Laura
and Spaeder, C. Michael
and Moorman, Randall J.
and Keim-Malpass, Jessica",
title="Accuracy and Monitoring of Pediatric Early Warning Score (PEWS) Scores Prior to Emergent Pediatric Intensive Care Unit (ICU) Transfer: Retrospective Analysis",
journal="JMIR Pediatr Parent",
year="2021",
month="Feb",
day="22",
volume="4",
number="1",
pages="e25991",
keywords="pediatric intensive care unit",
keywords="cardiorespiratory monitoring",
keywords="hospital transfer",
keywords="clinical deterioration",
keywords="monitoring",
keywords="ICU",
keywords="intensive care unit",
keywords="pediatric",
keywords="retrospective",
keywords="detection",
keywords="deterioration",
keywords="child",
keywords="accuracy",
keywords="cohort",
abstract="Background: Current approaches to early detection of clinical deterioration in children have relied on intermittent track-and-trigger warning scores such as the Pediatric Early Warning Score (PEWS) that rely on periodic assessment and vital sign entry. There are limited data on the utility of these scores prior to events of decompensation leading to pediatric intensive care unit (PICU) transfer. Objective: The purpose of our study was to determine the accuracy of recorded PEWS scores, assess clinical reasons for transfer, and describe the monitoring practices prior to PICU transfer involving acute decompensation. Methods: We conducted a retrospective cohort study of patients ?21 years of age transferred emergently from the acute care pediatric floor to the PICU due to clinical deterioration over an 8-year period. Clinical charts were abstracted to (1) determine the clinical reason for transfer, (2) quantify the frequency of physiological monitoring prior to transfer, and (3) assess the timing and accuracy of the PEWS scores 24 hours prior to transfer. Results: During the 8-year period, 72 children and adolescents had an emergent PICU transfer due to clinical deterioration, most often due to acute respiratory distress. Only 35\% (25/72) of the sample was on continuous telemetry or pulse oximetry monitoring prior to the transfer event, and 47\% (34/72) had at least one incorrectly documented PEWS score in the 24 hours prior to the event, with a score underreporting the actual severity of illness. Conclusions: This analysis provides support for the routine assessment of clinical deterioration and advocates for more research focused on the use and utility of continuous cardiorespiratory monitoring for patients at risk for emergent transfer. ",
doi="10.2196/25991",
url="https://pediatrics.jmir.org/2021/1/e25991",
url="http://www.ncbi.nlm.nih.gov/pubmed/33547772"
}


@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/10.2196/22696,
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/10.2196/20172,
author="Tanaka, Masanori
and Saito, Manabu
and Takahashi, Michio
and Adachi, Masaki
and Nakamura, Kazuhiko",
title="Interformat Reliability of Web-Based Parent-Rated Questionnaires for Assessing Neurodevelopmental Disorders Among Preschoolers: Cross-sectional Community Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Feb",
day="4",
volume="4",
number="1",
pages="e20172",
keywords="neurodevelopmental disorders",
keywords="web-based questionnaire",
keywords="preschoolers",
keywords="parents",
keywords="interformat reliability",
abstract="Background: Early detection and intervention for neurodevelopmental disorders are effective. Several types of paper questionnaires have been developed to assess these conditions in early childhood; however, the psychometric equivalence between the web-based and the paper versions of these questionnaires is unknown. Objective: This study examined the interformat reliability of the web-based parent-rated version of the Autism Spectrum Screening Questionnaire (ASSQ), Attention-Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS), Developmental Coordination Disorder Questionnaire 2007 (DCDQ), and Strengths and Difficulties Questionnaire (SDQ) among Japanese preschoolers in a community developmental health check-up setting. Methods: A set of paper-based questionnaires were distributed for voluntary completion to parents of children aged 5 years. The package of the paper format questionnaires included the ASSQ, ADHD-RS, DCDQ, parent-reported SDQ (P-SDQ), and several additional demographic questions. Responses were received from 508 parents of children who agreed to participate in the study. After 3 months, 300 parents, who were among the initial responders, were randomly selected and asked to complete the web-based versions of these questionnaires. A total of 140 parents replied to the web-based format and were included as a final sample in this study. Results: We obtained the McDonald $\omega$ coefficients for both the web-based and paper formats of the ASSQ (web-based: $\omega$=.90; paper: $\omega$=.86), ADHD-RS total and subscales (web-based: $\omega$=.88-.94; paper: $\omega$=.87-.93), DCDQ total and subscales (web-based: $\omega$=.82-.94; paper: $\omega$=.74-.92), and P-SDQ total and subscales (web-based: $\omega$=.55-.81; paper: $\omega$=.52-.80). The intraclass correlation coefficients between the web-based and paper formats were all significant at the 99.9\% confidence level: ASSQ (r=0.66, P<.001); ADHD-RS total and subscales (r=0.66-0.74, P<.001); DCDQ total and subscales (r=0.66-0.71, P<.001); P-SDQ Total Difficulties and subscales (r=0.55-0.73, P<.001). There were no significant differences between the web-based and paper formats for total mean score of the ASSQ (P=.76), total (P=.12) and subscale (P=.11-.47) mean scores of DCDQ, and the P-SDQ Total Difficulties mean score (P=.20) and mean subscale scores (P=.28-.79). Although significant differences were found between the web-based and paper formats for mean ADHD-RS scores (total: t132=2.83, P=.005; Inattention subscale: t133=2.15, P=.03; Hyperactivity/Impulsivity subscale: t133=3.21, P=.002), the effect sizes were small (Cohen d=0.18-0.22). Conclusions: These results suggest that the web-based versions of the ASSQ, ADHD-RS, DCDQ, and P-SDQ were equivalent, with the same level of internal consistency and intrarater reliability as the paper versions, indicating the applicability of the web-based versions of these questionnaires for assessing neurodevelopmental disorders. ",
doi="10.2196/20172",
url="https://pediatrics.jmir.org/2021/1/e20172",
url="http://www.ncbi.nlm.nih.gov/pubmed/33455899"
}


@Article{info:doi/10.2196/14774,
author="Su, Pen-Hua
and Yang, Chen
and Chao, Mei-Chyn
and Chiang, Chung-Lin",
title="Monitoring Adherence Rate to Growth Hormone Therapy and Growth Outcomes in Taiwanese Children Using Easypod Connect: Observational Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Jan",
day="15",
volume="4",
number="1",
pages="e14774",
keywords="growth hormone",
keywords="adherence",
keywords="easypod",
keywords="eHealth",
abstract="Background: Adherence to growth hormone therapy is difficult to detect reliably. Devices such as easypod have been developed for electronic recording of injections. The easypod connect observational study (ECOS) was an open-label, observational, multinational, phase IV study conducted in 24 countries around the world. The final results from ECOS in the Taiwanese cohort are reported in this paper. Objective: This study aimed to evaluate the adherence and long-term outcomes of growth hormone therapy in pediatric subjects using the easypod electromechanical device. Methods: Subjects (aged 2-18 years or >18 years without fusion of growth plates) who received Saizen (recombinant human growth hormone, somatropin) via the easypod device were enrolled in this study. The primary objective was to assess the level of adherence in subjects receiving Saizen via easypod. Results: In Taiwan, a total of 35 and 13 children fulfilled the criteria of full analysis set and complete analysis set, respectively. The mean (SD) age of the complete analysis set was 12.08 (2.72) years. All subjects were growth hormone--na{\"i}ve, with 38\% (5/13) females. The mean adherence rates of 13 subjects were 87.6\% at 3 months and 84.3\% at 6 months, that of 8 subjects was 81.0\% at 9 months, and that of 4 subjects was 91.6\% at 1 year. After 1 year of treatment, subjects had a median (Q1:Q3) change in height SD score of 0.30 (0.06:0.48), median height velocity of 6.50 (4.33:8.24) cm/year, and median change in height velocity SD score of 1.81 (--0.04:3.52). Conclusions: With the easypod device, patients with inadequate adherence and poor response to treatment can be identified. Adherence to growth hormone therapy administered via easypod was generally high in the first year of treatment but the adherence gradually decreased over time. Overall, growth outcomes after 1 year indicated a positive growth response to growth hormone treatment. Future efforts should be focused on personalized management of adherence by using the easypod system. ",
doi="10.2196/14774",
url="https://pediatrics.jmir.org/2021/1/e14774",
url="http://www.ncbi.nlm.nih.gov/pubmed/33448936"
}


@Article{info:doi/10.2196/25413,
author="Tiase, L. Victoria
and Sward, A. Katherine
and Del Fiol, Guilherme
and Staes, Catherine
and Weir, Charlene
and Cummins, R. Mollie",
title="Patient-Generated Health Data in Pediatric Asthma: Exploratory Study of Providers' Information Needs",
journal="JMIR Pediatr Parent",
year="2021",
month="Jan",
day="26",
volume="4",
number="1",
pages="e25413",
keywords="information needs",
keywords="asthma",
keywords="symptom management",
keywords="mobile health",
keywords="patient-generated health data",
keywords="pediatrics",
keywords="adolescents",
abstract="Background: Adolescents are using mobile health apps as a form of self-management to collect data on symptoms, medication adherence, and activity. Adding functionality to an electronic health record (EHR) to accommodate disease-specific patient-generated health data (PGHD) may support clinical care. However, little is known on how to incorporate PGHD in a way that informs care for patients. Pediatric asthma, a prevalent health issue in the United States with 6 million children diagnosed, serves as an exemplar condition to examine information needs related to PGHD. Objective: In this study we aimed to identify and prioritize asthma care tasks and decisions based on pediatric asthma guidelines and identify types of PGHD that might support the activities associated with the decisions. The purpose of this work is to provide guidance to mobile health app developers and EHR integration. Methods: We searched the literature for exemplar asthma mobile apps and examined the types of PGHD collected. We identified the information needs associated with each decision in accordance with consensus-based guidelines, assessed the suitability of PGHD to meet those needs, and validated our findings with expert asthma providers. Results: We mapped guideline-derived information needs to potential PGHD types and found PGHD that may be useful in meeting information needs. Information needs included types of symptoms, symptom triggers, medication adherence, and inhaler technique. Examples of suitable types of PGHD were Asthma Control Test calculations, exposures, and inhaler use. Providers suggested uncontrolled asthma as a place to focus PGHD efforts, indicating that they preferred to review PGHD at the time of the visit. Conclusions: We identified a manageable list of information requirements derived from clinical guidelines that can be used to guide the design and integration of PGHD into EHRs to support pediatric asthma management and advance mobile health app development. Mobile health app developers should examine PGHD information needs to inform EHR integration efforts. ",
doi="10.2196/25413",
url="http://pediatrics.jmir.org/2021/1/e25413/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33496674"
}