@Article{info:doi/10.2196/27551,
author="O'Dell, M. Sean
and Fisher, R. Heidi
and Schlieder, Victoria
and Klinger, Tracey
and Kininger, L. Rachel
and Cosottile, McKenna
and Cummings, Stacey
and DeHart, Kathy",
title="Engaging Parents and Health Care Stakeholders to Inform Development of a Behavioral Intervention Technology to Promote Pediatric Behavioral Health: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Oct",
day="5",
volume="4",
number="4",
pages="e27551",
keywords="primary care",
keywords="parenting",
keywords="targeted prevention",
keywords="behavioral intervention technology",
keywords="behavioral health",
abstract="Background: Despite effective psychosocial interventions, gaps in access to care persist for youth and families in need. Behavioral intervention technologies (BITs) that apply psychosocial intervention strategies using technological features represent a modality for targeted prevention that is promising for the transformation of primary care behavioral health by empowering parents to take charge of the behavioral health care of their children. To realize the potential of BITs for parents, research is needed to understand the status quo of parental self-help and parent-provider collaboration to address behavioral health challenges and unmet parental needs that could be addressed by BITs. Objective: The aim of this study is to conduct foundational research with parents and health care stakeholders (HCS) to discover current practices and unmet needs related to common behavioral health challenges to inform the design, build, and testing of BITs to address these care gaps within a predominantly rural health system. Methods: We conducted a convergent mixed-parallel study within a large, predominantly rural health system in which the BITs will be developed and implemented. We analyzed data from parent surveys (N=385) on current practices and preferences related to behavioral health topics to be addressed in BITs along with focus group data of 48 HCS in 9 clinics regarding internal and external contextual factors contributing to unmet parental needs and current practices. By comparing and relating the findings, we formed interpretations that will inform subsequent BIT development activities. Results: Parents frequently endorsed several behavioral health topics, and several topics were relatively more or less frequently endorsed based on the child's age. The HCS suggested that BITs may connect families with evidence-based guidance sooner and indicated that a web-based platform aligns with how parents already seek behavioral health guidance. Areas of divergence between parents and HCS were related to internalizing problems and cross-cutting issues such as parenting stress, which may be more difficult for health care HCS to detect or address because of the time constraints of routine medical visits. Conclusions: These findings provide a rich understanding of the complexity involved in meeting parents' needs for behavioral health guidance in a primary care setting using BITs. User testing studies for BIT prototypes are needed to successfully design, build, and test effective BITs to empower parents to take charge of promoting the behavioral health of their children. ",
doi="10.2196/27551",
url="https://pediatrics.jmir.org/2021/4/e27551",
url="http://www.ncbi.nlm.nih.gov/pubmed/34609324"
}


@Article{info:doi/10.2196/30169,
author="Wong, Jill
and Foussat, C. Agathe
and Ting, Steven
and Acerbi, Enzo
and van Elburg, M. Ruurd
and Mei Chien, Chua",
title="A Chatbot to Engage Parents of Preterm and Term Infants on Parental Stress, Parental Sleep, and Infant Feeding: Usability and Feasibility Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Oct",
day="26",
volume="4",
number="4",
pages="e30169",
keywords="chatbot",
keywords="parental stress",
keywords="parental sleep",
keywords="infant feeding",
keywords="preterm infants",
keywords="term infants",
keywords="sleep",
keywords="stress",
keywords="eHealth",
keywords="support",
keywords="anxiety",
keywords="usability",
abstract="Background: Parents commonly experience anxiety, worry, and psychological distress in caring for newborn infants, particularly those born preterm. Web-based therapist services may offer greater accessibility and timely psychological support for parents but are nevertheless labor intensive due to their interactive nature. Chatbots that simulate humanlike conversations show promise for such interactive applications. Objective: The aim of this study is to explore the usability and feasibility of chatbot technology for gathering real-life conversation data on stress, sleep, and infant feeding from parents with newborn infants and to investigate differences between the experiences of parents with preterm and term infants. Methods: Parents aged ?21 years with infants aged ?6 months were enrolled from November 2018 to March 2019. Three chatbot scripts (stress, sleep, feeding) were developed to capture conversations with parents via their mobile devices. Parents completed a chatbot usability questionnaire upon study completion. Responses to closed-ended questions and manually coded open-ended responses were summarized descriptively. Open-ended responses were analyzed using the latent Dirichlet allocation method to uncover semantic topics. Results: Of 45 enrolled participants (20 preterm, 25 term), 26 completed the study. Parents rated the chatbot as ``easy'' to use (mean 4.08, SD 0.74; 1=very difficult, 5=very easy) and were ``satisfied'' (mean 3.81, SD 0.90; 1=very dissatisfied, 5 very satisfied). Of 45 enrolled parents, those with preterm infants reported emotional stress more frequently than did parents of term infants (33 vs 24 occasions). Parents generally reported satisfactory sleep quality. The preterm group reported feeding problems more frequently than did the term group (8 vs 2 occasions). In stress domain conversations, topics linked to ``discomfort'' and ``tiredness'' were more prevalent in preterm group conversations, whereas the topic of ``positive feelings'' occurred more frequently in the term group conversations. Interestingly, feeding-related topics dominated the content of sleep domain conversations, suggesting that frequent or irregular feeding may affect parents' ability to get adequate sleep or rest. Conclusions: The chatbot was successfully used to collect real-time conversation data on stress, sleep, and infant feeding from a group of 45 parents. In their chatbot conversations, term group parents frequently expressed positive emotions, whereas preterm group parents frequently expressed physical discomfort and tiredness, as well as emotional stress. Overall, parents who completed the study gave positive feedback on their user experience with the chatbot as a tool to express their thoughts and concerns. Trial Registration: ClinicalTrials.gov NCT03630679; https://clinicaltrials.gov/ct2/show/NCT03630679 ",
doi="10.2196/30169",
url="https://pediatrics.jmir.org/2021/4/e30169",
url="http://www.ncbi.nlm.nih.gov/pubmed/34544679"
}


@Article{info:doi/10.2196/30242,
author="Mathur, Mala
and Kerr, R. Bradley
and Babal, C. Jessica
and Eickhoff, C. Jens
and Coller, J. Ryan
and Moreno, A. Megan",
title="US Parents' Acceptance of Learning About Mindfulness Practices for Parents and Children: National Cross-sectional Survey",
journal="JMIR Pediatr Parent",
year="2021",
month="Nov",
day="2",
volume="4",
number="4",
pages="e30242",
keywords="mindfulness",
keywords="mental health",
keywords="general pediatrics",
keywords="pediatrics",
keywords="children",
keywords="parents",
keywords="acceptability",
keywords="well-being",
keywords="parenting",
abstract="Background: Mindfulness practices are associated with improved health and well-being for children. Few studies have assessed parents' acceptance of learning about mindfulness practices. Objective: This study aims to assess parents' beliefs and interest in learning about mindfulness, including from their health care provider, and differences across demographic backgrounds. Methods: We conducted a national cross-sectional survey of parents with children aged 0-18 years in October 2018. Measures included beliefs and interest in learning about mindfulness. These measures were compared across demographic backgrounds using chi-square analysis. Multivariate linear and logistic regression analyses were used to perform adjusted comparisons between demographic backgrounds. Results: Participants (N=3000) were 87\% (n=2621) female and 82.5\% (n=2466) Caucasian. Most (n=1913, 64.2\%) reported beliefs that mindfulness can be beneficial when parenting, 56.4\% (n=1595) showed interest in learning about mindfulness to help their child stay healthy, and 40.8\% (n=1214) reported interest in learning about mindfulness from their health care provider. Parents with a college degree 49.6\% (n=444) were more likely to report interest in learning about mindfulness from a health care provider compared to those without 37.1\% (n=768; P<.001). Parents interested in learning about mindfulness were more likely to be male 62.6\% (n=223; P<.001). There was no significant difference in interest in learning about mindfulness from a health care provider based on race. Conclusions: This study indicates that many parents believe mindfulness can be beneficial while parenting and are interested in learning how mindfulness could help their child stay healthy. Findings suggest there is an opportunity to educate families about mindfulness practices. ",
doi="10.2196/30242",
url="https://pediatrics.jmir.org/2021/4/e30242",
url="http://www.ncbi.nlm.nih.gov/pubmed/34726605"
}


@Article{info:doi/10.2196/28608,
author="Borloz, Sylvie
and Bucher Della Torre, Sophie
and Collet, Tinh-Hai
and Jotterand Chaparro, Corinne",
title="Consumption of Ultraprocessed Foods in a Sample of Adolescents With Obesity and Its Association With the Food Educational Style of Their Parent: Observational Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Nov",
day="15",
volume="4",
number="4",
pages="e28608",
keywords="adolescent",
keywords="obesity",
keywords="ultraprocessed foods",
keywords="qualitative food intake",
keywords="food educational style",
keywords="smartphone application",
abstract="Background: Both parental education and the food environment influence dietary intake and may therefore contribute to childhood obesity. Objective: We aimed to assess the consumption of ultraprocessed foods (UPFs) in a convenience sample of adolescents with obesity and to determine its association with the food educational style of their parent. Methods: This observational study included 24 participants, 12 adolescents (8 boys and 4 girls) aged from 12 to 14 years and their 12 parents, who were followed in a specialized pediatric obesity clinic in the French-speaking part of Switzerland. The adolescents were asked to take a photograph with a smartphone application of all meals and beverages consumed in their daily routine over 14 consecutive days. They evaluated their parent's food educational style using the Kids' Child Feeding Questionnaire. The parent who was present at the study visits also completed the Feeding Style Questionnaire. A dietitian analyzed the pictures to extract food group portions and to identify UPFs using the NOVA classification. A nonparametric statistical test was used to investigate associations between UPF intake and food educational style. Results: Overall, the adolescents had unbalanced dietary habits compared to national recommendations. They consumed an insufficient quantity of vegetables, fruits, dairy products, and starchy foods and an excessive amount of meat portions and sugary and fatty products compared to the current Swiss recommendations. Their consumption of UPFs accounted for 20\% of their food intake. All adolescents defined their parent as being restrictive in terms of diet, with a mean parental restriction score of 3.3{\textpm}SD 0.4 (norm median=2.1). No parent reported a permissive food educational style. A higher intake of UPFs was associated with a lower parental restriction score (P=.04). Conclusions: Despite being followed in a specialized pediatric obesity clinic, this small group of adolescents had an unbalanced diet, which included 20\% UPFs. The intake of UPFs was lower in participants whose parent was more restrictive, suggesting the importance of parents as role models and to provide adequate food at home. Trial Registration: ClinicalTrials.gov NCT03241121; https://clinicaltrials.gov/ct2/show/NCT03241121 ",
doi="10.2196/28608",
url="https://pediatrics.jmir.org/2021/4/e28608",
url="http://www.ncbi.nlm.nih.gov/pubmed/34779776"
}


@Article{info:doi/10.2196/30160,
author="Prowse, Rachel
and Carsley, Sarah",
title="Digital Interventions to Promote Healthy Eating in Children: Umbrella Review",
journal="JMIR Pediatr Parent",
year="2021",
month="Nov",
day="25",
volume="4",
number="4",
pages="e30160",
keywords="children",
keywords="healthy eating",
keywords="eHealth",
keywords="nutrition intervention",
keywords="nutrition education",
keywords="food literacy",
keywords="digital health",
keywords="virtual delivery",
keywords="digital interventions",
keywords="nutrition interventions",
keywords="best practices",
keywords="education",
keywords="mobile phone",
abstract="Background: eHealth and web-based service delivery have become increasingly common during the COVID-19 pandemic. Digital interventions may be highly appealing to young people; however, their effectiveness compared with that of the usual face-to-face interventions is unknown. As nutrition interventions merge with the digital world, there is a need to determine the best practices for digital interventions for children. Objective: The aim of this study is to examine the effectiveness of digital nutrition interventions for children on dietary outcomes compared with status quo interventions (eg, conventional face-to-face programming or nondigital support). Methods: We conducted an umbrella review of systematic reviews of studies assessing primary research on digital interventions aimed at improving food and nutrition outcomes for children aged <18 years compared with conventional nutrition education were eligible for inclusion. Results: In total, 11 systematic reviews published since 2015 were included (7/11, 64\%, were of moderate quality). Digital interventions ranged from internet, computer, or mobile interventions to websites, programs, apps, email, videos, CD-ROMs, games, telehealth, SMS text messages, and social media, or a combination thereof. The dose and duration of the interventions varied widely (single to multiple exposures; 1-60 minutes). Many studies have been informed by theory or used behavior change techniques (eg, feedback, goal-setting, and tailoring). The effect of digital nutrition interventions for children on dietary outcomes is small and inconsistent. Digital interventions seemed to be the most promising for improving fruit and vegetable intake compared with other nutrition outcomes; however, reviews have found mixed results. Conclusions: Owing to the heterogeneity and duration of digital interventions, follow-up evaluations, comparison groups, and outcomes measured, the effectiveness of these interventions remains unclear. High-quality evidence with common definitions for digital intervention types evaluated with validated measures is needed to improve the state of evidence, to inform policy and program decisions for health promotion in children. Now is the time for critical, robust evaluation of the adopted digital interventions during and after the COVID-19 pandemic to establish best practices for nutrition interventions for children. ",
doi="10.2196/30160",
url="https://pediatrics.jmir.org/2021/4/e30160",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842561"
}


@Article{info:doi/10.2196/30695,
author="Soltys, Coyle Frank
and Spilo, Kimi
and Politi, C. Mary",
title="The Content and Quality of Publicly Available Information About Congenital Diaphragmatic Hernia: Descriptive Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Oct",
day="19",
volume="4",
number="4",
pages="e30695",
keywords="congenital diaphragmatic hernia",
keywords="prenatal counseling",
keywords="fetal care",
keywords="online information",
keywords="parental decision making",
abstract="Background: Congenital diaphragmatic hernia (CDH) diagnosis in an infant is distressing for parents. Parents often feel unable to absorb the complexities of CDH during prenatal consultations and use the internet to supplement their knowledge and decision making. Objective: We aimed to examine the content and quality of publicly available, internet-based CDH information. Methods: We conducted internet searches across 2 popular search engines (Google and Bing). Websites were included if they contained CDH information and were publicly available. We developed a coding instrument to evaluate websites. Two coders (FS and KS) were trained, achieved interrater reliability, and rated remaining websites independently. Descriptive statistics were performed. Results: Searches yielded 520 websites; 91 met inclusion criteria and were analyzed. Most websites provided basic CDH information including describing the defect (86/91, 95\%), need for neonatal intensive care (77/91, 85\%), and surgical correction (79/91, 87\%). Few mentioned palliative care, decisions about pregnancy termination (13/91, 14\%), or support resources (21/91, 23\%). Conclusions: Findings highlight the variability of information about CDH on the internet. Clinicians should work to develop or identify reliable, comprehensive information about CDH to support parents. ",
doi="10.2196/30695",
url="https://pediatrics.jmir.org/2021/4/e30695",
url="http://www.ncbi.nlm.nih.gov/pubmed/34665147"
}


@Article{info:doi/10.2196/17723,
author="Chu, Wai Joanna Ting
and Wadham, Angela
and Jiang, Yannan
and Stasiak, Karolina
and Shepherd, Matthew
and Bullen, Christopher",
title="Recruitment and Retention of Parents of Adolescents in a Text Messaging Trial (MyTeen): Secondary Analysis From a Randomized Controlled Trial",
journal="JMIR Pediatr Parent",
year="2021",
month="Dec",
day="20",
volume="4",
number="4",
pages="e17723",
keywords="parenting",
keywords="mHealth",
keywords="text messaging",
keywords="recruitment",
abstract="Background: Parenting programs are well established as an effective strategy for enhancing both parenting skills and the well-being of the child. However, recruitment for family programs in clinical and nonclinical settings remains low. Objective: This study aims to describe the recruitment and retention methods used in a text messaging program (MyTeen) trial for parents of adolescents (10-15 years) and identify key lessons learned. We aim to provide insights and direction for researchers who seek to recruit parents and build on the limited literature on recruitment and retention strategies for parenting program trials. Methods: A recruitment plan was developed, monitored, and modified as needed throughout the course of the project. Strategies to facilitate recruitment were identified (eg, program content and recruitment material, staff characteristics, and study procedures). Traditional and web-based recruitment strategies were used. Results: Over a 5-month period, 319 parents or caregivers expressed interest in our study, of which 221 agreed to participate in the study, exceeding our recruitment target of 214 participants. Attrition was low at the 1-month (4.5\% overall; intervention group: n=5, 4.6\%; control group: n=5, 4.5\%) and 3-month follow-ups (9\% overall; intervention group: n=10, 9.2\%; control group: n=10, 8.9\%). Conclusions: The use of web-based recruitment strategies appeared to be most effective for recruiting and retaining parents in a text-messaging program trial. However, we encountered recruitment challenges (ie, underrepresentation of ethnic minority groups and fathers) similar to those reported in the literature. Therefore, efforts to engage ethnic minorities and fathers are needed. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000117213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374307 ",
doi="10.2196/17723",
url="https://pediatrics.jmir.org/2021/4/e17723",
url="http://www.ncbi.nlm.nih.gov/pubmed/34932007"
}


@Article{info:doi/10.2196/18483,
author="Sinclair, Marlene
and McCullough, M. Julie E.
and Elliott, David
and Braz, Paula
and Cavero-Carbonell, Clara
and Dornan, Lesley
and Jamry-Dziurla, Anna
and Jo{\~a}o Santos, Ana
and Latos-Biele?ska, Anna
and Machado, Ausenda
and P{\'a}ramo-Rodr{\'i}guez, Luc{\'i}a",
title="Using Social Media as a Research Tool for a Bespoke Web-Based Platform for Stakeholders of Children With Congenital Anomalies: Development Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Nov",
day="15",
volume="4",
number="4",
pages="e18483",
keywords="Facebook",
keywords="YouTube",
keywords="Twitter",
keywords="social media",
keywords="metrics",
keywords="e-forum",
keywords="congenital anomalies",
keywords="coproduction",
keywords="COVID-19",
abstract="Background: Limited research evidence exists on the development of web-based platforms for reciprocal communication, coproduction research, and dissemination of information among parents, professionals, and researchers. This paper provides learning and the outcomes of setting up a bespoke web-based platform using social media. Objective: This study aims to explore the establishment of a web-based, multicontextual research communication platform for parents and stakeholders of children with congenital anomalies using social media and to identify associated research and ethical and technical challenges. Methods: The ConnectEpeople e-forum was developed using social media platforms with a stakeholder engagement process. A multilevel approach was implemented for reciprocal engagement between parents of children with congenital anomalies, researchers, health care professionals, and other stakeholders using private and invisible and public Facebook groups, closed Twitter groups, and YouTube. Ethical approval was obtained from Ulster University. Results: Nonprofit organizations (N=128) were invited to engage with an initial response rate of 16.4\% (21/128). Of the 105 parents contacted, 32 entered the private and invisible Facebook groups to participate in the coproduction research. Public Facebook page followers rose to 215, a total of 22 posts had an engagement of >10\%, and 34 posts had a reach of over 100. Webinars included requested information on childhood milestones and behavior. YouTube coverage included 106 ConnectEpeople videos with 28,708 impressions. Project information was obtained from 35 countries. The highest Facebook activity occurred during the early morning hours. Achievement of these results required dedicated time management, social media expertise, creativity, and sharing knowledge to curate valuable content. Conclusions: Building and maintaining a multilayered online forum for coproduction and information sharing is challenging. Technical considerations include understanding the functionality and versatility of social media metrics. Social media offers valuable, easily accessible, quantitative, and qualitative data that can drive the reciprocal process of forum development. The identification and integration of the needs of the ConnectEpeople e-forum was a key driver in the dissemination of useful, meaningful, and accessible information. The necessary dedicated administration to respond to requests and posts and collate data required significant time and effort. Participant safety, the development of trust, and the maintenance of confidentiality were major ethical considerations. Discussions on social media platforms enabled parents to support each other and their children. Social media platforms are particularly useful in identifying common family needs related to early childhood development. This research approach was challenging but resulted in valuable outputs requiring further application and testing. This may be of particular importance in response to COVID-19 or future pandemics. Incorporating flexible, adaptable social media strategies into research projects is recommended to develop effective platforms for collaborative and impactful research and dissemination. ",
doi="10.2196/18483",
url="https://pediatrics.jmir.org/2021/4/e18483",
url="http://www.ncbi.nlm.nih.gov/pubmed/34779778"
}


@Article{info:doi/10.2196/27297,
author="Chin, Samuel
and Carlin, Rebecca
and Mathews, Anita
and Moon, Rachel",
title="Infant Safe Sleep Practices as Portrayed on Instagram: Observational Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Nov",
day="15",
volume="4",
number="4",
pages="e27297",
keywords="sleep position",
keywords="bed-sharing",
keywords="social norms",
keywords="social media",
keywords="safe sleep",
keywords="bedding",
abstract="Background: Parenting practices are highly influenced by perceived social norms. Social norms and American Academy of Pediatrics (AAP) guidelines for infant safe sleep practices are often inconsistent. Instagram has become one of the most popular social media websites among young adults (including many expectant and new parents). We hypothesized that the majority of Instagram images of infant sleep and sleep environments are inconsistent with AAP guidelines, and that the number of ``likes'' for each image would not correlate with adherence of the image to these guidelines. Objective: The objective of this study was to determine the extent of adherence of Instagram images of infant sleep and sleep environments to safe infant sleep guidelines. Methods: We searched Instagram using hashtags that were relevant to infant sleeping practices and environments. We then used an open-source web scraper to collect images and the number of ``likes'' for each image from 27 hashtags. Images were analyzed for adherence to AAP safe sleep guidelines. Results: A total of 1563 images (1134 of sleeping infant; 429 of infant sleep environment without sleeping infant) met inclusion criteria and were analyzed. Only 117 (7.49\%) of the 1563 images were consistent with AAP guidelines. The most common reasons for inconsistency with AAP guidelines were presence of bedding (1173/1563, 75.05\%) and nonrecommended sleep position (479/1134, 42.24\%). The number of ``likes'' was not correlated with adherence of the image to AAP guidelines. Conclusions: Although individuals who use Instagram and post pictures of sleeping infants or infant sleep environments may not actually use these practices regularly, the consistent portrayal of images inconsistent with AAP guidelines reinforces that these practices are normative and may influence the practice of young parents. ",
doi="10.2196/27297",
url="https://pediatrics.jmir.org/2021/4/e27297",
url="http://www.ncbi.nlm.nih.gov/pubmed/34779783"
}


@Article{info:doi/10.2196/29049,
author="Ennab, Farah
and ElSaban, Mariam
and Khalaf, Eman
and Tabatabaei, Hanieh
and Khamis, Hassan Amar
and Devi, Radha Bindu
and Hanif, Kashif
and Elhassan, Hiba
and Saravanan, Ketharanathan
and Cremonesini, David
and Popatia, Rizwana
and Malik, Zainab
and Ho, B. Samuel
and Abusamra, Rania",
title="Clinical Characteristics of Children With COVID-19 in the United Arab Emirates: Cross-sectional Multicenter Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Nov",
day="5",
volume="4",
number="4",
pages="e29049",
keywords="pediatrics",
keywords="children",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="United Arab Emirates",
keywords="viral shedding",
keywords="pandemic",
keywords="treatment",
keywords="outcomes",
keywords="clinical",
keywords="public heath",
abstract="Background: COVID-19 has infected over 123 million people globally. The first confirmed case in the United Arab Emirates (UAE)\thinspacewas reported on January 29, 2020. According to studies conducted in the early epicenters of the pandemic, COVID-19 has fared mildly in the pediatric population. To date, there is a lack of published data about COVID-19 infection among children in the Arabian region. Objective: This study aims to investigate the clinical characteristics, laboratory findings, treatment, and outcomes of children with COVID-19. Methods: This cross-sectional, multicenter study included children with confirmed COVID-19 infection admitted to 3 large hospitals in Dubai, UAE, between March 1 and June 15, 2020. Serial COVID-19 polymerase chain reaction (PCR) testing data were collected, and patients' demographics, premorbid clinical characteristics, and inpatient hospital courses were examined. Results: In all, 111 children were included in our study and represented 22 nationalities. Of these, 59 (53.2\%) were boys. The mean age of the participants was 7 (SD 5.3) years. About 15.3\% of children were younger than 1 year. Only 4 (3.6\%) of them had pre-existing asthma, all of whom had uneventful courses. At presentation, of the 111 children, 43 (38.7\%) were asymptomatic, 68 (61.2\%) had mild or moderate symptoms, and none (0\%) had severe illness requiring intensive care. Fever (23/111, 20.7\%), cough (22/111, 19.8\%), and rhinorrhea (17/111, 15.3\%) were the most common presenting symptoms, and most reported symptoms resolved by day 5 of hospitalization. Most patients had no abnormality on chest x-ray. The most common laboratory abnormalities on admission included variations in neutrophil count (22/111, 24.7\%), aspartate transaminase (18/111, 22.5\%), alkaline phosphatase (29/111, 36.7\%), and lactate dehydrogenase (31/111, 42.5\%). Children were infrequently prescribed targeted medications, with only 4 (3.6\%) receiving antibiotics. None of the 52 patients tested for viral coinfections were positive. COVID-19 PCR testing turned negative at a median of 10 days (IQR: 6-14) after the first positive test. Overall, there was no significant difference of time to negative PCR results between symptomatic and asymptomatic children. Conclusions: This study of COVID-19 presentations and characteristics presents a first look into the burden of COVID-19 infection in the pediatric population in the UAE. We conclude that a large percentage of children experienced no symptoms and that severe COVID-19 disease is uncommon in the UAE. Various laboratory abnormalities were observed despite clinical stability. Ongoing surveillance, contact tracing, and public health measures will be important to contain future outbreaks. ",
doi="10.2196/29049",
url="https://pediatrics.jmir.org/2021/4/e29049",
url="http://www.ncbi.nlm.nih.gov/pubmed/34643535"
}


@Article{info:doi/10.2196/26842,
author="Lilja, Lotten Josefine
and Rupcic Ljustina, Mirna
and Nissling, Linnea
and Larsson, Caroline Anna
and Weineland, Sandra",
title="Youths' and Parents' Experiences and Perceived Effects of Internet-Based Cognitive Behavioral Therapy for Anxiety Disorders in Primary Care: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Nov",
day="1",
volume="4",
number="4",
pages="e26842",
keywords="internet",
keywords="CBT",
keywords="cognitive behavioral therapy",
keywords="adolescents",
keywords="parents",
keywords="anxiety",
keywords="primary care",
keywords="mixed methods",
keywords="experiences",
keywords="youths",
keywords="digital health",
abstract="Background: Anxiety is common among youths in primary care. Face-to-face treatment has been the first choice for clinicians, but during the COVID-19 pandemic, digital psychological interventions have substantially increased. Few studies have examined young people's interest in internet treatment or the attitudes they and their parents have toward it. Objective: This study aims to investigate adolescents' and parents' attitudes toward and experiences of internet-based cognitive behavioral anxiety treatment in primary care and its presumptive effects. Methods: The study used mixed methods, analyzing qualitative data thematically and quantitative data with nonparametric analysis. Participants were 14 adolescents and 14 parents recruited in adolescent primary health care clinics. The adolescents and their parents filled out mental health questionnaires before and after treatment, and were interviewed during ongoing treatment. Results: The quantitative data indicated that the internet-delivered cognitive behavioral therapy program used in this study was successful in reducing symptoms ($\chi$22=8.333; P=.02) and that adolescents' motivation is essential to the treatment outcome (r=0.58; P=.03). The qualitative results show that youths highly value their independence and freedom to organize treatment work on their own terms. The parents expressed uncertainty about their role and how to support their child in treatment. It was important for parents to respect the youths' need for autonomy while also engaging with them in the treatment work. Conclusions: Internet treatment in primary care is accepted by both youths and their parents, who need clarification about the difference between their role and the therapist's role. Patient motivation should be considered before treatment, and therapists need to continue to develop the virtual alliance. Finally, primary care should be clearer in informing adolescents and their parents about the possibility of internet treatment. ",
doi="10.2196/26842",
url="https://pediatrics.jmir.org/2021/4/e26842",
url="http://www.ncbi.nlm.nih.gov/pubmed/34723830"
}


@Article{info:doi/10.2196/26212,
author="Whale, Katie
and Beasant, Lucy
and Wright, J. Anne
and Yardley, Lucy
and Wallace, M. Louise
and Moody, Louise
and Joinson, Carol",
title="A Smartphone App for Supporting the Self-management of Daytime Urinary Incontinence in Adolescents: Development and Formative Evaluation Study of URApp",
journal="JMIR Pediatr Parent",
year="2021",
month="Nov",
day="15",
volume="4",
number="4",
pages="e26212",
keywords="incontinence",
keywords="urinary incontinence",
keywords="digital intervention",
keywords="child health",
keywords="pediatric",
keywords="pediatric incontinence",
keywords="smartphone",
keywords="intervention development",
keywords="mobile phone",
abstract="Background: Daytime urinary incontinence (UI) is common in childhood and often persists into adolescence. UI in adolescence is associated with a range of adverse outcomes, including depressive symptoms, peer victimization, poor self-image, and problems with peer relationships. The first-line conservative treatment for UI is bladder training (standard urotherapy) that aims to establish a regular fluid intake and a timed schedule for toilet visits. The success of bladder training is strongly dependent on good concordance, which can be challenging for young people. Objective: This paper aims to describe the development of a smartphone app (URApp) that aims to improve concordance with bladder training in young people aged 11 to 19 years. Methods: URApp was designed by using participatory co-design methods and was guided by the person-based approach to intervention design. The core app functions were based on clinical guidance and included setting a daily drinking goal that records fluid intake and toilet visits, setting reminders to drink fluids and go to the toilet, and recording progress toward drinking goals. The development of URApp comprised the following four stages: a review of current smartphone apps for UI, participatory co-design workshops with young people with UI for gathering user requirements and developing wireframes, the development of a URApp prototype, and the user testing of the prototype through qualitative interviews with 23 young people with UI or urgency aged 10 to 19 years and 8 clinicians. The app functions and additional functionalities for supporting concordance and behavior change were iteratively optimized throughout the app development process. Results: Young people who tested URApp judged it to be a helpful way of supporting their concordance with a timed schedule for toilet visits and drinking. They reported high levels of acceptability and engagement. Preliminary findings indicated that some young people experienced improvements in their bladder symptoms, including a reduction in UI. Clinicians reported that URApp was clinically appropriate and aligned with the best practice guidelines for bladder training. URApp was deemed age appropriate, with all clinicians reporting that they would use it within their own clinics. Clinicians felt URApp would be of particular benefit to patients whose symptoms were not improving or those who were not engaging with their treatment plans. Conclusions: The next stage is to evaluate URApp in a range of settings, including pediatric continence clinics, primary care, and schools. This research is needed to test whether URApp is an effective (and cost-effective) solution for improving concordance with bladder training, reducing bladder symptoms, and improving the quality of life. ",
doi="10.2196/26212",
url="https://pediatrics.jmir.org/2021/4/e26212",
url="http://www.ncbi.nlm.nih.gov/pubmed/34779780"
}


@Article{info:doi/10.2196/31908,
author="Ahlers-Schmidt, R. Carolyn
and Schunn, Christy
and Hervey, M. Ashley
and Torres, Maria
and Nelson, V. Jill Elizabeth",
title="Promoting Safe Sleep, Tobacco Cessation, and Breastfeeding to Rural Women During the COVID-19 Pandemic: Quasi-Experimental Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Nov",
day="22",
volume="4",
number="4",
pages="e31908",
keywords="COVID-19",
keywords="SIDS",
keywords="sudden infant death syndrome",
keywords="safe sleep",
keywords="tobacco cessation",
keywords="breastfeeding",
keywords="virtual education",
abstract="Background: Safe Sleep Community Baby Showers address strategies to prevent sleep-related infant deaths. Due to the COVID-19 pandemic, these events transitioned from in-person to virtual. Objective: This study describes outcomes of transitioning Safe Sleep Community Baby Showers to a virtual format and compares outcomes to previous in-person events. Methods: Participants from four rural Kansas counties were emailed the presurvey, provided educational materials (videos, livestream, or digital documents), and completed a postsurvey. Those who completed both surveys received a portable crib and wearable blanket. Within-group comparisons were assessed between pre- and postsurveys; between-group comparisons (virtual vs in-person) were assessed by postsurveys. Results: Based on data from 145 in-person and 74 virtual participants, virtual participants were more likely to be married (P<.001) and have private insurance (P<.001), and were less likely to report tobacco use (P<.001). Both event formats significantly increased knowledge and intentions regarding safe sleep and avoidance of secondhand smoke (all P?.001). Breastfeeding intentions did not change. Differences were observed between in-person and virtual meetings regarding confidence in the ability to avoid secondhand smoke (in-person: 121/144, 84\% vs virtual: 53/74, 72\%; P=.03), intention to breastfeed ?6 months (in-person: 79/128, 62\% vs virtual: 52/66, 79\%; P=.008), and confidence in the ability to breastfeed ?6 months (in-person: 58/123, 47\% vs virtual: 44/69, 64\%; P=.02). Conclusions: Although both event formats demonstrated increased knowledge/intentions to follow safe sleep recommendations, virtual events may further marginalize groups who are at high risk for poor birth outcomes. Strategies to increase technology access, recruit priority populations, and ensure disparities are not exacerbated will be critical for the implementation of future virtual events. ",
doi="10.2196/31908",
url="https://pediatrics.jmir.org/2021/4/e31908",
url="http://www.ncbi.nlm.nih.gov/pubmed/34550075"
}


@Article{info:doi/10.2196/29731,
author="Cooray, Nipuna
and Sun, Louise Si
and Ho, Catherine
and Adams, Susan
and Keay, Lisa
and Nassar, Natasha
and Brown, Julie",
title="Toward a Behavior Theory--Informed and User-Centered Mobile App for Parents to Prevent Infant Falls: Development and Usability Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Dec",
day="20",
volume="4",
number="4",
pages="e29731",
keywords="child injury",
keywords="Behaviour Change Wheel",
keywords="mobile app",
keywords="mobile phone",
abstract="Background: Falls account for approximately 50\% of infant injury hospitalizations, and caretaker behavior is central to preventing infant falls. Behavior theory--informed interventions for injury prevention have been suggested, but to date, few have been reported. The potential of using smartphones for injury prevention intervention delivery is also underexploited. Objective: This study aims to develop a behavior theory-- and evidence-based as well as user-centered digital intervention as a mobile app for parents to prevent infant falls following agile development practices. Methods: Infant falls while feeding was selected as the fall mechanism to demonstrate the approach being taken to develop this intervention. In phase 1, the Behaviour Change Wheel was used as a theoretical framework supported by a literature review to define intervention components that were then implemented as a mobile app. In phase 2, after the person-based approach, user testing through think-aloud interviews and comprehension assessments were used to refine the content and implementation of the intervention. Results: The target behaviors identified in phase 1 were adequate rest for the newborn's mother and safe feeding practices defined as prepare, position, and place. From behavioral determinants and the Behaviour Change Wheel, the behavior change functions selected to achieve these target behaviors were psychological capability, social opportunity, and reflective motivation. The selected behavior change techniques aligned with these functions were providing information on health consequences, using a credible source, instruction on performing each behavior, and social support. The defined intervention was implemented in a draft Android app. In phase 2, 4 rounds of user testing were required to achieve the predefined target comprehension level. The results from the think-aloud interviews were used to refine the intervention content and app features. Overall, the results from phase 2 revealed that users found the information provided to be helpful. Features such as self-tracking and inclusion of the social and environmental aspects of falls prevention were liked by the participants. Important feedback for the successful implementation of the digital intervention was also obtained from the user testing. Conclusions: To our knowledge, this is the first study to apply the Behaviour Change Wheel to develop a digital intervention for child injury prevention. This study provides a detailed example of evidence-based development of a behavior theory--informed mobile intervention for injury prevention refined using the person-based approach. ",
doi="10.2196/29731",
url="https://pediatrics.jmir.org/2021/4/e29731",
url="http://www.ncbi.nlm.nih.gov/pubmed/34932004"
}


@Article{info:doi/10.2196/17959,
author="Beerthuizen, Thijs
and Rikkers-Mutsaerts, M. E. R. V.
and Snoeck-Stroband, B. Jiska
and Sont, K. Jacob",
title="The Role of Education, Monitoring, and Symptom Perception in Internet-Based Self-management Among Adolescents With Asthma: Secondary Analysis of a Randomized Controlled Trial",
journal="JMIR Pediatr Parent",
year="2021",
month="Dec",
day="7",
volume="4",
number="4",
pages="e17959",
keywords="web-based monitoring",
keywords="internet self-management",
keywords="adolescents",
keywords="asthma",
keywords="education",
keywords="perception",
abstract="Background: Internet-based self-management programs improve asthma control and the asthma-related quality of life in adults and adolescents. The components of self-management programs include education and the web-based self-monitoring of symptoms; the latter requires adequate perception in order to timely adjust lifestyle or medication or to contact a care provider. Objective: We aimed to test the hypothesis that adherence to education and web-based monitoring and adequate symptom perception are important determinants for the improvement of asthma control in self-management programs. Methods: We conducted a subgroup analysis of the intervention group of a randomized controlled trial, which included adolescents who participated in the internet-based self-management arm. We assessed the impacts that attendance in education sessions, the frequency of web-based monitoring, and the level of perception had on changes in asthma control (Asthma Control Questionnaire [ACQ]) and asthma-related quality of life (Pediatric Asthma Quality of Life Questionnaire) from baseline to 12 months after intervention. Results: Adolescents who attended education sessions had significant and clinically relevant improvements in asthma control (ACQ score difference: ?0.6; P=.03) and exhibited a nonsignificant trend of improvement in asthma-related quality of life (Pediatric Asthma Quality of Life Questionnaire score difference: ?0.45; P=.15) when compared to those who did not adhere to education. Frequent monitoring alone did not improve asthma control (P=.07) and quality of life (P=.44) significantly, but its combination with education did result in improved ACQ scores (difference: ?0.88; P=.02). There were no significant differences in outcomes between normoperceivers and hypoperceivers. Conclusions: Education, especially in combination with frequent web-based monitoring, is an important determinant for the 1-year outcomes of asthma control in internet-based self-management programs for adolescents with partly controlled and uncontrolled asthma; however, we could not establish the effect of symptom perception. This study provides important knowledge on the effects of asthma education and monitoring in daily life. ",
doi="10.2196/17959",
url="https://pediatrics.jmir.org/2021/4/e17959",
url="http://www.ncbi.nlm.nih.gov/pubmed/34879001"
}


@Article{info:doi/10.2196/30681,
author="Basch, H. Corey
and Fera, Joseph
and Pellicane, Alessia
and Basch, E. Charles",
title="Videos With the Hashtag \#vaping on TikTok and Implications for Informed Decision-making by Adolescents: Descriptive Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Oct",
day="25",
volume="4",
number="4",
pages="e30681",
keywords="vaping",
keywords="TikTok",
keywords="social media",
keywords="misinformation",
keywords="decision-making",
keywords="adolescents",
keywords="young adults",
keywords="e-cigarettes",
keywords="public health",
keywords="informed decision-making",
abstract="Background: Despite the public health importance of vaping and the widespread use of TikTok by adolescents and young adults, research is lacking on the nature and scope of vaping content on this networking service. Objective: The purpose of this study is to describe the content of TikTok videos related to vaping. Methods: By searching the hashtag \#vaping in the discover feature, {\textasciitilde}478.4 million views were seen during the time of data collection. The first 100 relevant videos under that hashtag were used in this study. Relevance was determined by simply noting if the video was related in any way to vaping. Coding consisted of several categories directly related to vaping and additional categories, including the number of likes, comments, and views, and if the video involved music, humor, or dance. Results: The 100 videos included in the sample garnered 156,331,347 views; 20,335,800 likes; and 296,460 comments. The majority of the videos (n=59) used music and over one-third (n=37) used humor. The only content category observed in the majority of the videos sampled was the promotion of vaping, which was included in 57 videos that garnered over 74 million views (47.5\% of cumulative views). A total of 42\% (n=42) of the 100 videos sampled featured someone vaping or in the presence of vape pens, and these videos garnered over 22\% (>35 million) of the total views. Conclusions: It is necessary for public health agencies to improve understanding of the nature and content of videos that attract viewers' attention and harness the strength of this communication channel to promote informed decision-making about vaping. ",
doi="10.2196/30681",
url="https://pediatrics.jmir.org/2021/4/e30681",
url="http://www.ncbi.nlm.nih.gov/pubmed/34694231"
}


@Article{info:doi/10.2196/30889,
author="Claesdotter-Knutsson, Emma
and Andr{\'e}, Frida
and Fridh, Maria
and Delfin, Carl
and Hakansson, Anders
and Lindstr{\"o}m, Martin",
title="Gender-Based Differences and Associated Factors Surrounding Excessive Smartphone Use Among Adolescents: Cross-sectional Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Nov",
day="22",
volume="4",
number="4",
pages="e30889",
keywords="smartphone",
keywords="cell phone",
keywords="adolescent",
keywords="sleep",
keywords="anxiety",
keywords="substance use",
keywords="nicotine",
keywords="alcohol drinking",
keywords="smartphone use",
keywords="addiction",
keywords="behavioral addiction",
keywords="worry",
keywords="pathology",
keywords="internet",
abstract="Background: Excessive smartphone use is a new and debated phenomenon frequently mentioned in the context of behavioral addiction, showing both shared and distinct traits when compared to pathological gaming and gambling. Objective: The aim of this study is to describe excessive smartphone use and associated factors among adolescents, focusing on comparisons between boys and girls. Methods: This study was based on data collected through a large-scale public health survey distributed in 2016 to pupils in the 9th grade of primary school and those in the 2nd grade of secondary school. Bayesian binomial regression models, with weakly informative priors, were used to examine whether the frequency of associated factors differed between those who reported excessive smartphone use and those who did not. Results: The overall response rate was 77\% (9143/11,868) among 9th grade pupils and 73.4\% (7949/10,832) among 2nd grade pupils, resulting in a total of 17,092 responses. Based on the estimated median absolute percentage differences, along with associated odds ratios, we found that excessive smartphone use was associated with the use of cigarettes, alcohol, and other substances. The reporting of anxiety and worry along with feeling low more than once a week consistently increased the odds of excessive smartphone use among girls, whereas anxiety and worry elevated the odds of excessive smartphone use among boys. The reporting of less than 7 hours of sleep per night was associated with excessive smartphone use in all 4 study groups. Conclusions: The results varied across gender and grade in terms of robustness and the size of estimated difference. However, excessive smartphone use was associated with a higher frequency of multiple suspected associated factors, including ever having tried smoking, alcohol, or other substances; poor sleep; and often feeling low and feeling anxious. This study sheds light on some features and distinctions of a potentially problematic behavior among adolescents. ",
doi="10.2196/30889",
url="https://pediatrics.jmir.org/2021/4/e30889",
url="http://www.ncbi.nlm.nih.gov/pubmed/34813492"
}


@Article{info:doi/10.2196/27988,
author="Schroeder, Kristin
and Maiarana, James
and Gisiri, Mwitasrobert
and Joo, Emma
and Muiruri, Charles
and Zullig, Leah
and Masalu, Nestory
and Vasudevan, Lavanya",
title="Caregiver Acceptability of Mobile Phone Use for Pediatric Cancer Care in Tanzania: Cross-sectional Questionnaire Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Dec",
day="8",
volume="4",
number="4",
pages="e27988",
keywords="mHealth",
keywords="literacy",
keywords="smartphone use",
keywords="developing countries",
keywords="pediatric cancer",
keywords="cancer",
keywords="pediatrics",
keywords="children",
keywords="parents",
keywords="caregivers",
keywords="mobile health",
keywords="smartphone",
keywords="SMS",
keywords="education",
keywords="knowledge transfer",
keywords="communication",
abstract="Background: There is a 60\% survival gap between children diagnosed with cancer in low- and middle-income countries (LMICs) and those in high-income countries. Low caregiver knowledge about childhood cancer and its treatment results in presentation delays and subsequent treatment abandonment in LMICs. However, in-person education to improve caregiver knowledge can be challenging due to health worker shortages and inadequate training. Due to the rapid expansion of mobile phone use worldwide, mobile health (mHealth) technologies offer an alternative to delivering in-person education. Objective: The aim of this study is to assess patterns of mobile phone ownership and use among Tanzanian caregivers of children diagnosed with cancer as well as their acceptability of an mHealth intervention for cancer education, patient communication, and care coordination. Methods: In July 2017, caregivers of children <18 years diagnosed with cancer and receiving treatment at Bugando Medical Centre (BMC) were surveyed to determine mobile phone ownership, use patterns, technology literacy, and acceptability of mobile phone use for cancer education, patient communication, and care coordination. Descriptive statistics were generated from the survey data by using mean and SD values for continuous variables and percentages for binary or categorical variables. Results: All eligible caregivers consented to participate and completed the survey. Of the 40 caregivers who enrolled in the study, most used a mobile phone (n=34, 85\%) and expressed high acceptability in using these devices to communicate with a health care provider regarding treatment support (n=39, 98\%), receiving laboratory results (n=37, 93\%), receiving reminders for upcoming appointments (n=38, 95\%), and receiving educational information on cancer (n=35, 88\%). Although only 9\% (3/34) of mobile phone owners owned phones with smartphone capabilities, about 74\% (25/34) self-reported they could view and read SMS text messages. Conclusions: To our knowledge, this is the first study to assess patterns of mobile phone ownership and use among caregivers of children with cancer in Tanzania. The high rate of mobile phone ownership and caregiver acceptability for a mobile phone--based education and communication strategy suggests that a mobile phone--based intervention, particularly one that utilizes SMS technology, could be feasible in this setting. ",
doi="10.2196/27988",
url="https://pediatrics.jmir.org/2021/4/e27988",
url="http://www.ncbi.nlm.nih.gov/pubmed/34889763"
}


@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/10.2196/35350,
author="Lilja, Lotten Josefine
and Rupcic Ljustina, Mirna
and Nissling, Linnea
and Larsson, Caroline Anna
and Weineland, Sandra",
title="Correction: Youths' and Parents' Experiences and Perceived Effects of Internet-Based Cognitive Behavioral Therapy for Anxiety Disorders in Primary Care: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Dec",
day="2",
volume="4",
number="4",
pages="e35350",
doi="10.2196/35350",
url="https://pediatrics.jmir.org/2021/4/e35350",
url="http://www.ncbi.nlm.nih.gov/pubmed/34860680"
}