@Article{info:doi/10.2196/24791,
author="Monzani, Alice
and Tagliaferri, Francesco
and Bellone, Simonetta
and Genoni, Giulia
and Rabbone, Ivana",
title="A Global Overview of COVID-19 Research in the Pediatric Field: Bibliometric Review",
journal="JMIR Pediatr Parent",
year="2021",
month="Jul",
day="23",
volume="4",
number="3",
pages="e24791",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="children",
keywords="pediatrics",
keywords="bibliometric review",
keywords="publications",
keywords="research",
keywords="literature",
keywords="review",
abstract="Background: Since the beginning of the COVID-19 pandemic, a great number of papers have been published in the pediatric field. Objective: We aimed to assess research around the globe on COVID-19 in the pediatric field by bibliometric analysis, identifying publication trends and topic dissemination and showing the relevance of publishing authors, institutions, and countries. Methods: The Scopus database was comprehensively searched for all indexed documents published between January 1, 2020, and June 11, 2020, dealing with COVID-19 in the pediatric population (0-18 years). A machine learning bibliometric methodology was applied to evaluate the total number of papers and citations, journal and publication types, the top productive institutions and countries and their scientific collaboration, and core keywords. Results: A total of 2301 papers were retrieved, with an average of 4.8 citations per article. Of this, 1078 (46.9\%) were research articles, 436 (18.9\%) were reviews, 363 (15.8\%) were letters, 186 (8.1\%) were editorials, 7 (0.3\%) were conference papers, and 231 (10\%) were categorized as others. The studies were published in 969 different journals, headed by The Lancet. The retrieved papers were published by a total of 12,657 authors from 114 countries. The most productive countries were the United States, China, and Italy. The four main clusters of keywords were pathogenesis and clinical characteristics (keyword occurrences: n=2240), public health issues (n=352), mental health (n=82), and therapeutic aspects (n=70). Conclusions: In the pediatric field, a large number of articles were published within a limited period on COVID-19, testifying to the rush to spread new findings on the topic in a timely manner. The leading authors, countries, and institutions evidently belonged to the most impacted geographical areas. A focus on the pediatric population was often included in general articles, and pediatric research about COVID-19 mainly focused on the clinical features, public health issues, and psychological impact of the disease. ",
doi="10.2196/24791",
url="https://pediatrics.jmir.org/2021/3/e24791",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081597"
}


@Article{info:doi/10.2196/22784,
author="Siedlikowski, Maia
and Curiale, Lianna
and Rauch, Frank
and Tsimicalis, Argerie",
title="Experiences of Children With Osteogenesis Imperfecta in the Co-design of the Interactive Assessment and Communication Tool Sisom OI: Secondary Analysis of Qualitative Design Sessions",
journal="JMIR Pediatr Parent",
year="2021",
month="Aug",
day="10",
volume="4",
number="3",
pages="e22784",
keywords="child health",
keywords="symptom assessment",
keywords="communication",
keywords="mobile applications",
keywords="software",
abstract="Background: Children with osteogenesis imperfecta (OI) experience a diversity of symptoms that expose them to difficult physical, mental, and social challenges. Sisom (DHealth) is an interactive assessment and communication tool designed to help children aged 6-12 years with chronic conditions express their symptoms. Recently, the co-design of the Sisom OI paper prototype was launched by seeking the perspectives of end users, including children with OI and their clinicians. Objective: The aim of this study is to describe the experiences that children with OI were prompted to share with researchers during the co-design of the Sisom OI paper prototype. Methods: A secondary analysis of qualitative data was conducted at a university-affiliated, pediatric, orthopedic hospital. The data sources consisted of interview transcripts, drawings, field notes, and observations derived from interviewing 12 children with OI who participated in the co-design of the Sisom OI paper prototype. The themes and subthemes identified from the data sources were generated using qualitative description. Results: Three themes were identified. The first, Relating to Others, described the balance between feeling different versus feeling similar to other children. The subthemes were Common OI Experience, Feeling Different, and Feeling Just Like Others. The second, Relating to Their Condition, described children's positive and negative interactions with their own condition and health care. The subthemes were Understanding Their Condition, Special Relationship with the Hospital, and Difficult Treatments and Procedures. The third, Reflecting on Capabilities, described children's recognition of their strengths and limitations. The subthemes were Perceiving Limitations, Overcoming Isolation, and Celebrating Strengths. Conclusions: This co-design process provided children with OI the space to not only contribute to the development of the end product but also eloquently describe their experiences. These findings, based on the descriptions given by the children themselves, offer us a unique understanding of what it means to grow up with OI. ",
doi="10.2196/22784",
url="https://pediatrics.jmir.org/2021/3/e22784",
url="http://www.ncbi.nlm.nih.gov/pubmed/34383677"
}


@Article{info:doi/10.2196/26690,
author="Mclaughlin, Matthew
and Duff, Jed
and McKenzie, Tom
and Campbell, Elizabeth
and Sutherland, Rachel
and Wiggers, John
and Wolfenden, Luke",
title="Evaluating Digital Program Support for the Physical Activity 4 Everyone (PA4E1) School Program: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Jul",
day="26",
volume="4",
number="3",
pages="e26690",
keywords="process evaluation",
keywords="engagement",
keywords="think-aloud methodology",
keywords="mixed methods",
keywords="physical activity",
keywords="website",
keywords="digital health intervention",
keywords="implementation support",
keywords="delivery mode",
keywords="scale-up",
abstract="Background: Effectively scaled-up physical activity interventions are urgently needed to address the high prevalence of physical inactivity. To facilitate scale-up of an efficacious school-based physical activity program (Physical Activity 4 Everyone [PA4E1]), provision of implementation support to physical education (PE) teachers was adapted from face-to-face and paper-based delivery modes to partial delivery via a website. A lack of engagement (usage and subjective experience) with digital delivery modes, including websites, may in part explain the typical reduction in effectiveness of scaled-up interventions that use digital delivery modes. A process evaluation focused on the PA4E1 website was undertaken. Objective: The 2 objectives were to (1) describe the usage of the PA4E1 program website by in-school champions (PE teachers leading the program within their schools) and PE teachers using quantitative methods; (2) examine the usage, subjective experience, and usability of the PA4E1 program website from the perspective of in-school champions using mixed methods. Methods: The first objective used website usage data collected across all users (n=273) throughout the 9 school terms of the PA4E1 implementation support. The 4 usage measures were sessions, page views, average session duration, and downloads. Descriptive statistics were calculated and explored across the duration of the 26-month program. The second objective used mixed methods, triangulating data from the first objective with data from a think-aloud survey and usability test completed by in-school champions (n=13) at 12 months. Qualitative data were analyzed thematically alongside descriptive statistics from the quantitative data in a triangulation matrix, generating cross-cutting themes using the ``following a thread'' approach. Results: For the first objective, in-school champions averaged 48.0 sessions per user, PE teachers 5.8 sessions. PE teacher sessions were of longer duration (10.5 vs 7.6 minutes) and included more page views (5.4 vs 3.4). The results from the mixed methods analysis for the second objective found 9 themes and 2 meta-themes. The first meta-theme indicated that the website was an acceptable and appropriate delivery mode, and usability of the website was high. The second meta-theme found that the website content was acceptable and appropriate, and identified specific suggestions for improvement. Conclusions: Digital health interventions targeting physical activity often experience issues of lack of user engagement. By contrast, the findings from both the quantitative and mixed methods analyses indicate high usage and overall acceptability and appropriateness of the PA4E1 website to school teachers. The findings support the value of the website within a multidelivery mode implementation intervention to support schools to implement physical activity promoting practices. The analysis identified suggested intervention refinements, which may be adopted for future iterations and further scale-up of the PA4E1 program. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000681358; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372870 ",
doi="10.2196/26690",
url="https://pediatrics.jmir.org/2021/3/e26690",
url="http://www.ncbi.nlm.nih.gov/pubmed/34309565"
}


@Article{info:doi/10.2196/25801,
author="Allen, J. Brittany
and Stratman, E. Zoe
and Kerr, R. Bradley
and Zhao, Qianqian
and Moreno, A. Megan",
title="Associations Between Psychosocial Measures and Digital Media Use Among Transgender Youth: Cross-sectional Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Aug",
day="13",
volume="4",
number="3",
pages="e25801",
keywords="transgender person",
keywords="internet",
keywords="sex and gender minorities",
keywords="well-being",
keywords="adolescent",
keywords="mobile phone",
abstract="Background: Transgender, nonbinary, and gender-diverse (TNG) youth encounter barriers to psychosocial wellness and also describe exploring identities and communities on the web. Studies of cisgender youth connect increased digital technology use with lower well-being, parent relationships, and body image scores as well as increased loneliness and fear of missing out (FOMO). However, little is known about the psychosocial factors associated with digital technology use among TNG compared with cisgender youth. Objective: This study aims to examine the associations between psychosocial measures and digital technology use and its importance for cisgender and TNG youth. Methods: We surveyed a nationally representative sample of adolescents (aged 13-18 years) about psychosocial wellness and digital technology use. Psychosocial measures included assessment of well-being, parental relationships, body image, loneliness, and FOMO. Digital media use assessments included the short Problematic and Risky Internet Use Screening Scale-3 and the Adolescent Digital Technology Interactions and Importance (ADTI) scale and subscales. We compared psychosocial measures between gender identity groups. We also compared stratified correlations for psychosocial measures (well-being, parent relationships, body image, loneliness, and FOMO) with ADTI and Problematic and Risky Internet Use Screening Scale-3 scores between gender identity groups. All comparisons were adjusted for age, race, and ethnicity. Results: Among 4575 adolescents, 53 (1.16\%) self-identified as TNG youth. TNG youth had lower scores for well-being (23.76 vs 26.47; P<.001), parent relationships (19.29 vs 23.32; P<.001), and body image (13.50 vs 17.12; P<.001), and higher scores for loneliness (9.28 vs 6.55; P<.001) and FOMO (27.93 vs 23.89; P=.004), compared with cisgender peers. In a pattern different from that of their cisgender peers, better well-being scores and body image for TNG youth predicted higher problematic internet use (PIU) scores (correlation coefficients of 0.32 vs ?0.07; P=.004 and 0.26 vs ?0.21; P=.002, respectively). FOMO was a stronger positive predictor of higher ADTI total and subscale scores for cisgender youth compared with TNG youth. Conclusions: Overall, this study supports previously demonstrated disparities in the psychosocial wellness of TNG youth and adds that these disparities include loneliness and FOMO. This study shows prediction of PIU by both higher well-being and better body image, indicating that PIU may not be unilaterally driven by problematic factors among TNG youth. We suggest that this may be because of the specific digital media functions that TNG youth engage with as a disenfranchised population. ",
doi="10.2196/25801",
url="https://pediatrics.jmir.org/2021/3/e25801",
url="http://www.ncbi.nlm.nih.gov/pubmed/34398792"
}


@Article{info:doi/10.2196/21471,
author="Ntalindwa, Theoneste
and Nduwingoma, Mathias
and Karangwa, Evariste
and Rashid Soron, Tanjir
and Uworwabayeho, Alphonse
and Uwineza, Annette",
title="Development of a Mobile App to Improve Numeracy Skills of Children With Autism Spectrum Disorder: Participatory Design and Usability Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Aug",
day="31",
volume="4",
number="3",
pages="e21471",
keywords="autism spectrum disorder",
keywords="mobile app",
keywords="learning",
keywords="information and communication technologies",
keywords="education",
keywords="numeracy",
keywords="mathematics",
abstract="Background: The use of information and communication technologies is transforming the lives of millions of people including children with autism spectrum disorder (ASD). However, the process of developing a user-friendly and effective mobile app needs to follow a complex standard protocol and culture-sensitive customization, and involves multiple sectors. This complex work becomes even more challenging when considering children with ASD in low- and middle-income countries as the users. Objective: This study aimed to design and develop a more intuitive mobile app to improve numeracy skills of children with ASD in Rwanda and evaluate the usability of the app. Methods: A participatory design approach was utilized in this study in which 40 children with ASD, 5 teachers, and 10 parents of children with ASD participated in focus group discussions (FGDs) and usability testing. A narrative literature review was performed to explore existing mobile apps and compare previous studies to design the questions for FGD and facilitate a framework for designing the app. The agile methodology was used to develop the mobile app, and the heuristics evaluation method was used to test and evaluate the usability of the initial version of the app to improve its functionalities. The interviews were recorded, transcribed, and analyzed following the guidelines of the qualitative narrative analysis (QNA) method. Results: During the FGDs the respondents shared their need for a mobile app in teaching and learning numeracy for children with ASD and pointed to possibilities of integrating the mobile app into existing curriculum. Ten themes emerged from the FGDs and exercise of developing the mobile app. The themes were related to (1) teaching and learning numeracy for children with ASD, (2) planning and development of a mobile app for a person with ASD, (3) testing a mobile app, (4) strength of the developed app against the existing ones, (5) behavioral maintenance and relapse prevention, (6) possibilities to integrate the mobile app into the existing curriculum, (7) data protection for users, (8) social implications, (9) challenges in Rwanda, and (10) focus on future. Conclusions: The community plays an important role in the planning, development, and evaluation of a mobile app for children with ASD. In this study, inputs from teachers and parents resulted in an optimally designed mobile app that can improve numeracy skills in children diagnosed with ASD to support the implementation of competency-based curriculum in Rwanda. ",
doi="10.2196/21471",
url="https://pediatrics.jmir.org/2021/3/e21471",
url="http://www.ncbi.nlm.nih.gov/pubmed/34463629"
}


@Article{info:doi/10.2196/30240,
author="Levey, J. Elizabeth
and Onyeaka, Henry
and Bartles, M. Sophia
and Sanchez Calderon, Elena
and Sanchez, E. Sixto
and Prom, C. Maria
and Fesseha, M. Eden
and Gelaye, Bizu",
title="Mobile Technology Access and Use Among Adolescent Mothers in Lima, Peru: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Sep",
day="17",
volume="4",
number="3",
pages="e30240",
keywords="access to care",
keywords="adolescent motherhood",
keywords="LMICs",
keywords="mobile phone",
keywords="perinatal mental health",
keywords="telehealth",
abstract="Background: Research shows promise for the use of mobile health interventions to improve access to care for mothers and infants. Although adolescent mothers in particular are comfortable with technology and often face barriers to accessing care, data on the use of digital interventions with young mothers are limited. Objective: This study aims to examine technology access and use behavior among adolescent mothers in Lima, Peru, to inform the development of technology-mediated perinatal interventions for high-risk mothers and infants in low- and middle-income countries and other areas with limited access to care. Methods: This mixed methods study consisted of a phone survey about technology access (N=29), focus group discussions with clinicians (N=25), and semistructured in-depth interviews with adolescent mothers (N=10) and their family members (N=8) in Lima. Results: All adolescent mothers surveyed had access to a smartphone, and nearly half had access to a computer or tablet. However, participants reported a number of obstacles to consistent smartphone access related to the financial precarity of their situations. Examples of this included difficulty affording phone services, using shared plans, and losing smartphones because of theft. Conclusions: These findings indicate that adolescent mothers are connected to technology, highlighting the potential scalability of technology-based health interventions for adolescent mothers in low- and middle-income countries while identifying barriers that need to be addressed. ",
doi="10.2196/30240",
url="https://pediatrics.jmir.org/2021/3/e30240",
url="http://www.ncbi.nlm.nih.gov/pubmed/34533473"
}


@Article{info:doi/10.2196/25014,
author="Perkins, C. Ryan
and Gross, Rachel
and Regan, Kayla
and Bishay, Lara
and Sawicki, S. Gregory",
title="Perceptions of Social Media Use to Augment Health Care Among Adolescents and Young Adults With Cystic Fibrosis: Survey Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Aug",
day="16",
volume="4",
number="3",
pages="e25014",
keywords="cystic fibrosis",
keywords="social media",
keywords="mobile health",
keywords="adherence",
keywords="adolescents",
keywords="young adults",
abstract="Background: For individuals with cystic fibrosis (CF), adolescence and young adulthood are times of significant vulnerability and have been associated with clinical and psychosocial challenges. Social media may offer innovative care delivery solutions to address these challenges. Objective: This study explored motivations and attitudes regarding current social media use and preferences for a social media platform in a sample of adolescents and young adults (AYA) with CF. Methods: A cross-sectional survey was administered to 50 AYA with CF followed at a large pediatric-adult CF center. The survey included questions regarding social media platform utilization, attitudes toward general and CF-specific online activities, and preferences for a CF-specific care delivery platform. Results: YouTube, Snapchat, and Instagram were the most commonly used social media platforms. AYA with CF do not report routinely using social media for health-related information acquisition, social support, or help with adherence. However, their perceptions of social media utilization and preferences for platform development suggest interest in doing so in the future. Conclusions: AYA with CF use social media and expressed interest in the development of a social media platform. Platform development will allow for gaps in health care delivery to be addressed by improving social support and adherence while augmenting current methods of health information acquisition. ",
doi="10.2196/25014",
url="https://pediatrics.jmir.org/2021/3/e25014",
url="http://www.ncbi.nlm.nih.gov/pubmed/34232121"
}


@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/10.2196/26040,
author="Canares, Therese
and Parrish, Carisa
and Santos, Christine
and Badawi, Alia
and Stewart, Alyssa
and Kleinman, Keith
and Psoter, Kevin
and McGuire, Joseph",
title="Pediatric Coping During Venipuncture With Virtual Reality: Pilot Randomized Controlled Trial",
journal="JMIR Pediatr Parent",
year="2021",
month="Jul",
day="28",
volume="4",
number="3",
pages="e26040",
keywords="pediatrics",
keywords="psychological distress",
keywords="virtual reality",
keywords="procedural pain",
keywords="anxiety",
keywords="phlebotomy",
abstract="Background: Virtual reality (VR) has shown promise in reducing children's pain and anxiety during venipuncture, but studies on VR lack objective observations of pediatric coping. Notably, the process of capturing objective behavioral coping data can be labor- and personnel-intensive. Objective: The primary aims of this pilot trial were to assess the feasibility of conducting a trial of VR in a pediatric emergency department and the feasibility of documenting observed coping behaviors during pediatric procedures. Secondarily, this study examined whether VR affects child and caregiver coping and distress during venipuncture in the pediatric emergency department. Methods: This stratified, randomized, controlled pilot trial compared coping and distress between child life--supported VR engagement and child life specialist support without VR during painful procedures in children aged 7-22 years in the pediatric emergency department. An external control (reference group) received no standardized support. Primary feasibility outcomes included rates of recruitment, rates of withdrawal from VR, and rates of completed Child Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF) observations. Secondary clinical outcomes were applied to venipuncture procedures and included CAMPIS-SF coping and distress (range 0-1.0), pain and anxiety on a visual analog scale (range 0-10), and cybersickness symptoms. Results: Overall recruitment was 93\% (66/71), VR withdrawal rate was 27\% (4/15), and of the completed procedures, 100\% (63/63) CAMPIS-SF observations were completed. A total of 55 patients undergoing venipuncture in the pediatric emergency department were included in the analyses of clinical outcomes: 15 patients (15 caregivers) randomized to VR, 20 patients (15 caregivers) randomized to child life specialist support, and 20 patients (17 caregivers) in the reference group. Patient coping differed across groups with higher coping in the VR group and child life specialist group than in the reference group (P=.046). There were no significant differences in the distress and pain ratings for patients and caregivers between the groups. Caregivers rated the lowest perceived anxiety in the child life specialist group (P=.03). There was no apparent change in cybersickness symptoms before and after VR use (P=.37). Conclusions: Real-time documentation of observed behaviors in patients and caregivers was feasible during medical procedures in which VR was utilized, particularly with the availability of research staff. VR and child life specialists improved coping in children during venipuncture procedures. Given the high participation rate, future studies to evaluate the efficacy of VR are recommended to determine whether an off-the-shelf VR headset can be a low-cost and low-risk tool to improve children's coping during venipuncture or other related procedures. Trial Registration: ClinicalTrials.gov NCT03686176; https://clinicaltrials.gov/ct2/show/NCT03686176 ",
doi="10.2196/26040",
url="https://pediatrics.jmir.org/2021/3/e26040",
url="http://www.ncbi.nlm.nih.gov/pubmed/34319249"
}


@Article{info:doi/10.2196/27999,
author="Milne-Ives, Madison
and Lam, Ching
and Meinert, Edward",
title="Digital Technologies for Monitoring and Improving Treatment Adherence in Children and Adolescents With Asthma: Scoping Review of Randomized Controlled Trials",
journal="JMIR Pediatr Parent",
year="2021",
month="Sep",
day="17",
volume="4",
number="3",
pages="e27999",
keywords="asthma",
keywords="disease management",
keywords="child",
keywords="adolescent",
keywords="telemedicine",
abstract="Background: Inadequate pediatric asthma care has resulted in potentially avoidable unplanned hospital admissions and morbidity. A wide variety of digital technologies have been developed to monitor and support treatment adherence in children and adolescents with asthma. However, existing reviews need to be updated and expanded to provide an overview of the current state of research on these technologies and how they are being integrated into existing health care services and care pathways. Objective: This study aims to provide an overview of the current research landscape and knowledge gaps regarding the use of digital technologies to support the care of children and adolescents with asthma. Methods: This study was structured according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and Population, Intervention, Comparator, Outcome, and Study frameworks. Five databases (PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, Embase, and PsycINFO) were systematically searched for studies published in English from 2014 onward. Two reviewers independently screened the references and selected studies for inclusion based on the eligibility criteria. Data were systematically extracted per research question, which were synthesized in a descriptive analysis. Results: A wide variety of study characteristics, including the number and age of participants, study duration, and type of digital intervention, were identified. There was mixed evidence for the effectiveness of the interventions. Of the 10 studies that evaluated treatment adherence, 7 (70\%) found improvements, but the evidence was inconsistent for asthma control (6/9, 67\% of studies reported improvement or maintenance, but only 1 was significantly different between groups) and health outcome variables (5/9, 56\% of studies found no evidence of effectiveness). The 6 studies that examined patient perceptions and assessments of acceptability and usability generally had positive findings. Conclusions: A wide range of digital interventions are being developed and evaluated to support the monitoring and treatment adherence of children and adolescents with asthma. Meta-analyses are inhibited by the use of samples with a variety of overlapping age ranges; a theoretical framework for evaluating specific age groups would aid comparison between studies. Most studies found significant evidence for improved adherence to treatment or medications, but there was mixed evidence of the impact of the digital interventions on asthma control and other health outcomes. There are gaps in the literature relating to cost-effectiveness and integration with existing clinical care pathways. This study will be necessary to determine which digital interventions for children and young people with asthma are worth supporting and adopting in the clinical care pathways. ",
doi="10.2196/27999",
url="https://pediatrics.jmir.org/2021/3/e27999",
url="http://www.ncbi.nlm.nih.gov/pubmed/34533463"
}


@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/10.2196/28630,
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/10.2196/25873,
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/10.2196/27049,
author="So, Lydia
and Miller, Erin
and Eastwood, John",
title="Exploring Mothers' Experience of a Linguistic Feedback Technology for Children at Risk of Poor Language Development: Qualitative Pilot Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Aug",
day="31",
volume="4",
number="3",
pages="e27049",
keywords="language development",
keywords="technology",
keywords="feedback",
keywords="socioeconomic factors",
abstract="Background: The early language environment is important for language development and a child's life-course trajectory. Risk factors associated with poor language development outcomes in children include maternal anxiety and depression, low educational attainment, substance misuse, and low socioeconomic status. Language Environment Analysis (LENA) is a wearable technology designed to promote caregivers' engagement in supporting their children's language development. LENA provides quantitative linguistic feedback, which has been shown to improve caregiver language output, thus enhancing a child's language environment. There is limited research on the uptake of this technology by families with developmentally at-risk children. Objective: This qualitative study aims to explore the conditions under which mothers with children at risk of poor developmental outcomes are willing to adopt the use of LENA to monitor and improve caregiver language output. Methods: Using a qualitative interpretive design, semistructured, in-depth interviews were conducted with 8 mothers. Participants were recruited purposively to select the maximal variation of socioeconomic and ethnodemographic backgrounds. The transcribed interview data were analyzed thematically and interpretatively. Themes were mapped abductively to an extended Unified Theory of Acceptance and Use of Technology, which included contextual factors for LENA acceptance. Results: Factors that influenced the intention to use LENA included both technology-specific acceptance factors and contextual factors. Technology acceptance themes included reassurance, feeling overwhelmed, and trust. These themes were mapped to performance expectancy, effort expectancy, and social influence. Contextual themes included emergent success and the intrusion of past difficulties. These were mapped to parenting self-efficacy and perceived risk. The theme of building on success described behavioral intention. Mothers were more likely to adopt LENA when the technology was viewed as acceptable, and this was influenced by parenting self-efficacy and perceived risk. Conclusions: LENA is a technology that is acceptable to mothers with children who are at risk of poor language development outcomes. Further studies are needed to establish LENA's effectiveness as an adjunct to strategies to enrich a child's early language environment. ",
doi="10.2196/27049",
url="https://pediatrics.jmir.org/2021/3/e27049",
url="http://www.ncbi.nlm.nih.gov/pubmed/34463633"
}