%0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e66401 %T Exploring Stress and Stress-Reduction With Caregivers and Clinicians in the Neonatal Intensive Care Unit to Inform Intervention Development: Qualitative Interview Study %A Ginsberg,Kristin Harrison %A Alsweiler,Jane %A Rogers,Jenny %A Ross,Phoebe %A Serlachius,Anna %K neonatal intensive care unit %K NICU %K parents %K preterm infants %K stress %K stress reduction %K intervention development %K digital %K neonatology %K pediatric %K infants %K babies %K neonatal %K toddler %K children %K caregiver %K telemedicine %K telehealth %K virtual care %K virtual health %K virtual medicine %K remote consultation %K qualitative study %D 2025 %7 2.4.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Parents and caregivers with preterm babies in the neonatal intensive care unit (NICU) experience high levels of distress and are at an increased risk of anxiety, depression, and acute stress disorders. Effective interventions to reduce this distress are well described in the literature, but this research has been conducted primarily in Europe and North America. To our knowledge, few interventions of this sort have been developed in Australasia, and none have been developed or tested in Aotearoa New Zealand. Objective: The primary aims of this study were to explore sources of stress with caregivers and clinicians in a NICU in Aotearoa New Zealand and gather participant ideas on ways to reduce caregiver stress to inform intervention development. Methods: This qualitative design used an essentialist and realist methodology to generate findings aimed at future intervention development. Overall, 10 NICU clinicians (neonatologists, nurses, and mental health clinicians) and 13 caregivers (mothers, fathers, and extended family members) of preterm babies, either currently admitted or discharged from the NICU within the last 12 months, were recruited to participate in interviews exploring stress and stress-reduction in the NICU. Results: The 23 participants included 10 clinicians (all female, with an average of 15 years of experience in the NICU) and 13 parents and caregivers (majority of them were female; 10/13, 77%) of preterm babies. We identified 6 themes relevant to intervention development. Three themes focused on caregiver stress: the emotional “rollercoaster” of NICU; lack of support, both culturally and emotionally; and caregivers feeling “left out” and confused. Three themes focused on participant-proposed solutions to reduce stress: caregiver empowerment, improving emotional support, and communication on “my” terms (ie, digitally). Conclusions: Participants reported high levels of caregiver stress in the NICU, and they proposed a range of stress-reducing solutions, including increasing caregiver empowerment and improving emotional and cultural support. Clinicians and caregivers also strongly agreed on providing more information for caregivers in digital, mobile-friendly formats. %R 10.2196/66401 %U https://pediatrics.jmir.org/2025/1/e66401 %U https://doi.org/10.2196/66401 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e65107 %T Implementing Diabetes Distress Screening in a Pediatric Endocrinology Clinic Using a Digital Health Platform: Quantitative Secondary Data Analysis %A Kahhan,Nicole A %A Fox,Larry A %A Benson,Matthew %A Patton,Susana R %K type 1 diabetes %K diabetes mellitus, type 1 %K pediatric %K child %K children %K youth %K parents %K diabetes distress %K eHealth %K screening %K digital health %K diabetes %K diabetic %K type 1 %K DM %K T1D %K endocrinology %K alert %K best practice alert %K BPA %K patient education %D 2025 %7 6.2.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Type 1 diabetes (T1D) management requires following a complex and constant regimen relying on child or caregiver behaviors, skills, and knowledge. Psychological factors such as diabetes distress (DD), depression, and burnout are pertinent considerations in the treatment of pediatric T1D. Approximately 40% of youth and 61% of caregivers experience DD. Implementation of DD screening as part of clinical best practice is recommended and may facilitate treatment referral, perhaps leading to improved health or well-being for youth with T1D and their caregivers. By building on existing institutional infrastructure when available, screening via digital health platforms (applications, or “apps”) may allow for timely screening of, and response to, DD. Objective: This work details the creation, implementation, and refinement of a process to screen for DD in youth and their caregivers in the context of routine T1D care using a digital health platform. Methods: DD screening was implemented in an outpatient endocrinology clinic over 1 year as part of a larger screen-to-treat trial for children aged 8‐12.99 years and their caregivers. Validated measures were sent via digital health platform to be completed prior to the clinic visit. Results were initially reviewed manually, but a digital best practice alert (BPA) was later built to notify staff of elevated scores. Families experiencing DD received resources sent via the digital health platform. For this secondary analysis, child demographics and glycated hemoglobin A1c (HbA1c) were collected. Results: During the screening period, absolute completion rates were 36.78% and 38.83%, with adjusted screening rates at 52.02% and 54.48%, for children and caregivers, respectively. A total of 21 children (mean HbA1c 8.04%, SD 1.39%) and 26 caregivers (child mean HbA1c 8.04%, SD 1.72%) reported elevated DD. Prior to BPA development, resources were sent to all but 1 family. After BPA implementation, all families were sent resources. Conclusions: Early findings indicate that DD education, screening, and response can be integrated via digital platforms in a freestanding outpatient endocrinology clinic, thereby facilitating timely treatment referral and provision of resources for those identified with distress. Notably, in the observed 1-year screening period, screening rates were low, and barriers to implementation were identified. While some implementation challenges were iteratively addressed, there is a need for future quality improvement initiatives to improve screening rates and the identification of, or response to, DD in our pediatric patients and their families. Trial Registration: ClinicalTrials.gov NCT05268250; https://clinicaltrials.gov/study/NCT05268250 %R 10.2196/65107 %U https://pediatrics.jmir.org/2025/1/e65107 %U https://doi.org/10.2196/65107 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 9 %N %P e56667 %T Pediatric Sleep Quality and Parental Stress in Neuromuscular Disorders: Descriptive Analytical Study %A Khaksar,Sajjad %A Jafari-Oori,Mehdi %A Sarhangi,Forogh %A Moayed,Malihe Sadat %K spinal muscular atrophy %K neuromuscular disorders %K sleep quality %K pediatrics %K parental stress %K children %K parents %K muscular atrophy %K muscular disorders %D 2025 %7 28.1.2025 %9 %J Asian Pac Isl Nurs J %G English %X Background: Neuromuscular disorders (NMDs) constitute a heterogeneous group of disorders that affect motor neurons, neuromuscular junctions, and muscle fibers, resulting in symptoms such as muscle weakness, fatigue, and reduced mobility. These conditions significantly affect patients’ quality of life and impose a substantial burden on caregivers. Spinal muscular atrophy (SMA) is a relatively common NMD in children that presents in various types with varying degrees of severity. Objective: This study aimed to evaluate the sleep quality of children with NMDs, particularly SMA types 1, 2, and 3 and assess the stress levels experienced by their parents. Methods: A descriptive analytical study was conducted from February to October 2023, in selected hospitals and dystrophy associations in Tehran and Isfahan, Iran. A total of 207 children aged 1‐14 years with various NMDs were included in the study. Data were collected using a web-based questionnaire with 3 parts: demographic information, the Children’s Sleep Habits Questionnaire to assess children’s sleep, and the Stress Response Inventory to measure parental stress. Statistical analyses were performed using SPSS version 22, with an α level of .05. Results: Significant differences in sleep quality were found among SMA types, with mean scores of 74.76 (SD 7.48) for SMA type 1, 76.4 (SD 7.29) for SMA type 2, 72.88 (SD 6.73) for SMA type 3, and 75.87 (SD 5.74) for other NMDs (P=.02). A correlation was found between sleep and length of hospital stay (r=0.234, P<.001)and between sleep and the child’s sex (r=−0.140, P=.04). Parental stress scores averaged 95.73 (SD 32.12). There was not a statistically significant difference in parental stress scores among the 4 groups (P=.78). This suggests that parental stress levels were similar across different NMD groups. Conclusions: Sleep disorders are prevalent among children with NMDs, especially SMA. Parents experience high levels of stress that can affect the care they provide. Therefore, interventions to improve children’s sleep and address parental stress are crucial. Regular screening, counseling, and tailored support are recommended to enhance the well-being of children with NMDs and their families. %R 10.2196/56667 %U https://apinj.jmir.org/2025/1/e56667 %U https://doi.org/10.2196/56667 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54862 %T Stunting Super App as an Effort Toward Stunting Management in Indonesia: Delphi and Pilot Study %A Erika,Kadek Ayu %A Fadilah,Nur %A Latif,Aulia Insani %A Hasbiah,Nurhikmawaty %A Juliaty,Aidah %A Achmad,Harun %A Bustamin,Anugrayani %K stunting %K stunting prevention %K mobile app %D 2024 %7 17.12.2024 %9 %J JMIR Hum Factors %G English %X Background: Currently, 30 million children are experiencing acute malnutrition, and 8 million children are severely underweight. Objective: This study aimed to develop a stunting super app, a one-stop app designed to prevent and manage stunting in Indonesia. Methods: This study consisted of three stages. Stage 1 used a 3-round Delphi study involving 12 experts. In stage 2, 4 experts and a parent of children with stunted growth created an Android app containing stunting educational materials. In stage 3, a pilot study involving a control group was conducted to evaluate parents’ knowledge about stunting prevention through the app and standard interventions. Results: In the Delphi study, 11 consensus statements were extracted; arranged in three major themes, including maternal health education, child health education, and environmental education; and applied in the form of the Sistem Evaluasi Kesehatan Anak Tumbuh Ideal (SEHATI) app. This app was assessed using a content validity index, with a cumulative agreement of ≥80% among the 5 individuals. The pilot study showed an increase in the knowledge of mothers of toddlers with stunted growth before and after the educational intervention (P=.001). Conclusions: The SEHATI app provides educational content on stunting prevention that can increase the knowledge of mothers of toddlers with stunted growth. %R 10.2196/54862 %U https://humanfactors.jmir.org/2024/1/e54862 %U https://doi.org/10.2196/54862 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e64669 %T Parental Assessment of Postsurgical Pain in Infants at Home Using Artificial Intelligence–Enabled and Observer-Based Tools: Construct Validity and Clinical Utility Evaluation Study %A Sada,Fatos %A Chivers,Paola %A Cecelia,Sokol %A Statovci,Sejdi %A Ukperaj,Kujtim %A Hughes,Jeffery %A Hoti,Kreshnik %+ Faculty of Medicine, University of Prishtina, 31 George Bush St, Prishtina, 10000, Kosovo, 383 44945173, kreshnik.hoti@uni-pr.edu %K PainChek Infant %K Observer-Administered Visual Analog Scale %K parents %K infant pain %K pain assessment %K circumcision %K infant home assessment %K clinical utility %K construct validity %K artificial intelligence %D 2024 %7 3.12.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Pain assessment in the infant population is challenging owing to their inability to verbalize and hence self-report pain. Currently, there is a paucity of data on how parents identify and manage this pain at home using standardized pain assessment tools. Objective: This study aimed to explore parents’ assessment and intervention of pain in their infants at home following same-day surgery, using standardized pain assessment tools. Methods: This prospective study initially recruited 109 infant boys undergoing circumcision (same-day surgery). To assess pain at home over 3 days after surgery, parents using iOS devices were assigned to use the PainChek Infant tool, which is a point-of-care artificial intelligence–enabled tool, while parents using Android devices were assigned to use the Observer-Administered Visual Analog Scale (ObsVAS) tool. Chi-square analysis compared the intervention undertaken and pain presence. Generalized estimating equations were used to evaluate outcomes related to construct validity and clinical utility. Receiver operating characteristic analysis assessed pain score cutoffs in relation to the intervention used. Results: A total of 69 parents completed postsurgery pain assessments at home and returned their pain diaries. Of these 69 parents, 24 used ObsVAS and 45 used PainChek Infant. Feeding alone and feeding with medication were the most common pain interventions. Pain presence over time reduced. In the presence of pain, an intervention was likely to be administered (χ22=21.4; P<.001), with a medicinal intervention being 12.6 (95% CI 4.3-37.0; P<.001) times more likely and a nonmedicinal intervention being 5.2 (95% CI 1.8-14.6; P=.002) times more likely than no intervention. In the presence of intervention, score cutoff values were ≥2 for PainChek Infant and ≥20 for ObsVAS. A significant effect between the use of the pain instrument (χ21=7.2, P=.007) and intervention (χ22=43.4, P<.001) was found, supporting the construct validity of both instruments. Standardized pain scores were the highest when a medicinal intervention was undertaken (estimated marginal mean [EMM]=34.2%), followed by a nonmedicinal intervention (EMM=23.5%) and no intervention (EMM=11.2%). Similar trends were seen for both pain instruments. Pain was reduced in 94.5% (224/237) of assessments where parents undertook an intervention. In 75.1% (178/237) of assessments indicative of pain, the score changed from pain to no pain, with PainChek Infant assessments more likely to report this change (odds ratio 4.1, 95% CI 1.4-12.3) compared with ObsVAS assessments. Conclusions: The use of standardized pain assessment instruments by parents at home to assess pain in their infants can inform their decision-making regarding pain identification and management, including determining the effectiveness of the chosen intervention. In addition to the construct validity and clinical utility of PainChek Infant and ObsVAS in this setting, feeding alone and a combination of feeding with medication use were the key pain intervention strategies used by parents. %M 39626240 %R 10.2196/64669 %U https://pediatrics.jmir.org/2024/1/e64669 %U https://doi.org/10.2196/64669 %U http://www.ncbi.nlm.nih.gov/pubmed/39626240 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e62878 %T Parent-Led Applied Behavior Analysis to Impact Clinical Outcomes for Individuals on the Autism Spectrum: Retrospective Chart Review %A Garikipati,Anurag %A Ciobanu,Madalina %A Singh,Navan Preet %A Barnes,Gina %A Dinenno,Frank A %A Geisel,Jennifer %A Mao,Qingqing %A Das,Ritankar %K applied behavior analysis %K autism spectrum disorder %K parent training %K patient outcomes %K skill acquisition %K pediatrics %D 2024 %7 30.10.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Autism spectrum disorder (ASD) can have traits that impact multiple domains of functioning and quality of life, which can persevere throughout life. To mitigate the impact of ASD on the long-term trajectory of an individual’s life, it is imperative to seek early and adequate treatment via scientifically validated approaches, of which applied behavior analysis (ABA) is the gold standard. ABA treatment must be delivered via a behavior technician with oversight from a board-certified behavior analyst. However, shortages in certified ABA therapists create treatment access barriers for individuals on the autism spectrum. Increased ASD prevalence demands innovations for treatment delivery. Parent-led treatment models for neurodevelopmental conditions are effective yet underutilized and may be used to fill this care gap. Objective: This study reports findings from a retrospective chart review of clinical outcomes for children that received parent-led ABA treatment and intends to examine the sustained impact that modifications to ABA delivery have had on a subset of patients of Montera, Inc. dba Forta (“Forta”), as measured by progress toward skill acquisition within multiple focus areas (FAs). Methods: Parents received ≥40 hours of training in ABA prior to initiating treatment, and patients were prescribed focused (<25 hours/week) or comprehensive (>25‐40 hours/week) treatment plans. Retrospective data were evaluated over ≥90 days for 30 patients. The clinical outcomes of patients were additionally assessed by age (2-5 years, 6-12 years, 13‐22 years) and utilization of prescribed treatment. Treatment encompassed skill acquisition goals; to facilitate data collection consistency, successful attempts were logged within a software application built in-house. Results: Improved goal achievement success between weeks 1‐20 was observed for older age, all utilization, and both treatment plan type cohorts. Success rates increased over time for most FAs, with the exception of executive functioning in the youngest cohort and comprehensive plan cohort. Goal achievement experienced peaks and declines from week to week, as expected for ABA treatment; however, overall trends indicated increased skill acquisition success rates. Of 40 unique combinations of analysis cohorts and FAs, 20 showed statistically significant positive linear relationships (P<.05). Statistically significant positive linear relationships were observed in the high utilization cohort (communication with P=.04, social skills with P=.02); in the fair and full utilization cohorts (overall success with P=.03 for the fair utilization cohort and P=.001 for the full utilization cohort, and success in emotional regulation with P<.001 for the fair utilization cohort and P<.001 for the full utilization cohort); and in the comprehensive treatment cohort (communication with P=.001, emotional regulation with P=.045). Conclusions: Parent-led ABA can lead to goal achievement and improved clinical outcomes and may be a viable solution to overcome treatment access barriers that delay initiation or continuation of care. %R 10.2196/62878 %U https://pediatrics.jmir.org/2024/1/e62878 %U https://doi.org/10.2196/62878 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e53151 %T Evaluating the Effectiveness of an Online Course on Pediatric Malnutrition for Syrian Health Professionals: Qualitative Delphi Study %A Sahyouni,Amal %A Zoukar,Imad %A Dashash,Mayssoon %K effectiveness %K online course %K pediatric %K malnutrition %K essential competencies %K e-learning %K health professional %K Syria %K pilot study %K acquisition knowledge %D 2024 %7 28.10.2024 %9 %J JMIR Med Educ %G English %X Background: There is a shortage of competent health professionals in managing malnutrition. Online education may be a practical and flexible approach to address this gap. Objective: This study aimed to identify essential competencies and assess the effectiveness of an online course on pediatric malnutrition in improving the knowledge of pediatricians and health professionals. Methods: A focus group (n=5) and Delphi technique (n=21 health professionals) were used to identify 68 essential competencies. An online course consisting of 4 educational modules in Microsoft PowerPoint (Microsoft Corp) slide form with visual aids (photos and videos) was designed and published on the Syrian Virtual University platform website using an asynchronous e-learning system. The course covered definition, classification, epidemiology, anthropometrics, treatment, and consequences. Participants (n=10) completed a pretest of 40 multiple-choice questions, accessed the course, completed a posttest after a specified period, and filled out a questionnaire to measure their attitude and assess their satisfaction. Results: A total of 68 essential competencies were identified, categorized into 3 domains: knowledge (24 competencies), skills (29 competencies), and attitudes (15 competencies). These competencies were further classified based on their focus area: etiology (10 competencies), assessment and diagnosis (21 competencies), and management (37 competencies). Further, 10 volunteers, consisting of 5 pediatricians and 5 health professionals, participated in this study over a 2-week period. A statistically significant increase in knowledge was observed among participants following completion of the online course (pretest mean 24.2, SD 6.1, and posttest mean 35.2, SD 3.3; P<.001). Pediatricians demonstrated higher pre- and posttest scores compared to other health care professionals (all P values were <.05). Prior malnutrition training within the past year positively impacted pretest scores (P=.03). Participants highly rated the course (mean satisfaction score >3.0 on a 5-point Likert scale), with 60% (6/10) favoring a blended learning approach. Conclusions: In total, 68 essential competencies are required for pediatricians to manage children who are malnourished. The online course effectively improved knowledge acquisition among health care professionals, with high participant satisfaction and approval of the e-learning environment. %R 10.2196/53151 %U https://mededu.jmir.org/2024/1/e53151 %U https://doi.org/10.2196/53151 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60626 %T Effectiveness of a Bullying Intervention (Be-Prox) in Norwegian Early Childhood and Education Care Centers: Protocol for a Cluster Randomized Controlled Trial %A Kvestad,Ingrid %A Adolfsen,Frode %A Angeles,Renira Corinne %A Brandseth,Oda Lekve %A Breivik,Kyrre %A Evertsen,Janne Grete %A Foer,Irene Kvåle %A Haaland,Morten %A Homola,Birgit Millerjord %A Hoseth,Gro Elisabeth %A Jonsson,Josefine %A Kjerstad,Egil %A Kyrrestad,Henriette %A Martinussen,Monica %A Moberg,Annelene %A Moberg,Karianne %A Skogstrand,Anita %A Solberg,Line Remme %A Aasheim,Merete %+ NORCE Norwegian Research Center, 5838 Bergen, Bergen, Norway, 47 99400431, inkv@norceresearch.no %K peer bullying in early childhood education and care %K The Bernese Program %K cluster randomized controlled trial %K bullying %K child %K preschool %K program evaluation %D 2024 %7 24.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: A new and growing body of research has studied bullying among children in early childhood education and care centers (ECECs). The Bernese Program (Be-Prox) is designed to systematically prevent and handle bullying between children in Swiss ECECs. However, the effectiveness of the Be-Prox intervention has not yet been explored in a Norwegian ECEC setting. Objective: This study aims to evaluate the effectiveness of Be-Prox in preventing and handling bullying among peers in Norwegian ECECs. Methods: ECECs from 2 Norwegian municipalities were invited to participate in a cluster randomized controlled trial (RCT) to evaluate the effectiveness of the Be-Prox intervention on peer bullying in Norwegian ECECs. After baseline measures were taken, project ECECs were randomized to either an intervention or a control arm. The Be-Prox intervention was introduced to ECECs in the intervention arm through 6 modules over a 9-month period immediately after the randomization. ECECs in the control arm participated in the data collection and were offered the Be-Prox intervention the following year. The primary outcome of the effect evaluation is the mean sum of negative behavior between peers after the Be-Prox training is completed in the intervention arm. Secondary outcomes include child bystander behavior, teacher self-efficacy, and ECEC’s authoritative climate. An extensive implementation and process evaluation, as well as cost-effectiveness analyses, will be conducted alongside the RCT. Results: Baseline data collection was conducted in September 2023, and the postintervention data collection started in May 2024. At baseline, we collected data on 708 children and 413 personnel from 38 project ECECs in the 2 Norwegian municipalities. The results from the study will be available in late 2024 at the earliest. Conclusions: The proposed project includes a comprehensive evaluation of the effectiveness of Be-Prox in Norwegian ECECs directly targeting the prevention and handling of bullying, including implementation and cost-effectiveness evaluations. The results from the project have the potential to fill in identified knowledge gaps in the understanding of negative behavior and bullying between peers in ECECs, and how these may be prevented. If proven efficient, our ambition is to offer Be-Prox to Norwegian ECECs as an evidence-based practice to prevent and handle bullying among preschool children. Trial Registration: ClinicalTrials.gov NCT06040437; https://clinicaltrials.gov/study/NCT06040437 International Registered Report Identifier (IRRID): DERR1-10.2196/60626 %M 39447170 %R 10.2196/60626 %U https://www.researchprotocols.org/2024/1/e60626 %U https://doi.org/10.2196/60626 %U http://www.ncbi.nlm.nih.gov/pubmed/39447170 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54914 %T Parent Education and Counseling (PairEd-C) Intervention to Improve Family-Centered Care: Protocol for a Prospective Acceptability Study Using the Theoretical Framework of Acceptability %A Deribe,Leul %A Girma,Eshetu %A Lindström,Nataliya %A Gidey,Abdulkadir %A Teferra,Solomon %A Addissie,Adamu %+ Department of Applied Information Technology, University of Gothenburg, Universitetsplatsen 1, Forskningsgången, Göteborg, 405 30, Sweden, 46 733268716, nataliya.berbyuk.lindstrom@ait.gu.se %K family-centered care %K child cancer %K theoretical framework of acceptability %K education and counseling %K acceptability %K parent education %K family centered %K care service %K theoretical framework %K study protocol %K family %K health care %K well-being %K children %K implementation %K design intervention %D 2024 %7 4.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Family-centered care (FCC) is an intervention approach based on a respectful relationship between family and health care providers (HCPs) to ensure the health and well-being of children and their families. Although HCPs have a better perception of FCC, the level of its implementation is low. Reasons for low implementation include limited understanding, lack of training, and lack of implementation guidelines and tools to support implementation. Thus, we developed the Parent Education and Counseling (PairEd-C) intervention to improve FCC in pediatric oncology settings and assess its acceptability. Objective: The objective of this study is to assess the prospective acceptability of the PairEd-C intervention using the theoretical framework of acceptability (TFA) in the pediatric oncology department in a tertiary hospital in Ethiopia. Methods: The study was conducted using an exploratory qualitative study design. We aimed to recruit 10 to 15 participants for the in-depth interview. The study participants were health service leaders working in child cancer, HCPs, social workers, and parents of children with cancer. The intervention was developed using the integration of the first phase of the Medical Research Council (MRC) framework for developing and testing complex interventions and the behavior change wheel (BCW) framework. The main PairEd-C intervention components align with the intervention functions of education, persuasion, training, environmental restructuring, modeling, and enablement, which were intended to improve FCC in the pediatric oncology unit by providing structured and comprehensive education and counseling of parents of children with cancer. The intervention was implemented by providing training for the health care team, facilitating discussion among HCPs and setting a shared plan, improving the commitment of the health care team, providing education for parents, improving parents’ capacity to attend the intervention sessions, arranging discussion among parents of children with cancer, and provision of education and counseling on distress. The HCPs working in the unit received training on the designed intervention. The trained educators and the health care provider delivered the intervention. Data will be analyzed using deductive thematic coding with a framework analysis technique based on the 7 TFA constructs. Atlas ti. version 9 will be used for data analysis. Results: Funding was acquired in 2017, and ethical clearance for conducting the study was obtained. We conducted the interviews with the study participants from December 2023 to January 2024. As of the acceptance of this protocol (June 2024), 12 study participants were interviewed. The data analysis process was started subsequently, and the manuscript will be completed and submitted for publication in early 2025. Conclusions: This acceptability study is expected to show that the designed intervention is acceptable to study participants, and the findings will be used to improve the intervention before progressing to the next step of our project. International Registered Report Identifier (IRRID): DERR1-10.2196/54914 %M 39365661 %R 10.2196/54914 %U https://www.researchprotocols.org/2024/1/e54914 %U https://doi.org/10.2196/54914 %U http://www.ncbi.nlm.nih.gov/pubmed/39365661 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e64216 %T Stepped-Care Web-Based Parent Support Following Congenital Heart Disease: Protocol for a Randomized Controlled Trial %A Taylor,Marin %A Bondi,Bianca Christina %A Andrade,Brendan F %A Au-Young,Stephanie H %A Chau,Vann %A Danguecan,Ashley %A Désiré,Naddley %A Guo,Ting %A Ostojic-Aitkens,Dragana %A Wade,Shari %A Miller,Steven %A Williams,Tricia Samantha %+ The Department of Psychology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada, 1 416 813 8507, tricia.williams@sickkids.ca %K congenital heart disease %K neurodevelopmental outcomes %K web-based mental health care %K stepped care %K positive parenting %K family well-being %K mental health %K I-InTERACT-North %D 2024 %7 4.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Early neurodevelopmental risks, compounded with traumatic medical experiences, contribute to emotional and behavioral challenges in as many as 1 in 2 children with congenital heart disease (CHD). Parents report a strong need for supports; yet, there remains a lack of accessible, evidence-based behavioral interventions available for children with CHD and their families. I-InTERACT-North is a web-based stepped-care mental health program designed to support family well-being and reduce behavioral concerns through positive parenting for children with early medical complexity. In previous pilot studies, the program was effective in increasing positive parenting skills and decreasing child behavior problems, with high parent-reported acceptability. This paper presents the protocol for the first randomized study of stepped-care parent support for families of children with CHD. Objective: This study will involve a single-site, 2-arm, single-blind randomized controlled trial to evaluate (1) the feasibility and acceptability of a web-based stepped-care parent support program (I-InTERACT-North) and (2) the effectiveness of the program in enhancing positive parenting skills and reducing behavioral concerns among families of children with CHD. Methods: Families will be randomized (1:1) to either receive treatment or continue with care as usual for 12 months. Randomization will be stratified by child’s sex assigned at birth and baseline parent-reported child behavior intensity. Primary outcomes include positive parenting skills and child behavior at baseline, 3 months, 6 months, and 12 months. Secondary outcomes include parental mental health, quality of life, service usage, and feasibility including program reach and adherence. A sample size of 244 families will provide >95% power to detect an effect size of d=0.64. Based on attrition data from pilot studies, a target of 382 families will be enrolled. Parent reports of acceptability, adoption, and suggested adaptability of the program will be examined using cross-case thematic analyses. Primary efficacy analysis will be conducted using an intent-to-treat approach. Generalized estimating equations will be used to examine changes in positive parenting. Child behavior, quality of life, and parent mental health will be tested with repeated-measures analyses. Additional sensitivity and replication analyses will also be carried out. Results: Recruitment began in February 2024, and recruitment and follow-up will continue until January 2029. We anticipate results in late 2029. Conclusions: This study aims to test the effectiveness of I-InTERACT-North web-based stepped-care parent support in improving positive parenting skills and reducing child behavior problems in families of children with CHD compared with a care as usual control group. Results will inform future clinical implementation and expansion of this program among families of children with early medical conditions. Trial Registration: ClinicalTrials.gov NCT06075251; https://clinicaltrials.gov/study/NCT06075251 International Registered Report Identifier (IRRID): DERR1-10.2196/64216 %M 39365658 %R 10.2196/64216 %U https://www.researchprotocols.org/2024/1/e64216 %U https://doi.org/10.2196/64216 %U http://www.ncbi.nlm.nih.gov/pubmed/39365658 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e51606 %T Development of MyREADY Transition BBD Mobile App, a Health Intervention Technology Platform, to Improve Care Transition for Youth With Brain-Based Disabilities: User-Centered Design Approach %A Marelli,Ariane %A Rozenblum,Ronen %A Bolster-Foucault,Clara %A Via-Dufresne Ley,Alicia %A Maynard,Noemie %A Amaria,Khush %A Galuppi,Barb %A Strohm,Sonya %A Nguyen,Linda %A Dawe-McCord,Claire %A Putterman,Connie %A Kovacs,Adrienne H %A Gorter,Jan Willem %+ McGill Adult Unit for Congenital Heart Disease Excellence, McGill University Health Centre, 1001 Decarie Boulevard, D055108, Montreal, QC, H4A3J1, Canada, 1 5149341934 ext 31978, ariane.marelli@mcgill.ca %K patient-centered care %K patient engagement %K mobile app %K health IT %K health care transition %K mobile phone %D 2024 %7 1.10.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Transition from pediatric to adult health care varies and is resource intensive. Patient-centered health information technology (HIT) interventions are increasingly being developed in partnership with patients. Objective: This study aims to develop an internet-based mobile app intervention for patients with brain-based disabilities to improve transition in care readiness. Methods: The app was designed for patients aged 15 to 17 years with brain-based disabilities having the ability to use a mobile app. A multidisciplinary team, an industry partner, and a patient and family advisory council was assembled. We hypothesized that existing tools could be migrated into the app to address education, empowerment, and navigation. We used cognitive learning theory to support chapters targeting transition in care skill sets. We used the agile iterative methodology to engage stakeholders. Results: We developed a novel MyREADY Transition HIT platform. An electronic mentor supported cognitive learning with messaging, quizzes, rewards, and videos. We used gaming to guide navigation through a fictitious health care city. Adapting existing tools was achieved by the patient and family advisory council requesting personalization. Our iterative design required time-consuming back-end technology management. Developing the platform took 24 months instead of our grant-approved 12 months, impacting the onset of the planned trial within the allotted budget. Conclusions: A novel patient-centered HIT platform to improve health care transition was successfully developed in partnership with patients and industry. Careful resource management was needed to achieve timely delivery of the end product, flagging the cautious planning required to deliver HIT tools in time for the much-needed trials informing their clinical application. Trial Registration: ClinicalTrials.gov NCT03852550; https://clinicaltrials.gov/study/NCT03852550 %M 39352737 %R 10.2196/51606 %U https://pediatrics.jmir.org/2024/1/e51606 %U https://doi.org/10.2196/51606 %U http://www.ncbi.nlm.nih.gov/pubmed/39352737 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e60330 %T Red Blood Cell Transfusion for Incidence of Retinopathy of Prematurity: Prospective Multicenter Cohort Study %A Wang,Xiaoling %A Rao,Rui %A Li,Hua %A Lei,Xiaoping %A Dong,Wenbin %K red blood cell transfusion %K retinopathy of prematurity %K VPI %K very preterm infants %K ROP %K visual impairment %K blindness %K RBC %K red blood cell %D 2024 %7 18.9.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Retinopathy of prematurity (ROP) is a leading cause of visual impairment and blindness in preterm infants. Objective: This study sought to investigate the association between red blood cell (RBC) transfusion and ROP in very preterm infants (VPIs) to inform clinical strategies for ROP prevention and treatment. Methods: We designed a prospective multicenter cohort study that included VPIs and follow-up data from January 2017 to December 2022 at 3 neonatal clinical medicine centers. They were categorized into a transfusion group (infants who received an RBC transfusion within 4 wk) and a nontransfusion group. The relationship between RBC transfusion and ROP incidence was assessed using binary logistic regression, with subgroup analyses based on gestational age, birth weight, sex, and sepsis status. Inverse probability of treatment weighting and propensity score matching were applied to account for all potential confounding factors that could affect ROP development, followed by sensitivity analysis. Results: The study included 832 VPIs, including 327 in the nontransfusion group and 505 in the transfusion group. The transfusion group had a lower average birth weight and gestational age and a greater incidence of ROP, ≥stage 2 ROP, and severe ROP. Logistic regression analysis revealed that the transfusion group had a significantly greater risk of ROP (adjusted odds ratio [aOR] 1.70, 95% CI 1.14‐2.53, P=.009) and ≥stage 2 ROP (aOR 1.68, 95% CI 1.02‐2.78, P=.04) but not severe ROP (aOR 1.75, 95% CI 0.61‐5.02, P=.30). The trend analysis also revealed an increased risk of ROP with an increasing number of transfusions and a larger volume of blood transfused (P for trend<.001). Subgroup analyses confirmed a consistent trend, with the transfusion group at a higher risk for ROP across all subgroups. Inverse probability of treatment weighting and propensity score matching analyses supported the initial findings. Conclusions: For VPIs, RBC transfusion significantly increases the risk of ROP, and the risk increases with an increasing number of transfusions and volume of blood transfused. %R 10.2196/60330 %U https://pediatrics.jmir.org/2024/1/e60330 %U https://doi.org/10.2196/60330 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59636 %T Testing a Conceptual Model of Early Adversity, Neural Function, and Psychopathology: Protocol for a Retrospective Observational Cohort Study %A Murgueitio,Nicolas %A Tate,Maresa %A Lurie,Lucy %A Priddy,Zoe %A Boda,Sneha %A Shipkova,Michelle %A Rodriguez,Micaela %A Machlin,Laura %A Furlong,Sarah %A Mitchell,Amanda %A McLaughlin,Katie %A Sheridan,Margaret %+ Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, 235 E Cameron Ave, Chapel Hill, NC, 27514, United States, 1 9196027286, jnicolas@email.unc.edu %K early adversity %K psychopathology %K neurodevelopment %K adverse childhood events %K child development %D 2024 %7 17.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Early adversity, broadly defined as a set of negative exposures during childhood, is extremely common and increases risk for psychopathology across the life span. Previous research suggests that separate dimensions of adversity increase risk through developmental plasticity mechanisms shaping unique neurobiological pathways. Specifically, research suggests that deprivation is associated with deficits in higher order cognition, while threat is associated with atypicality in fear learning and emotion dysregulation. However, most of this research has been conducted in adolescent and adult samples, long after exposure to adversity occurs and far from periods of peak developmental plasticity. Objective: The Wellness Health and Life Experiences (WHALE) study examines the neurobiological and behavioral mechanisms by which deprivation, threat, and unpredictability increase risk for psychopathology in early childhood (age 4-7 years) directly following periods of peak developmental plasticity. The objective of this study is to describe the study rationale and aims, the research design and procedures, and the analytical plan to test the study hypotheses. Methods: This is a retrospective cohort study that examines associations between exposure to deprivation and threat and their hypothesized neurobiological mechanisms, how these neurobiological mechanisms link early adversity and psychopathology, and associations between unpredictability, reward learning, and psychopathology. The sample was a convenience sample of children (aged 4-7 years) and their families, identified through flyers, email blasts to listserves, school-based advertising, and involvement in community events. Data were collected during a home visit, a subsequent laboratory visit, and a final neuroimaging visit. Planned analyses include linear regression, path analyses, and functional magnetic resonance imaging analyses to explore the role of neural function in the association between early adversity and psychopathology. Results: Participants (N=301) have been recruited into the study, and data collection has commenced. The expected results will be available in 2024. Conclusions: The findings of this study will help elucidate the neurobiological mechanisms by which early adversity increases risk for psychopathology in early childhood. This study represents the earliest test of an influential theory of biological embedding of early adversity. International Registered Report Identifier (IRRID): DERR1-10.2196/59636 %M 39287225 %R 10.2196/59636 %U https://www.researchprotocols.org/2024/1/e59636 %U https://doi.org/10.2196/59636 %U http://www.ncbi.nlm.nih.gov/pubmed/39287225 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63505 %T Effectiveness of an mHealth App That Uses Financial Incentives and Gamification to Promote Health Behavior Change in Adolescents and Caregivers: Protocol for a Clinic-Based Randomized Controlled Trial %A Braddock,Amy %A Ghosh,Parijat %A Montgomery,Emma %A Lim,Crystal %A Ghosh,Jaya %A Henry,Nicole %A Popescu,Mihail %A Kimchi,Kimberly %A Guo,Congyu %A Bosworth,K Taylor %A Koopman,Richelle J %+ Family and Community Medicine, University of Missouri, Columbia, MA306, 1 Hospital Drive, Columbia, MO, 65212, United States, 1 5738847733, williamsamy@health.missouri.edu %K mHealth %K adolescents %K apps %K caregivers %K obesity %K healthy lifestyle %K CommitFit %K mobile health %D 2024 %7 10.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescent and adult obesity continues to be a public health epidemic in the United States. Despite the popularity of mHealth apps with gamification among adolescents, there are insufficient studies to evaluate the efficacy of gamified mHealth apps and financial incentives to motivate sustained health behavior change in adolescents or their adult caregivers. Objective: This study aims to evaluate the effectiveness of gamification techniques and financial incentives used in the novel “CommitFit” mHealth app to motivate health behavior change and improve various mental and physical health metrics in adolescents and their caregivers. Methods: This study is a 3-month randomized controlled trial (RCT) with 30 adolescents (aged 13-15 years) and their adult caregivers (N=60). It evaluates “CommitFit,” which uses gamification including points and leaderboards to motivate logging and achievement of self-selected health behavior goals (eg, more water, sleep, physical activity, fruits, or vegetables or fewer sugary beverages). The RCT had three arms, each with 10 dyads: (1) CommitFit-only users; (2) CommitFit$, where adolescents were paid US $0.05 for each point they earned; and (3) waitlist control. Intervention dyads used the app for 3 months and had the option to use it for the fourth month without prompts or extra financial incentives. User analytic software was used to evaluate the frequency of user logs and goal achievement. Monthly surveys evaluated self-reported change in the 5 CommitFit health behaviors. Changes in BMI and blood pressure were evaluated for all participants at 3 clinical visits. Mental health, gamification, and behavior economics surveys were completed during the clinical visits. Results: Recruitment began in August 2023 and was completed in 10 weeks. The research team successfully recruited and enrolled 30 dyads. Researchers emailed and called 89 caregivers on a physician-approved adolescent patient list, a 33% recruitment rate. Data collection and analysis will be conducted in the spring and summer of 2024. The results of this study are anticipated to be published between late 2024 and early 2025. Conclusions: This RCT will expand knowledge of the effectiveness of gamification techniques, financial incentives, and mHealth apps to motivate sustained health behavior change among adolescents and caregivers. These results may offer new opportunities to caregivers, health insurers, health care systems, and clinicians to motivate health behavior change in adolescents and caregivers, with the ultimate goal of preventing or reducing obesity and obesity-related diseases. Additional gamification, mental health surveys, and app user analytics included in the study may provide further insight into the characteristics of adolescents or caregivers who would benefit the most from using a gamified mHealth app like CommitFit. International Registered Report Identifier (IRRID): DERR1-10.2196/63505 %M 39255473 %R 10.2196/63505 %U https://www.researchprotocols.org/2024/1/e63505 %U https://doi.org/10.2196/63505 %U http://www.ncbi.nlm.nih.gov/pubmed/39255473 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60621 %T Effectiveness of a Mobile App (Meds@HOME) to Improve Medication Safety for Children With Medical Complexity: Protocol for a Randomized Controlled Trial %A Werner,Nicole E %A Morgen,Makenzie %A Kooiman,Sophie %A Jolliff,Anna %A Warner,Gemma %A Feinstein,James %A Chui,Michelle %A Katz,Barbara %A Storhoff,Brittany %A Sodergren,Kristan %A Coller,Ryan %+ University of Wisconsin-Madison School of Medicine and Public Health, H6/559, 600 Highland Ave, Madison, WI, 53792, United States, 1 (608) 265 5445, rcoller@pediatrics.wisc.edu %K medication safety %K children with medical complexity %K caregiving %K polypharmacy %K medication management %D 2024 %7 9.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: This study will pilot-test the mobile app, Medication Safety @HOME—Meds@HOME intervention to improve medication administration accuracy, reduce preventable adverse drug events, and ultimately improve chronic care management for children with medical complexity (CMC). The Meds@HOME app was co-designed with CMC families, secondary caregivers (SCGs), and health professionals to support medication management for primary caregivers (PCGs) and SCGs of CMC. We hypothesize that Meds@HOME will improve caregivers’ medication administration accuracy, reduce preventable adverse drug events, and ultimately improve chronic care management. Objective: This study aims to evaluate the effectiveness of Meds@HOME on medication administration accuracy for PCGs and SCGs. Methods: This study will recruit up to 152 PCGs and 304 SCGs of CMC who are prescribed at least 1 scheduled high-risk medication and receive care at the University of Wisconsin American Family Children’s Hospital. PCGs will be randomly assigned, for the 6-month trial, to either the control group (not trialing Meds@HOME) or the intervention group (trialing Meds@HOME) using 1:1 ratio. The Meds@HOME app allows caregivers to create a child profile, store medication and care instructions, and receive reminders for upcoming and overdue care routines and medication refills. Surveys completed both at the start and end of the trial measure demographics, medication delivery knowledge, confidence in the CMC’s caregiving network, and comfort with medical information. Univariate and multivariate generalized estimation equations will be used for primary statistical analysis. The primary outcome is the PCG’s rate of medication administration accuracy measured as correct identification of each of the following for a randomly selected high-risk medication: indication, formulation, dose, frequency, and route at baseline and after 6 months. Secondary outcomes include SCG medication administration accuracy (indication, formulation, dose, frequency, and route), count of University of Wisconsin hospital and emergency department encounters, PCG-reported medication adherence, count of deaths, and PCG medication confidence and understanding. Results: Recruitment for this study began on November 29, 2023. As of May 15, 2024, we have enrolled 94/152 (62%) PCGs. We expect recruitment to end by August 1, 2024, and the final participant will complete the study by January 28, 2025, at which point we will start analyzing the complete responses. We expect publication of results at the end of 2025. Conclusions: The Meds@HOME mobile app provides a promising strategy for improving PCG medication safety for CMC who take high-risk medications. In addition, this protocol highlights novel procedures for recruiting SCGs of CMC. In the future, this app could be used more broadly across diverse caregiving networks to navigate complex medication routines and promote medication safety. Trial Registration: ClinicalTrials.gov NCT05816590; https://clinicaltrials.gov/study/NCT05816590 International Registered Report Identifier (IRRID): DERR1-10.2196/60621 %M 39250787 %R 10.2196/60621 %U https://www.researchprotocols.org/2024/1/e60621 %U https://doi.org/10.2196/60621 %U http://www.ncbi.nlm.nih.gov/pubmed/39250787 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e55411 %T Parental Autonomy in the Care of Premature Newborns and the Experience of a Neonatal Team: Observational Prospective Study %A Piris-Borregas,Salvador %A Bellón-Vaquerizo,Beatriz %A Velasco-Echeburúa,Leticia %A Niño-Díaz,Lidia %A Sánchez-Aparicio,Susana %A López-Maestro,María %A Pallás-Alonso,Carmen Rosa %K family-centered care %K neonatal intensive care unit %K kangaroo mother care %K mother %K mothers %K parent %K parents %K parental %K ICU %K intensive care %K training %K education %K educational %K premature %K pediatric %K pediatrics %K paediatric %K paediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K newborn %K newborns %K intensive care unit %D 2024 %7 30.8.2024 %9 %J JMIR Pediatr Parent %G English %X Background: The European Foundation for the Care of Newborn Infants (EFCNI) has promoted the importance of parental involvement in the care of children. Objective: The study aimed to examine how the time required by parents to achieve autonomy in the care of their very low–birth weight newborn infants was modified during the implementation of a training program. Methods: This was an observational prospective study in the context of a quality improvement initiative. The Cuídame (meaning “Take Care of Me” in English) program was aimed at achieving parental autonomy. It was implemented over 2 periods: period 1, from September 1, 2020, to June 15, 2021; and period 2, from July 15, 2021, to May 31, 2022. The days required by parents to achieve autonomy in several areas of care were collected from the electronic health system. Results: A total of 54 and 43 families with newborn infants were recruited in periods 1 and 2, respectively. Less time was required to acheive autonomy in period 2 for participation in clinical rounds (median 10.5, IQR 5‐20 vs 7, IQR 4‐10.5 d; P<.001), feeding (median 53.5, IQR 34‐68 vs 44.5, IQR 37‐62 d; P=.049), and observation of neurobehavior (median 18, IQR 9‐33 vs 11, IQR 7‐16 d; P=.049). More time was required to achieve autonomy for kangaroo mother care (median 14, IQR 7‐23 vs 21, IQR 10‐31 d; P=.02), diaper change (median 9.5, IQR 4‐20 vs 14.5, IQR 9‐32 d; P=.04), and infection prevention (median 1, IQR 1‐2 vs 6, IQR 3‐12; P<.001). Conclusions: Parents required less time to achieve autonomy for participation in clinical rounds, feeding, and observation of neurobehavior during the implementation of the training program. Nevertheless, they required more time to achieve autonomy for kangaroo mother care, diaper change, and infection prevention. %R 10.2196/55411 %U https://pediatrics.jmir.org/2024/1/e55411 %U https://doi.org/10.2196/55411 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e56722 %T Online Delivery of Interprofessional Adverse Childhood Experiences Training to Rural Providers: Usability Study %A Kapp,Julie M %A Dicke,Rachel %A Quinn,Kathleen %K adverse childhood experiences %K ACE %K training %K trauma-informed care %K provider %K rural %K adverse %K trauma %K traumatic %K provider %K providers %K teaching %K curriculum %K curricula %K education %K educational %K social work %K social worker %K social workers %K psychologist %K psychologists %K counselor %K counselors %K interprofessional %K pediatric %K pediatrics %K paediatric %K paediatrics %K child %K children %K experience %K experiences %K continuing education %D 2024 %7 7.8.2024 %9 %J JMIR Pediatr Parent %G English %X Background: The population health burden of adverse childhood experiences (ACEs) reflects a critical need for evidence-based provider training. Rural children are also more likely than urban children to have any ACEs. A large proportion of providers are unaware of the detrimental effects of ACEs. There is a significant documented need for training providers about ACEs and trauma-informed care, in addition to a demand for that training. Objective: The objective was to develop, implement, and evaluate an online ACEs training curriculum tailored to Missouri providers, particularly those in rural areas given the higher prevalence of ACEs. Methods: From July 2021 to June 2022, we conducted literature reviews and environmental scans of training videos, partner organizations, clinical practice guidelines, and community-based resources to curate appropriate and tailored content for the course. We developed the ACEs training course in the Canvas learning platform (Instructure) with the assistance of an instructional designer and media designer. The course was certified for continuing medical education, as well as continuing education for licensed professional counselors, psychologists, and social workers. Recruitment occurred via key stakeholder email invitations and snowball recruitment. Results: Overall, 135 providers across Missouri requested enrollment, with 72.6% (n=98) enrolling and accessing the training. Of the latter, 49% (n=48) completed course requirements, with 100% of respondents agreeing that the content was relevant to their work, life, or practice; they intend to apply the content to their work, life, or practice; they feel confident to do so; and they would recommend the course to others. Qualitative responses supported active intent to translate knowledge into practice. Conclusions: This study demonstrated the feasibility, acceptability, and effectiveness of interprofessional workforce ACEs training. Robust interest statewide reflects recognition of the topic’s importance and intention to translate knowledge into practice. %R 10.2196/56722 %U https://pediatrics.jmir.org/2024/1/e56722 %U https://doi.org/10.2196/56722 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57950 %T Mobile App Promoting Resilience in Stress Management for Adolescents and Young Adults With Cancer: Protocol for a Pilot Randomized Controlled Trial %A Lau,Nancy %A Palermo,Tonya M %A Zhou,Chuan %A Badillo,Isabel %A Hong,Shannon %A Aalfs,Homer %A Yi-Frazier,Joyce P %A McCauley,Elizabeth %A Chow,Eric J %A Weiner,Bryan J %A Ben-Zeev,Dror %A Rosenberg,Abby R %+ Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA, 98101, United States, 1 206 884 8238, nancy.lau@seattlechildrens.org %K adolescents %K young adult %K cancer %K mHealth %K psychosocial intervention %K stress management %K coping %K resilience %K health-related quality of life %K randomized controlled trial %K mobile phone %D 2024 %7 30.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents and young adults (AYAs) with cancer are at risk of poor psychosocial outcomes. AYAs grew up with the internet and digital technology, and mobile Health (mHealth) psychosocial interventions have the potential to overcome care access barriers. Objective: This pilot randomized controlled trial (RCT) aimed to establish the feasibility, acceptability, and preliminary efficacy of a fully automated mobile app version of the Promoting Resilience in Stress Management intervention (mPRISM). Promoting Resilience in Stress Management is an evidence-based intervention developed in collaboration with AYAs, based on stress and coping theory, resilience theory, and evidence-based coping strategies. We hypothesized that mPRISM would be feasible, acceptable, and appropriate. Methods: This is a parallel, 2-arm, single-site pilot RCT with a waitlist control design. The study will recruit 80 AYAs with cancer from a clinic. Eligible AYAs are aged 12 to 25 years, within 12 months of a new cancer diagnosis, receiving chemotherapy or radiation therapy, speak, read, or write in English, and are cognitively able to participate in study procedures. Recruitment by clinical research coordinators will occur remotely by phone, video, or text. Participants will be randomized to psychosocial usual care (UC) alone or UC plus mPRISM for an 8-week intervention period, and will remain unblinded to study condition. Enrolled participants will complete surveys at baseline before randomization, 8 weeks, and 3-month follow-up. Using a waitlist design, the UC arm will receive mPRISM upon completion of 3-month follow-up surveys. Those in the UC arm will complete 2 additional measurement points at immediate posttreatment and 3 months later. The primary outcomes of interest are feasibility, defined as ≥60% enrollment and ≥70% retention (ie, percentage of participants who completed the study), and “feasibility, acceptability, and appropriateness” as defined by cut-off scores ≥4/5 on 3 brief validated implementation outcome measures (feasibility of implementation measure, acceptability of intervention measure [AIM], intervention appropriateness measure [IAM]). We will apply top-box scoring for the implementation measures. Exploratory outcomes of interest include patient-reported health-related quality of life, resilience, distress, anxiety, depression, pain, and sleep. We will conduct an intention-to-treat analysis to compare the outcomes of the mPRISM arm versus the control arm with covariate-adjusted regression models. We will summarize individual digital usage metrics using descriptive statistics. Results: Since September 2023, we have enrolled 20 participants and recruitment is ongoing. Conclusions: Although our previous work suggests AYAs with cancer are interested in mHealth psychosocial interventions, such interventions have not yet been sufficiently evaluated or implemented among AYA oncology patients. mPRISM may serve as a potential mHealth intervention to fill this gap. In this study, we will test the feasibility, acceptability, and preliminary efficacy of mPRISM. This work will inform future larger-scale RCTs powered for efficacy outcomes. Trial Registration: ClinicalTrials.gov NCT05842902; https://clinicaltrials.gov/study/NCT05842902 International Registered Report Identifier (IRRID): DERR1-10.2196/57950 %M 39079108 %R 10.2196/57950 %U https://www.researchprotocols.org/2024/1/e57950 %U https://doi.org/10.2196/57950 %U http://www.ncbi.nlm.nih.gov/pubmed/39079108 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 1 %N %P e56447 %T Enhancement of Immersive Technology Use in Pediatric Health Care With Accessible, Context-Specific Training: Descriptive Feasibility Study %A Li,Brian S K %A Fereday,Brendan %A Wang,Ellen %A Rodriguez,Samuel %A Forssell,Karin %A Bollaert,André N %A Menendez,Maria %A Caruso,Thomas J %+ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 453 Quarry Rd, MC 5663, Palo Alto, CA, 94305, United States, 1 (650) 723 5728, tjcaruso@stanford.edu %K immersive technology %K implementation %K adult learning %K education %K pediatric %K accessibility %K training %K therapeutic %K pediatric care %K utilization %K virtual reality %K VR %K monitoring %K license %K development %K software %K monitoring software %D 2024 %7 30.7.2024 %9 Original Paper %J JMIR XR Spatial Comput %G English %X Background: Immersive technology provides adjuncts for pediatric care. However, accessibility and inadequate training limit implementation of this technology. Standardized instruction with no-cost software licensing may improve health care professionals’ facility with immersive technologies. Objective: This descriptive feasibility study aimed to examine the applications of immersive technologies in pediatric health care, including virtual reality (VR) and projectors. Methods: We developed immersive technology instructional guides for pediatric health care. The training guides were created for multiple software content and hardware types across several clinical scenarios. Content was available in print and digital versions. The primary outcome was technology use across sites with no-cost software agreements. The secondary outcome was the specific application types used at a single site, stratified by sessions and minutes. Data were analyzed using descriptive statistics. Results: Data were collected from 19 licensed sites from January through June 2022. Among the 19 sites, 32% (n=6) used 10 or more VR units. Among the 6 sites that had projectors, half used 5 or more units. The mean minutes of use per month of all sites combined was 2199 (IQR 51-1058). Three sites had more than 10,000 minutes of total use during the 6-month review period. Secondary results indicated that active VR (977 total sessions) and passive projector streaming (1261 total sessions) were the most popular application types by session, while active projector (66,849 total minutes) and passive projector streaming (32,711 total minutes) were the most popular types when stratified by minutes of use. The active VR application with the most minutes of use was an application often used in physical therapy. Conclusions: Context-specific technological instruction coupled to no-cost licenses may increase access to immersive technology in pediatric health care settings. %R 10.2196/56447 %U https://xr.jmir.org/2024/1/e56447 %U https://doi.org/10.2196/56447 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e62775 %T Author’s Reply: Mental Health Problems Among Children and Adolescents From a Sports Sociology Perspective %A Aldridge,Grace %+ Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Clayton, 3168, Australia, 61 39905 072, grace.aldridge@monash.edu %K parenting interventions %K technology %K sports sociology %K child mental health %K adolescent mental health %K adverse childhood experiences %K systematic review %K intervention %K digital technology, parenting %K parenting program %K engagement %K support %D 2024 %7 3.7.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 38959063 %R 10.2196/62775 %U https://www.jmir.org/2024/1/e62775 %U https://doi.org/10.2196/62775 %U http://www.ncbi.nlm.nih.gov/pubmed/38959063 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60513 %T Mental Health Problems Among Children and Adolescents From a Sports Sociology Perspective %A Li,Yuan %A Zhai,Qun %A Peng,Weihang %+ Faculty of Health Sciences and Sports, Macao Polytechnic University, Comes Street, Macao, 999078, Macao, 853 68911106, zqun@mpu.edu.mo %K sociology of sport %K children %K adolescents %K mental health %K systematic review %K intervention %K digital technology, parenting %K technology %K parenting program %K engagement %K support %K adverse childhood experiences %D 2024 %7 3.7.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 38959025 %R 10.2196/60513 %U https://www.jmir.org/2024/1/e60513 %U https://doi.org/10.2196/60513 %U http://www.ncbi.nlm.nih.gov/pubmed/38959025 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51734 %T Association Between Early-Life Exposure to Antibiotics and Development of Child Obesity: Population-Based Study in Italy %A Cantarutti,Anna %A Rescigno,Paola %A Da Borso,Claudia %A Gutierrez de Rubalcava Doblas,Joaquin %A Bressan,Silvia %A Barbieri,Elisa %A Giaquinto,Carlo %A Canova,Cristina %+ Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Milano, 20126, Italy, 39 0264485828, anna.cantarutti@unimib.it %K childhood obesity %K BMI z score %K pediatric population-based %K antibiotics %K real-world data %K association %K exposure %K child obesity %K obesity %K population-based %K gut microbiome %K early life %K pediatric %K prescription %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Childhood obesity is a significant public health problem representing the most severe challenge in the world. Antibiotic exposure in early life has been identified as a potential factor that can disrupt the development of the gut microbiome, which may have implications for obesity. Objective: This study aims to evaluate the risk of developing obesity among children exposed to antibiotics early in life. Methods: An Italian retrospective pediatric population-based cohort study of children born between 2004 and 2018 was adopted using the Pedianet database. Children were required to be born at term, with normal weight, and without genetic diseases or congenital anomalies. We assessed the timing of the first antibiotic prescription from birth to 6, 12, and 24 months of life and the dose-response relationship via the number of antibiotic prescriptions recorded in the first year of life (none, 1, 2, and ≥3 prescriptions). Obesity was defined as a BMI z score >3 for children aged ≤5 years and >2 for children aged >5 years, using the World Health Organization growth references. The obese incidence rate (IR) × 100 person-years and the relative 95% CI were computed using infant sex, area of residence, preschool and school age, and area deprivation index, which are the covariates of interest. A mixed-effect Cox proportional hazards model was used to estimate the hazard ratio and 95% CI for the association between antibiotic exposure in early life and child obesity between 24 months and 14 years of age, considering the family pediatricians as a random factor. Several subgroup and sensitivity analyses were performed to assess the robustness of our results. Results: Among 121,540 children identified, 54,698 were prescribed at least an antibiotic within the first year of life and 26,990 were classified as obese during follow-up with an incidence rate of 4.05 cases (95% CI 4.01-4.10) × 100 person-year. The risk of obesity remained consistent across different timings of antibiotic prescriptions at 6 months, 1 year, and 2 years (fully adjusted hazard ratio [aHR] 1.07, 95% CI 1.04-1.10; aHR 1.06, 95% CI 1.03-1.09; and aHR 1.07, 95% CI 1.04-1.10, respectively). Increasing the number of antibiotic exposures increases the risk of obesity significantly (P trend<.001). The individual-specific age analysis showed that starting antibiotic therapy very early (between 0 and 5 months) had the greatest impact (aHR 1.12, 95% CI 1.08-1.17) on childhood obesity with respect to what was observed among those who were first prescribed antibiotics after the fifth month of life. These results were consistent across subgroup and sensitivity analyses. Conclusions: The results from this large population-based study support the association between early exposure to antibiotics and an increased risk of childhood obesity. This association becomes progressively stronger with both increasing numbers of antibiotic prescriptions and younger age at the time of the first prescription. %M 38820573 %R 10.2196/51734 %U https://publichealth.jmir.org/2024/1/e51734 %U https://doi.org/10.2196/51734 %U http://www.ncbi.nlm.nih.gov/pubmed/38820573 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e41567 %T Association of Child Growth Failure Indicators With Household Sanitation Practices in India (1998-2021): Spatiotemporal Observational Study %A Jain,Lovely %A Pradhan,Sreya %A Aggarwal,Arun %A Padhi,Bijaya Kumar %A Itumalla,Ramaiah %A Khatib,Mahalaqua Nazli %A Gaidhane,Shilpa %A Zahiruddin,Quazi Syed %A Santos,Celso Augusto Guimarães %A AL-Mugheed,Khalid %A Alrahbeni,Tahani %A Kukreti,Neelima %A Satapathy,Prakasini %A Rustagi,Sarvesh %A Heidler,Petra %A Marzo,Roy Rillera %+ Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160036, India, 91 8763766300, bkpadhi@gmail.com %K undernutrition %K malnutrition %K stunting %K wasting %K underweight %K sanitation %K WaSH %K LISA %K NFHS %K DHS %K spatial epidemiology %K epidemiology %K children %K child %K India %K intervention %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Undernutrition among children younger than 5 years is a subtle indicator of a country’s health and economic status. Despite substantial macroeconomic progress in India, undernutrition remains a significant burden with geographical variations, compounded by poor access to water, sanitation, and hygiene services. Objective: This study aimed to explore the spatial trends of child growth failure (CGF) indicators and their association with household sanitation practices in India. Methods: We used data from the Indian Demographic and Health Surveys spanning 1998-2021. District-level CGF indicators (stunting, wasting, and underweight) were cross-referenced with sanitation and sociodemographic characteristics. Global Moran I and Local Indicator of Spatial Association were used to detect spatial clustering of the indicators. Spatial regression models were used to evaluate the significant determinants of CGF indicators. Results: Our study showed a decreasing trend in stunting (44.9%-38.4%) and underweight (46.7%-35.7%) but an increasing prevalence of wasting (15.7%-21.0%) over 15 years. The positive values of Moran I between 1998 and 2021 indicate the presence of spatial autocorrelation. Geographic clustering was consistently observed in the states of Madhya Pradesh, Jharkhand, Odisha, Uttar Pradesh, Chhattisgarh, West Bengal, Rajasthan, Bihar, and Gujarat. Improved sanitation facilities, a higher wealth index, and advanced maternal education status showed a significant association in reducing stunting. Relative risk maps identified hotspots of CGF health outcomes, which could be targeted for future interventions. Conclusions: Despite numerous policies and programs, malnutrition remains a concern. Its multifaceted causes demand coordinated and sustained interventions that go above and beyond the usual. Identifying hotspot locations will aid in developing control methods for achieving objectives in target areas. %M 38787607 %R 10.2196/41567 %U https://publichealth.jmir.org/2024/1/e41567 %U https://doi.org/10.2196/41567 %U http://www.ncbi.nlm.nih.gov/pubmed/38787607 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e40796 %T Attrition Rates in HIV Viral Load Monitoring and Factors Associated With Overdue Testing Among Children Within South Africa’s Antiretroviral Treatment Program: Retrospective Descriptive Analysis %A Haeri Mazanderani,Ahmad %A Radebe,Lebohang %A Sherman,Gayle G %+ Centre for HIV & STIs, National Institute for Communicable Diseases, National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2031, South Africa, 27 826428609, ahmadh@nicd.ac.za %K HIV %K monitoring %K viral load %K suppression %K overdue %K retention %K VL test %K attrition %K child %K youth %K pediatric %K paediatric %K sexually transmitted %K sexual transmission %K virological failure %K South Africa %K infant %K adolescent %K big data %K descriptive analysis %K laboratory data %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Numerous studies in South Africa have reported low HIV viral load (VL) suppression and high attrition rates within the pediatric HIV treatment program. Objective: Using routine laboratory data, we evaluated HIV VL monitoring, including mobility and overdue VL (OVL) testing, within 5 priority districts in South Africa. Methods: We performed a retrospective descriptive analysis of National Health Laboratory Service (NHLS) data for children and adolescents aged 1-15 years having undergone HIV VL testing between May 1, 2019, and April 30, 2020, from 152 facilities within the City of Johannesburg, City of Tshwane, eThekwini, uMgungundlovu, and Zululand. HIV VL test–level data were deduplicated to patient-level data using the NHLS CDW (Corporate Data Warehouse) probabilistic record-linking algorithm and then further manually deduplicated. An OVL was defined as no subsequent VL determined within 18 months of the last test. Variables associated with the last VL test, including age, sex, VL findings, district type, and facility type, are described. A multivariate logistic regression analysis was performed to identify variables associated with an OVL test. Results: Among 21,338 children and adolescents aged 1-15 years who had an HIV VL test, 72.70% (n=15,512) had a follow-up VL test within 18 months. Furthermore, 13.33% (n=2194) of them were followed up at a different facility, of whom 3.79% (n=624) were in a different district and 1.71% (n=281) were in a different province. Among patients with a VL of ≥1000 RNA copies/mL of plasma, the median time to subsequent testing was 6 (IQR 4-10) months. The younger the age of the patient, the greater the proportion with an OVL, ranging from a peak of 52% among 1-year-olds to a trough of 21% among 14-year-olds. On multivariate analysis, 2 consecutive HIV VL findings of ≥1000 RNA copies/mL of plasma were associated with an increased adjusted odds ratio (AOR) of having an OVL (AOR 2.07, 95% CI 1.71-2.51). Conversely, patients examined at a hospital (AOR 0.86, 95% CI 0.77-0.96), those with ≥2 previous tests (AOR 0.78, 95% CI 0.70-0.86), those examined in a rural district (AOR 0.63, 95% CI 0.54-0.73), and older age groups of 5-9 years (AOR 0.56, 95% CI 0.47-0.65) and 10-14 years (AOR 0.51, 95% CI 0.44-0.59) compared to 1-4 years were associated with a significantly decreased odds of having an OVL test. Conclusions: Considerable attrition occurs within South Africa’s pediatric HIV treatment program, with over one-fourth of children having an OVL test 18 months subsequent to their previous test. In particular, younger children and those with virological failure were found to be at increased risk of having an OVL test. Improved HIV VL monitoring is essential for improving outcomes within South Africa’s pediatric antiretroviral treatment program. %M 38743934 %R 10.2196/40796 %U https://publichealth.jmir.org/2024/1/e40796 %U https://doi.org/10.2196/40796 %U http://www.ncbi.nlm.nih.gov/pubmed/38743934 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 1 %N %P e56188 %T Factors Associated With Risky Drinking Decisions in a Virtual Reality Alcohol Prevention Simulation: Structural Equation Model %A Hrynyschyn,Robert %A Guldager,Julie Dalgaard %A Schulze,Daniel %A Lyk,Patricia Bianca %A Majgaard,Gunver %A Stock,Christiane %+ Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, Augustenburger Platz 1, Berlin, 13353, Germany, 49 30450529030, robert.hrynyschyn@charite.de %K alcohol %K prevention %K virtual reality %K risk behavior %K structural equation model %D 2024 %7 6.5.2024 %9 Original Paper %J JMIR XR Spatial Comput %G English %X Background: Risky alcohol consumption among adolescents is a significant public health concern in most Western countries. Various motives and factors (eg, sensation seeking, gender, reduced self-efficacy) known in the literature are associated with risky drinking decisions in real life. Efforts to tackle risky drinking decisions in real life through skills training to deal with social pressures have been successful. However, interventions of this nature require significant resources. Technological solutions, such as virtual reality (VR), offer advantages, as they enable immersive experiences that replicate real-life scenarios. However, a question persists pertaining to the fidelity of real-world behaviors within virtual environments. Objective: This study is exploratory and aims to ascertain if the established drinking motives and factors for risky drinking decisions are transferrable to the virtual environment in the simulation game VR FestLab and to uncover determinants linked to risky drinking decisions within the simulation. Methods: The study analyzed data from the intervention arm of a cluster-randomized study of 161 Danish students aged 14-18 years who tested the virtual alcohol prevention simulation VR FestLab. At baseline and before playing VR FestLab, independent variables such as age, gender, alcohol consumption, use of other drugs, sensation seeking, drinking refusal skills, knowledge of blood alcohol concentration, and refusal communication skills were recorded. The dependent variable, virtual risk decisions, was measured immediately after the gameplay. Confirmatory factor analysis and structural equation modeling were used to examine the latent variables in relation to virtual risk decisions. Moderation analyses for age and gender in relation to the latent characteristics and the primary outcome were also conducted. Results: The data indicate that 73.9% (119/161) of the participants engaged in binge drinking at least once in their lifetime. The confirmatory factor analysis demonstrated a good fit of the items for their respective constructs; therefore, they were adopted without modification in the structural equation model. The data suggest that individuals with prior alcohol experience are 4 times more likely to engage in virtual risk decisions within the simulated environment (odds ratio 4.31, 95% CI 1.70-10.84; P=.01). Knowledge and awareness of blood alcohol concentration were associated with a lower chance to engage in virtual risk decisions (odds ratio 0.32, 95% CI 0.11-0.93; P=.04). However, no significant associations were found between virtual risk decisions and other latent variables. Gender and age did not moderate the associations. Conclusions: The immersive and lifelike properties of VR partially reflected risk-related decisions. However, it remains unclear which factors favor the mapping of real-world behaviors in virtual simulations. Therefore, future research should address the mechanisms underlying behavioral dynamics in virtual simulations and explore the translation of virtual behaviors into real behaviors to gain a comprehensive understanding of the potential of virtual simulations for alcohol prevention. %R 10.2196/56188 %U https://xr.jmir.org/2024/1/e56188 %U https://doi.org/10.2196/56188 %0 Journal Article %@ 2561-6722 %I %V 7 %N %P e54610 %T Photos Shared on Facebook in the Context of Safe Sleep Recommendations: Content Analysis of Images %A Pretorius,Kelly %A Kang,Sookja %A Choi,Eunju %K SUID %K SIDS %K parenting %K safe sleep %K photo analysis %K pediatric %K pediatrics %K paediatric %K paediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K newborn %K newborns %K sleep %K safety %K death %K mortality %K social media %K picture %K pictures %K photo %K photos %K photographs %K image %K images %K Facebook %K mother %K mothers %K parent %K co-sleeping %K sudden infant death %K sudden unexpected infant death %K adherence %K parent education %K parents' education %K awareness %D 2024 %7 23.4.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Sudden unexpected infant death (SUID) remains a leading cause of infant mortality; therefore, understanding parental practices of infant sleep at home is essential. Since social media analyses yield invaluable patient perspectives, understanding sleep practices in the context of safe sleep recommendations via a Facebook mothers’ group is instrumental for policy makers, health care providers, and researchers. Objective: This study aimed to identify photos shared by mothers discussing SUID and safe sleep online and assess their consistency with infant sleep guidelines per the American Academy of Pediatrics (AAP). We hypothesized the photos would not be consistent with guidelines based on prior research and increasing rates of accidental suffocation and strangulation in bed. Methods: Data were extracted from a Facebook mothers’ group in May 2019. After trialing various search terms, searching for the term “SIDS” on the selected Facebook group resulted in the most relevant discussions on SUID and safe sleep. The resulting data, including 20 posts and 912 comments among 512 mothers, were extracted and underwent qualitative descriptive content analysis. In completing the extraction and subsequent analysis, 24 shared personal photos were identified among the discussions. Of the photos, 14 pertained to the infant sleep environment. Photos of the infant sleep environment were then assessed for consistency with safe sleep guidelines per the AAP standards by 2 separate reviewers. Results: Of the shared photos relating to the infant sleep environment, 86% (12/14) were not consistent with AAP safe sleep guidelines. Specific inconsistencies included prone sleeping, foreign objects in the sleeping environment, and use of infant sleeping devices. Use of infant monitoring devices was also identified. Conclusions: This study is unique because the photos originated from the home setting, were in the context of SUID and safe sleep, and were obtained without researcher interference. Despite study limitations, the commonality of prone sleeping, foreign objects, and the use of both infant sleep and monitoring devices (ie, overall inconsistency regarding AAP safe sleep guidelines) sets the stage for future investigation regarding parental barriers to practicing safe infant sleep and has implications for policy makers, clinicians, and researchers. %R 10.2196/54610 %U https://pediatrics.jmir.org/2024/1/e54610 %U https://doi.org/10.2196/54610 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54783 %T The Effects of an Educational Intervention About Front-of-Package Labeling on Food and Beverage Selection Among Children and Their Caregivers: Protocol for a Randomized Controlled Trial %A Avila-Montiel,Diana %A Vilchis-Gil,Jenny %A Miranda-Lora,América Liliana %A Velázquez-López,Lubia %A Klünder-Klünder,Miguel %+ Epidemiological Research Unit in Endocrinology and Nutrition, Hospital Infantil de México Federico Gómez, Dr. Marquez 162, CDMX, 06720, Mexico, 52 5552289917 ext 4319, klunderk@gmail.com %K e-Health nutrition education %K ultraprocessed foods %K malnutrition %K children %K Mexico %K intervention %K obesity %K food %K food selection %K labeling %K package labeling %D 2024 %7 1.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Overweight and obesity pose a global public health challenge and have a multifactorial origin. One of these factors includes obesogenic environments, which promote ultraprocessed foods characterized by being high in calories, saturated fats, added sugars, and sodium. In Mexico, it has been estimated that 30% of the total energy consumed comes from processed foods. The Modification to the Official Mexican Standards introduces nutritional information through black octagonal seals that alert consumers about products with excessive amounts of some components for a better food selection in the population. However, the effects of warning labels on processed food selection and purchases among children remain unknown. Objective: We aimed to evaluate the impact of a digital educational intervention focusing on front-of-package warning labels on the food selection and purchasing behavior of elementary schoolchildren and their caregivers. Methods: Children from 4 elementary schools in Mexico City, 2 public and 2 private schools, will participate in a randomized controlled trial. The schools will be chosen by simple random sampling. Schools will be randomized into 2 groups: intervention and control. In the control group, the dyads (caregiver-schoolchildren) will receive general nutritional education, and in the intervention group, they will receive guidance on reading labels and raising awareness about the impact of consuming ultraprocessed products on health. The educational intervention will be conducted via a website. Baseline measurements will be taken for both groups at 3 and 6 months. All participants will have access to an online store through the website, allowing them to engage in exercises for selecting and purchasing food and beverages. In addition, other measures will include a brief 5-question exam to evaluate theoretical understanding, a 24-hour reminder, a survey on food habits and consumption, application of a food preference scale, anthropometric measurements, and recording of school lunch choices. Results: Registration and funding were authorized in 2022, and we will begin data collection in September 2024. Recruitment has not yet taken place, but the status of data analysis and expected results will be published in April 2025. Conclusions: The study is expected to contribute to evaluating whether reinforcing front-of-package warning labels with education enhances its effects and makes them more sustainable. Conducting this study will allow us to propose whether or not it is necessary to develop new intervention strategies related to front-of-package labeling for a better understanding of the population, improved food choices, and better health outcomes. Trial Registration: ClinicalTrials.gov NCT06102473; https://clinicaltrials.gov/study/NCT06102473 International Registered Report Identifier (IRRID): PRR1-10.2196/54783 %M 38557591 %R 10.2196/54783 %U https://www.researchprotocols.org/2024/1/e54783 %U https://doi.org/10.2196/54783 %U http://www.ncbi.nlm.nih.gov/pubmed/38557591 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48682 %T Correlation of Socioeconomic and Environmental Factors With Incidence of Crohn Disease in Children and Adolescents: Systematic Review and Meta-Regression %A Weidner,Jens %A Glauche,Ingmar %A Manuwald,Ulf %A Kern,Ivana %A Reinecke,Ines %A Bathelt,Franziska %A Amin,Makan %A Dong,Fan %A Rothe,Ulrike %A Kugler,Joachim %+ Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, Dresden, 01307, Germany, 49 351458 ext 89910, jens.weidner@tu-dresden.de %K Crohn’s disease %K inflammatory bowel disease %K pediatric %K children %K adolescents %K environmental factors %K Crohn disease %K gastroenteritis %K inflammatory bowel diseases %K bowel disease %K digestive system %K gastrointestinal disease %D 2024 %7 25.3.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: The worldwide incidence of Crohn disease (CD) in childhood and adolescence has an increasing trend, with significant differences between different geographic regions and individual countries. This includes an increase in the incidence of CD in countries and geographic regions where CD was not previously prevalent. In response to the increasing incidence, the pediatric care landscape is facing growing challenges. Objective: This systematic review and meta-analysis were undertaken to comprehensively delineate the incidence rates of CD in pediatric populations across different countries and to explore potential influencing factors. Methods: We performed a systematic review of PubMed and Embase (via Ovid) for studies from January 1, 1970, to December 31, 2019. In addition, a manual search was performed in relevant and previously published reviews. The results were evaluated quantitatively. For this purpose, random effects meta-analyses and meta-regressions were performed to investigate the overall incidence rate and possible factors influencing the incidence. Results: A qualitative synthesis of 74 studies was performed, with 72 studies included in the meta-analyses and 52 in the meta-regressions. The results of our meta-analysis showed significant heterogeneity between the individual studies, which cannot be explained by a sample effect alone. Our findings showed geographical differences in incidence rates, which increased with increasing distance from the equator, although no global temporal trend was apparent. The meta-regression analysis also identified geographic location, UV index, and Human Development Index as significant moderators associated with CD incidence. Conclusions: Our results suggest that pediatric CD incidence has increased in many countries since 1970 but varies widely with geographic location, which may pose challenges to the respective health care systems. We identified geographic, environmental, and socioeconomic factors that contribute to the observed heterogeneity in incidence rates. These results can serve as a basis for future research. To this end, implementations of internationally standardized and interoperable registries combined with the dissemination of health data through federated networks based on a common data model, such as the Observational Medical Outcomes Partnership, would be beneficial. This would deepen the understanding of CD and promote evidence-based approaches to preventive and interventional strategies as well as inform public health policies aimed at addressing the increasing burden of CD in children and adolescents. Trial Registration: PROSPERO International prospective register of systematic reviews CRD42020168644; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=168644 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-037669 %M 38526534 %R 10.2196/48682 %U https://publichealth.jmir.org/2024/1/e48682 %U https://doi.org/10.2196/48682 %U http://www.ncbi.nlm.nih.gov/pubmed/38526534 %0 Journal Article %@ 2561-6722 %I %V 7 %N %P e51574 %T Electronic Medical Record Data Missingness and Interruption in Antiretroviral Therapy Among Adults and Children Living With HIV in Haiti: Retrospective Longitudinal Study %A Secor,Andrew M %A Célestin,Kemar %A Jasmin,Margareth %A Honoré,Jean Guy %A Wagner,Anjuli D %A Beima-Sofie,Kristin %A Pintye,Jillian %A Puttkammer,Nancy %K HIV %K Haiti %K pediatrics %K combination antiretroviral therapy %K electronic medical record %K data quality %K child %K children %K antiretroviral %K therapy %K longitudinal study %K HIV diagnosis %K diagnosis %K HIV care %K patient records %K quality of care %K treatment %K engagement %D 2024 %7 6.3.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Children (aged 0-14 years) living with HIV often experience lower rates of HIV diagnosis, treatment, and viral load suppression. In Haiti, only 63% of children living with HIV know their HIV status (compared to 85% overall), 63% are on treatment (compared to 85% overall), and 48% are virally suppressed (compared to 73% overall). Electronic medical records (EMRs) can improve HIV care and patient outcomes, but these benefits are largely dependent on providers having access to quality and nonmissing data. Objective: We sought to understand the associations between EMR data missingness and interruption in antiretroviral therapy treatment by age group (pediatric vs adult). Methods: We assessed associations between patient intake record data missingness and interruption in treatment (IIT) status at 6 and 12 months post antiretroviral therapy initiation using patient-level data drawn from iSanté, the most widely used EMR in Haiti. Missingness was assessed for tuberculosis diagnosis, World Health Organization HIV stage, and weight using a composite score indicator (ie, the number of indicators of interest missing). Risk ratios were estimated using marginal parameters from multilevel modified Poisson models with robust error variances and random intercepts for the facility to account for clustering. Results: Data were drawn from 50 facilities and comprised 31,457 patient records from people living with HIV, of which 1306 (4.2%) were pediatric cases. Pediatric patients were more likely than adult patients to experience IIT (n=431, 33% vs n=7477, 23.4% at 6 months; P<.001). Additionally, pediatric patient records had higher data missingness, with 581 (44.5%) pediatric records missing at least 1 indicator of interest, compared to 7812 (25.9%) adult records (P<.001). Among pediatric patients, each additional indicator missing was associated with a 1.34 times greater likelihood of experiencing IIT at 6 months (95% CI 1.08-1.66; P=.008) and 1.24 times greater likelihood of experiencing IIT at 12 months (95% CI 1.05-1.46; P=.01). These relationships were not statistically significant for adult patients. Compared to pediatric patients with 0 missing indicators, pediatric patients with 1, 2, or 3 missing indicators were 1.59 (95% CI 1.26-2.01; P<.001), 1.74 (95% CI 1.02-2.97; P=.04), and 2.25 (95% CI 1.43-3.56; P=.001) times more likely to experience IIT at 6 months, respectively. Among adult patients, compared to patients with 0 indicators missing, having all 3 indicators missing was associated with being 1.32 times more likely to experience IIT at 6 months (95% CI 1.03-1.70; P=.03), while there was no association with IIT status for other levels of missingness. Conclusions: These findings suggest that both EMR data quality and quality of care are lower for children living with HIV in Haiti. This underscores the need for further research into the mechanisms by which EMR data quality impacts the quality of care and patient outcomes among this population. Efforts to improve both EMR data quality and quality of care should consider prioritizing pediatric patients. %R 10.2196/51574 %U https://pediatrics.jmir.org/2024/1/e51574 %U https://doi.org/10.2196/51574 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53728 %T Psychostimulant Medications for Physical Function and Spasticity in Children With Cerebral Palsy: Protocol for a Randomized Controlled Trial %A Alotaibi,Mansour %A Almutairi,Anwar B %A Alhirsan,Saleh %A Alkazemi,Afrah %A Alharbi,Maha %A Alrashdi,Naif %A Taqi,Ahmad %A Alamiri,Bibi %A Vogtle,Laura %A Alqahtani,Mohammed M %+ Department of Rehabilitation, Faculty of Applied Medical Sciences, Northern Border University, 4636 Jawhara Dist, Arar, 73551, Saudi Arabia, 966 558811790, mansour.alotaibi@nbu.edu.sa %K cerebral palsy %K CNS stimulants %K spasticity %K motor performance %K gross motor function %K psychostimulant %K medications %K physical function %K CP %K children %K child %K pediatrics %K pediatric %K impairment %K movement %K central nervous system %K safety %K tolerability %K efficacy %K methylphenidate %K modafinil %K Kuwait %K rehabilitation %K physical therapy %D 2024 %7 5.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cerebral palsy (CP) is a prevalent nonprogressive disorder that leads to impaired movement (ie, spasticity), posture, and balance, which affects functions such as walking and upper extremity tasks. Current medical treatments show efficacy in improving motor performance but have considerable side effects. Emerging off-label use of central nervous system (CNS) medications for improving motor performance has shown promising results in children with CP and other populations. Objective: The aim of this study is to describe a protocol for a pilot randomized controlled trial (RCT) to examine the safety, tolerability, and efficacy of methylphenidate (MPH) and modafinil on spasticity and motor performance in children with CP. Methods: This will be a protocol study for a pilot, triple-masked, placebo-controlled RCT (a class I trial following the American Academy of Neurology criteria) with blinded patients, outcome assessors, and intervention delivery team. Eligible children should be diagnosed with CP levels I or II based on the Gross Motor Function Classification System and be aged between 7 and 12 years. Thirty-six children with CP will be randomized into 3 groups to receive (1) MPH (2.5 mg of MPH + 100 mg placebo), (2) modafinil (100 mg modafinil + 2.5 mg placebo), or (3) a placebo (2.5 mg placebo + 100 mg placebo), in addition to physical therapy for 12 weeks. Primary outcomes include the Gross Motor Function Measure–66 and the Modified Ashworth Scale. Secondary outcomes include the Timed Up and Go test, 5 Time Sit to Stand test, Modified Clinical Test for Sensory Interaction of Balance, and 10-Meter Walk Test. Results: The protocol has been accepted by Kuwait University (VDR/EC-225) and the Ministry of Health of Kuwait (2022/2157). The inclusion of participants will start in June 2024. Conclusions: The combination of CNS stimulant medications and controlling for rehabilitation has not been studied yet. The findings of this study may determine if using CNS stimulant medications is beneficial for the reduction of spasticity and improvement of physical function in children with spastic CP. Trial Registration: ClinicalTrials.gov NCT05675098; https://clinicaltrials.gov/study/NCT05675098 International Registered Report Identifier (IRRID): PRR1-10.2196/53728 %M 38441919 %R 10.2196/53728 %U https://www.researchprotocols.org/2024/1/e53728 %U https://doi.org/10.2196/53728 %U http://www.ncbi.nlm.nih.gov/pubmed/38441919 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e55560 %T Rates of Trauma Exposure and Posttraumatic Stress in a Pediatric Digital Mental Health Intervention: Retrospective Analysis of Associations With Anxiety and Depressive Symptom Improvement Over Time %A Lawrence-Sidebottom,Darian %A Huffman,Landry Goodgame %A Beam,Aislinn Brenna %A Guerra,Rachael %A Parikh,Amit %A Roots,Monika %A Huberty,Jennifer %+ Bend Health Inc, 2801 Marshall Ct, Madison, WI, 53705, United States, 1 8005160975, darian.lawrence@bendhealth.com %K collaborative care model %K telehealth %K childhood trauma %K DMHI %K digital health %K mental health %K telemedicine %K trauma %K traumatic %K pediatric %K pediatrics %K paediatric %K paediatrics %K child %K children %K youth %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K retrospective %K anxiety %K depression %K depressive %K co-occurring %K comorbid %K comorbidity %K comorbidities %K association %K associations %K correlation %K correlations %K correlate %D 2024 %7 27.2.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: More than 2 out of 3 children and adolescents in the United States experience trauma by the age of 16 years. Exposure to trauma in early life is linked to a range of negative mental health outcomes throughout the lifespan, particularly co-occurring symptoms of posttraumatic stress (PTS), anxiety, and depression. There has been an increasing uptake of digital mental health interventions (DMHIs) among youths, particularly for anxiety and depression. However, little is known regarding the incidence of trauma exposure and PTS symptoms among youths participating in DMHIs and whether PTS symptoms impact anxiety and depressive symptom treatment response. Moreover, it is unclear whether participation in a DMHI for anxiety and depressive symptoms is associated with secondary effects on PTS symptoms among trauma-exposed youths. Objective: This study aims to use retrospective data from youths participating in a DMHI to (1) characterize rates of trauma, PTS, and comorbid anxiety and depressive symptoms; (2) determine whether trauma exposure and elevated PTS symptoms impact the improvement of comorbid anxiety and depressive symptoms throughout participation in care; and (3) determine whether participation in a non–posttraumatic DMHI is linked to reductions in PTS symptoms. Methods: This study was conducted using retrospective data from members (children ages 6 to 12 years) involved in a pediatric collaborative care DMHI. Participating caregivers reported their children’s trauma exposure. PTS, anxiety, and depressive symptom severity were measured monthly using validated assessments. Results: Among eligible participants (n=966), 30.2% (n=292) reported at least 1 traumatic event. Of those with trauma exposure and elevated symptoms of PTS (n=119), 73% (n=87) exhibited elevated anxiety symptoms and 50% (n=59) exhibited elevated depressive symptoms. Compared to children with no trauma, children with elevated PTS symptoms showed smaller reductions per month in anxiety but not depressive symptoms (anxiety: F2,287=26.11; P<.001). PTS symptoms also decreased significantly throughout care, with 96% (n=79) of participants showing symptom reductions. Conclusions: This study provides preliminary evidence for the frequency of trauma exposure and comorbid psychiatric symptoms, as well as variations in treatment response between trauma-exposed and nontrauma-exposed youths, among participants in a pediatric collaborative care DMHI. Youths with traumatic experiences may show increased psychiatric comorbidities and slower treatment responses than their peers with no history of trauma. These findings deliver compelling evidence that collaborative care DMHIs may be well-suited to address mental health symptoms in children with a history of trauma while also highlighting the critical need to assess symptoms of PTS in children seeking treatment. %M 38412001 %R 10.2196/55560 %U https://pediatrics.jmir.org/2024/1/e55560 %U https://doi.org/10.2196/55560 %U http://www.ncbi.nlm.nih.gov/pubmed/38412001 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e49316 %T Evaluating Users’ Experiences of a Child Multimodal Wearable Device: Mixed Methods Approach %A McElwain,Nancy L %A Fisher,Meghan C %A Nebeker,Camille %A Bodway,Jordan M %A Islam,Bashima %A Hasegawa-Johnson,Mark %+ Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, 2004 Doris Christopher Hall, 904 West Nevada Street, Urbana, IL, 61801, United States, 1 217 244 7168, mcelwn@illinois.edu %K wearable devices %K multimodal sensing %K user experience %K usability %K privacy %K children %K mobile phone %D 2024 %7 8.2.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Wearable devices permit the continuous, unobtrusive collection of data from children in their natural environments and can transform our understanding of child development. Although the use of wearable devices has begun to emerge in research involving children, few studies have considered families’ experiences and perspectives of participating in research of this kind. Objective: Through a mixed methods approach, we assessed parents’ and children’s experiences of using a new wearable device in the home environment. The wearable device was designed specifically for use with infants and young children, and it integrates audio, electrocardiogram, and motion sensors. Methods: In study 1, semistructured phone interviews were conducted with 42 parents of children aged 1 month to 9.5 years who completed 2 day-long recordings using the device, which the children wore on a specially designed shirt. In study 2, a total of 110 parents of children aged 2 months to 5.5 years responded to a questionnaire assessing their experience of completing 3 day-long device recordings in the home. Guided by the Digital Health Checklist, we assessed parental responses from both studies in relation to the following three key domains: (1) access and usability, (2) privacy, and (3) risks and benefits. Results: In study 1, most parents viewed the device as easy to use and safe and remote visits as convenient. Parents’ views on privacy related to the audio recordings were more varied. The use of machine learning algorithms (vs human annotators) in the analysis of the audio data, the ability to stop recordings at any time, and the view that the recordings reflected ordinary family life were some reasons cited by parents who expressed minimal, if any, privacy concerns. Varied risks and benefits were also reported, including perceived child comfort or discomfort, the need to adjust routines to accommodate the study, the understanding gained from the study procedures, and the parent’s and child’s enjoyment of study participation. In study 2, parents’ ratings on 5 close-ended items yielded a similar pattern of findings. Compared with a “neutral” rating, parents were significantly more likely to agree that (1) device instructions were helpful and clear (t109=−45.98; P<.001), (2) they felt comfortable putting the device on their child (t109=−22.22; P<.001), and (3) they felt their child was safe while wearing the device (t109=−34.48; P<.001). They were also less likely to worry about the audio recordings gathered by the device (t108=6.14; P<.001), whereas parents’ rating of the burden of the study procedures did not differ significantly from a “neutral” rating (t109=−0.16; P=.87). Conclusions: On the basis of parents’ feedback, several concrete changes can be implemented to improve this new wearable platform and, ultimately, parents’ and children’s experiences of using child wearable devices in the home setting. %M 38329785 %R 10.2196/49316 %U https://humanfactors.jmir.org/2024/1/e49316 %U https://doi.org/10.2196/49316 %U http://www.ncbi.nlm.nih.gov/pubmed/38329785 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e43994 %T Engaging Parents in Technology-Assisted Interventions for Childhood Adversity: Systematic Review %A Aldridge,Grace %A Tomaselli,Alessandra %A Nowell,Clare %A Reupert,Andrea %A Jorm,Anthony %A Yap,Marie Bee Hui %+ Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, Australia, 61 3 9905 0723, marie.yap@monash.edu %K systematic review %K intervention %K digital technology %K parenting %K children %K technology %K parenting program %K engagement %K support %K adverse childhood experiences %D 2024 %7 19.1.2024 %9 Review %J J Med Internet Res %G English %X Background: Youth mental health problems are a major public health concern and are strongly associated with adverse childhood experiences (ACEs). Technology-assisted parenting programs can intervene with ACEs that are within a parent’s capacity to modify. However, engagement with such programs is suboptimal. Objective: This review aims to describe and appraise the efficacy of strategies used to engage parents in technology-assisted parenting programs targeting ACEs on the behavioral and subjective outcomes of engagement. Methods: Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines, we conducted a systematic review of peer-reviewed papers that described the use of at least 1 engagement strategy in a technology-assisted parenting program targeting ACEs that are within a parent’s capacity to modify. A total of 8 interdisciplinary bibliographic databases (CENTRAL, CINAHL, Embase, OVID MEDLINE, OVID PsycINFO, Scopus, ACM, and IEEE Xplore) and gray literature were searched. The use of engagement strategies and measures was narratively synthesized. Associations between specific engagement strategies and engagement outcomes were quantitatively synthesized using the Stouffer method of combining P values. Results: We identified 13,973 articles for screening. Of these, 156 (1.12%) articles were eligible for inclusion, and 29 (18.2%) of the 156 were associated with another article; thus, 127 studies were analyzed. Preliminary evidence for a reliable association between 5 engagement strategies (involving parents in a program’s design, delivering a program on the web compared to face-to-face, use of personalization or tailoring features, user control features, and provision of practical support) and greater engagement was found. Three engagement strategies (professional support features, use of videos, and behavior change techniques) were not found to have a reliable association with engagement outcomes. Conclusions: This review provides a comprehensive assessment and description of the use of engagement strategies and engagement measures in technology-assisted parenting programs targeting parenting-related ACEs and extends the current evidence with preliminary quantitative findings. Heterogeneous definition and measurement of engagement and insufficient engagement outcome data were caveats to this synthesis. Future research could use integrated definitions and measures of engagement to support robust systematic evaluations of engagement in this context. Trial Registration: PROSPERO CRD42020209819; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209819 %M 38241066 %R 10.2196/43994 %U https://www.jmir.org/2024/1/e43994 %U https://doi.org/10.2196/43994 %U http://www.ncbi.nlm.nih.gov/pubmed/38241066 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 6 %N %P e49278 %T A Mobile Health App for Facilitating Disease Management in Children With Atopic Dermatitis: Feasibility and Impact Study %A Zvulunov,Alex %A Lenevich,Stepan %A Migacheva,Natalia %+ Sheba Medical Center, Reichman University, Herzliya, Tel-Hashomer, Ramat Gan, Israel, 972 584440189, Alex.Zvulunov@sheba.health.gov.il %K atopic dermatitis %K eczema %K Atopic App mobile health application %K artificial intelligence %K dermatitis %K dermatology %K skin %K disease management %K child %K children %K pediatric %K pediatrics %K feasibility %K mHealth %K mobile health %K app %K apps %K applications %K applications %D 2023 %7 13.12.2023 %9 Original Paper %J JMIR Dermatol %G English %X Background: Inadequate control of atopic dermatitis (AD) increases the frequency of exacerbations and reduces the quality of life. Mobile health apps provide information and communication technology and may increase treatment adherence and facilitate disease management at home. The mobile health app, Atopic App, designed for patients and their caregivers, and the associated web-based patient education program, Atopic School, provide an opportunity for improving patients’ and caregivers’ engagement and adherence to the management of AD. Objective: This noninterventional, observational study aimed to explore the feasibility and potential impact on the management of AD in children by caregivers using the Atopic App mobile health app. Methods: The patient-oriented eczema measure (POEM) and numerical rating scale for the grading of pruritus were used as severity scores (scale range: 0-28). The artificial intelligence model of the app was used to assess the severity of AD based on the eczema area and severity index approach. The deidentified data enabled the analysis of the severity of AD, treatment plan history, potential triggers of flare-ups, usage of available features of the app, and the impact of patient education. Results: During a 12-month period, of the 1223 users who installed the app, 910 (74.4%) registered users were caregivers of children with AD. The web-based Atopic School course was accessed by 266 (29.2%) caregivers of children with AD, 134 (50.4%) of whom completed the course. Usage of the app was significantly more frequent among those who completed the Atopic School program than among those who did not access or did not complete the course (P<.001). Users who completed a second POEM 21 to 27 days apart exhibited a significant improvement of AD severity based on the POEM score (P<.001), with an average improvement of 3.86 (SD 6.85) points. The artificial intelligence severity score and itching score were highly correlated with the POEM score (r=0.35 and r=0.52, respectively). Conclusions: The Atopic App provides valuable real-world data on the epidemiology, severity dynamics, treatment patterns, and exacerbation-trigger correlations in patients with AD. The significant reduction in the POEM score among users of the Atopic App indicates a potential impact of this tool on health care engagement by caregivers of children with AD. %M 38090787 %R 10.2196/49278 %U https://derma.jmir.org/2023/1/e49278 %U https://doi.org/10.2196/49278 %U http://www.ncbi.nlm.nih.gov/pubmed/38090787 %0 Journal Article %@ 2561-6722 %I %V 6 %N %P e53120 %T Pediatric Delirium Educational Tool Development With Intensive Care Unit Clinicians and Caregivers in Canada: Focus Group Study %A Wood,Michael %A Gandhi,Kavi %A Chapman,Andrea %A Skippen,Peter %A Krahn,Gordon %A Görges,Matthias %A Stewart,S Evelyn %K pediatric delirium education %K pediatric ICU %K focus groups, prototyping %K end users %K users %K education %K educational %K educational tool %K tool %K development %K caregiver %K Canada %K PICU %K pediatric intensive care unit %K quality of life %K child %K children %K family resource %K cognition %K clinical utility %K intensive care unit %D 2023 %7 11.12.2023 %9 %J JMIR Pediatr Parent %G English %X Background: Pediatric intensive care unit (PICU)–associated delirium contributes to a decline in postdischarge quality of life, with worse outcomes for individuals with delayed identification. As delirium screening rates remain low within PICUs, caregivers may be able to assist with early detection, for which they need more education, as awareness of pediatric delirium among caregivers remains limited. Objective: This study aimed to develop an educational tool for caregivers to identify potential delirium symptoms during their child’s PICU stay, educate them on how to best support their child if they experience delirium, and guide them to relevant family resources. Methods: Web-based focus groups were conducted at a tertiary pediatric hospital with expected end users of the tool (ie, PICU health care professionals and caregivers of children with an expected PICU length of stay of over 48 h) to identify potential educational information for inclusion in a family resource guide and to identify strategies for effective implementation. Data were analyzed thematically to generate requirements to inform prototype development. Participants then provided critical feedback on the initial prototype, which guided the final design. Results: In all, 24 participants (18 health care professionals and 6 caregivers) attended 7 focus groups. Participants identified five informational sections for inclusion: (1) delirium definition, (2) key features of delirium (signs and symptoms), (3) postdischarge outcomes associated with delirium, (4) tips to inform family-centered care, and (5) education or supportive resources. Participants identified seven design requirements: information should (1) be presented in an order that resembles the structure of the clinical discussion around delirium; (2) increase accessibility, recall, and preparedness by providing multiple formats; (3) aim to reduce stress by implementing positive framing; (4) minimize cognitive load to ensure adequate information processing; (5) provide supplemental electronic resources via QR codes; (6) emphasize collaboration between caregivers and the health care team; and (7) use prompting questions to act as a call to action for caregivers. Conclusions: Key design requirements derived from end-user feedback were established and guided the development of a novel pediatric delirium education tool. Implementing this tool into regular practice has the potential to reduce distress and assist in the early recognition and treatment of delirium in the PICU domain. Future evaluation of its clinical utility is necessary. %R 10.2196/53120 %U https://pediatrics.jmir.org/2023/1/e53120 %U https://doi.org/10.2196/53120 %0 Journal Article %@ 2561-6722 %I %V 6 %N %P e48004 %T Detection and Characterization of Web-Based Pediatric COVID-19 Vaccine Discussions and Racial and Ethnic Minority Topics: Retrospective Analysis of Twitter Data %A McMann,Tiana %A Wenzel,Christine %A Le,Nicolette %A Li,Zhuoran %A Xu,Qing %A Cuomo,Raphael E %A Mackey,Tim %K COVID-19 vaccine %K vaccine hesitancy %K pediatric vaccine %K pediatric COVID-19 vaccine %K vaccine beliefs %K vaccine-related concerns %K vaccine-related confidence %K vaccine barriers %K vaccine facilitators %K racial and ethnic minority %D 2023 %7 30.11.2023 %9 %J JMIR Pediatr Parent %G English %X Background: Despite pediatric populations representing a smaller proportion of COVID-19 cases and having a less severe prognosis, those belonging to racial and ethnic minority groups are at an increased risk of developing more severe COVID-19–related outcomes. Vaccine coverage is crucial to pandemic mitigation efforts, yet since the start of the COVID-19 pandemic, vaccine hesitancy has increased and routine pediatric immunizations have decreased. Limited research exists on how vaccine hesitancy may contribute to low pediatric COVID-19 vaccine uptake among racial and ethnic minority populations. Objective: This study aimed to characterize COVID-19 vaccine–related discussion and sentiment among Twitter users, particularly among racial and ethnic minority users. Methods: We used the Twitter application programming interface to collect tweets and replies. Tweets were selected by filtering for keywords associated with COVID-19 vaccines and pediatric-related terms. From this corpus of tweets, we used the Biterm Topic Model to output topics and examined the top 200 retweeted tweets that were coded for pediatric COVID-19 vaccine relevance. Relevant tweets were analyzed using an inductive coding approach to characterize pediatric COVID-19 vaccine–related themes. Replies to relevant tweets were collected and coded. User metadata were assessed for self-reporting of race or ethnic group affiliation and verified account status. Results: A total of 863,007 tweets were collected from October 2020 to October 2021. After outputting Biterm Topic Model topics and reviewing the 200 most retweeted tweets, 208,666 tweets and 3905 replies were identified as being pediatric COVID-19 vaccine related. The majority (150,262/208,666, 72.01%) of tweets expressed vaccine-related concerns. Among tweets discussing vaccine confidence, user replies expressing agreement were significantly outweighed by those expressing disagreement (1016/3106, 32.71% vs 2090/3106, 67.29%; P<.001). The main themes identified in the Twitter interactions were conversations regarding vaccine-related concerns including adverse side effects, concerns that the vaccine is experimental or needs more testing and should not be tested on pediatric populations, the perception that the vaccine is unnecessary given the perceived low risk of pediatric infection, and conversations associated with vaccine-related confidence (ie, the vaccine is protective). Among signal tweets and replies, we identified 418 users who self-identified as a racial minority individual and 40 who self-identified as an ethnic minority individual. Among the subcodes identified in this study, the vaccine being protective was the most discussed topic by racial and ethnic minority groups (305/444, 68.7%). Conclusions: Vaccine-related concerns can have negative consequences on vaccine uptake and participation in vaccine-related clinical trials. This can impact the uptake and development of safe and effective vaccines, especially among racial and ethnic minority populations. %R 10.2196/48004 %U https://pediatrics.jmir.org/2023/1/e48004 %U https://doi.org/10.2196/48004 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e51459 %T Effectiveness of Technology-Based Interventions for School-Age Children With Attention-Deficit/Hyperactivity Disorder: Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Wong,Ka Po %A Qin,Jing %A Xie,Yao Jie %A Zhang,Bohan %+ Department of Applied Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hong Kong, China (Hong Kong), 852 64860214, portia.wong@polyu.edu.hk %K attention-deficit/hyperactivity disorder %K school-age children %K computer-assisted training program %K ADHD %K neurofeedback training %K virtual reality %K cognitive functions %D 2023 %7 21.11.2023 %9 Review %J JMIR Ment Health %G English %X Background: Attention-deficit/hyperactivity disorder (ADHD) is relatively common among school-age children. Technology-based interventions, such as computer-assisted training programs, neurofeedback training, and virtual reality, show promise in regulating the behaviors and cognitive functions of children with ADHD. An increasing number of randomized controlled trials have been conducted to evaluate the effectiveness of these technologies in improving the conditions of children with ADHD. Objective: This study aims to conduct a systematic review of technological interventions for school-age children with ADHD and perform a meta-analysis of the outcomes of technology-based interventions. Methods: A total of 19 randomized controlled studies involving 1843 participants were selected from a pool of 2404 articles across 7 electronic databases spanning from their inception to April 2022. ADHD behaviors, cognitive functions, learning ability, and quality of life were addressed in this study. Results: Random effects meta-analyses found that children with ADHD receiving technology-based intervention showed small and significant effect sizes in computer-rated inattention (standardized mean difference [SMD] −0.35; P<.04), parent-rated overall executive function measured by the Behavior Rating Inventory of Executive Function (SMD −0.35; P<.04), parent-rated disruptive behavior disorder measured by the Child Behavior Checklist (SMD −0.50; P<.001) and Disruptive Behavior Disorder Rating Scale (SMD −0.31; P<.02), and computer-rated visual attention measured by the Continuous Performance Test (SMD −0.42; P<.001) and Reaction Time (SMD −0.43; P<.02). Conclusions: Technology-based interventions are promising treatments for improving certain ADHD behaviors and cognitive functions among school-age children with ADHD. Trial Registration: PROSPERO CRD42023446924; https://tinyurl.com/7ee5t24n %M 37988139 %R 10.2196/51459 %U https://mental.jmir.org/2023/1/e51459 %U https://doi.org/10.2196/51459 %U http://www.ncbi.nlm.nih.gov/pubmed/37988139 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e47663 %T Health Care Professionals’ Experiences and Views of eHealth in Pediatric Care: Qualitative Interview Study Applying a Theoretical Framework for Implementation %A Castor,Charlotte %A Lindkvist,Rose-Marie %A Hallström,Inger Kristensson %A Holmberg,Robert %+ Department of Health Sciences, Lund University, Box 117, Sölvegatan 19, Lund, 22100, Sweden, 46 703668523, charlotte.castor@med.lu.se %K communication %K digital %K experiences %K eHealth %K health care professionals %K implementation %K NASSS %K pediatric care %D 2023 %7 18.10.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The development and evaluation of eHealth interventions in clinical care should be accompanied by a thorough assessment of their implementation. The NASSS (Non-adoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies) framework was designed to facilitate the implementation and scale-up of health technology programs, providing an option for analyzing the progression of these initiatives as they are implemented in real-time. Considering health care provider perspectives within the framework for implementation offers valuable insights into the early identification of barriers and facilitators in the implementation of potentially effective eHealth innovations. Nevertheless, there is a dearth of studies on eHealth interventions that encompass longer time frames and delve into the complexities of scaling up and sustaining such interventions within real-world health care environments. Objective: This study aims to investigate the perspectives and insights of health care professionals (HCPs) regarding the implementation of an eHealth intervention in pediatric health care while applying the NASSS framework to theorize and evaluate the conditions influencing the implementation of eHealth solutions. Methods: Semistructured interviews were performed with health care providers, including both staff and management personnel, within a university pediatric hospital (N=10). The data collection process occurred concurrently with a clinical trial focused on developing and assessing an eHealth app for self-management in pediatric care following hospital discharge. Using an abductive approach, the interviews were initially analyzed qualitatively and subsequently mapped onto the 7 domains of the NASSS framework to identify factors influencing implementation, encompassing facilitators, barriers, and varying levels of complexity. Results: In the realm of pediatric care, the family was identified as the primary unit of care, and patient heterogeneity was a prominent feature. The implementation of eHealth tools, while deemed usable and flexible, was also seen as a delicate balance between safety and adaptability, highlighting challenges related to health care integration. Child participation and secrecy, especially for adolescents, contributed to the complexity of using eHealth. HCPs had high eHealth literacy, and thus challenges concerning adoption were related to work adaptations and the risk of “app overload.” The readiness for implementation was experienced as induced through the research study and the pandemic situation. However, to move from research to implementation in clinical practice, organizational challenges identified a need to update the concept of care and ensure activity measurements. In a wider context, HCPs raised concerns related to regulatory requirements for documentation, public procurement, and data safety. Implementation became more complex due to a lack of overview in a large organization. Conclusions: Important perspectives for implementation were considerations of regulatory requirements, as well as the need for a shared vision of eHealth and the establishment of eHealth-related work as part of regular health care. Key contextual factors that support reach and impact are communication channels between different levels at the hospital and a need for paths and procedures compatible with legal, technological, and security concerns. Further research should focus on how eHealth interventions are perceived by children, adolescents, their parents, and other stakeholders. Trial Registration: ClinicalTrials.gov NCT04150120; https://clinicaltrials.gov/ct2/show/NCT04150120 %M 37851500 %R 10.2196/47663 %U https://pediatrics.jmir.org/2023/1/e47663 %U https://doi.org/10.2196/47663 %U http://www.ncbi.nlm.nih.gov/pubmed/37851500 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e46893 %T Evaluating the Usefulness and Ease of Use of a Next-Generation–Connected Drug Delivery Device for Growth Hormone Therapy: Qualitative Study of Health Care Professionals’ Perceptions %A Labarta,José I %A Dimitri,Paul %A Keiser,Matthew %A Koledova,Ekaterina %A Rivera-Romero,Octavio %+ Electronic Technology Department, Universidad de Sevilla, Avda. Reina Mercedes s/n, Seville, 41012, Spain, 34 954 55 27 89, orivera@us.es %K connected health %K growth hormone deficiency %K participatory health informatics %K recombinant human growth hormone %K technology acceptance %K mobile phone %D 2023 %7 2.8.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital solutions targeting children’s health have become an increasingly important element in the provision of integrated health care. For the treatment of growth hormone deficiency (GHD), a unique connected device is available to facilitate the delivery of recombinant human growth hormone (r-hGH) by automating the daily injection process and collecting injection data such that accurate adherence information is available to health care professionals (HCPs), caregivers, and patients. The adoption of such digital solutions requires a good understanding of the perspectives of HCPs as key stakeholders because they leverage data collection and prescribe these solutions to their patients. Objective: This study aimed to evaluate the third generation of the easypod device (EP3) for the delivery of r-hGH treatment from the HCP perspective, with a focus on perceived usefulness and ease of use. Methods: A qualitative study was conducted, based on a participatory workshop conducted in Zaragoza, Spain, with 10 HCPs experienced in the management of pediatric GHD from 7 reference hospitals in Spain. Several activities were designed to promote discussion among participants about predefined topics based on the Technology Acceptance Model and the Unified Theory of Acceptance and Use of Technology to provide their perceptions about the new device. Results: Participants reported 2 key advantages of EP3 over previous easypod generations: the touch screen interface and the real-time data transmission functionality. All participants (10/10, 100%) agreed that the new device should be part of a digital health ecosystem that provides complementary functionalities including data analysis. Conclusions: This study explored the perceived value of the EP3 autoinjector device for the treatment of GHD by HCPs. HCPs rated the new capabilities of the device as having substantial improvements and concluded that it was highly recommendable for clinical practice. EP3 will enhance decision-making and allow for more personalized care of patients receiving r-hGH. %M 37531173 %R 10.2196/46893 %U https://humanfactors.jmir.org/2023/1/e46893 %U https://doi.org/10.2196/46893 %U http://www.ncbi.nlm.nih.gov/pubmed/37531173 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e47084 %T Assessing Detection of Children With Suicide-Related Emergencies: Evaluation and Development of Computable Phenotyping Approaches %A Edgcomb,Juliet Beni %A Tseng,Chi-hong %A Pan,Mengtong %A Klomhaus,Alexandra %A Zima,Bonnie T %+ Mental Health Informatics and Data Science (MINDS) Hub, Center for Community Health, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90095, United States, 1 310 794 8278, jedgcomb@mednet.ucla.edu %K child mental health %K suicide %K self-harm %K machine learning %K phenotyping %D 2023 %7 21.7.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Although suicide is a leading cause of death among children, the optimal approach for using health care data sets to detect suicide-related emergencies among children is not known. Objective: This study aimed to assess the performance of suicide-related International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and suicide-related chief complaint in detecting self-injurious thoughts and behaviors (SITB) among children compared with clinician chart review. The study also aimed to examine variations in performance by child sociodemographics and type of self-injury, as well as develop machine learning models trained on codified health record data (features) and clinician chart review (gold standard) and test model detection performance. Methods: A gold standard classification of suicide-related emergencies was determined through clinician manual review of clinical notes from 600 emergency department visits between 2015 and 2019 by children aged 10 to 17 years. Visits classified with nonfatal suicide attempt or intentional self-harm using the Centers for Disease Control and Prevention surveillance case definition list of ICD-10-CM codes and suicide-related chief complaint were compared with the gold standard classification. Machine learning classifiers (least absolute shrinkage and selection operator–penalized logistic regression and random forest) were then trained and tested using codified health record data (eg, child sociodemographics, medications, disposition, and laboratory testing) and the gold standard classification. The accuracy, sensitivity, and specificity of each detection approach and relative importance of features were examined. Results: SITB accounted for 47.3% (284/600) of the visits. Suicide-related diagnostic codes missed nearly one-third (82/284, 28.9%) and suicide-related chief complaints missed more than half (153/284, 53.9%) of the children presenting to emergency departments with SITB. Sensitivity was significantly lower for male children than for female children (0.69, 95% CI 0.61-0.77 vs 0.84, 95% CI 0.78-0.90, respectively) and for preteens compared with adolescents (0.66, 95% CI 0.54-0.78 vs 0.86, 95% CI 0.80-0.92, respectively). Specificity was significantly lower for detecting preparatory acts (0.68, 95% CI 0.64-0.72) and attempts (0.67, 95% CI 0.63-0.71) than for detecting ideation (0.79, 95% CI 0.75-0.82). Machine learning–based models significantly improved the sensitivity of detection compared with suicide-related codes and chief complaint alone. Models considering all 84 features performed similarly to models considering only mental health–related ICD-10-CM codes and chief complaints (34 features) and models considering non–ICD-10-CM code indicators and mental health–related chief complaints (53 features). Conclusions: The capacity to detect children with SITB may be strengthened by applying a machine learning–based approach to codified health record data. To improve integration between clinical research informatics and child mental health care, future research is needed to evaluate the potential benefits of implementing detection approaches at the point of care and identifying precise targets for suicide prevention interventions in children. %M 37477974 %R 10.2196/47084 %U https://mental.jmir.org/2023/1/e47084 %U https://doi.org/10.2196/47084 %U http://www.ncbi.nlm.nih.gov/pubmed/37477974 %0 Journal Article %@ 2291-9694 %I %V 11 %N %P e45496 %T Interoperable, Domain-Specific Extensions for the German Corona Consensus (GECCO) COVID-19 Research Data Set Using an Interdisciplinary, Consensus-Based Workflow: Data Set Development Study %A Lichtner,Gregor %A Haese,Thomas %A Brose,Sally %A Röhrig,Larissa %A Lysyakova,Liudmila %A Rudolph,Stefanie %A Uebe,Maria %A Sass,Julian %A Bartschke,Alexander %A Hillus,David %A Kurth,Florian %A Sander,Leif Erik %A Eckart,Falk %A Toepfner,Nicole %A Berner,Reinhard %A Frey,Anna %A Dörr,Marcus %A Vehreschild,Jörg Janne %A von Kalle,Christof %A Thun,Sylvia %K interoperability %K research data set %K Fast Healthcare Interoperability Resources %K FHIR %K FAIR principle %K COVID-19 %K interoperable %K SARS-CoV-2 %K pediatric %K immunization %K cardiology %K standard %D 2023 %7 18.7.2023 %9 %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic has spurred large-scale, interinstitutional research efforts. To enable these efforts, researchers must agree on data set definitions that not only cover all elements relevant to the respective medical specialty but also are syntactically and semantically interoperable. Therefore, the German Corona Consensus (GECCO) data set was developed as a harmonized, interoperable collection of the most relevant data elements for COVID-19–related patient research. As the GECCO data set is a compact core data set comprising data across all medical fields, the focused research within particular medical domains demands the definition of extension modules that include data elements that are the most relevant to the research performed in those individual medical specialties. Objective: We aimed to (1) specify a workflow for the development of interoperable data set definitions that involves close collaboration between medical experts and information scientists and (2) apply the workflow to develop data set definitions that include data elements that are the most relevant to COVID-19–related patient research regarding immunization, pediatrics, and cardiology. Methods: We developed a workflow to create data set definitions that were (1) content-wise as relevant as possible to a specific field of study and (2) universally usable across computer systems, institutions, and countries (ie, interoperable). We then gathered medical experts from 3 specialties—infectious diseases (with a focus on immunization), pediatrics, and cardiology—to select data elements that were the most relevant to COVID-19–related patient research in the respective specialty. We mapped the data elements to international standardized vocabularies and created data exchange specifications, using Health Level Seven International (HL7) Fast Healthcare Interoperability Resources (FHIR). All steps were performed in close interdisciplinary collaboration with medical domain experts and medical information specialists. Profiles and vocabulary mappings were syntactically and semantically validated in a 2-stage process. Results: We created GECCO extension modules for the immunization, pediatrics, and cardiology domains according to pandemic-related requests. The data elements included in each module were selected, according to the developed consensus-based workflow, by medical experts from these specialties to ensure that the contents aligned with their research needs. We defined data set specifications for 48 immunization, 150 pediatrics, and 52 cardiology data elements that complement the GECCO core data set. We created and published implementation guides, example implementations, and data set annotations for each extension module. Conclusions: The GECCO extension modules, which contain data elements that are the most relevant to COVID-19–related patient research on infectious diseases (with a focus on immunization), pediatrics, and cardiology, were defined in an interdisciplinary, iterative, consensus-based workflow that may serve as a blueprint for developing further data set definitions. The GECCO extension modules provide standardized and harmonized definitions of specialty-related data sets that can help enable interinstitutional and cross-country COVID-19 research in these specialties. %R 10.2196/45496 %U https://medinform.jmir.org/2023/1/e45496 %U https://doi.org/10.2196/45496 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e41806 %T Health Information From Web Search Engines and Virtual Assistants About Pre-Exposure Prophylaxis for HIV Prevention in Adolescents and Young Adults: Content Analysis %A Darien,Kaja %A Lee,Susan %A Knowles,Kayla %A Wood,Sarah %A Langer,Miriam D %A Lazar,Nellie %A Dowshen,Nadia %+ PolicyLab, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 10th Floor, Philadelphia, PA, 19146, United States, 1 267 426 9523, darienk@chop.edu %K pre-exposure prophylaxis %K PrEP %K prophylaxis %K internet use %K search engine %K adolescent %K youth %K pediatric %K adolescence %K young adult %K readability %K human immunodeficiency virus %K HIV %K virtual assistant %K health information %K information quality %K accuracy %K credibility %K patient education %K comprehension %K comprehensible %K web-based %K online information %K sexual health %K reading level %D 2023 %7 18.7.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Adolescents and young adults are disproportionately affected by HIV, suggesting that HIV prevention methods such as pre-exposure prophylaxis (PrEP) should focus on this group as a priority. As digital natives, youth likely turn to internet resources regarding health topics they may not feel comfortable discussing with their medical providers. To optimize informed decision-making by adolescents and young adults most impacted by HIV, the information from internet searches should be educational, accurate, and readable. Objective: The aims of this study were to compare the accuracy of web-based PrEP information found using web search engines and virtual assistants, and to assess the readability of the resulting information. Methods: Adolescent HIV prevention clinical experts developed a list of 23 prevention-related questions that were posed to search engines (Ask.com, Bing, Google, and Yahoo) and virtual assistants (Amazon Alexa, Microsoft Cortana, Google Assistant, and Apple Siri). The first three results from search engines and virtual assistant web references, as well as virtual assistant verbal responses, were recorded and coded using a six-tier scale to assess the quality of information produced. The results were also entered in a web-based tool determining readability using the Flesch-Kincaid Grade Level scale. Results: Google web search engine and Google Assistant more frequently produced PrEP information of higher quality than the other search engines and virtual assistants with scores ranging from 3.4 to 3.7 and 2.8 to 3.3, respectively. Additionally, the resulting information generally was presented in language at a seventh and 10th grade reading level according to the Flesch-Kincaid Grade Level scale. Conclusions: Adolescents and young adults are large consumers of technology and may experience discomfort discussing their sexual health with providers. It is important that efforts are made to ensure the information they receive about HIV prevention methods, and PrEP in particular, is comprehensive, comprehensible, and widely available. %M 37463044 %R 10.2196/41806 %U https://pediatrics.jmir.org/2023/1/e41806 %U https://doi.org/10.2196/41806 %U http://www.ncbi.nlm.nih.gov/pubmed/37463044 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44467 %T Pediatric Injury Surveillance From Uncoded Emergency Department Admission Records in Italy: Machine Learning–Based Text-Mining Approach %A Azzolina,Danila %A Bressan,Silvia %A Lorenzoni,Giulia %A Baldan,Giulia Andrea %A Bartolotta,Patrizia %A Scognamiglio,Federico %A Francavilla,Andrea %A Lanera,Corrado %A Da Dalt,Liviana %A Gregori,Dario %+ Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Leonardo Loredan 18, Padua, 35128, Italy, 39 049 8275384, dario.gregori@unipd.it %K machine learning %K pediatrics %K child and adolescent health %K text mining %K injury %K death %K surveillance %K pediatric admission %K hospitalization %K patient record %K unintentional injury %K emergency department %K emergency %K epidemiological surveillance %D 2023 %7 12.7.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Unintentional injury is the leading cause of death in young children. Emergency department (ED) diagnoses are a useful source of information for injury epidemiological surveillance purposes. However, ED data collection systems often use free-text fields to report patient diagnoses. Machine learning techniques (MLTs) are powerful tools for automatic text classification. The MLT system is useful to improve injury surveillance by speeding up the manual free-text coding tasks of ED diagnoses. Objective: This research aims to develop a tool for automatic free-text classification of ED diagnoses to automatically identify injury cases. The automatic classification system also serves for epidemiological purposes to identify the burden of pediatric injuries in Padua, a large province in the Veneto region in the Northeast Italy. Methods: The study includes 283,468 pediatric admissions between 2007 and 2018 to the Padova University Hospital ED, a large referral center in Northern Italy. Each record reports a diagnosis by free text. The records are standard tools for reporting patient diagnoses. An expert pediatrician manually classified a randomly extracted sample of approximately 40,000 diagnoses. This study sample served as the gold standard to train an MLT classifier. After preprocessing, a document-term matrix was created. The machine learning classifiers, including decision tree, random forest, gradient boosting method (GBM), and support vector machine (SVM), were tuned by 4-fold cross-validation. The injury diagnoses were classified into 3 hierarchical classification tasks, as follows: injury versus noninjury (task A), intentional versus unintentional injury (task B), and type of unintentional injury (task C), according to the World Health Organization classification of injuries. Results: The SVM classifier achieved the highest performance accuracy (94.14%) in classifying injury versus noninjury cases (task A). The GBM method produced the best results (92% accuracy) for the unintentional and intentional injury classification task (task B). The highest accuracy for the unintentional injury subclassification (task C) was achieved by the SVM classifier. The SVM, random forest, and GBM algorithms performed similarly against the gold standard across different tasks. Conclusions: This study shows that MLTs are promising techniques for improving epidemiological surveillance, allowing for the automatic classification of pediatric ED free-text diagnoses. The MLTs revealed a suitable classification performance, especially for general injuries and intentional injury classification. This automatic classification could facilitate the epidemiological surveillance of pediatric injuries by also reducing the health professionals’ efforts in manually classifying diagnoses for research purposes. %M 37436799 %R 10.2196/44467 %U https://publichealth.jmir.org/2023/1/e44467 %U https://doi.org/10.2196/44467 %U http://www.ncbi.nlm.nih.gov/pubmed/37436799 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e44792 %T Using Human-Centered Design and Cocreation to Create the Live 5-2-1-0 Mobile App to Promote Healthy Behaviors in Children: App Design and Development %A Yau,Kiana W %A Tang,Tricia S %A Görges,Matthias %A Pinkney,Susan %A Amed,Shazhan %+ Research Institute, BC Children's Hospital, A4-196, 950 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada, 1 6048753113, SAmed@cw.bc.ca %K childhood obesity %K mobile health %K health behaviors %K prevention %K mobile health app %K mHealth app %K human-centered design %K cocreation %K participatory approach %K mobile phone %D 2023 %7 17.5.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The prevalence of obesity among Canadian children is rising, partly because of increasingly obesogenic environments that limit opportunities for physical activity and healthy nutrition. Live 5-2-1-0 is a community-based multisectoral childhood obesity prevention initiative that engages stakeholders to promote and support the message of consuming ≥5 servings of vegetables and fruits, having <2 hours of recreational screen time, participating in ≥1 hour of active play, and consuming 0 sugary drinks every day. A Live 5-2-1-0 Toolkit for health care providers (HCPs) was previously developed and piloted in 2 pediatric clinics at British Columbia Children’s Hospital. Objective: This study aimed to co-create, in partnership with children, parents, and HCPs, a Live 5-2-1-0 mobile app that supports healthy behavior change and could be used as part of the Live 5-2-1-0 Toolkit for HCPs. Methods: Three focus groups (FGs) were conducted using human-centered design and participatory approaches. In FG 1, children (separately) and parents and HCPs (together) participated in sessions on app conceptualization and design. Researchers and app developers analyzed and interpreted qualitative data from FG 1 in an ideation session, and key themes were subsequently presented separately to parents, children, and HCPs in FG-2 (co-creation) sessions to identify desired app features. Parents and children tested a prototype in FG 3, provided feedback on usability and content, and completed questionnaires. Thematic analysis and descriptive statistics were used for the qualitative and quantitative data, respectively. Results: In total, 14 children (mean age 10.2, SD 1.3 years; 5/14, 36% male; 5/14, 36% White), 12 parents (9/12, 75% aged 40-49 years; 2/12, 17% male; 7/12, 58% White), and 18 HCPs participated; most parents and children (20/26, 77%) participated in ≥2 FGs. Parents wanted an app that empowered children to adopt healthy behaviors using internal motivation and accountability, whereas children described challenge-oriented goals and family-based activities as motivating. Parents and children identified gamification, goal setting, daily steps, family-based rewards, and daily notifications as desired features; HCPs wanted baseline behavior assessments and to track users’ behavior change progress. Following prototype testing, parents and children reported ease in completing tasks, with a median score of 7 (IQR 6-7) on a 7-point Likert scale (1=very difficult; 7=very easy). Children liked most suggested rewards (28/37, 76%) and found 79% (76/96) of suggested daily challenges (healthy behavior activities that users complete to achieve their goal) realistic to achieve. Participant suggestions included strategies to maintain users’ interest and content that further motivates healthy behavior change. Conclusions: Co-creating a mobile health app with children, parents, and HCPs was feasible. Stakeholders desired an app that facilitated shared decision-making with children as active agents in behavior change. Future research will involve clinical implementation and assessment of the usability and effectiveness of the Live 5-2-1-0 app. %M 37195754 %R 10.2196/44792 %U https://pediatrics.jmir.org/2023/1/e44792 %U https://doi.org/10.2196/44792 %U http://www.ncbi.nlm.nih.gov/pubmed/37195754 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45358 %T Racial/Ethnic Disparity in Association Between Fetal Alcohol Syndrome and Alcohol Intake During Pregnancy: Multisite Retrospective Cohort Study %A Oh,Sarah Soyeon %A Kang,Bada %A Park,Jewel %A Kim,SangMin %A Park,Eun-Cheol %A Lee,Seung Hee %A Kawachi,Ichiro %+ Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea, 82 2 2228 3283, bdkang@yuhs.ac %K fetal alcohol syndrome %K ethnic disparity %K alcohol intake %K pregnancy %K health disparity %K public health %K minority population %K vulnerable population %K women's health %K pediatrics %K fetal health %K pediatrics %D 2023 %7 21.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Alcohol consumption during pregnancy is associated with a range of adverse birth-related outcomes, including stillbirth, low birth weight, preterm birth, and fetal alcohol syndrome (FAS). With more than 10% of women consuming alcohol during pregnancy worldwide, it is increasingly important to understand how racial/ethnic variations affect FAS onset. However, whether race and ethnicity inform FAS risk assessment when daily ethanol intake is controlled for remains unknown. Objective: This study aimed to assess racial/ethnic disparities in FAS risk associated with alcohol consumption during pregnancy. Methods: We used data from a longitudinal cohort study (the Collaborative Initiative on Fetal Alcohol Spectrum Disorders) at 5 hospital sites around the United States of 595 women who consumed alcohol during pregnancy from 2007 to 2017. Questionnaires, in-person interviews, and reviews of medical, legal, and social service records were used to gather data on average alcoholic content (AAC) during pregnancy. Self-reports of maternal race (American Indian/Alaska Native [AI/AN], Asian, Native Hawaiian or other Pacific Islander, Black or African American, White, more than one race, and other) and ethnicity (Hispanic/Latino or not Hispanic/Latino), as well as FAS diagnoses based on standardized dysmorphological criteria, were used for analysis. Log-binomial regression was used to examine the risk of FAS associated with each 1-gram increase in ethanol consumption during pregnancy, stratified by race/ethnicity. Results: A total of 3.4% (20/595) of women who reported consuming alcohol during pregnancy gave birth to a baby with FAS. Women who gave birth to a baby with FAS had a mean AAC of 32.06 (SD 9.09) grams, which was higher than that of women who did not give birth to a baby with FAS (mean 12.07, SD 15.87 grams). AI/AN mothers with FAS babies had the highest AAC (mean 42.62, SD 8.35 grams), followed by White (mean 30.13, SD 4.88 grams) and Black mothers (mean 27.05, SD 12.78 grams). White (prevalence ratio [PR] 1.10, 95% CI 1.03-1.19), Black (PR 1.13, 95% CI 1.04-1.23), and AI/AN (PR 1.10, 95% CI 1.00-1.21) mothers had 10% to 13% increased odds of giving birth to a baby with FAS given the same exposure to alcohol during pregnancy. Regardless of race, a 1-gram increase in AAC resulted in a 4% increase (PR 1.04, 95% CI 1.02-1.07) in the chance of giving birth to a baby with ≥2 facial anomalies (ie, short palpebral fissures, thin vermilion border of the upper lip, and smooth philtrum) and a 4% increase (PR 1.04, 95% CI 1.01-1.07) in the chance of deficient brain growth. Conclusions: The risk of delivering a baby with FAS was comparable among White, Black, and AI/AN women at similar levels of drinking during pregnancy. Regardless of race, a 1-gram increase in AAC resulted in increased odds of giving birth to a baby with facial anomalies or deficient brain growth. %M 37083819 %R 10.2196/45358 %U https://publichealth.jmir.org/2023/1/e45358 %U https://doi.org/10.2196/45358 %U http://www.ncbi.nlm.nih.gov/pubmed/37083819 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41010 %T The Evaluation of Health Care Services for Children and Adolescents With Post–COVID-19 Condition: Protocol for a Prospective Longitudinal Study %A Rathgeb,Chiara %A Pawellek,Maja %A Behrends,Uta %A Alberer,Martin %A Kabesch,Michael %A Gerling,Stephan %A Brandstetter,Susanne %A Apfelbacher,Christian %+ Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Leipziger Str 44, Magdeburg, 39120, Germany, 49 0391 6724316, christian.apfelbacher@med.ovgu.de %K post-COVID %K long COVID %K post–COVID-19 condition %K PCC %K post–COVID-19 syndrome %K PCS %K CFS/ME %K children and adolescents %K health care services %K EQ-5D %K SDQ %K PROMIS %K DSQ-PEM %K COVID-19 %K pediatrics %K child %K adolescent %K service delivery %K healthcare delivery %K healthcare service %K care network %K healthcare %K therapeutic service %K healthcare utilization %K patient reported outcome %D 2023 %7 11.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Some children and adolescents suffer from late effects of a SARS-CoV-2 infection despite a frequently mild course of the disease. Nevertheless, extensive care for post–COVID-19 condition, also known as post–COVID-19 syndrome, in children and young people is not yet available. A comprehensive care network, Post-COVID Kids Bavaria (PoCo), for children and adolescents with post–COVID-19 condition has been set up as a model project in Bavaria, Germany. Objective: The aim of this study is to evaluate the health care services provided within this network structure of care for children and adolescents with post–COVID-19 condition in a pre-post study design. Methods: We have already recruited 117 children and adolescents aged up to 17 years with post–COVID-19 condition who were diagnosed and treated in 16 participating outpatient clinics. Health care use, treatment satisfaction, patient-reported outcomes related to health-related quality of life (the primary endpoint), fatigue, postexertional malaise, and mental health are being assessed at different time points (at baseline and after 4 weeks, 3 months, and 6 months) using routine data, interviews, and self-report questionnaires. Results: The study recruitment process ran from April 2022 until December 2022. Interim analyses will be carried out. A full analysis of the data will be conducted after follow-up assessment is completed, and the results will be published. Conclusions: The results will contribute to the evaluation of therapeutic services provided for post–COVID-19 condition in children and adolescents, and avenues for optimizing care may be identified. International Registered Report Identifier (IRRID): DERR1-10.2196/41010 %M 36867709 %R 10.2196/41010 %U https://www.researchprotocols.org/2023/1/e41010 %U https://doi.org/10.2196/41010 %U http://www.ncbi.nlm.nih.gov/pubmed/36867709 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e42680 %T Children and Young People’s Involvement in Designing Applied Games: Scoping Review %A Saiger,Michael John %A Deterding,Sebastian %A Gega,Lina %+ Dyson School of Design Engineering, Imperial College London, 25 Exhibition Road, South Kensington, London, SW7 2DB, United Kingdom, 44 020 7594 8888, s.deterding@imperial.ac.uk %K serious game %K game design %K end user %K participatory design %K co-design %K user involvement method %K interventions %K game development %K children %K pediatric %K young people %K child %K youth %K review method %K scoping %K applied game %D 2023 %7 16.3.2023 %9 Review %J JMIR Serious Games %G English %X Background: User involvement is widely accepted as key for designing effective applied games for health. This especially holds true for children and young people as target audiences, whose abilities, needs, and preferences can diverge substantially from those of adult designers and players. Nevertheless, there is little shared knowledge about how concretely children and young people have been involved in the design of applied games, let alone consensus guidance on how to do so effectively. Objective: The aim of this scoping review was to describe which user involvement methods have been used in the design of applied games with children and young people, how these methods were implemented, and in what roles children and young people were involved as well as what factors affected their involvement. Methods: We conducted a systematic literature search and selection across the ACM Digital Library, IEEE Xplore, Scopus, and Web of Science databases using State of the Art through Systematic Review software for screening, selection, and data extraction. We then conducted a qualitative content analysis on the extracted data using NVivo. Results: We retrieved 1085 records, of which 47 (4.33%) met the eligibility criteria. The chief involvement methods were participatory design (20/47, 43%) and co-design (16/47, 37%), spanning a wide range of 45 concrete activities with paper prototyping, group discussions, and playtesting being the most frequent. In only half of the studies (24/47, 51%), children and young people participated as true design partners. Our qualitative content analysis suggested 5 factors that affect their successful involvement: comprehension, cohesion, confidence, accessibility, and time constraints. Conclusions: Co-design, participatory design, and similar high-level labels that are currently used in the field gloss over very uneven degrees of participation in design and a wide variety of implementations that greatly affect actual user involvement. This field would benefit from more careful consideration and documentation of the reason of user involvement. Future research should explore concrete activities and configurations that can address the common challenges of involving children and young people, such as comprehension, cohesion, confidence, and accessibility. %M 36928258 %R 10.2196/42680 %U https://games.jmir.org/2023/1/e42680 %U https://doi.org/10.2196/42680 %U http://www.ncbi.nlm.nih.gov/pubmed/36928258 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e39744 %T Understanding Child Wasting in Ethiopia: Cross-sectional Analysis of 2019 Ethiopian Demographic and Health Survey Data Using Generalized Linear Latent and Mixed Models %A Gilano,Girma %A Hailegebreal,Samuel %A Sako,Sewunet %A Haile,Firehiwot %A Gilano,Kasarto %A Seboka,Binyam Tariku %A Kashala,Kefita %+ Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Southern Nation Nationalities Peoples' Region, Ethiopia, 251 913 930384, gilanog@yahoo.com %K wasting %K Generalized Linear Latent and Mixed Models %K GLLAMM %K under-five children %K factors %K Ethiopia %D 2023 %7 8.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Wasting is an immediate, visible, and life-threatening form of undernutrition in children aged <5 years. Within a short time, wasting causes recurrent sickness, delayed physical and mental growth, impatience, poor feeding, and low body weight. The long-term consequences of wasting and undernutrition are stunting, inability to learn, poor health status, and poor work performance. Wasting remains a public health problem in Ethiopia. According to the World Health Organization, countries have to reduce undernutrition including child wasting to below 5% by 2025. Ethiopia is attempting to attain national and international targets of undernutrition while struggling with many problems. Objective: This study aimed to identify the prevalence and associated factors of wasting to provide information for further renewing policy commitments. Methods: We used community-based, cross-sectional data from the Ethiopian Mini Demographic and Health Survey. The survey was conducted in 9 regions and 2 city administrations. Two-stage cluster sampling was used to recruit study participants. In the first stage, enumerations areas were selected, and 28-35 households per enumeration area were selected in the second stage. Our analysis included 2016 women with children aged <5 years from the 2019 EMDHS data set. We dropped incomplete records and included all women who fulfilled the eligibility criteria. We used multilevel ordinal regression using Generalized Linear Latent and Mixed Models (GLLAMM) and predicted probability with log-likelihood ratio tests. Fulfilling the proportional odds model’s assumption during the application of multilevel ordinary logistic regression was a cumbersome task. GLLAMM enabled us to perform the multilevel proportional odds model using an alternative method. Results: In our analysis, wasting was 7.68% (95% CI 6.56%-8.93%). Around 26.82% of mothers never used antenatal care for their current child. Most mothers (52.2%) did not have formal education, and 86.8% did not have postnatal care for their children. Additionally, half (50.93%) of the mothers have ≥6 household members. Wasting was associated with feeding diverse foods (coefficient 4.90, 95% CI 4.90-4.98), female sex of the household head (–40.40, 95% CI –40.41 to –40.32), home delivery (–35.51, 95% CI –35.55 to –35.47), first (16.66, 95% CI, 16.60-16.72) and second (16.65, 95% CI 16.60-16.70) birth order, female child (–12.65, 95% CI –12.69 to –12.62), and household size of 1 to 3 (10.86, 95% CI 10.80-10.92). Conclusions: According to the target set by World Health Organization for reducing undernutrition in children aged <5 years to below 5% by 2025, child wasting of 7.68% in Ethiopia should spark an immediate reaction from the government and stakeholders. Informed policy decisions, technology-based child-feeding education, and food self-sufficiency support could improve the current challenges. Additional effort is important to improve low maternal education, family planning, awareness of sex preferences, women empowerment, and maternal health services. %M 36753309 %R 10.2196/39744 %U https://publichealth.jmir.org/2023/1/e39744 %U https://doi.org/10.2196/39744 %U http://www.ncbi.nlm.nih.gov/pubmed/36753309 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e43027 %T Validation of Prediction Rules for Computed Tomography Use in Children With Blunt Abdominal or Blunt Head Trauma: Protocol for a Prospective Multicenter Observational Cohort Study %A Ugalde,Irma T %A Chaudhari,Pradip P %A Badawy,Mohamed %A Ishimine,Paul %A McCarten-Gibbs,Kevan A %A Yen,Kenneth %A Atigapramoj,Nisa S %A Sage,Allyson %A Nielsen,Donovan %A Adelson,P David %A Upperman,Jeffrey %A Tancredi,Daniel %A Kuppermann,Nathan %A Holmes,James F %+ Department of Emergency Medicine, University of California Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA, 95817, United States, 1 916 734 5010, jfholmes@ucdavis.edu %K pediatric trauma %K intra-abdominal injury %K traumatic brain injury %K clinical prediction rules %K emergency medicine %D 2022 %7 24.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Traumatic brain injuries (TBIs) and intra-abdominal injuries (IAIs) are 2 leading causes of traumatic death and disability in children. To avoid missed or delayed diagnoses leading to increased morbidity, computed tomography (CT) is used liberally. However, the overuse of CT leads to inefficient care and radiation-induced malignancies. Therefore, to maximize precision and minimize the overuse of CT, the Pediatric Emergency Care Applied Research Network (PECARN) previously derived clinical prediction rules for identifying children at high risk and very low risk for IAIs undergoing acute intervention and clinically important TBIs after blunt trauma in large cohorts of children who are injured. Objective: This study aimed to validate the IAI and age-based TBI clinical prediction rules for identifying children at high risk and very low risk for IAIs undergoing acute intervention and clinically important TBIs after blunt trauma. Methods: This was a prospective 6-center observational study of children aged <18 years with blunt torso or head trauma. Consistent with the original derivation studies, enrolled children underwent routine history and physical examinations, and the treating clinicians completed case report forms prior to knowledge of CT results (if performed). Medical records were reviewed to determine clinical courses and outcomes for all patients, and for those who were discharged from the emergency department, a follow-up survey via a telephone call or SMS text message was performed to identify any patients with missed IAIs or TBIs. The primary outcomes were IAI undergoing acute intervention (therapeutic laparotomy, angiographic embolization, blood transfusion, or intravenous fluid for ≥2 days for pancreatic or gastrointestinal injuries) and clinically important TBI (death from TBI, neurosurgical procedure, intubation for >24 hours for TBI, or hospital admission of ≥2 nights due to a TBI on CT). Prediction rule accuracy was assessed by measuring rule classification performance, using standard point and 95% CI estimates of the operational characteristics of each prediction rule (sensitivity, specificity, positive and negative predictive values, and diagnostic likelihood ratios). Results: The project was funded in 2016, and enrollment was completed on September 1, 2021. Data analyses are expected to be completed by December 2022, and the primary study results are expected to be submitted for publication in 2023. Conclusions: This study will attempt to validate previously derived clinical prediction rules to accurately identify children at high and very low risk for clinically important IAIs and TBIs. Assuming successful validation, widespread implementation is then indicated, which will optimize the care of children who are injured by better aligning CT use with need. International Registered Report Identifier (IRRID): RR1-10.2196/43027 %M 36422920 %R 10.2196/43027 %U https://www.researchprotocols.org/2022/11/e43027 %U https://doi.org/10.2196/43027 %U http://www.ncbi.nlm.nih.gov/pubmed/36422920 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e40707 %T Effectiveness of a Web-Based Intervention to Prevent Anxiety in the Children of Parents With Anxiety: Protocol for a Randomized Controlled Trial %A Dunn,Abigail %A Alvarez,James %A Arbon,Amy %A Bremner,Stephen %A Elsby-Pearson,Chloe %A Emsley,Richard %A Jones,Christopher %A Lawrence,Peter %A Lester,Kathryn J %A Majdandžić,Mirjana %A Morson,Natalie %A Perry,Nicky %A Simner,Julia %A Thomson,Abigail %A Cartwright-Hatton,Sam %+ Department of Psychology, University of Sussex, Pevensey 1 Building, Falmer, Brighton, BN1 9QH, United Kingdom, 44 07532077207, ad560@sussex.ac.uk %K anxiety %K parenting %K online %K RCT %K child %K parent %K randomized controlled trial %K youth %K pediatric %K mental health %K mental well-being %K online intervention %K digital intervention %D 2022 %7 10.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Anxiety is the most common childhood mental health condition and is associated with impaired child outcomes, including increased risk of mental health difficulties in adulthood. Anxiety runs in families: when a parent has anxiety, their child has a 50% higher chance of developing it themselves. Environmental factors are predominant in the intergenerational transmission of anxiety and, of these, parenting processes play a major role. Interventions that target parents to support them to limit the impact of any anxiogenic parenting behaviors are associated with reduced anxiety in their children. A brief UK-based group intervention delivered to parents within the UK National Health Service led to a 16% reduction in children meeting the criteria for an anxiety disorder. However, this intervention is not widely accessible. To widen access, a 9-module web-based version of this intervention has been developed. This course comprises psychoeducation and home practice delivered through text, video, animations, and practice tasks. Objective: This study seeks to evaluate the feasibility of delivering this web-based intervention and assess its effectiveness in reducing child anxiety symptoms. Methods:  This is the protocol for a randomized controlled trial (RCT) of a community sample of 1754 parents with self-identified high levels of anxiety with a child aged 2-11 years. Parents in the intervention arm will receive access to the web-based course, which they undertake at a self-determined rate. The control arm receives no intervention. Follow-up data collection is at months 6 and months 9-21. Intention-to-treat analysis will be conducted on outcomes including child anxiety, child mental health symptoms, and well-being; parental anxiety and well-being; and parenting behaviors. Results: Funding was received in April 2020, and recruitment started in February 2021 and is projected to end in October 2022. A total of 1350 participants have been recruited as of May 2022. Conclusions: The results of this RCT will provide evidence on the utility of a web-based course in preventing intergenerational transmission of anxiety and increase the understanding of familial anxiety. Trial Registration: ClinicalTrials.gov NCT04755933; https://clinicaltrials.gov/ct2/show/NCT04755933 International Registered Report Identifier (IRRID): DERR1-10.2196/40707 %M 36355406 %R 10.2196/40707 %U https://www.researchprotocols.org/2022/11/e40707 %U https://doi.org/10.2196/40707 %U http://www.ncbi.nlm.nih.gov/pubmed/36355406 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e40856 %T Upper Extremity Examination for Neuromuscular Diseases (U-EXTEND): Protocol for a Multimodal Feasibility Study %A Gutierrez,Robert %A McCrady,Allison %A Masterson,Chelsea %A Tolman,Sarah %A Boukhechba,Mehdi %A Barnes,Laura %A Blemker,Silvia %A Scharf,Rebecca %+ University of Virginia Children's Hospital, 1204 W. Main St., Charlottesville, VA, 22903, United States, 1 434 924 1647, rebeccascharf@virginia.edu %K mHealth %K ubiquitous computing %K neuromuscular disorders %K inertial measurement unit %K motor function %K specific torque %K cross-sectional area %K echogenicity %D 2022 %7 27.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Neuromuscular diseases, such as spinal muscular atrophy (SMA) and Duchenne muscular dystrophy (DMD), may result in the loss of motor movements, respiratory failure, and early mortality in young children and in adulthood. With novel treatments now available, new evaluation methods are needed to assess progress that is not currently captured in existing motor scale tests. Objective: With our feasibility study, our interdisciplinary team of investigators aims to develop a novel, multimodal paradigm of measuring motor function in children with neuromuscular diseases that will revolutionize the way that clinical trial end points are measured, thereby accelerating the pipeline of new treatments for childhood neuromuscular diseases. Through the Upper Extremity Examination for Neuromuscular Diseases (U-EXTEND) study, we hypothesize that the novel objective measures of upper extremity muscle structure and function proposed herein will be able to capture small changes and differences in function that cannot be measured with current clinical metrics. Methods: U-EXTEND introduces a novel paradigm in which concrete, quantitative measures are used to assess motor function in patients with SMA and DMD. Aim 1 will focus on the use of ultrasound techniques to study muscle size, quality, and function, specifically isolating the biceps and pronator muscles of the upper extremities for follow-ups over time. To achieve this, clinical investigators will extract a set of measurements related to muscle structure, quality, and function by using ultrasound imaging and handheld dynamometry. Aim 2 will focus on leveraging wearable wireless sensor technology to capture motion data as participants perform activities of daily living. Measurement data will be examined and compared to those from a healthy cohort, and a motor function score will be calculated. Results: Data collection for both aims began in January 2021. As of July 2022, we have enrolled 44 participants (9 with SMA, 20 with DMD, and 15 healthy participants). We expect the initial results to be published in summer 2022. Conclusions: We hypothesize that by applying the described tools and techniques for measuring muscle structure and upper extremity function, we will have created a system for the precise quantification of changes in motor function among patients with neuromuscular diseases. Our study will allow us to track the minimal clinically important difference over time to assess progress in novel treatments. By comparing the muscle scores and functional scores over multiple visits, we will be able to detect small changes in both the ability of the participants to perform the functional tasks and their intrinsic muscle properties. International Registered Report Identifier (IRRID): DERR1-10.2196/40856 %M 36301603 %R 10.2196/40856 %U https://www.researchprotocols.org/2022/10/e40856 %U https://doi.org/10.2196/40856 %U http://www.ncbi.nlm.nih.gov/pubmed/36301603 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e38940 %T The Current State of Mobile Apps Owned by Large Pediatric Hospitals in the United States: Systematic Search and Analysis on Google Play and Apple App Stores %A Lieser,Tyler %A Huang,Yungui %A Sezgin,Emre %+ The Abigail Wexner Research Institute, Nationwide Children's Hospital, 575 Children's Xrd, Columbus, OH, 43215, United States, 1 6147222210, tyler.lieser@nationwidechildrens.org %K pediatric %K child %K hospital %K mobile app %K mobile health %K mHealth %K health app %K digital health %K eHealth %K hospital-owned app %K telehealth %K review %K app feature %K accessibility %K patient experience %K functionality %D 2022 %7 6.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Pediatric hospitals in the United States are increasingly leveraging patient-facing mobile apps as their digital front doors for patients, families, and caretakers. These mobile health apps are sanctioned by pediatric hospitals to inform the public or populations about pediatric care to provide individualized information, to enhance communication, and to improve patient experience. Yet the functionalities and user feedback of these hospital mobile apps have not been systematically investigated. Objective: Our aim was to understand the current state of hospital-owned mobile apps provided by large pediatric hospitals, comparatively analyze and report the services provided, and identify potential gaps to inform developers and providers. The American Hospital Association defines large hospitals as those having a bed count of more than 400. Methods: We conducted a systematic search on Google Play and Apple App Store to identify all hospital-owned mobile apps from the large pediatric hospitals included in our review. Our inclusion criteria were (1) apps provided by large pediatric hospitals; (2) hospital-owned apps available in Apple App Store and Google Play; and (3) apps that are provided for general populations. Specialty apps that serve specific user groups or populations focusing on education, telehealth, specific conditions or procedures, or apps intended for research or clinician use were excluded. The features and functionality of the included apps were examined. Results: Of the 16 pediatric hospitals included in our review, 4 (25%) had no general patient-facing apps, 4 (25%) had one app, and 8 (50%) had more than one app available on Google Play or Apple App Store. The 12 hospitals with at least one mobile app had a combined total of 72 apps. Of these 72 apps, 61 (85%) were considered specialty and were excluded from our review, leaving a total of 11 (15%) apps to analyze. Among the 11 apps analyzed, the most common feature was appointment scheduling or reminder (n=9, 82%). Doctor search (n=8, 73%) and patient resources (n=8, 73%) were the second most common, followed by payment, billing, or claims (n=7, 64%), patient portal integration (n=6, 55%), personal health management (n=6, 55%), hospital way finding (n=5, 45%), message a provider (n=4, 36%), urgent care wait times (n=4, 36%), video chat (n=4, 36%), and health information access (n=4, 36%). Parking information (n=3, 27%) was the least common. Conclusions: Out of the 16 pediatric hospitals identified for our review, 75% (n=12) offer mobile apps. Based on the most common features, these apps were intended to help improve accessibility for patients and families in terms of finding providers, scheduling appointments, and accessing patient resources. We believe the findings will inform pediatric hospital administrators, developers, and other stakeholders to improve app feature offerings and increase their impact on service accessibility and patient experience. %M 36201385 %R 10.2196/38940 %U https://pediatrics.jmir.org/2022/4/e38940 %U https://doi.org/10.2196/38940 %U http://www.ncbi.nlm.nih.gov/pubmed/36201385 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e34588 %T Intervention Mapping of a Gamified Therapy Prescription App for Children With Disabilities: User-Centered Design Approach %A Johnson,Rowan W %A White,Becky K %A Gucciardi,Daniel F %A Gibson,Noula %A Williams,Sian A %+ Therapy Services, Ability WA, 106 Bradford Street, Coolbinia, Perth, 6069, Australia, 61 1300106106, rowan.johnson@abilitywa.com.au %K neurodevelopmental disability %K mobile health %K self-determination theory %K gamification %K physiotherapy %K occupational therapy %K speech pathology %K behavior change %K mobile phone %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Mobile health (mHealth) apps for children are increasing in availability and scope. Therapy (physiotherapy, speech pathology, and occupational therapy) prescription apps to improve home or school program adherence work best when developed to be highly engaging for children and when they incorporate behavior change techniques (BCTs) within their design. Objective: The aim of this study was to describe the development of a user-centered therapy prescription app for children (aged 6-12 years) with neurodevelopmental disabilities (eg, cerebral palsy, autism spectrum disorder, and intellectual disability) incorporating intervention mapping (IM) and gamified design. Methods: We used an iterative, user-centered app development model incorporating the first 3 steps of IM. We conducted a needs analysis with user feedback from our previous mHealth app study, a literature review, and a market audit. Change objectives were then specified in alignment with the psychological needs of autonomy, competence, and relatedness identified in self-determination theory. From these objectives, we then selected BCTs, stipulating parameters for effectiveness and how each BCT would be operationalized. A gamification design was planned and implemented focusing on maximizing engagement in children. In total, 2 rounds of consultations with parents, teachers, and therapists and 1 round of prototype app testing with children were conducted to inform app development, with a final iteration developed for further testing. Results: The IM process resulted in the specification of app elements, self-determination theory–informed BCTs, that were embedded into the app design. The gamification design yielded the selection of a digital pet avatar with a fantasy anime visual theme and multiple layers of incentives earned by completing prescribed therapy activities. Consultation groups with professionals working with children with disabilities (4 therapists and 3 teachers) and parents of children with disabilities (n=3) provided insights into the motivation of children and the pragmatics of implementing app-delivered therapy programs that informed the app development. User testing with children with disabilities (n=4) highlighted their enthusiasm for the app and the need for support in the initial phase of learning the app. App quality testing (Mobile Application Rating Scale-user version) with the children yielded means (out of 5) of 4.5 (SD 0.8) for engagement, 3.3 (SD 1.6) for function, 3.3 (SD 1.7) for aesthetics, and 4.3 (SD 1.1) for subjective quality. Conclusions: mHealth apps designed for children can be greatly enhanced with a systematic yet flexible development process considering the specific contextual needs of the children with user-centered design, addressing the need for behavior change using the IM process, and maximizing engagement with gamification and strong visual design. %M 35943782 %R 10.2196/34588 %U https://pediatrics.jmir.org/2022/3/e34588 %U https://doi.org/10.2196/34588 %U http://www.ncbi.nlm.nih.gov/pubmed/35943782 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e35487 %T Web-Based Delivery of a Family-Based Dating Violence Prevention Program for Youth Who Have Been Exposed to Intimate Partner Violence: Protocol for an Acceptability and Feasibility Study %A Reyes,H Luz McNaughton %A Langoni,Eliana Gabriela Armora %A Sharpless,Laurel %A Blackburn,Natalie %A McCort,Agnieszka %A Macy,Rebecca J %A Moracco,Kathryn E %A Foshee,Vangie A %+ Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 302 Rosenau Hall CB 7440, Chapel Hill, NC, 27599-7440, United States, 1 919 593 4081, mcnaught@email.unc.edu %K dating violence %K adolescents %K family-based prevention %K web-based delivery %K feasibility and acceptability %K mobile phone %D 2022 %7 5.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Children exposed to intimate partner violence (IPV) between caregivers are at an increased risk of becoming involved in dating violence during adolescence. However, to date, few adolescent dating violence (ADV) prevention programs have been developed for and evaluated with youth exposed to IPV. An exception is Moms and Teens for Safe Dates (MTSD), an evidence-based ADV prevention program for mothers or maternal caregivers (mothers) exposed to IPV and their teenagers. The MTSD program comprises a series of booklets that families complete together in a home that includes activities to promote positive family communication and healthy teenager relationships. We developed a web-adapted version of the MTSD program—entitled eMoms and Teens for Safe Dates (eMTSD)—to provide a delivery format that may increase program appeal for digitally oriented teenagers, lower dissemination costs, lower reading burden for low-literacy participants, and incorporate built-in cues and reminders to boost program adherence. Objective: This protocol is for a research study that has the following three main objectives: to assess the acceptability of eMTSD; to identify the feasibility of the research process, including program adherence and participant recruitment and assessment; and to explore the acceptability, feasibility, and preliminary efficacy of 2 features—text reminders and the creation of an action plan for engaging with the program—that may increase program uptake and completion. Methods: Approximately 100 mothers and their teenagers will be invited to complete eMTSD, which includes six 30-minute web-based modules over a 6-week period. Mothers will be recruited through community organizations and social media advertising and will be eligible to participate if they have at least 1 teenager aged 12 to 16 years living with them, have experienced IPV after the teenager was born, are not currently living with an abusive partner, and have access to an internet-enabled device. Using a factorial design, enrolled dyads will be randomized to the following four adherence support groups (n=25 dyads per group): text reminders and action planning, text reminders only, action planning only, and no adherence supports. All participants will complete brief web-based assessments at enrollment after each module is completed, after the full program is completed, and 90 days after enrollment. Program adherence will be tracked using website use metrics. Results: The data collected will be synthesized to assess the acceptability of the program and the feasibility of the study procedures. An exploratory analysis will examine the impact of adherence support on program completion levels. In November 2021, ethical approval was received and recruitment was initiated. Data collection is expected to continue until December 2022. Conclusions: The web-based delivery of a family-based healthy relationship program for teenagers exposed to IPV may offer a convenient, low-cost, and engaging approach to preventing ADV. The findings from this study are expected to guide future research. International Registered Report Identifier (IRRID): DERR1-10.2196/35487 %M 35930332 %R 10.2196/35487 %U https://www.researchprotocols.org/2022/8/e35487 %U https://doi.org/10.2196/35487 %U http://www.ncbi.nlm.nih.gov/pubmed/35930332 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e36756 %T Trends in the Prevalence of Chronic Medication Use Among Children in Israel Between 2010 and 2019: Protocol for a Retrospective Cohort Study %A Sadaka,Yair %A Horwitz,Dana %A Wolff,Leor %A Sela,Tomer %A Meyerovitch,Joseph %A Peleg,Assaf %A Bachmat,Eitan %A Benis,Arriel %+ Neuro-Developmental Research Centre, Beer Sheva Mental Health Centre, Ministry of Health, Hatzadik Meyerushalim 2, Beer Sheva, 8461144, Israel, 972 587800404, yair.sadaka@moh.healh.gov.il %K psychotropic drugs %K central nervous system stimulants %K mental health %K medication therapy management %K drug prescriptions %K attention deficit hyperactivity disorder %K ADHD, Israel %K children %K data mining %K machine learning %K electronic medical records %K pediatrics %K chronic disease %K epidemiology %D 2022 %7 5.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Prescription of psychostimulants has significantly increased in most countries worldwide for both preschool and school-aged children. Understanding the trends of chronic medication use among children in different age groups and from different sociodemographic backgrounds is essential. It is essential to distinguish between selected therapy areas to help decision-makers evaluate not only the relevant expected medication costs but also the specific services related to these areas. Objective: This study will analyze differences in trends regarding medications considered psychobehavioral treatments and medications considered nonpsychobehavioral treatments and will identify risk factors and predictors for chronic medication use among children. Methods: This is a retrospective study. Data will be extracted from the Clalit Health Services data warehouse. For each year between 2010 and 2019, there are approximately 1,500,000 children aged 0-18 years. All medication classes will be identified using the Anatomical Therapeutic Chemical code. A time-trend analysis will be performed to investigate if there is a significant difference between the trends of children’s psychobehavioral and nonpsychobehavioral medication prescriptions. A logistic regression combined with machine learning models will be developed to identify variables that may increase the risk for specific chronic medication types and identify children likely to get such treatment. Results: The project was funded in 2019. Data analysis is currently underway, and the results are expected to be submitted for publication in 2022. Understanding trends regarding medications considered psychobehavioral treatments and medications considered nonpsychobehavioral treatments will support the identification of risk factors and predictors for chronic medication use among children. Conclusions: Analyzing the response of the patient (and their parents or caregivers) population over time will hopefully help improve policies for prescriptions and follow-up of chronic treatments in children. International Registered Report Identifier (IRRID): DERR1-10.2196/36756 %M 35775233 %R 10.2196/36756 %U https://www.researchprotocols.org/2022/8/e36756 %U https://doi.org/10.2196/36756 %U http://www.ncbi.nlm.nih.gov/pubmed/35775233 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e37929 %T Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT): Protocol for a Multisite Longitudinal Cohort Study %A Burns,Joy %A Rivers,Patrick %A LeClair,Lindsay B %A Jovel,Krystal S %A Rai,Ramona P %A Lowe,Ashley A %A Edwards,Laura J %A Khan,Sana M %A Mathenge,Clare %A Ferraris,Maria %A Kuntz,Jennifer L %A Lamberte,Julie Mayo %A Hegmann,Kurt T %A Odean,Marilyn J %A McLeland-Wieser,Hilary %A Beitel,Shawn %A Odame-Bamfo,Leah %A Schaefer Solle,Natasha %A Mak,Josephine %A Phillips,Andrew L %A Sokol,Brian E %A Hollister,James %A Ochoa,Jezahel S %A Grant,Lauren %A Thiese,Matthew S %A Jacoby,Keya B %A Lutrick,Karen %A Pubillones,Felipe A %A Yoo,Young M %A Rentz Hunt,Danielle %A Ellingson,Katherine %A Berry,Mark C %A Gerald,Joe K %A Lopez,Joanna %A Gerald,Lynn B %A Wesley,Meredith G %A Krupp,Karl %A Herring,Meghan K %A Madhivanan,Purnima %A Caban-Martinez,Alberto J %A Tyner,Harmony L %A Meece,Jennifer K %A Yoon,Sarang K %A Fowlkes,Ashley L %A Naleway,Allison L %A Gwynn,Lisa %A Burgess,Jefferey L %A Thompson,Mark G %A Olsho,Lauren EW %A Gaglani,Manjusha %+ COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, H24-7, Atlanta, GA, 30333, United States, 1 404 822 1999, ahl4@cdc.gov %K COVID-19 %K SARS-CoV-2 %K vaccine effectiveness %K vaccine %K efficacy %K effectiveness %K cohort study %K pediatric %K child %K inoculation %K vaccination %K public health %K children %K health care professional %K health care %K caregiver %K health data %K online survey %K incidence %D 2022 %7 28.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Assessing the real-world effectiveness of COVID-19 vaccines and understanding the incidence and severity of SARS-CoV-2 illness in children are essential to inform policy and guide health care professionals in advising parents and caregivers of children who test positive for SARS-CoV-2. Objective: This report describes the objectives and methods for conducting the Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT) study. PROTECT is a longitudinal prospective pediatric cohort study designed to estimate SARS-CoV-2 incidence and COVID-19 vaccine effectiveness (VE) against infection among children aged 6 months to 17 years, as well as differences in SARS-CoV-2 infection and vaccine response between children and adolescents. Methods: The PROTECT multisite network was initiated in July 2021, which aims to enroll approximately 2305 children across four US locations and collect data over a 2-year surveillance period. The enrollment target was based on prospective power calculations and accounts for expected attrition and nonresponse. Study sites recruit parents and legal guardians of age-eligible children participating in the existing Arizona Healthcare, Emergency Response, and Other Essential Workers Surveillance (HEROES)-Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) network as well as from surrounding communities. Child demographics, medical history, COVID-19 exposure, vaccination history, and parents/legal guardians’ knowledge and attitudes about COVID-19 are collected at baseline and throughout the study. Mid-turbinate nasal specimens are self-collected or collected by parents/legal guardians weekly, regardless of symptoms, for SARS-CoV-2 and influenza testing via reverse transcription-polymerase chain reaction (RT-PCR) assay, and the presence of COVID-like illness (CLI) is reported. Children who test positive for SARS-CoV-2 or influenza, or report CLI are monitored weekly by online surveys to report exposure and medical utilization until no longer ill. Children, with permission of their parents/legal guardians, may elect to contribute blood at enrollment, following SARS-CoV-2 infection, following COVID-19 vaccination, and at the end of the study period. PROTECT uses electronic medical record (EMR) linkages where available, and verifies COVID-19 and influenza vaccinations through EMR or state vaccine registries. Results: Data collection began in July 2021 and is expected to continue through the spring of 2023. As of April 13, 2022, 2371 children are enrolled in PROTECT. Enrollment is ongoing at all study sites. Conclusions: As COVID-19 vaccine products are authorized for use in pediatric populations, PROTECT study data will provide real-world estimates of VE in preventing infection. In addition, this prospective cohort provides a unique opportunity to further understand SARS-CoV-2 incidence, clinical course, and key knowledge gaps that may inform public health. International Registered Report Identifier (IRRID): RR1-10.2196/37929 %M 35635842 %R 10.2196/37929 %U https://www.researchprotocols.org/2022/7/e37929 %U https://doi.org/10.2196/37929 %U http://www.ncbi.nlm.nih.gov/pubmed/35635842 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e37353 %T Identification of Requirements for a Postoperative Pediatric Pain Risk Communication Tool: Focus Group Study With Clinicians and Family Members %A Wood,Michael D %A Correa,Kim %A Ding,Peijia %A Sreepada,Rama %A Loftsgard,Kent C %A Jordan,Isabel %A West,Nicholas C %A Whyte,Simon D %A Portales-Casamar,Elodie %A Görges,Matthias %+ Department of Anesthesiology Pharmacology and Therapeutics, The University of British Columbia, Rm V3-317, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada, 1 604 875 2000 ext 6920, michael.wood@bcchr.ca %K eHealth %K risk communication %K risk %K decision aid %K pain %K individualized risk %K surgery %K anesthesia %K anesthetic %K anesthesiology %K focus group %K requirement definition %K prototyping %K prototype %K pediatrics %K pediatric %K child %K postoperative %K prediction %K digital health %K development %K user feedback %K patient feedback %K user-centered design %D 2022 %7 15.7.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Pediatric surgery is associated with a risk of postoperative pain that can impact the family’s quality of life. Although some risk factors for postoperative pain are known, these are often not consistently communicated to families. In addition, although tools for risk communication exist in other domains, none are tailored to pediatric surgery. Objective: As part of a larger project to develop pain risk prediction tools, we aimed to design an easy-to-use tool to effectively communicate a child’s risk of postoperative pain to both clinicians and family members. Methods: With research ethics board approval, we conducted virtual focus groups (~1 hour each) comprising clinicians and family members (people with lived surgical experience and parents of children who had recently undergone surgery/medical procedures) at a tertiary pediatric hospital to understand and evaluate potential design approaches and strategies for effectively communicating and visualizing postoperative pain risk. Data were analyzed thematically to generate design requirements and to inform iterative prototype development. Results: In total, 19 participants (clinicians: n=10, 53%; family members: n=9, 47%) attended 6 focus group sessions. Participants indicated that risk was typically communicated verbally by clinicians to patients and their families, with severity indicated using a descriptive or a numerical representation or both, which would only occasionally be contextualized. Participants indicated that risk communication tools were seldom used but that families would benefit from risk information, time to reflect on the information, and follow-up with questions. In addition, 9 key design requirements and feature considerations for effective risk communication were identified: (1) present risk information clearly and with contextualization, (2) quantify the risk and contextualize it, (3) include checklists for preoperative family preparation, (4) provide risk information digitally to facilitate recall and sharing, (5) query the family’s understanding to ensure comprehension of risk, (6) present the risk score using multimodal formats, (7) use color coding that is nonthreatening and avoids limitations with color blindness, (8) present the most significant factors contributing to the risk prediction, and (9) provide risk mitigation strategies to potentially decrease the patient’s level of risk. Conclusions: Key design requirements for a pediatric postoperative pain risk visualization tool were established and guided the development of an initial prototype. Implementing a risk communication tool into clinical practice has the potential to bridge existing gaps in the accessibility, utilization, and comprehension of personalized risk information between health care professionals and family members. Future iterative codesign and clinical evaluation of this risk communication tool are needed to confirm its utility in practice. %M 35838823 %R 10.2196/37353 %U https://pediatrics.jmir.org/2022/3/e37353 %U https://doi.org/10.2196/37353 %U http://www.ncbi.nlm.nih.gov/pubmed/35838823 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e33172 %T Experiences, Motivations, and Perceived Impact of Participation in a Facebook-Based Support Group for Caregivers of Children and Youth With Complex Care Needs: Qualitative Descriptive Study %A Kelly,Katherine Jennifer %A Doucet,Shelley %A Luke,Alison %A Azar,Rima %A Montelpare,William %+ Health Centred Research Clinic, Department of Applied Human Sciences, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada, 1 902 566 0827, kjkelly@upei.ca %K caregiver experiences %K peer-to-peer support %K social support %K social media %K children with complex care needs %K Facebook group %D 2022 %7 6.7.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Caregivers of children and youth with complex care needs (CCNs) often require considerable support to ensure the well-being of their families. Social media present an opportunity to better support caregivers through computer-mediated communication for social support. Peer-to-peer (P2P) support groups are a way in which caregivers are accessing needed support; however, the experiences of caregivers who use these groups and the perceived impact that participation has on caregivers of children and youth with CCNs are not known. Objective: This study aimed to explore the experiences of caregivers of children and youth with CCNs who use a Facebook-based P2P support group to communicate, understand their motivations to use the group, and investigate its perceived impact on knowledge of programs and services and sense of community belonging among caregivers. Methods: A qualitative descriptive design was used to explore the experiences and perceived impact of a Facebook-based (Meta Platforms) P2P support group for caregivers of children and youth with CCNs in New Brunswick, Canada. The group was launched on the web in October 2020, during the COVID-19 pandemic, and resulted in 108 caregivers joining the group. A web-based survey was distributed, and semistructured interviews were conducted in February 2021 with a subsample of members. Thematic analysis was used to identify and report patterns related to caregivers’ experiences and perceived impacts of participation. Results: A subsample of members in the Facebook group completed the web-based survey (39/108, 36.1%) and interviews (14/108, 12.9%). A total of 5 themes emerged from the interviews: safe space, informational support and direction, web-based connection with peers, impact on knowledge of programs and services, and degree of community belonging. Participants reported joining the group to obtain geography-specific information support and connect with peers. Many participants reported an improvement in their knowledge of programs and services and felt connected to the community; however, the short observation period and diversity among the caregiver population were cited as barriers to community belonging. Conclusions: Social media present an important opportunity to facilitate the exchange of support between patients and caregivers in an accessible and curated environment. Findings from this study suggest that involvement in web-based, geography-specific P2P support groups can influence perceived knowledge of services and resources and sense of community belonging among caregivers of children and youth with CCNs. Furthermore, this study provides insight into the experiences and motivations of caregivers of children and youth with CCNs who participate in a private social media environment. %M 35793139 %R 10.2196/33172 %U https://pediatrics.jmir.org/2022/3/e33172 %U https://doi.org/10.2196/33172 %U http://www.ncbi.nlm.nih.gov/pubmed/35793139 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e36229 %T Continuous Versus Intermittent Nutrition in Pediatric Intensive Care Patients: Protocol for a Randomized Controlled Trial %A Veldscholte,Karlien %A Cramer,Arnout B G %A de Jonge,Rogier C J %A Eveleens,Renate D %A Joosten,Koenraad F M %A Verbruggen,Sascha C A T %+ Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Postbus 2060, Rotterdam, 3000 CB, Netherlands, 31 107032770, s.verbruggen@erasmusmc.nl %K pediatric intensive care unit %K PICU %K pediatric critical illness %K time-restricted feeding %K intermittent fasting %K feeding intolerance %K ketones %K circadian rhythm %D 2022 %7 23.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Intermittent fasting is a time-restricted feeding strategy with proven health benefits, which is based on multiple metabolic and endocrine changes, in several patient populations and healthy participants. In the pediatric intensive care unit (PICU), artificial feeding is usually administered 24 hours a day, although solid evidence supporting this practice is lacking. This discards the potential benefits of fasting in this population. We hypothesize that intermittent nutrition with a focus on an overnight feeding interruption (intermittent fasting), as compared with 24-hour continuous nutrition, is a feasible and safe strategy, with potential benefits, for critically ill children. Objective: The aim of the Continuous versus Intermittent Nutrition in Pediatric Intensive Care randomized controlled trial (RCT) is to investigate a strategy of intermittent nutrition with a focus on an overnight feeding interruption period versus 24-hour nutrition during the first 14 days in the PICU. Methods: The Continuous versus Intermittent Nutrition in Pediatric Intensive Care study is an investigator-initiated RCT in a tertiary referral PICU. Critically ill children (term newborn to 18 years), expected to stay in the PICU for ≥48 hours, and dependent on artificial nutrition, are eligible for inclusion. This study will randomize critically ill children (n=140) to a continuous versus intermittent nutrition strategy. In both groups, similar daily caloric targets will be prescribed. In the continuous group (control), nutrition will be administered 24 hours a day, with a maximum interruption period of 2 hours. In the intermittent group (intervention), nutrition will be interrupted during an age-dependent overnight fasting period. The study intervention will last until admission day 14, initiation of oral intake, or discharge from the PICU, whichever comes first. The primary outcome is the difference in ketosis between the groups under the condition of noninferiority regarding caloric intake. Secondary outcomes are feeding intolerance; the proportion of severe and resistant hypoglycemic events and severe gastrointestinal complications; and additional observed effects on nutritional intake, circadian rhythm, and clinically relevant outcome measures of the intermittent feeding strategy compared with continuous nutrition. Results: The study was approved by the Dutch national ethical review board in February 2020. The first patient was enrolled on May 19, 2020. By May 2022, a total of 132 patients had been included in the study. Recruitment of the last patient is expected in Q3 2022. Conclusions: Although intermittent fasting has been proven to have many health benefits in both animal and human studies, the feasibility and safety of this strategy in a PICU setting must be investigated. This RCT will help physicians gain more insight into the feasibility, safety, and potential clinical effects of intermittent feeding with overnight fasting in critically ill children. Trial Registration: Netherlands Trial Register NL7877; https://trialsearch.who.int/Trial2.aspx?TrialID=NL7877 International Registered Report Identifier (IRRID): DERR1-10.2196/36229 %M 35737448 %R 10.2196/36229 %U https://www.researchprotocols.org/2022/6/e36229 %U https://doi.org/10.2196/36229 %U http://www.ncbi.nlm.nih.gov/pubmed/35737448 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e33981 %T Emergency Departments’ Uptake of Telehealth for Stroke Versus Pediatric Care: Observational Study %A Zachrison,Kori S %A Hayden,Emily M %A Boggs,Krislyn M %A Boyle,Tehnaz P %A Gao,Jingya %A Samuels-Kalow,Margaret E %A Marcin,James P %A Camargo Jr,Carlos A %+ Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, United States, 1 6177266636, kzachrison@partners.org %K telehealth %K telemedicine %K emergency care %K stroke %K pediatric care %D 2022 %7 20.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Telehealth for emergency stroke care delivery (telestroke) has had widespread adoption, enabling many hospitals to obtain stroke center certification. Telehealth for pediatric emergency care has been less widely adopted. Objective: Our primary objective was to determine whether differences in policy or certification requirements contributed to differential uptake of telestroke versus pediatric telehealth. We hypothesized that differences in financial incentives, based on differences in patient volume, prehospital routing policy, and certification requirements, contributed to differential emergency department (ED) adoption of telestroke versus pediatric telehealth. Methods: We used the 2016 National Emergency Department Inventory–USA to identify EDs that were using telestroke and pediatric telehealth services. We surveyed all EDs using pediatric telehealth services (n=339) and a convenience sample of the 1758 EDs with telestroke services (n=366). The surveys characterized ED staffing, transfer patterns, reasons for adoption, and frequency of use. We used bivariate comparisons to examine differences in reasons for adoption and use between EDs with only telestroke services, only pediatric telehealth services, or both. Results: Of the 442 EDs surveyed, 378 (85.5%) indicated use of telestroke, pediatric telehealth, or both. EDs with both services were smaller in bed size, volume, and ED attending coverage than those with only telestroke services or only pediatric telehealth services. EDs with telestroke services reported more frequent use, overall, than EDs with pediatric telehealth services: 14.1% (45/320) of EDs with telestroke services reported weekly use versus 2.9% (8/272) of EDs with pediatric telehealth services (P<.001). In addition, 37 out of 272 (13.6%) EDs with pediatric telehealth services reported no consults in the past year. Across applications, the most frequently selected reason for adoption was “improving level of clinical care.” Policy-related reasons (ie, for compliance with outside certification or standards or for improving ED performance on quality metrics) were rarely indicated as the most important, but these reasons were indicated slightly more often for telestroke adoption (12/320, 3.8%) than for pediatric telehealth adoption (1/272, 0.4%; P=.003). Conclusions: In 2016, more US EDs had telestroke services than pediatric telehealth services; among EDs with the technology, consults were more frequently made for stroke than for pediatric patients. The most frequently indicated reason for adoption among all EDs was related to clinical care. %M 35723927 %R 10.2196/33981 %U https://www.jmir.org/2022/6/e33981 %U https://doi.org/10.2196/33981 %U http://www.ncbi.nlm.nih.gov/pubmed/35723927 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e34115 %T Experience of Pediatricians and Pediatric Surgeons With Virtual Care During the COVID-19 Pandemic: Descriptive Study %A McCrady,Emma %A Strychowsky,Julie E %A Woolfson,Jessica P %+ Department of Pediatrics, London Health Sciences Centre Children's Hospital, Office B3-444, London, ON, N6A 5W9, Canada, 1 5198789608, emccrad@uwo.ca %K virtual care %K web-based care %K COVID-19 %K pediatrics %K pandemic %K physicians %K digital health %K pediatricians %K telehealth %D 2022 %7 15.6.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Prior to the COVID-19 pandemic, in-clinic visits were the standard of care for pediatric physicians and surgeons at our center. At the pandemic onset, web-based care was adopted at an unprecedented scale and pace. Objective: This descriptive study explores the web-based care experience of pediatric physicians and surgeons during the pandemic by determining factors that supported and challenged web-based care adoption. Methods: This study took place at the Children’s Hospital at London Health Sciences Centre, a children’s hospital in London, Ontario, Canada, which provides pediatric care for patients from the London metropolitan area and the rest of Southwestern Ontario. The Donabedian model was used to structure a web-based survey evaluating web-based care experience, which was distributed to 121 department-affiliated pediatric physicians (including generalists and subspecialists in surgery and medicine). Recruitment occurred via department listserv email. Qualitative data were collected through discrete and free-text survey responses. Results: Survey response rate was 52.1% (63/121). Before the pandemic, few physicians within the Department of Paediatrics used web-based care, and physicians saw <10% of patients digitally. During March-May 2020, the majority transitioned to web-based care, seeing >50% of patients digitally. Web-based care use in our sample fell from June to September 2020, with the majority seeing <50% of patients digitally. Telephone and Ontario Telemedicine Network were the platforms most used from March to September 2020. Web-based care was rated to be convenient for most providers and their patients, despite the presence of technical difficulties. Challenges included lack of physical exam, lower patient volumes, and poor patient digital care etiquette. Regardless of demographics, 96.4% (116/121) would continue web-based care, ideally for patients who live far away and for follow-ups or established diagnoses. Conclusions: Transition to web-based care during COVID-19 was associated with challenges but also positive experiences. Willingness among pediatricians and pediatric surgeons to continue web-based care was high. Web-based care experiences at our center could be improved with patient education and targeting select populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for web-based care. %M 35666938 %R 10.2196/34115 %U https://pediatrics.jmir.org/2022/2/e34115 %U https://doi.org/10.2196/34115 %U http://www.ncbi.nlm.nih.gov/pubmed/35666938 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e34969 %T A Multiprofessional and Intersectoral Working Model to Detect and Support Preschool Children With Neurodevelopmental Difficulties (PLUSS Model): Protocol for an Evaluation Study %A Gustafsson,Berit M %A Korhonen,Laura %+ Linköping University, Department of Child and Adolescent Psychiatry, Department of Biomedical and Clinical Sciences, Sandbäcksgatan 7, Linkoping, 581 83, Sweden, 46 13281000, berit.m.gustafsson@liu.se %K early detection %K early intervention %K preschool children %K multiprofessional %K neurodevelopmental difficulties %K parental support %K preschool support %K mental health %K neurological %K behavioural %K emotional %K paediatrics %K pediatrics %K parenting %K children %K neurodevelopmental %K developmental %D 2022 %7 15.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Neurodevelopmental difficulties with various emotional and behavioral symptoms increase the risk of mental health problems later in life. Although we know that early detection and interventions are effective, there is a lack of intersectoral, integrative, and evidence-based working models to provide these services for preschool children and their parents. PLUSS (Psykisk hälsa Lärande Utveckling Samverkan kring Små barn; English translation: mental health, learning, development, collaboration around preschool children) is a collaborative “one way in” model involving parents, health care providers, preschools, social services, and researchers. PLUSS provides coordinated services to screen, evaluate, and support toddlers with neurodevelopmental problems. It also offers parental interventions and education for preschool teachers. Objective: The model will be studied in a research project that aims to investigate (1) using a quasi-experimental study on longitudinal trajectories of neurodevelopmental difficulties and ability to function among participating preschoolers, (2) user satisfaction, and (3) implementation of the model and its effectiveness. The long-term goal is to provide evidence-based, coordinated services to reduce problems related to neurodevelopmental difficulties among preschool children and promote well-being and functioning in everyday life. Methods: The population of interest is children aged 1.5-5 years, whom the child health care nurse refers for further assessment due to suspected neurodevelopmental problems. Data are collected using questionnaires and semistructured interviews. Measures include sociodemographic data, longitudinal data on neurodevelopmental problems, parental well-being and satisfaction, the effectiveness of parental and preschool teacher training and implementation of the model, and fostered multisectoral collaborations. Data will be analyzed with qualitative and quantitative methods. Results: The PLUSS model has been approved by the National Ethics Review Board (2019–04839). This study was supported by FUTURUM grants 910161 and 910441. Data collection started in April 2019, with the data collection period planned to end in May 2024. Conclusions: PLUSS is an integrative working model with multiprofessional competence and intersectoral collaboration capacity to help preschool children with neurodevelopmental problems and their parents. It will be studied using quasi-experimental cross-sectional and longitudinal study designs. Data will be collected from parents, health care providers, and preschool teachers, and will be analyzed using quantitative and qualitative methods. The study will run in one Swedish county, and generalizability needs to be studied separately. Loss of follow-up could impact the longitudinal analysis. Trial Registration: ClinicalTrials.gov NCT04815889; https://clinicaltrials.gov/ct2/show/NCT04815889 International Registered Report Identifier (IRRID): DERR1-10.2196/34969 %M 35704376 %R 10.2196/34969 %U https://www.researchprotocols.org/2022/6/e34969 %U https://doi.org/10.2196/34969 %U http://www.ncbi.nlm.nih.gov/pubmed/35704376 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e37927 %T Primary Prevention of Stroke in Children With Sickle Cell Anemia in Nigeria: Protocol for a Mixed Methods Implementation Study in a Community Hospital %A Bello-Manga,Halima %A Haliru,Lawal %A Ahmed,Kudrat Abdulkareem %A Tabari,Abdulkadir Musa %A Farouk,Bilkisu Usman %A Bahago,Gloria Yimi %A Kazaure,Aisha Shuaibu %A Muhammad,Abdulrasheed Sani %A Gwarzo,Samira Abubakar %A Baumann,Ana A %A DeBaun,Michael R %A King,Allison A %+ Department of Hematology and Blood Transfusion, Barau Dikko Teaching Hospital/Kaduna State University, Lafiya Road, Kaduna, 80001, Nigeria, 234 08033470592, mamanzara@yahoo.co.uk %K sickle cell anemia %K stroke prevention %K transcranial Doppler ultrasonography %D 2022 %7 13.6.2022 %9 Proposal %J JMIR Res Protoc %G English %X Background: In Nigeria, approximately 150,000 children with sickle cell anemia (SCA) are born annually, accounting for more than half of all SCA births worldwide. Without intervention, about 11% of children with SCA will develop a stroke before their 20th birthday. Evidence-based practices for primary stroke prevention include screening for abnormal transcranial Doppler (TCD) measurements coupled with regular blood transfusion therapy for at least one year, followed by hydroxyurea (HU) therapy indefinitely. In high-resource countries, this strategy contributes to a 92% decrease in stroke incidence rates. In 2016, as part of a capacity building objective of the Stroke Prevention Trial in Nigeria (1R01NS094041: SPRING), TCD screening was adopted as standard care at Barau Dikko Teaching Hospital in Kaduna. However, with just 70 radiologists and only 3 certified in TCD screening in the state, just 5.49% (1101/20,040) of eligible children with SCA were screened. Thus, there is a need to explore alternate implementation strategies to ensure children with SCA receive standard care TCD screening to decrease stroke incidence. Objective: This protocol describes a study to create a stroke prevention program in a community hospital in Kaduna through task shifting TCD screening to nurses and training medical officers to initiate and monitor HU utilization for stroke prevention. Methods: This study will be conducted at 2 sites (teaching hospital and community hospital) over a period of 3 years (November 2020 to November 2023), in 3 phases using both quasi-experimental and effectiveness-implementation study designs. In the needs assessment phase, focus groups and structured interviews will be conducted with health care providers and hospital administrators to identify barriers and facilitators to evidence-based stroke prevention practices. Results from the needs assessment will inform intervention strategies and a process plan to fit the needs of the community hospital. In the capacity building phase, nurses and medical officers at the community hospital will be trained on TCD screening and HU initiation and monitoring. In the implementation phase, children with SCA aged 2-16 years will be recruited into a nonrandomized single-arm prospective trial to determine the feasibility of initiating a task-shifted stroke prevention program by recording recruitment, retention, and adherence rates. The Reach and Effectiveness components of the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework will be used to evaluate implementation outcomes between the community and teaching hospitals. Results: The needs assessment phase of the study was completed in February 2021. Manuscript on findings is currently in preparation. Capacity building is ongoing with TCD training and sickle cell disease and stroke education sessions for nurses and doctors in the community hospital. Recruitment for the implementation trial is expected to commence in July 2022. Conclusions: This study proposes a structured, theory-driven approach to create a stroke prevention program in a community hospital in Kaduna, Nigeria, to decrease stroke incidence among children with SCA. Results will provide preliminary data for a definitive randomized clinical trial in implementation science. International Registered Report Identifier (IRRID): PRR1-10.2196/37927 %M 35700018 %R 10.2196/37927 %U https://www.researchprotocols.org/2022/6/e37927 %U https://doi.org/10.2196/37927 %U http://www.ncbi.nlm.nih.gov/pubmed/35700018 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e33170 %T Exploring the Use of a Facebook-Based Support Group for Caregivers of Children and Youth With Complex Care Needs: Qualitative Descriptive Study %A Kelly,Katherine Jennifer %A Doucet,Shelley %A Luke,Alison %A Azar,Rima %A Montelpare,William %+ Health Centred Research Clinic, Department of Applied Human Sciences, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada, 1 902 566 0827, kjkelly@upei.ca %K peer-to-peer support %K children %K youth %K complex care needs %K social media %K social support %D 2022 %7 7.6.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Caregivers of children and youth with complex care needs (CCN) require substantial support to ensure the well-being of their families. Web-based peer-to-peer (P2P) support groups present an opportunity for caregivers to seek and provide timely informational and emotional support. Despite the widespread use of social media for health-related support across diverse patient and caregiver populations, it is unclear how caregivers of children and youth with CCN use and potentially benefit from these groups. Objective: The aim of this study is to explore the use of a web-based P2P support group for caregivers of children and youth with CCN in New Brunswick, Canada, and investigate factors related to its use by members. Methods: The study sample consisted of individuals who joined a closed Facebook group and an analysis of content published to the group. In phase 1, a Facebook group was developed in consultation with a patient and family advisory council, and members were recruited to the group. Phase 2 of this study consisted of an observation period during which posts and related interactions (ie, likes, loves, and comments) by members were collected. In phase 3, a web-based survey was distributed, and semistructured interviews were conducted with a subsample of group members. Survey and interview data were analyzed using thematic analysis. Results: A total of 108 caregivers joined the Facebook group between October 2020 and March 2021. There were 93 posts with 405 comments and 542 associated interactions (448/542, 82.7% likes and 94/542, 17.3% loves). Of these 93 posts, 37 (40%) were made by group members, and 56 (60%) were made by moderators. Of the 108 members, a subsample of 39 (36.1%) completed a web-based survey, and 14 (13%) participated in the interviews. Content analyses of posts by members revealed that inquiry (17/37, 46%), informational (15/37, 41%), and emotional posts (4/37, 11%) were the most common. Emotional posts received the highest number of interactions (median 24.5). In total, 5 themes emerged from the interviews related to the use of the group and mediating factors of interactions between group members: resource for information, altruistic contribution, varying level of engagement, perceived barriers to and facilitators of group activity, and moderators as contributing members. Conclusions: These findings demonstrate that caregivers of children and youth with CCN seek geography-specific P2P support groups to meet informational and social support needs. This study contributes to the knowledge on how caregivers use Facebook groups to meet their support needs through moderate and passive engagement. %M 35671082 %R 10.2196/33170 %U https://pediatrics.jmir.org/2022/2/e33170 %U https://doi.org/10.2196/33170 %U http://www.ncbi.nlm.nih.gov/pubmed/35671082 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 14 %N 1 %P e37759 %T In Anticipation of Sharing Pediatric Inpatient Notes: Focus Group Study With Stakeholders %A Smith,Catherine Arnott %A Kelly,Michelle M %+ The Information School, University of Wisconsin-Madison, 600 North Park Street, Madison, WI, 53706, United States, 1 6082632900, casmith24@wisc.edu %K medical informatics %K information sharing %K electronic health records %K patient portals %K hospitals %K pediatrics %K focus group %K inpatient care %K caregivers %D 2022 %7 30.5.2022 %9 Original Paper %J J Particip Med %G English %X Background: Patient portals are a health information technology that allows patients and their proxies, such as caregivers and family members, to access designated portions of their electronic health record using mobile devices and web browsers. The Open Notes initiative in the United States, which became federal law in April 2021, has redrawn and expanded the boundaries of medical records. Only a few studies have focused on sharing notes with parents or caregivers of pediatric patients. Objective: This study aimed to investigate the anticipated impact of increasing the flow of electronic health record information, specifically physicians’ daily inpatient progress notes, via a patient portal to parents during their child’s acute hospital stay—an understudied population and an understudied setting. Methods: A total of 5 in-person focus groups were conducted with 34 stakeholders most likely impacted by sharing of physicians’ inpatient notes with parents of hospitalized children: hospital administrators, hospitalist physicians, interns and resident physicians, nurses, and the parents themselves. Results: Distinct themes identified as benefits of pediatric inpatient Open Notes for parents emerged from all the 5 focus groups. These themes were communication, recapitulation and reinforcement, education, stress reduction, quality control, and improving family-provider relationships. Challenges identified included burden on provider, medical jargon, communication, sensitive content, and decreasing trust. Conclusions: Providing patients and, in the case of pediatrics, caregivers with access to medical records via patient portals increases the flow of information and, in turn, their ability to participate in the discourse of their care. Parents in this study demonstrated not only that they act as monitors and guardians of their children’s health but also that they are observers of the clinical processes taking place in the hospital and at their child’s bedside. This includes the clinical documentation process, from the creation of notes to the reading and sharing of the notes. Parents acknowledge not only the importance of notes in the clinicians’ workflow but also their collaboration with providers as part of the health care team. %M 35635743 %R 10.2196/37759 %U https://jopm.jmir.org/2022/1/e37759 %U https://doi.org/10.2196/37759 %U http://www.ncbi.nlm.nih.gov/pubmed/35635743 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e32490 %T Implementation of a Brief Dialectical Behavioral Therapy Skills Group in High Schools for At-Risk Youth: Protocol for a Mixed Methods Study %A Zapolski,Tamika %A Whitener,MacKenzie %A Khazvand,Shirin %A Crichlow,Queenisha %A Revilla,Rebecca %A Salgado,Eduardo F %A Aalsma,Matthew %A Cyders,Melissa %A Salyers,Michelle %A Wu,Wei %+ Department of Psychology, School of Science, Indiana University–Purdue University Indianapolis, 402 N Blackford Street, LD 126K, Indianapolis, IN, 46202, United States, 1 317 274 2934, tzapolsk@iu.edu %K dialectical behavioral therapy %K adolescents %K high school %K intervention %K high school %K teenagers %K risk-taking behavior %K impulsivity %K emotion dysregulation %K social and emotional learning %K youth %D 2022 %7 12.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescence is a developmental period marked by engagement in risk-taking behaviors, especially among impulsive or emotionally dysregulated youth. Thus, interventions that teach skills to reduce the risk of negative outcomes associated with emotional dysregulation are required. Social and emotional learning (SEL) programs have been developed to address both adolescent emotional dysregulation and risk-taking behaviors; however, current programs have mostly been implemented among younger youth and are used as a tier 1 universal intervention rather than a targeted tier 2 intervention for youth identified with emotional regulation difficulties. Objective: This study aimed to address the need for SEL programming that can be delivered in schools, particularly for older youth who have difficulties with emotional or behavioral dysregulation, to reduce the risk of health-risk behaviors among this population. Methods: Here, we outline the implementation of an SEL intervention titled Going 4 Goals, a 9-session adaptation of the Dialectical Behavioral Therapy for Adolescents (DBT-A) program delivered to at-risk high school students in a school setting. The primary objectives of the study are to test whether participating in the skills group intervention produces significant increases in the core DBT-A skills of mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness, while also producing significant decreases in substance use and risky behaviors. These primary outcomes are based on changes in participant scores between baseline and after the intervention and follow-ups at 1, 3, and 6 months compared with a control group of youth participating in the school’s health curriculum at the same time points. Qualitative interviews will also be conducted with intervention participants and school staff to examine acceptability and facilitators of and barriers to the intervention. Results: A total of 171 participants across 13 groups had been enrolled in the intervention, with data collection ending December 2021. Data analysis will begin in the spring of 2022, with expected results to be published in the spring of 2023. Conclusions: This paper describes the protocol of the 9-session school-based adaptation of the DBT-A intervention and discusses the strengths and limitations of the study and future directions. International Registered Report Identifier (IRRID): DERR1-10.2196/32490 %M 35551054 %R 10.2196/32490 %U https://www.researchprotocols.org/2022/5/e32490 %U https://doi.org/10.2196/32490 %U http://www.ncbi.nlm.nih.gov/pubmed/35551054 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e37126 %T Physical Activity and Nutrition Intervention for Middle Schoolers (Move More, Get More): Protocol for a Quasi-Experimental Study %A Grimes,Amanda %A Lightner,Joseph S %A Eighmy,Katlyn %A Wray,Bridget D %A Valleroy,Ella %A Baughn,Maya %+ School of Nursing and Health Studies, University of Missouri, 2464 Charlotte St, Kansas City, MO, 64108, United States, 1 816 235 1737, grimesa@umkc.edu %K intervention protocol %K physical activity %K food intake %K nutrition %K healthy eating %K middle schoolers %K youth %K school %K student %K fitness %K exercise %K food consumption %K diet %K fruit consumption %K vegetable consumption %D 2022 %7 4.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity and nutrition behaviors are important to reducing the prevalence of childhood obesity. Previous research has identified school-based interventions as effective strategies to improve physical activity and nutrition. However, the results are often mixed, and middle schoolers are an under-studied population. Objective: Our study aims to fill this gap by developing an after-school intervention to increase physical activity and fruit and vegetable consumption that is influenced by national guidelines and formative research. Methods: This study was an after-school, quasi-experimental study spanning 9 months. Enrollment began in September 2021 and continued on a rolling basis through February 2022. Weekly, middle schoolers were offered 2-3 physical activity sessions and 1 produce kit. Physical activity was measured using accelerometers and questionnaires. Nutrition behaviors were assessed using questionnaires, and physical literacy was assessed using researcher observations. Follow-up data collection occurred in December 2021 and in April 2022. Difference scores will be calculated and analyzed for each outcome variable. Results: The intervention started in September 2021 and will conclude in May 2022. Published study results are expected in late 2022. Conclusions: An increase in physical literacy, physical activity, and fruit and vegetable consumption is expected. If successful, future studies will focus on reach and sustainability. Lastly, this study may serve as a model for improving health outcomes in middle schools. International Registered Report Identifier (IRRID): DERR1-10.2196/37126 %M 35507392 %R 10.2196/37126 %U https://www.researchprotocols.org/2022/5/e37126 %U https://doi.org/10.2196/37126 %U http://www.ncbi.nlm.nih.gov/pubmed/35507392 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e37279 %T Investigating New Sensory Methods Related to Taste Sensitivity, Preferences, and Diet of Mother-Infant Pairs and Their Relationship With Body Composition and Biomarkers: Protocol for an Explorative Study %A Fuchs-Neuhold,Bianca %A Staubmann,Wolfgang %A Peterseil,Marie %A Rath,Anna %A Schweighofer,Natascha %A Kronberger,Anika %A Riederer,Monika %A van der Kleyn,Moenie %A Martin,Jochen %A Hörmann-Wallner,Marlies %A Waldner,Irmgard %A Konrad,Manuela %A Aufschnaiter,Anna Lena %A Siegmund,Barbara %A Berghold,Andrea %A Holasek,Sandra %A Pail,Elisabeth %+ Health Perception Lab, Institute of Dietetics and Nutrition, FH JOANNEUM GmbH - University of Applied Sciences, Eggenberger Allee 11, Graz, 8010, Austria, 43 316 5453 ext 6726, bianca.fuchsneuhold@fh-joanneum.at %K taste %K preferences %K nutrition %K biomarkers %K body composition %K air displacement plethysmography %K Baby Facial Actions Coding System %K mother %K infant %K parenting %K pediatrics %K prenatal %K postnatal %D 2022 %7 27.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Early experiences with different flavors play an important role in infant development, including food and taste acceptance. Flavors are already perceived in utero with the development of the taste and olfactory system and are passed on to the child through breast and bottle feeding. Therefore, the first 1000 days of life are considered a critical window for infant developmental programming. Objective: The objective of our study is to investigate, both in the prenatal and postnatal period, taste sensitivity, preferences, and dietary diversity of mother-infant pairs. The explorative study design will also report on the impact of these variables on body composition (BC) and biomarkers. In contrast to conventional methods, this study involves long-term follow-up data collection from mother-infant pairs; moreover, the integration of audiovisual tools for recording infants' expressions pertaining to taste stimuli is a novelty of this study. Considering these new methodological approaches, the study aims to assess taste-related data in conjunction with BC parameters like fat-free mass or fat mass, biomarkers, and nutritional intake in infants and children. Methods: Healthy pregnant women aged between 18 and 50 years (BMI≥18.5 kg/m2 to ≤30 kg/m2; <28 weeks of gestation) were recruited from January 2014 to October 2014. The explorative design implies 2 center visits during pregnancy (24-28 weeks of gestation and 32-34 weeks of gestation) and 2 center visits after delivery (6-8 weeks postpartum and 14-16 weeks postpartum) as well as follow-up visits at 1, 3-3.5, and 6 years after delivery. Data collection encompasses anthropometric and biochemical measurements as well as BC analyses with air displacement plethysmography, taste perception assessments, and multicomponent questionnaires on demographics, feeding practices, and nutritional and lifestyle behaviors. Audiovisual data from infants’ reactions to sensory stimuli are collected and coded by trained staff using Baby Facial Action Coding and the Body Action Posture System. Birth outcomes and weight development are obtained from medical records, and additional qualitative data are gathered from 24 semistructured interviews. Results: Our cohort represents a homogenous group of healthy women with stringent exclusion criteria. A total of 54 women met the eligibility criteria, whereas 47 mother-child pairs completed data collection at 4 center visits during and after pregnancy. Follow-up phases, data analyses, and dissemination of the findings are scheduled for the end of 2023. The study was approved by the ethics committee of the Medical University of Graz (EC No 26–066 ex 13/14), and all participants provided informed consent. Conclusions: The results of this study could be useful for elucidating the connections between maternal and infant statuses regarding diet, taste, biomarkers, and prenatal and postnatal weight development. This study may also be relevant to the establishment of further diagnostic and interventional strategies targeting childhood obesity and early body fat development. International Registered Report Identifier (IRRID): DERR1-10.2196/37279 %M 35475790 %R 10.2196/37279 %U https://www.researchprotocols.org/2022/4/e37279 %U https://doi.org/10.2196/37279 %U http://www.ncbi.nlm.nih.gov/pubmed/35475790 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e33552 %T Oral Health Status and Practices, and Anthropometric Measurements of Preschool Children: Protocol for a Multi-African Country Survey %A El Tantawi,Maha %A Folayan,Morenike O %A Bhayat,Ahmed %+ Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champolion St., Azarita, Alexandria, 21527, Egypt, 20 01227824017, maha_tantawy@hotmail.com %K oral health %K early childhood caries %K oral hygiene %K dietary intake %K Africa %K preschool children %K dentistry %K oral disease %D 2022 %7 27.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Oral diseases are among the most prevalent conditions with significant impact on the growth and development of young children. Data are required to plan effectively for the management of early childhood caries (ECC) and other oral diseases in this age. There are currently very few African countries with updated and nationally representative data on ECC prevalence, and risk indicators and regional data on ECC and other oral diseases are scarce. Objective: We aim to determine the oral health status and practices, dietary intake, and anthropometric measurements of preschool children in several African countries. Methods: A cross-sectional study will be conducted in several African countries using a standardized questionnaire and clinical examination for data collection from healthy preschool children in kindergartens and primary health care facilities. The clinical examination will assess ECC using the decayed, missing due to caries, and filled teeth (dmft) index according to the World Health Organization (WHO) criteria, dental erosion (using the Basic Erosive Wear Examination Index), deciduous molar hypomineralization (using the European Association of Paediatric Dentistry criteria), dental fluorosis (using Dean’s Index), oral hygiene status (using the Oral Hygiene Index Simplified), and oral mucosal lesions. Oral hygiene habits and dental visits will be assessed using the WHO child questionnaire, and dietary intake will be assessed using the Food and Agriculture Organization method. Anthropometric measurements will be obtained following the International Society for the Advancement of Kinanthropometry standard protocol, and the children’s nutritional status will be assessed following the WHO child growth standards. To train and calibrate examiners, educational resources and electronic forms will be used to reach interexaminer and intraexaminer reliability with κ>0.6. Descriptive analysis will determine the prevalence of clinical conditions by age and sex. Bivariate analysis and multivariable regression will assess associations between the clinical conditions and sociodemographic factors, and oral health behaviors. Results: Data collection will begin after approvals and ethical clearance are obtained. The first stage will include 3 countries, namely Egypt, Nigeria, and South Africa, and collaborators from other African countries will join afterward. Conclusions: This study will lay down the foundations for using validated tools to collect data on the oral health of young children in Africa, allowing researchers from different countries across Africa to collect standardized data on ECC and other oral conditions. This will facilitate comparisons and analysis of risk factors that might be unique to the African continent. The results will provide baseline data on the prevalence of oral diseases and enable planning to address the treatment needs of young African children and design programs to prevent oral diseases in the African continent. International Registered Report Identifier (IRRID): PRR1-10.2196/33552 %M 35476047 %R 10.2196/33552 %U https://www.researchprotocols.org/2022/4/e33552 %U https://doi.org/10.2196/33552 %U http://www.ncbi.nlm.nih.gov/pubmed/35476047 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e30260 %T Distracting Through Procedural Pain and Distress Using Virtual Reality and Guided Imagery in Pediatric, Adolescent, and Young Adult Patients: Randomized Controlled Trial %A Hoag,Jennifer A %A Karst,Jeffrey %A Bingen,Kristin %A Palou-Torres,Akasha %A Yan,Ke %+ Division of Pediatric Psychology and Developmental Medicine, Department of Pediatrics, Medical College of Wisconsin, 8701 W Watertown Plank Road, MFRC 3018, Milwaukee, WI, 53226, United States, 1 414 955 5738, jhoag@mcw.edu %K virtual reality %K procedural %K pain %K anxiety %K pediatric %K guided imagery %D 2022 %7 18.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Children with acute and chronic illness undergo frequent, painful, and distressing procedures. Objective: This randomized controlled trial was used to evaluate the effectiveness of guided imagery (GI) versus virtual reality (VR) on the procedural pain and state anxiety of children and young adults undergoing unsedated procedures. We explored the role of trait anxiety and pain catastrophizing in intervention response. Methods: Children and young adults were recruited from the hematology, oncology, and blood and marrow transplant clinics at a children’s hospital. Each study participant completed the GI and VR intervention during separate but consecutive unsedated procedures. Self-report measures of pain and anxiety were completed before and after the procedures. Results: A total of 50 participants (median age 13 years) completed both interventions. GI and VR performed similarly in the management of procedural pain. Those with high pain catastrophizing reported experiencing less nervousness about pain during procedures that used VR than those using GI. State anxiety declined pre- to postprocedure in both interventions; however, the decrease reached the level of significance during the VR intervention only. Those with high trait anxiety had less pain during GI. Conclusions: In our sample, VR worked as well as GI to manage the pain and distress associated with common procedures experienced by children with acute or chronic illnesses. Children who are primed for pain based on beliefs about pain or because of their history of chronic pain had a better response to VR. GI was a better intervention for those with high trait anxiety. Trial Registration: ClinicalTrials.gov NCT04892160; https://clinicaltrials.gov/ct2/show/NCT04892160 %M 35436209 %R 10.2196/30260 %U https://www.jmir.org/2022/4/e30260 %U https://doi.org/10.2196/30260 %U http://www.ncbi.nlm.nih.gov/pubmed/35436209 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 4 %P e33394 %T Influence of Maternal Exposure to Mass Media on Growth Stunting Among Children Under Five: Mediation Analysis Through the Water, Sanitation, and Hygiene Program %A Huo,Shutong %A Wang,Kai %A Liu,Zongchao %A Yang,Yuao %A Hee,Jia Yi %A He,Qiwei %A Takesue,Rie %A Tang,Kun %+ Vanke School of Public Health, Tsinghua University, 4th Floor Mingli Building, Haidian District, Beijing, 100083, China, 86 010 62781788, tangk@tsinghua.edu.cn %K water, sanitation and hygiene %K mass media %K malnutrition %K Democratic Republic of Congo %K DRC %K mediation analysis %K children %K pediatric %K stunting %K television %K internet %K sanitation %K hygiene %D 2022 %7 6.4.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The issue of malnutrition in the Democratic Republic of Congo is severe. Meanwhile, the Water, Sanitation, and Hygiene program has been demonstrated to be effective in reducing the rates of growth stunting among children. Objective: We aimed to explore the association between maternal exposure to mass media and stunting in children through water, sanitation, and hygiene behaviors. Methods: Mediation analysis was conducted using data from the 2018 Multiple Indicators Cluster Surveys. Results: Mothers’ exposures to television and the internet in the Democratic Republic of Congo significantly decreases the risk of stunting in children by 5% and 10%, respectively, mediated by household water, sanitation, and hygiene facilities and practices. Conclusions: These findings could inform interventions and policies to reduce the rate of stunting rate children by promoting water, sanitation, and hygiene through mass media, especially through the internet and television. %M 35384848 %R 10.2196/33394 %U https://publichealth.jmir.org/2022/4/e33394 %U https://doi.org/10.2196/33394 %U http://www.ncbi.nlm.nih.gov/pubmed/35384848 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e34822 %T Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development %A Shore,Josh %A Nalder,Emily %A Hutchison,Michael %A Reed,Nick %A Hunt,Anne %+ Department of Occupational Science and Occupational Therapy, University of Toronto, Rehabilitation Sciences Building, 160-500 University Ave., Toronto, ON, M5G 1V7, Canada, 1 (416) 946 8568, anne.hunt@utoronto.ca %K concussion %K pediatrics %K active rehabilitation %K telehealth %K exercise %K mobile phone %D 2022 %7 4.4.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Active rehabilitation involving subsymptom threshold exercise combined with education and support promotes recovery in youth with concussion but is typically delivered in person, which may limit accessibility for families because of a lack of services in their communities or logistical challenges to attending in-person sessions. Objective: This paper describes the evidence-based and theory-informed development of the Tele-Active Rehabilitation (Tele-AR) intervention for pediatric concussion, which was specifically designed for remote service delivery. Methods: The intervention was designed by clinician-researchers with experience in pediatric concussion rehabilitation following the Medical Research Council guidance for developing complex interventions. Development involved a critical review of the literature to identify existing evidence, the expansion of the theoretical basis for active rehabilitation, and the modeling of the intervention process and outcomes. Results: Tele-AR is a 6-week home exercise and education and support program facilitated through weekly videoconferencing appointments with a clinician. Exercise consists of low- to moderate-intensity subsymptom threshold aerobic activity and coordination drills that are individualized to participant needs and interests (prescribed for 3 days per week). Education includes the evidence-supported Concussion & You self-management program, which covers topics related to energy management, nutrition, hydration, sleep hygiene, and return to activity. Elements of self-determination theory are incorporated to support motivation and engagement. We present a logic model describing predicted intervention effects using a biopsychosocial conceptualization of outcomes after concussion. Conclusions: The Tele-AR intervention may help to increase access to care that improves recovery and promotes a timely return to activity in youth with concussion. Future research is needed to evaluate the feasibility and efficacy of this approach. %M 35377326 %R 10.2196/34822 %U https://pediatrics.jmir.org/2022/2/e34822 %U https://doi.org/10.2196/34822 %U http://www.ncbi.nlm.nih.gov/pubmed/35377326 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e34698 %T Feasibility, Enjoyment, and Language Comprehension Impact of a Tablet- and GameFlow-Based Story-Listening Game for Kindergarteners: Methodological and Mixed Methods Study %A Vanden Bempt,Femke %A Economou,Maria %A Dehairs,Ward %A Vandermosten,Maaike %A Wouters,Jan %A Ghesquière,Pol %A Vanderauwera,Jolijn %+ Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leopold Vanderkelenstraat 32/3765, Leuven, 3000, Belgium, 32 16376202, femke.vandenbempt@kuleuven.be %K serious gaming %K language comprehension %K enjoyment %K feasibility %K GameFlow %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Enjoyment plays a key role in the success and feasibility of serious gaming interventions. Unenjoyable games will not be played, and in the case of serious gaming, learning will not occur. Therefore, a so-called GameFlow model has been developed, which intends to guide (serious) game developers in the process of creating and evaluating enjoyment in digital (serious) games. Regarding language learning, a variety of serious games targeting specific language components exist in the market, albeit often without available assessments of enjoyment or feasibility. Objective: This study evaluates the enjoyment and feasibility of a tablet-based, serious story-listening game for kindergarteners, developed based on the principles of the GameFlow model. This study also preliminarily explores the possibility of using the game to foster language comprehension. Methods: Within the framework of a broader preventive reading intervention, 91 kindergarteners aged 5 years with a cognitive risk for dyslexia were asked to play the story game for 12 weeks, 6 days per week, either combined with a tablet-based phonics intervention or control games. The story game involved listening to and rating stories and responding to content-related questions. Game enjoyment was assessed through postintervention questionnaires, a GameFlow-based evaluation, and in-game story rating data. Feasibility was determined based on in-game general question response accuracy (QRA), reflecting the difficulty level, attrition rate, and final game exposure and training duration. Moreover, to investigate whether game enjoyment and difficulty influenced feasibility, final game exposure and training duration were predicted based on the in-game initial story ratings and initial QRA. Possible growth in language comprehension was explored by analyzing in-game QRA as a function of the game phase and baseline language skills. Results: Eventually, data from 82 participants were analyzed. The questionnaire and in-game data suggested an overall enjoyable game experience. However, the GameFlow-based evaluation implied room for game design improvement. The general QRA confirmed a well-adapted level of difficulty for the target sample. Moreover, despite the overall attrition rate of 39% (32/82), 90% (74/82) of the participants still completed 80% of the game, albeit with a large variation in training days. Higher initial QRA significantly increased game exposure (β=.35; P<.001), and lower initial story ratings significantly slackened the training duration (β=−0.16; P=.003). In-game QRA was positively predicted by game phase (β=1.44; P=.004), baseline listening comprehension (β=1.56; P=.002), and vocabulary (β=.16; P=.01), with larger QRA growth over game phases in children with lower baseline listening comprehension skills (β=−0.08; P=.04). Conclusions: Generally, the story game seemed enjoyable and feasible. However, the GameFlow model evaluation and predictive relationships imply room for further game design improvements. Furthermore, our results cautiously suggest the potential of the game to foster language comprehension; however, future randomized controlled trials should further elucidate the impact on language comprehension. %M 35319480 %R 10.2196/34698 %U https://games.jmir.org/2022/1/e34698 %U https://doi.org/10.2196/34698 %U http://www.ncbi.nlm.nih.gov/pubmed/35319480 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e33614 %T Locating Youth Exposed to Parental Justice Involvement in the Electronic Health Record: Development of a Natural Language Processing Model %A Boch,Samantha %A Hussain,Syed-Amad %A Bambach,Sven %A DeShetler,Cameron %A Chisolm,Deena %A Linwood,Simon %+ College of Nursing, University of Cincinnati, 3110 Vine St, Cincinnati, OH, 45221, United States, 1 513 558 5280, bochsj@ucmail.uc.edu %K parental incarceration %K machine learning %K natural language processing %K parental justice involvement %K adverse childhood experiences %K pediatrics %K pediatric health %K parenting %K digital health %K electronic health record %K eHealth %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parental justice involvement (eg, prison, jail, parole, or probation) is an unfortunately common and disruptive household adversity for many US youths, disproportionately affecting families of color and rural families. Data on this adversity has not been captured routinely in pediatric health care settings, and if it is, it is not discrete nor able to be readily analyzed for purposes of research. Objective: In this study, we outline our process training a state-of-the-art natural language processing model using unstructured clinician notes of one large pediatric health system to identify patients who have experienced a justice-involved parent. Methods: Using the electronic health record database of a large Midwestern pediatric hospital-based institution from 2011-2019, we located clinician notes (of any type and written by any type of provider) that were likely to contain such evidence of family justice involvement via a justice-keyword search (eg, prison and jail). To train and validate the model, we used a labeled data set of 7500 clinician notes identifying whether the patient was ever exposed to parental justice involvement. We calculated the precision and recall of the model and compared those rates to the keyword search. Results: The development of the machine learning model increased the precision (positive predictive value) of locating children affected by parental justice involvement in the electronic health record from 61% (a simple keyword search) to 92%. Conclusions: The use of machine learning may be a feasible approach to addressing the gaps in our understanding of the health and health services of underrepresented youth who encounter childhood adversities not routinely captured—particularly for children of justice-involved parents. %M 35311681 %R 10.2196/33614 %U https://pediatrics.jmir.org/2022/1/e33614 %U https://doi.org/10.2196/33614 %U http://www.ncbi.nlm.nih.gov/pubmed/35311681 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e27760 %T An mHealth Intervention to Reduce the Packing of Discretionary Foods in Children’s Lunch Boxes in Early Childhood Education and Care Services: Cluster Randomized Controlled Trial %A Pearson,Nicole %A Finch,Meghan %A Sutherland,Rachel %A Kingsland,Melanie %A Wolfenden,Luke %A Wedesweiler,Taya %A Herrmann,Vanessa %A Yoong,Sze Lin %+ Hunter New England Population Health, Longworth Avenue, Wallsend, 2308, Australia, 61 02 49246031 ext 46031, Nicole.Pearson@health.nsw.gov.au %K nutrition %K mHealth %K child %K preschool %K parents %D 2022 %7 17.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Interventions in early childhood education and care (ECEC) services have the potential to improve children’s diet at the population level. Objective: This study aims to test the efficacy of a mobile health intervention in ECEC services to reduce parent packing of foods high in saturated fat, sugar, and sodium (discretionary foods) in children’s (aged 3-6 years) lunch boxes. Methods: A cluster randomized controlled trial was undertaken with 355 parent and child dyads recruited by phone and in person from 17 ECEC services (8 [47%] intervention and 9 [53%] control services). Parents in the intervention group received a 10-week fully automated program targeting barriers to packing healthy lunch boxes delivered via an existing service communication app. The program included weekly push notifications, within-app messages, and links to further resources, including websites and videos. The control group did not receive any intervention. The primary outcomes were kilojoules from discretionary foods and associated nutrients (saturated fat, free sugars, and sodium) packed in children’s lunch boxes. Secondary outcomes included consumption of kilojoules from discretionary foods and related nutrients and the packing and consumption of serves of discretionary foods and core food groups. Photography and weights of foods in children’s lunch boxes were recorded by trained researchers before and after the trial to assess primary and secondary outcomes. Outcome assessors were blinded to service allocation. Feasibility, appropriateness, and acceptability were assessed via an ECEC service manager survey and a parent web-based survey. Use of the app was assessed via app analytics. Results: Data on packed lunch box contents were collected for 88.8% (355/400) of consenting children at baseline and 84.3% (337/400) of children after the intervention. There was no significant difference between groups in kilojoule from discretionary foods packed (77.84 kJ, 95% CI −163.49 to 319.18; P=.53) or the other primary or secondary outcomes. The per-protocol analysis, including only data from children of parents who downloaded the app, also did not find any statistically significant change in primary (−1.98 kJ, 95% CI −343.87 to 339.90; P=.86) or secondary outcomes. Approximately 61.8% (102/165) of parents in the intervention group downloaded the app, and the mean service viewing rate of weekly within-app messages was 26% (SD 14.9). Parents who responded to the survey and participating services agreed that it was appropriate to receive lunch box information via the app (40/50, 80% and 6/8, 75%, respectively). Conclusions: The intervention was unable to demonstrate an impact on kilojoules or associated nutrients from discretionary foods packed in children’s lunch boxes. Low app downloads and program message views indicate a need to explore how to improve factors related to implementation before further testing similar mobile health interventions in this setting. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000133235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374379 %M 35297768 %R 10.2196/27760 %U https://www.jmir.org/2022/3/e27760 %U https://doi.org/10.2196/27760 %U http://www.ncbi.nlm.nih.gov/pubmed/35297768 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e31820 %T Assessment of the Readability of Web-Based Patient Education Material From Major Canadian Pediatric Associations: Cross-sectional Study %A Man,Alice %A van Ballegooie,Courtney %+ Department of Experimental Therapeutics, British Columbia Cancer Research Institute, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada, 1 604 675 8000 ext 7024, cballegooie@bccrc.ca %K health literacy %K accessibility %K online health information %K pediatrics %K patient education %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Web-based patient education materials (PEMs) are frequently written above the recommended reading level in North America. Poor PEM readability limits the accessibility of medical information for individuals with average literacy levels or lower. Pediatric hospital and association websites have not only been shown to be a preferred source of information among caregivers but have also become a necessity during the COVID-19 pandemic. The readability of Canadian pediatric association websites has not yet been assessed. Objective: The aim of this study is to determine if the content of PEMs from Canadian pediatric associations is written at a reading level that the majority of Canadians can understand. Methods: A total of 258 PEMs were extracted from 10 Canadian pediatric associations and evaluated for their reading level using 10 validated readability scales. The PEMs underwent a difficult word analysis and comparisons between PEMs from different associations were conducted. Results: Web-based PEMs were identified from 3 pediatric association websites, where the reading level (calculated as a grade level) was found to be an average of 8.8 (SD 1.8) for the Caring for Kids website, 9.5 (SD 2.2) for the Pediatric Endocrine Group website, and 13.1 (SD 2.1) for the Atlantic Pediatric Society website. The difficult word analysis identified that 19.9% (SD 6.6%) of words were unfamiliar, with 13.3% (SD 5.3%) and 31.9% (SD 6.1%) of words being considered complex (≥3 syllables) and long (≥6 letters), respectively. Conclusions: The web-based PEMs were found to be written above the recommended seventh-grade reading level for Canadians. Consideration should be made to create PEMs at an appropriate reading level for both patients and their caregivers to encourage health literacy and ultimately promote preventative health behaviors and improve child health outcomes. %M 35293875 %R 10.2196/31820 %U https://pediatrics.jmir.org/2022/1/e31820 %U https://doi.org/10.2196/31820 %U http://www.ncbi.nlm.nih.gov/pubmed/35293875 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e31325 %T Level of Physical Activity, Sedentary Behavior, and Sleep in the Child and Adolescent Population in the Autonomous Community of the Basque Country (6-17 Years Old): Protocol for the Mugikertu Study %A Larrinaga-Undabarrena,Arkaitz %A Albisua,Neritzel %A Río,Xabier %A Angulo-Garay,Garazi %A González-Santamaria,Xabier %A Etxeberria Atxa,Iker %A Martínez de Lahidalga Aguirre,Gorka %A Ruiz de Azua Larrinaga,Malen %A Martínez Aguirre-Betolaza,Aitor %A Gorostegi-Anduaga,Ilargi %A Maldonado-Martín,Sara %A Aldaz Arregui,Juan %A Guerra-Balic,Myriam %A Bringas,Mikel %A Sánchez Isla,José Ramón %A Coca,Aitor %+ Faculty of Education and Sport, University of Deusto, Avenida de las Universidades, 24, Bilbao, 48007, Spain, 34 944139003 ext 3411, a.larrinaga@deusto.es %K physical activity %K sedentary behavior %K sleep %K Basque Autonomous Community %K accelerometry %K adolescents %K children %K healthy behavior %K mobility %D 2022 %7 11.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical inactivity and sedentary behavior are increasingly common problems in the general population, which can lead to overweight, obesity, diabetes, cardiovascular disease, and decreased motor and cognitive capacity among children and adolescents. Establishing healthy habits in childhood on the basis of the World Health Organization’s 2020 Physical Activity Guidelines is essential for proper physical, motor, and cognitive development. Objective: The primary aim of this study is to describe the level of physical activity (PA), sedentary behavior, and sleep of the child and adolescent population from 6 to 17 years of age in the Basque Autonomous Community (BAC). Our secondary aim is to establish a starting point for future research and intervention protocols to improve the existing reality. Methods: This cross-sectional study aims to recruit 1111 children and adolescents, aged 6 to 17 years from the BAC in a representative random sample. Participants will wear the ActiGraph WGT3X-BT triaxial accelerometer for 7 consecutive days in their nondominant wrist, and fill out a habit diary log of PA, mobility, and sleep routine. PA intensities, sedentary behavior, and sleep parameters (total bedtime, total sleep time, and sleep efficiency) will be calculated from raw accelerometer data using SPSS (IBM Corp). Participants will be randomly selected. Results: The results of this study intend to demonstrate significant differences in PA levels in different age and gender groups since the volume of school PA in the BAC decreases as the age of the schoolchildren increases. The total study sample includes 1111 participants. In April 2021, up to 50% of the sample size was reached, which is expected to increase to 100% by April 2022. This sample will allow us to analyze, discuss, compare, and assess the reality of the school population, in a sensitive period of adherence to behavior patterns, using data from the geographical and administrative area of the BAC. This study will provide a realistic insight into PA levels among children and adolescents in the BAC. It will also offer scientific contributions on the positive relationship between PA levels and sleep quality in this population. Conclusions: This study might highlight the need for the promotion of cross-sectional policies so that children and adolescents may increase their levels of PA, thus improving both the school environment and positive healthy behavior. Trial Registration: ISRCTN Registry ISRCTN65573865; https://www.isrctn.com/ISRCTN65573865 International Registered Report Identifier (IRRID): DERR1-10.2196/31325 %M 35275088 %R 10.2196/31325 %U https://www.researchprotocols.org/2022/3/e31325 %U https://doi.org/10.2196/31325 %U http://www.ncbi.nlm.nih.gov/pubmed/35275088 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e35399 %T Usability Testing and Technology Acceptance of an mHealth App at the Point of Care During Simulated Pediatric In- and Out-of-Hospital Cardiopulmonary Resuscitations: Study Nested Within 2 Multicenter Randomized Controlled Trials %A Siebert,Johan N %A Gosetto,Laëtitia %A Sauvage,Manon %A Bloudeau,Laurie %A Suppan,Laurent %A Rodieux,Frédérique %A Haddad,Kevin %A Hugon,Florence %A Gervaix,Alain %A Lovis,Christian %A Combescure,Christophe %A Manzano,Sergio %A Ehrler,Frederic %A , %A , %+ Department of Pediatric Emergency Medicine, Geneva Children’s Hospital, Geneva University Hospitals, Avenue de la Roseraie, 47, Geneva, 1205, Switzerland, 41 795534072, Johan.Siebert@hcuge.ch %K cardiopulmonary resuscitation %K drugs %K emergency medical services %K medication errors %K mobile health %K mobile apps %K out-of-hospital cardiac arrest %K paramedics %K pediatrics %K System Usability Scale %K Unified Theory of Acceptance and Use of Technology %K smartphone %K mobile phone %D 2022 %7 1.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile apps are increasingly being used in various domains of medicine. Few are evidence-based, and their benefits can only be achieved if end users intend to adopt and use them. To date, only a small fraction of mobile apps have published data on their field usability and end user acceptance results, especially in emergency medicine. Objective: This study aims to determine the usability and acceptance of an evidence-based mobile app while safely preparing emergency drugs at the point of care during pediatric in- and out-of-hospital cardiopulmonary resuscitations by frontline caregivers. Methods: In 2 multicenter randomized controlled parent trials conducted at 6 pediatric emergency departments from March 1 to December 31, 2017, and 14 emergency medical services from September 3, 2019, to January 21, 2020, the usability and technology acceptance of the PedAMINES (Pediatric Accurate Medication in Emergency Situations) app were evaluated among skilled pediatric emergency nurses and advanced paramedics when preparing continuous infusions of vasoactive drugs and direct intravenous emergency drugs at pediatric dosages during standardized, simulation-based, pediatric in- and out-of-hospital cardiac arrest scenarios, respectively. Usability was measured using the 10-item System Usability Scale. A 26-item technology acceptance self-administered survey (5-point Likert-type scales), adapted from the Unified Theory of Acceptance and Use of Technology model, was used to measure app acceptance and intention to use. Results: All 100% (128/128) of nurses (crossover trial) and 49.3% (74/150) of paramedics (parallel trial) were assigned to the mobile app. Mean total scores on the System Usability Scale were excellent and reached 89.5 (SD 8.8; 95% CI 88.0-91.1) for nurses and 89.7 (SD 8.7; 95% CI 87.7-91.7) for paramedics. Acceptance of the technology was very good and rated on average >4.5/5 for 5 of the 8 independent constructs evaluated. Only the image construct scored between 3.2 and 3.5 by both participant populations. Conclusions: The results provide evidence that dedicated mobile apps can be easy to use and highly accepted at the point of care during in- and out-of-hospital cardiopulmonary resuscitations by frontline emergency caregivers. These findings can contribute to the implementation and valorization of studies aimed at evaluating the usability and acceptance of mobile apps in the field by caregivers, even in critical situations. Trial Registration: ClinicalTrials.gov NCT03021122; https://clinicaltrials.gov/ct2/show/NCT03021122. ClinicalTrials.gov NCT03921346; https://clinicaltrials.gov/ct2/show/NCT03921346 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3726-4 %M 35230243 %R 10.2196/35399 %U https://humanfactors.jmir.org/2022/1/e35399 %U https://doi.org/10.2196/35399 %U http://www.ncbi.nlm.nih.gov/pubmed/35230243 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e29656 %T Using the Social Robot NAO for Emotional Support to Children at a Pediatric Emergency Department: Randomized Clinical Trial %A Rossi,Silvia %A Santini,Silvano Junior %A Di Genova,Daniela %A Maggi,Gianpaolo %A Verrotti,Alberto %A Farello,Giovanni %A Romualdi,Roberta %A Alisi,Anna %A Tozzi,Alberto Eugenio %A Balsano,Clara %+ Department of Life, Health & Environmental Sciences, School of Emergency and Urgency Medicine, University of L'Aquila, via spennati L'aquila 67100, L'Aquila, Italy, 39 0862434774, clara.balsano@univaq.it %K children %K emotional health %K emergency department %K social robots %K anxiety %K stress %D 2022 %7 13.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Social robots (SRs) have been used for improving anxiety in children in stressful clinical situations, such as during painful procedures. However, no studies have yet been performed to assess their effect in children while waiting for emergency room consultations. Objective: This study aims to assess the impact of SRs on managing stress in children waiting for an emergency room procedure through the assessment of salivary cortisol levels. Methods: This was an open randomized clinical trial in children attending a pediatric emergency department. Children accessing the emergency room were randomized to 1 of 3 groups: (1) playing with a NAO SR, (2) playing with a study nurse, or (3) waiting with parents. The salivary cortisol levels of all children were measured through a swab. Salivary cortisol levels before and after the intervention were compared in the 3 groups. We calculated the effect size of our interventions through the Cohen d-based effect size correlation (r). Results: A total of 109 children aged 3-10 years were enrolled in the study, and 94 (86.2%) had complete data for the analyses. Salivary cortisol levels significantly decreased more in the group exposed to robot interaction than in the other two groups (r=0.75). Cortisol levels decreased more in girls (r=0.92) than in boys (r=0.57). Conclusions: SRs are efficacious in decreasing stress in children accessing the emergency room and may be considered a tool for improving emotional perceptions of children and their families in such a critical setting. Trial Registration: ClinicalTrials.gov NCT04627909; https://clinicaltrials.gov/ct2/show/study/NCT04627909 %M 34854814 %R 10.2196/29656 %U https://www.jmir.org/2022/1/e29656 %U https://doi.org/10.2196/29656 %U http://www.ncbi.nlm.nih.gov/pubmed/34854814 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e25466 %T Electrophysiological Brain Changes Associated With Cognitive Improvement in a Pediatric Attention Deficit Hyperactivity Disorder Digital Artificial Intelligence-Driven Intervention: Randomized Controlled Trial %A Medina,Rafael %A Bouhaben,Jaime %A de Ramón,Ignacio %A Cuesta,Pablo %A Antón-Toro,Luis %A Pacios,Javier %A Quintero,Javier %A Ramos-Quiroga,Josep Antoni %A Maestú,Fernando %+ Sincrolab Ltd, Prensa 7, Madrid, 28033, Spain, 34 630 364 425, nacho@sincrolab.es %K ADHD %K cognitive stimulation %K magnetoencephalography %K artificial intelligence %K Conners continuous performance test %K KAD_SCL_01 %K AI %K cognitive impairment %K attention deficit hyperactivity disorder %K pediatrics %K children %K rehabilitation %D 2021 %7 26.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive stimulation therapy appears to show promising results in the rehabilitation of impaired cognitive processes in attention deficit hyperactivity disorder. Objective: Encouraged by this evidence and the ever-increasing use of technology and artificial intelligence for therapeutic purposes, we examined whether cognitive stimulation therapy implemented on a mobile device and controlled by an artificial intelligence engine can be effective in the neurocognitive rehabilitation of these patients. Methods: In this randomized study, 29 child participants (25 males) underwent training with a smart, digital, cognitive stimulation program (KAD_SCL_01) or with 3 commercial video games for 12 weeks, 3 days a week, 15 minutes a day. Participants completed a neuropsychological assessment and a preintervention and postintervention magnetoencephalography study in a resting state with their eyes closed. In addition, information on clinical symptoms was collected from the child´s legal guardians. Results: In line with our main hypothesis, we found evidence that smart, digital, cognitive treatment results in improvements in inhibitory control performance. Improvements were also found in visuospatial working memory performance and in the cognitive flexibility, working memory, and behavior and general executive functioning behavioral clinical indexes in this group of participants. Finally, the improvements found in inhibitory control were related to increases in alpha-band power in all participants in the posterior regions, including 2 default mode network regions of the interest: the bilateral precuneus and the bilateral posterior cingulate cortex. However, only the participants who underwent cognitive stimulation intervention (KAD_SCL_01) showed a significant increase in this relationship. Conclusions: The results seem to indicate that smart, digital treatment can be effective in the inhibitory control and visuospatial working memory rehabilitation in patients with attention deficit hyperactivity disorder. Furthermore, the relation of the inhibitory control with alpha-band power changes could mean that these changes are a product of plasticity mechanisms or changes in the neuromodulatory dynamics. Trial Registration: ISRCTN Registry ISRCTN71041318; https://www.isrctn.com/ISRCTN71041318 %M 34842533 %R 10.2196/25466 %U https://www.jmir.org/2021/11/e25466 %U https://doi.org/10.2196/25466 %U http://www.ncbi.nlm.nih.gov/pubmed/34842533 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e31041 %T A Web-Based Risk-Reframing Intervention to Influence Early Childhood Educators’ Attitudes and Supportive Behaviors Toward Outdoor Play: Protocol for the OutsidePlay Study Randomized Controlled Trial %A Brussoni,Mariana %A Han,Christina S %A Jacob,John %A Munday,Fritha %A Zeni,Megan %A Walters,Melanie %A Cheng,Tina %A Schneeberg,Amy %A Fox,Emily %A Oberle,Eva %+ Department of Pediatrics, University of British Columbia, F511-4480 Oak St, Vancouver, BC, V6H 0B3, Canada, 1 604 875 3712, mbrussoni@bcchr.ubc.ca %K early years %K risky play %K teacher %K childcare %K early learning %K risk perception %K outdoor play %D 2021 %7 18.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Early learning and childcare centers (ELCCs) can offer young children critical opportunities for quality outdoor play. There are multiple actual and perceived barriers to outdoor play at ELCCs, ranging from safety fears and lack of familiarity with supporting play outdoors to challenges around diverse perspectives on outdoor play among early childhood educators (ECEs), administrators, licensing officers, and parents. Objective: Our study objective is to develop and evaluate a web-based intervention that influences ECEs’ and ELCC administrators’ perceptions and practices in support of children’s outdoor play at ELCCs. Methods: The development of the fully automated, open-access, web-based intervention was guided by the intervention mapping process. We first completed a needs assessment through focus groups of ECEs, ELCC administrators, and licensing officers. We identified key issues, needs, and challenges; opportunities to influence behavior change; and intervention outcomes and objectives. This enabled us to develop design objectives and identify features of the OutsidePlay web-based intervention that are central to addressing the issues, needs, and challenges of ECEs and ELCC administrators. We used social cognitive theory and behavior change techniques to select methods, applications, and technology to deliver the intervention. We will use a two-parallel-group randomized controlled trial (RCT) design to evaluate the efficacy of the intervention. We will recruit 324 ECEs and ELCC administrators through a variety of web-based means, including Facebook advertisements and mass emails through our partner networks. The RCT study will be a purely web-based trial where outcomes will be self-assessed through questionnaires. The RCT participants will be randomized into the intervention group or the control group. The control group participants will read the Position Statement on Active Outdoor Play. Results: The primary outcome is increased tolerance of risk in children’s play, as measured by the Teacher Tolerance of Risk in Play Scale. The secondary outcome is self-reported attainment of a self-developed behavior change goal. We will use mixed effects models to test the hypothesis that there will be a difference between the intervention and control groups with respect to tolerance of risk in children’s play. Differences in goal attainment will be tested using logistic regression analysis. Conclusions: The OutsidePlay web-based intervention guides users through a personalized journey that is split into 3 chapters. An effective intervention that addresses the barriers to outdoor play in ELCC settings has the potential to improve children’s access to outdoor play and support high-quality early childhood education. Trial Registration: ClinicalTrials.gov NCT04624932; https://clinicaltrials.gov/ct2/show/NCT04624932 International Registered Report Identifier (IRRID): DERR1-10.2196/31041 %M 34792479 %R 10.2196/31041 %U https://www.researchprotocols.org/2021/11/e31041 %U https://doi.org/10.2196/31041 %U http://www.ncbi.nlm.nih.gov/pubmed/34792479 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e29049 %T Clinical Characteristics of Children With COVID-19 in the United Arab Emirates: Cross-sectional Multicenter Study %A Ennab,Farah %A ElSaban,Mariam %A Khalaf,Eman %A Tabatabaei,Hanieh %A Khamis,Amar Hassan %A Devi,Bindu Radha %A Hanif,Kashif %A Elhassan,Hiba %A Saravanan,Ketharanathan %A Cremonesini,David %A Popatia,Rizwana %A Malik,Zainab %A Ho,Samuel B %A Abusamra,Rania %+ College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Al Razi St - Umm Hurair 2, Dubai Healthcare City, Dubai, United Arab Emirates, 971 563786236, rania.abdelkarim@mediclinic.ae %K pediatrics %K children %K COVID-19 %K SARS-CoV-2 %K United Arab Emirates %K viral shedding %K pandemic %K treatment %K outcomes %K clinical %K public heath %D 2021 %7 5.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: COVID-19 has infected over 123 million people globally. The first confirmed case in the United Arab Emirates (UAE) was 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. %M 34643535 %R 10.2196/29049 %U https://pediatrics.jmir.org/2021/4/e29049 %U https://doi.org/10.2196/29049 %U http://www.ncbi.nlm.nih.gov/pubmed/34643535 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e25745 %T Artificial Intelligence in Rehabilitation Targeting the Participation of Children and Youth With Disabilities: Scoping Review %A Kaelin,Vera C %A Valizadeh,Mina %A Salgado,Zurisadai %A Parde,Natalie %A Khetani,Mary A %+ Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 West Taylor Street, Room 316A, Chicago, IL, 60612-7250, United States, 1 312 996 0942, mkhetani@uic.edu %K health care %K pediatric rehabilitation %K technology %K young persons %K robotics %K human-machine interaction %K personalization %K customization %K goal-setting %K natural language processing %K machine learning %D 2021 %7 4.11.2021 %9 Review %J J Med Internet Res %G English %X Background: In the last decade, there has been a rapid increase in research on the use of artificial intelligence (AI) to improve child and youth participation in daily life activities, which is a key rehabilitation outcome. However, existing reviews place variable focus on participation, are narrow in scope, and are restricted to select diagnoses, hindering interpretability regarding the existing scope of AI applications that target the participation of children and youth in a pediatric rehabilitation setting. Objective: The aim of this scoping review is to examine how AI is integrated into pediatric rehabilitation interventions targeting the participation of children and youth with disabilities or other diagnosed health conditions in valued activities. Methods: We conducted a comprehensive literature search using established Applied Health Sciences and Computer Science databases. Two independent researchers screened and selected the studies based on a systematic procedure. Inclusion criteria were as follows: participation was an explicit study aim or outcome or the targeted focus of the AI application; AI was applied as part of the provided and tested intervention; children or youth with a disability or other diagnosed health conditions were the focus of either the study or AI application or both; and the study was published in English. Data were mapped according to the types of AI, the mode of delivery, the type of personalization, and whether the intervention addressed individual goal-setting. Results: The literature search identified 3029 documents, of which 94 met the inclusion criteria. Most of the included studies used multiple applications of AI with the highest prevalence of robotics (72/94, 77%) and human-machine interaction (51/94, 54%). Regarding mode of delivery, most of the included studies described an intervention delivered in-person (84/94, 89%), and only 11% (10/94) were delivered remotely. Most interventions were tailored to groups of individuals (93/94, 99%). Only 1% (1/94) of interventions was tailored to patients’ individually reported participation needs, and only one intervention (1/94, 1%) described individual goal-setting as part of their therapy process or intervention planning. Conclusions: There is an increasing amount of research on interventions using AI to target the participation of children and youth with disabilities or other diagnosed health conditions, supporting the potential of using AI in pediatric rehabilitation. On the basis of our results, 3 major gaps for further research and development were identified: a lack of remotely delivered participation-focused interventions using AI; a lack of individual goal-setting integrated in interventions; and a lack of interventions tailored to individually reported participation needs of children, youth, or families. %M 34734833 %R 10.2196/25745 %U https://www.jmir.org/2021/11/e25745 %U https://doi.org/10.2196/25745 %U http://www.ncbi.nlm.nih.gov/pubmed/34734833 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e26957 %T Clustering of Hypoglycemia Events in Patients With Hyperinsulinism: Extension of the Digital Phenotype Through Retrospective Data Analysis %A Worth,Chris %A Harper,Simon %A Salomon-Estebanez,Maria %A O'Shea,Elaine %A Nutter,Paul W %A Dunne,Mark J %A Banerjee,Indraneel %+ Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, United Kingdom, 44 07837740913, christophersimon.worth@mft.nhs.uk %K hyperinsulinism %K continuous glucose monitoring %K digital phenotype %K hypoglycemia %K nocturnal hypoglycemia %D 2021 %7 29.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Hyperinsulinism (HI) due to excess and dysregulated insulin secretion is the most common cause of severe and recurrent hypoglycemia in childhood. High cerebral glucose use in the early hours results in a high risk of hypoglycemia in people with diabetes and carries a significant risk of brain injury. Prevention of hypoglycemia is the cornerstone of the management of HI, but the risk of hypoglycemia at night or the timing of hypoglycemia in children with HI has not been studied; thus, the digital phenotype remains incomplete and management suboptimal. Objective: This study aims to quantify the timing of hypoglycemia in patients with HI to describe glycemic variability and to extend the digital phenotype. This will facilitate future work using computational modeling to enable behavior change and reduce exposure of patients with HI to injurious hypoglycemic events. Methods: Patients underwent continuous glucose monitoring (CGM) with a Dexcom G4 or G6 CGM device as part of their clinical assessment for either HI (N=23) or idiopathic ketotic hypoglycemia (IKH; N=24). The CGM data were analyzed for temporal trends. Hypoglycemia was defined as glucose levels <3.5 mmol/L. Results: A total of 449 hypoglycemic events totaling 15,610 minutes were captured over 237 days from 47 patients (29 males; mean age 70 months, SD 53). The mean length of hypoglycemic events was 35 minutes. There was a clear tendency for hypoglycemia in the early hours (3-7 AM), particularly for patients with HI older than 10 months who experienced hypoglycemia 7.6% (1480/19,370 minutes) of time in this period compared with 2.6% (2405/92,840 minutes) of time outside this period (P<.001). This tendency was less pronounced in patients with HI who were younger than 10 months, patients with a negative genetic test result, and patients with IKH. Despite real-time CGM, there were 42 hypoglycemic events from 13 separate patients with HI lasting >30 minutes. Conclusions: This is the first study to have taken the first step in extending the digital phenotype of HI by describing the glycemic trends and identifying the timing of hypoglycemia measured by CGM. We have identified the early hours as a time of high hypoglycemia risk for patients with HI and demonstrated that simple provision of CGM data to patients is not sufficient to eliminate hypoglycemia. Future work in HI should concentrate on the early hours as a period of high risk for hypoglycemia and must target personalized hypoglycemia predictions. Focus must move to the human-computer interaction as an aspect of the digital phenotype that is susceptible to change rather than simple mathematical modeling to produce small improvements in hypoglycemia prediction accuracy. %M 34435596 %R 10.2196/26957 %U https://www.jmir.org/2021/10/e26957 %U https://doi.org/10.2196/26957 %U http://www.ncbi.nlm.nih.gov/pubmed/34435596 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29441 %T Characteristics of Acute Childhood Illness Apps for Parents: Environmental Scan %A Benoit,James %A Hartling,Lisa %A Chan,Michelle %A Scott,Shannon %+ Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 4-472 Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, AB, T6G 1C9, Canada, 1 780 492 6124, hartling@ualberta.ca %K internet %K mHealth %K mobile health %K digital health %K ehealth %K app %K mobile application %K Android %K Apple %K marketplace %K environmental scan %K review %K acute childhood illness %K knowledge translation %K child %K parent %K caregiver %K mobile phone %D 2021 %7 19.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Providing parents with resources that aid in the identification and management of acute childhood illnesses helps those parents feel better equipped to assess their children’s health and significantly changes parental health-seeking behaviors. Some of these resources are limited by accessibility and scalability. Remote locations and staffing limitations create challenges for parents aiming to access their child’s health information. Mobile health apps offer a scalable, accessible solution for improving health literacy by enabling access to health information through mobile devices.  Objective: The aim of our study is to create an inventory of acute childhood illness apps that are available to North American parents and caregivers, assess their quality, and identify the areas in which future apps can be improved. Methods: We conducted an environmental scan to identify and summarize app information for parents and digital health researchers. The Google and Apple app marketplaces were used as search platforms. We built a list of search terms and searched the platforms for apps targeted at parents and related to acute pediatric illnesses in the United States and Canada. We assessed apps meeting the inclusion criteria using the Mobile App Rating Scale (MARS), a validated tool for assessing the quality of health apps. The MARS examines apps on 5 subscales: engagement, functionality, aesthetics, information quality, and subjective quality. Data were analyzed by MARS subscale averages and individual item scores. Results: Overall, 650 unique apps were screened, and 53 (8.2%) were included. On a scale of 1-5, apps had an average engagement score of 2.82/5 (SD 0.86), functionality score of 3.98/5 (SD 0.72), aesthetics score of 3.09/5 (SD 0.87), information quality score of 2.73/5 (SD 1.32), and subjective quality score of 2.20/5 (SD 0.79). On the same scale of 1-5, app scores ranged from 2.2/5 to 4.5/5 (mean 3.2, SD 0.6). The top 3 MARS-scored apps were Baby and Child First Aid (4.5/5), Ada (4.5/5), and HANDi Paediatric (4.2/5). Taken together, the top 3 apps covered topics of emergency pediatric first aid, identification of (and appropriate response to) common childhood illnesses, a means of checking symptoms, and a means of responding to emergency situations. There was a lack of Canadian-based app content available to parents in both marketplaces; this space was filled with content originating primarily in the United Kingdom and the United States. In addition, published evidence of the impact of the included apps was poor: of 53 apps, only 5 (9%) had an evidence base showing that the app had been trialed for usability or efficacy. Conclusions: There is a need for evidence-based acute childhood illness apps of Canadian origin. This environmental scan offers a comprehensive picture of the health app landscape by examining trends in acute childhood illness apps that are readily available to parents and by identifying gaps in app design. %M 34665144 %R 10.2196/29441 %U https://www.jmir.org/2021/10/e29441 %U https://doi.org/10.2196/29441 %U http://www.ncbi.nlm.nih.gov/pubmed/34665144 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e29899 %T Augmented Reality in Pediatric Septic Shock Simulation: Randomized Controlled Feasibility Trial %A Toto,Regina L %A Vorel,Ethan S %A Tay,Khoon-Yen E %A Good,Grace L %A Berdinka,Jesse M %A Peled,Adam %A Leary,Marion %A Chang,Todd P %A Weiss,Anna K %A Balamuth,Frances B %+ Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, United States, 1 2155901000, totor@chop.edu %K augmented reality %K simulation %K septic shock %K children %K pediatrics %K simulation-based education %K application %K fluid administration %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Septic shock is a low-frequency but high-stakes condition in children requiring prompt resuscitation, which makes it an important target for simulation-based education. Objective: In this study, we aimed to design and implement an augmented reality app (PediSepsisAR) for septic shock simulation, test the feasibility of measuring the timing and volume of fluid administration during septic shock simulation with and without PediSepsisAR, and describe PediSepsisAR as an educational tool. We hypothesized that we could feasibly measure our desired data during the simulation in 90% of the participants in each group. With regard to using PediSepsisAR as an educational tool, we hypothesized that the PediSepsisAR group would report that it enhanced their awareness of simulated patient blood flow and would more rapidly verbalize recognition of abnormal patient status and desired management steps. Methods: We performed a randomized controlled feasibility trial with a convenience sample of pediatric care providers at a large tertiary care pediatric center. Participants completed a prestudy questionnaire and were randomized to either the PediSepsisAR or control (traditional simulation) arms. We measured the participants’ time to administer 20, 40, and 60 cc/kg of intravenous fluids during a septic shock simulation using each modality. In addition, facilitators timed how long participants took to verbalize they had recognized tachycardia, hypotension, or septic shock and desired to initiate the sepsis pathway and administer antibiotics. Participants in the PediSepsisAR arm completed a poststudy questionnaire. We analyzed data using descriptive statistics and a Wilcoxon rank-sum test to compare the median time with event variables between groups. Results: We enrolled 50 participants (n=25 in each arm). The timing and volume of fluid administration were captured in all the participants in each group. There was no statistically significant difference regarding time to administration of intravenous fluids between the two groups. Similarly, there was no statistically significant difference between the groups regarding time to verbalized recognition of patient status or desired management steps. Most participants in the PediSepsisAR group reported that PediSepsisAR enhanced their awareness of the patient’s perfusion. Conclusions: We developed an augmented reality app for use in pediatric septic shock simulations and demonstrated the feasibility of measuring the volume and timing of fluid administration during simulation using this modality. In addition, our findings suggest that PediSepsisAR may enhance participants’ awareness of abnormal perfusion. %M 34612836 %R 10.2196/29899 %U https://mededu.jmir.org/2021/4/e29899 %U https://doi.org/10.2196/29899 %U http://www.ncbi.nlm.nih.gov/pubmed/34612836 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30582 %T Pediatric Chronic Critical Illness: Protocol for a Scoping Review %A Zorko,David %A McNally,James Dayre %A Rochwerg,Bram %A Pinto,Neethi %A Couban,Rachel %A O’Hearn,Katie %A Choong,Karen %+ Department of Pediatrics, McMaster University, Room 3E20, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada, 1 905 521 2100 ext 76651, david.zorko@medportal.ca %K pediatrics %K critical care %K intensive care units %K chronic critical illness %K research design %D 2021 %7 1.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Improvements in the delivery of intensive care have increased survival among even the most critically ill children, thereby leading to a growing number of children with chronic complex medical conditions in the pediatric intensive care unit (PICU). Some of these children are at a significant risk of recurrent and prolonged critical illness, with higher morbidity and mortality, making them a unique population described as having chronic critical illness (CCI). To date, pediatric CCI has been understudied and lacks an accepted consensus case definition. Objective: This study aims to describe the protocol and methodology used to perform a scoping review that will describe how pediatric CCI has been defined in the literature, including the concept of prolonged PICU admission and the methodologies used to develop any existing definitions. It also aims to describe patient characteristics and outcomes evaluated in the included studies. Methods: We will search four electronic databases for studies that evaluated children admitted to any PICU identified with CCI. We will also search for studies describing prolonged PICU admission, as this concept is related to pediatric CCI. Furthermore, we will develop a hybrid crowdsourcing and machine learning (ML) methodology to complete citation screening. Screening and data abstraction will be performed by 2 reviewers independently and in duplicate. Data abstraction will include the details of population definitions, demographic and clinical characteristics of children with CCI, and evaluated outcomes. Results: The database search, crowd reviewer recruitment, and ML algorithm development began in March 2021. Citation screening and data abstraction were completed in April 2021. Final data verification is ongoing, with analysis and results anticipated to be completed by fall 2021. Conclusions: This scoping review will describe the existing or suggested definitions of pediatric CCI and important demographic and clinical characteristics of patients to whom these definitions have been applied. This review’s results will help inform the development of a consensus case definition for pediatric CCI and set a priority agenda for future research. We will use and demonstrate the validity of crowdsourcing and ML methodologies for improving the efficiency of large scoping reviews. International Registered Report Identifier (IRRID): DERR1-10.2196/30582 %M 34596576 %R 10.2196/30582 %U https://www.researchprotocols.org/2021/10/e30582 %U https://doi.org/10.2196/30582 %U http://www.ncbi.nlm.nih.gov/pubmed/34596576 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28345 %T Automated Size Recognition in Pediatric Emergencies Using Machine Learning and Augmented Reality: Within-Group Comparative Study %A Schmucker,Michael %A Haag,Martin %+ GECKO Institute, Heilbronn University of Applied Sciences, Max-Planck-Str 39, Heilbronn, 74074, Germany, 49 1757581477, michael.schmucker@hs-heilbronn.de %K resuscitation %K emergency medicine %K mobile applications %K mobile phone %K user-computer interface %K augmented reality %K machine learning %D 2021 %7 20.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Pediatric emergencies involving children are rare events, and the experience of emergency physicians and the results of such emergencies are accordingly poor. Anatomical peculiarities and individual adjustments make treatment during pediatric emergency susceptible to error. Critical mistakes especially occur in the calculation of weight-based drug doses. Accordingly, the need for a ubiquitous assistance service that can, for example, automate dose calculation is high. However, few approaches exist due to the complexity of the problem. Objective: Technically, an assistance service is possible, among other approaches, with an app that uses a depth camera that is integrated in smartphones or head-mounted displays to provide a 3D understanding of the environment. The goal of this study was to automate this technology as much as possible to develop and statistically evaluate an assistance service that does not have significantly worse measurement performance than an emergency ruler (the state of the art). Methods: An assistance service was developed that uses machine learning to recognize patients and then automatically determines their size. Based on the size, the weight is automatically derived, and the dosages are calculated and presented to the physician. To evaluate the app, a small within-group design study was conducted with 17 children, who were each measured with the app installed on a smartphone with a built-in depth camera and a state-of-the-art emergency ruler. Results: According to the statistical results (one-sample t test; P=.42; α=.05), there is no significant difference between the measurement performance of the app and an emergency ruler under the test conditions (indoor, daylight). The newly developed measurement method is thus not technically inferior to the established one in terms of accuracy. Conclusions: An assistance service with an integrated augmented reality emergency ruler is technically possible, although some groundwork is still needed. The results of this study clear the way for further research, for example, usability testing. %M 34542416 %R 10.2196/28345 %U https://formative.jmir.org/2021/9/e28345 %U https://doi.org/10.2196/28345 %U http://www.ncbi.nlm.nih.gov/pubmed/34542416 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e27855 %T Assessment of the Feasibility, Acceptability, and Impact of Implementing Seasonal Malaria Chemoprevention in Nampula Province, Mozambique: Protocol for a Hybrid Effectiveness-Implementation Study %A Wharton-Smith,Alexandra %A Baker,Kevin %A Roca-Feltrer,Arantxa %A Rodrigues,Maria %A Richardson,Sol %A Bonnington,Craig A %A Rassi,Christian %A Marasciulo,Madeleine %A Enosse,Sonia %A Saute,Francisco %A Aide,Pedro %A Macete,Eusebio %A Candrinho,Baltazar %+ Malaria Consortium, The Green House 244-254 Cambridge Heath Road, London, E2 9DA, United Kingdom, 44 (0)20 35596431, k.baker@malariaconsortium.org %K malaria %K seasonal malaria chemoprevention %K sulfadoxine-pyrimethamine amodiaquine %K resistance %K children under five %K implementation research %K Mozambique %K Africa %K mobile phone %D 2021 %7 15.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Malaria is a significant cause of morbidity and mortality in children aged under 5 years in Mozambique. The World Health Organization recommends seasonal malaria chemoprevention (SMC), the administration of four monthly courses of sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ), to children aged 3-59 months during rainy season. However, as resistance to SP is widespread in East and Southern Africa, SMC has so far only been implemented across the Sahel in West Africa. Objective: This protocol describes the first phase of a pilot project that aims to assess the protective effect of SP and AQ when used for SMC and investigate the levels of molecular markers of resistance of Plasmodium falciparum to antimalarial medicines in the study districts. In addition, it is important to understand whether SMC is a feasible and acceptable intervention in the context of Nampula Province, Mozambique. Methods: This study will adopt a hybrid effectiveness-implementation design to conduct a mixed methods evaluation with six objectives: a molecular marker study, a nonrandomized controlled trial, an analysis of reported malaria morbidity indicators, a documentation exercise of the contextual SMC adaptation, an acceptability and feasibility assessment, and a coverage and quality assessment. Results: Ethical approval for this study was granted by the Mozambican Ministry of Health National Bioethics Committee on September 15, 2020. Data collection began in October 2020, and data analysis is expected to be completed by August 2021. Conclusions: This research will make a unique contribution to our understanding of whether the combination of SP and AQ, when used for SMC, can confer a protective effect against malaria in children aged 3-59 months in a region where malaria transmission is seasonal and SP resistance is expected to be high. If the project is successful, subsequent phases are expected to provide a more comprehensive assessment of the effectiveness and sustainability of SMCs. International Registered Report Identifier (IRRID): DERR1-10.2196/27855 %M 34524109 %R 10.2196/27855 %U https://www.researchprotocols.org/2021/9/e27855 %U https://doi.org/10.2196/27855 %U http://www.ncbi.nlm.nih.gov/pubmed/34524109 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e28619 %T Mucopolysaccharidosis Type I Disease Prevalence Among Patients With Idiopathic Short Stature in Saudi Arabia: Protocol for a Multicenter Cross-sectional Study %A Alsafadi,Danyah %A Ezzat,Aly %A Altamimi,Fatima %A ElBagoury,Marwan %A Olfat,Mohammed %A Saleh,Mohammed %A Roushdy,Sherif %A Aktham,Yahia %+ Medical Affairs Department, Sanofi-Genzyme, Gate C, 2nd floor, Nojoud Center, Tahlia St, Jeddah, Saudi Arabia, 966 544271984, marwanessam@hotmail.com %K mucopolysaccharidosis %K lysosomal storage disorders %K epidemiology %K Saudi Arabia %D 2021 %7 31.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Since the underlying cause of idiopathic short stature can indeed be undiagnosed mucopolysaccharidosis type I, it is critical to identify patients with mucopolysaccharidosis type I among screened patients with idiopathic short stature. Objective: The primary objective of this study is to determine the prevalence of mucopolysaccharidosis type I disease in a high-risk group (ie, patients with idiopathic short stature). Methods: We plan to perform a multicenter, cross-sectional screening study to primarily assess the prevalence of mucopolysaccharidosis type I disease in patients with idiopathic short stature. All eligible patients will be tested after obtaining written informed consent from their parents and guardians. Eligible patients will be recruited over 18 months from specialty care centers for pediatrics and genetics. Results: This protocol was approved by the Institutional Review Board of King Fahd Medical City and funded by Sanofi Genzyme Saudi Arabia. We expect to collect data from ≥800 patients, as determined by our sample size calculation. Conclusions: Saudi Arabia is the largest country in the Arabian Peninsula; it has a population of more than 28 million people. To date, there are no reliable data regarding the incidence and prevalence of mucopolysaccharidosis type I in Saudi Arabia; therefore, future multicenter studies will be needed. Further, the prevalence of an attenuated form of mucopolysaccharidosis type I is largely underestimated in Saudi Arabia due to the absence of an effective newborn screening program. Therefore, the implementation of a nationwide newborn screening program is essential for the accurate estimation of the burden of mucopolysaccharidosis and the early diagnosis of patients. International Registered Report Identifier (IRRID): PRR1-10.2196/28619 %M 34463634 %R 10.2196/28619 %U https://www.researchprotocols.org/2021/8/e28619 %U https://doi.org/10.2196/28619 %U http://www.ncbi.nlm.nih.gov/pubmed/34463634 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e25873 %T Analysis of Social Determinants and the Utilization of Pediatric Tele–Urgent Care During the COVID-19 Pandemic: Cross-sectional Study %A Khairat,Saif %A McDaniel,Phillip %A Jansen,Matthew %A Francis,Tia %A Edson,Barbara %A Gianforcaro,Robert %+ Cecil G. Sheps Center for Health Services Research, 725 M.L.K. Jr Blvd, Chapel Hill, NC, 27516, United States, 1 9198435413, saif@unc.edu %K telehealth %K pediatrics %K social %K determinants %K COVID-19 %K use %K children %K infant %K consultation %K telemedicine %K urgent care %K vulnerable population %K cross-sectional %K minority %D 2021 %7 30.8.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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. %M 34459742 %R 10.2196/25873 %U https://pediatrics.jmir.org/2021/3/e25873 %U https://doi.org/10.2196/25873 %U http://www.ncbi.nlm.nih.gov/pubmed/34459742 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e30861 %T Comparison of the Differences Between Web-Based and Traditional Questionnaire Surveys in Pediatrics: Comparative Survey Study %A Fang,Heping %A Xian,Ruoling %A Ma,Zhuoying %A Lu,Mingyue %A Hu,Yan %+ Department of Child Health Care, Children’s Hospital of Chongqing Medical University, No.136, 2nd Zhongshan Road, Yuzhong District, Chongqing, , China, 86 023 63622764, hy420@126.com %K pediatrics %K survey %K questionnaire %K web survey %K comparative study %D 2021 %7 26.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A web-based survey is a novel method for data capture. Some studies have applied web-based surveys in pediatrics, but few of them have reported data on the differences between web-based and traditional questionnaire surveys. Objective: The objective of our study was to evaluate the internal consistency of a web-based survey and compare it with a traditional questionnaire survey in pediatrics. Methods: A convenience sample of caregivers was invited to participate in the survey on feeding patterns and their children’s eating behaviors if their children were aged 2 to 7 years. A web-based survey and a traditional questionnaire survey were carried out between October 2018 and July 2019. A total of 1085 caregivers were involved in this study, and they were divided into the following three groups based on methods and sources: (1) web-based survey from a web source, (2) web-based survey from a hospital source, and (3) traditional questionnaire survey from a hospital source. The data were then compared and analyzed. Results: A total of 735 caregivers participated in the web-based survey and 350 caregivers participated in the traditional questionnaire survey, and 816 cases were then included in the analyses after data processing. The effective rate of the web-based survey was 70.1% (515/735), and the completeness rate of the traditional questionnaire survey was 86.0% (301/350). There were no significant differences between web-based surveys from different sources. However, demographic characteristics were significantly different between the web-based and traditional questionnaire surveys, mainly in terms of age and caregivers (χ²4=16.509, P=.002 and χ²4=111.464, P<.001, respectively). Caregivers of children aged 2 to 3 years and grandparents were more likely to respond to the web-based survey. Age-specific stratified analysis showed that the score of “monitoring” and the reporting rate of “poor appetite” in children aged 2 to 3 years were significantly higher in the web-based survey compared to the traditional questionnaire survey after adjusting for demographic characteristics. Conclusions: A web-based survey could be a feasible tool in pediatric studies. However, differences in demographic characteristics and their possible impacts on the results should be considered in the analyses. %M 34319240 %R 10.2196/30861 %U https://www.jmir.org/2021/8/e30861 %U https://doi.org/10.2196/30861 %U http://www.ncbi.nlm.nih.gov/pubmed/34319240 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e22784 %T 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 %A Siedlikowski,Maia %A Curiale,Lianna %A Rauch,Frank %A Tsimicalis,Argerie %+ Ingram School of Nursing, McGill University, 680 Sherbrooke West, Suite #1800 Room 1835, Montreal, QC, H3A 2M7, Canada, 1 514 770 6069, argerie.tsimicalis@mcgill.ca %K child health %K symptom assessment %K communication %K mobile applications %K software %D 2021 %7 10.8.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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. %M 34383677 %R 10.2196/22784 %U https://pediatrics.jmir.org/2021/3/e22784 %U https://doi.org/10.2196/22784 %U http://www.ncbi.nlm.nih.gov/pubmed/34383677 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e26040 %T Pediatric Coping During Venipuncture With Virtual Reality: Pilot Randomized Controlled Trial %A Canares,Therese %A Parrish,Carisa %A Santos,Christine %A Badawi,Alia %A Stewart,Alyssa %A Kleinman,Keith %A Psoter,Kevin %A McGuire,Joseph %+ Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, 1800 Orleans Street Suite G1509, Baltimore, MD, 21287-0010, United States, 1 4439964711, tcanare1@jhmi.edu %K pediatrics %K psychological distress %K virtual reality %K procedural pain %K anxiety %K phlebotomy %D 2021 %7 28.7.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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 %M 34319249 %R 10.2196/26040 %U https://pediatrics.jmir.org/2021/3/e26040 %U https://doi.org/10.2196/26040 %U http://www.ncbi.nlm.nih.gov/pubmed/34319249 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e24791 %T A Global Overview of COVID-19 Research in the Pediatric Field: Bibliometric Review %A Monzani,Alice %A Tagliaferri,Francesco %A Bellone,Simonetta %A Genoni,Giulia %A Rabbone,Ivana %+ Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy, 39 03213733868, alice.monzani@med.uniupo.it %K COVID-19 %K SARS-CoV-2 %K children %K pediatrics %K bibliometric review %K publications %K research %K literature %K review %D 2021 %7 23.7.2021 %9 Review %J JMIR Pediatr Parent %G English %X 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. %M 34081597 %R 10.2196/24791 %U https://pediatrics.jmir.org/2021/3/e24791 %U https://doi.org/10.2196/24791 %U http://www.ncbi.nlm.nih.gov/pubmed/34081597 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e23242 %T Using Social Media for the Prevention of Pediatric Burn Injuries: Pilot Design and Usability Study %A Batra,Nikita %A Colson,Cindy D %A Alberto,Emily C %A Burd,Randall S %+ Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, United States, 1 202 476 2151, rburd@cnmc.org %K accident prevention %K burns %K pediatric %K public health %K social media %D 2021 %7 15.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Most pediatric burn injuries are preventable. Social media is an effective method for delivering large-scale messaging and may be useful for injury prevention in this domain. Objective: This study evaluates the feasibility of creating a social media campaign for pediatric burn injury prevention. Methods: Ad spots containing a headline, short introduction, and video were created and posted on Facebook and Instagram over 4 months. Ad spots were targeted to parents and caregivers of children in our region with the highest number of burn injuries. We assessed the impact of each ad set using ThruPlays, reach, and video plays. Results: We created 55 ad spots, with an average length of 24.1 (range 10-44) seconds. We reached 26,496 people during the campaign. The total ThruPlays of the 55 ad spots were 14,460 at US $0.19 per ThruPlay. Ad spots related to home safety had a significantly higher daily ThruPlay rate than those related to fire safety (6.5 vs 0.5 per day; P<.001). Conclusions: Social media is a feasible modality for delivering public health messages focused on preventing pediatric burn injuries. Engagement with these ads is influenced by ad presentation and the focus of the underlying injury prevention message. %M 34264194 %R 10.2196/23242 %U https://formative.jmir.org/2021/7/e23242 %U https://doi.org/10.2196/23242 %U http://www.ncbi.nlm.nih.gov/pubmed/34264194 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 2 %P e27075 %T Surgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review %A Maleki,Arash %A Qoreishy,Seyyed Mohammad %A Bahrami,Mohammad Nabi %+ Orthopedic Department, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, Iran, 98 9178851457, mnabibahrami1364@gmail.com %K surgical treatment %K Legg-Calvé-Perthes disease %K pediatric %K hip %K treatment outcome %D 2021 %7 3.5.2021 %9 Review %J Interact J Med Res %G English %X Background: Legg-Calvé-Perthes disease (LCPD) is a common public health problem that usually occurs between the ages of 4 and 8 years, but it can occur between the ages of 2 and 15 years. This condition occurs due to the interruption of blood supply to the femoral head. Up to now, different surgical and nonsurgical treatments, including femoral varus osteotomy, innominate osteotomy, pelvic osteotomies, triple osteotomy, Chiari osteotomy, and shelf acetabuloplasty, have been suggested for noncontainable LCPD hips. Objective: The aim of this comprehensive review was to investigate the various surgical techniques used for LCPD. Methods: An advanced electronic search of the English-language literature was performed from October 8 to 14, 2020. The electronic databases PubMed, MEDLINE, Web of Science, Embase, Ovid, and Google scholar were searched using appropriate search terms. A manual search of references also was performed. After retrieving the studies, duplicates were removed, and the remining studies were screened based on the title, abstract, and full text. The quality of the selected articles was assessed, and the required data were extracted from eligible articles. Results: A total of 22 studies were included in the review. Based on the results of the reviewed studies, there are three main factors that influence the treatment outcomes in patients with Perthes disease. These factors are onset age, femoral head involvement severity, and treatment method. The disease has a poor prognosis in children over 8 years old, but this group of patients can also benefit from advanced surgical methods. In patients aged less than 6 years, the disease has a generally good prognosis, but in those aged between 6 and 8 years, its prognosis is variable. Thus, the need for surgical intervention requires close observation of signs. Once any head signs are observed, dynamic arthrography is beneficial before choosing the treatment approach. Conclusions: This review provides clinicians with a brief guideline for the treatment of patients with LCPD. %M 33938444 %R 10.2196/27075 %U https://www.i-jmr.org/2021/2/e27075 %U https://doi.org/10.2196/27075 %U http://www.ncbi.nlm.nih.gov/pubmed/33938444 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 2 %P e25054 %T Impact of an Educational Comic to Enhance Patient-Physician–Electronic Health Record Engagement: Prospective Observational Study %A Alkureishi,Maria A %A Johnson,Tyrone %A Nichols,Jacqueline %A Dhodapkar,Meera %A Czerwiec,M K %A Wroblewski,Kristen %A Arora,Vineet M %A Lee,Wei Wei %+ Department of Academic Pediatrics, University of Chicago, 5841 S Maryland Ave, MC 6082 Rm C124, Chicago, IL, 60637, United States, 1 773 834 8927, malkureishi@peds.bsd.uchicago.edu %K electronic health records %K patient %K comic %K education %K engagement %D 2021 %7 28.4.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Electronic health record (EHR) use can impede or augment patient-physician communication. However, little research explores the use of an educational comic to improve patient-physician-EHR interactions. Objective: To evaluate the impact of an educational comic on patient EHR self-advocacy behaviors to promote patient engagement with the EHR during clinic visits. Methods: We conducted a prospective observational study with adult patients and parents of pediatric patients at the University of Chicago General Internal Medicine (GIM) and Pediatric Primary Care (PPC) clinics. We developed an educational comic highlighting EHR self-advocacy behaviors and distributed it to study participants during check-in for their primary care visits between May 2017 and May 2018. Participants completed a survey immediately after their visit, which included a question on whether they would be interested in a follow-up telephone interview. Of those who expressed interest, 50 participants each from the adult and pediatric parent cohorts were selected at random for follow-up telephone interviews 8 months (range 3-12 months) post visit. Results: Overall, 71.0% (115/162) of adult patients and 71.6% (224/313) of pediatric parents agreed the comic encouraged EHR involvement. African American and Hispanic participants were more likely to ask to see the screen and become involved in EHR use due to the comic (adult P=.01, P=.01; parent P=.02, P=.006, respectively). Lower educational attainment was associated with an increase in parents asking to see the screen and to be involved (ρ=−0.18, P=.003; ρ=−0.19, P<.001, respectively) and in adults calling for physician attention (ρ=−0.17, P=.04), which was confirmed in multivariate analyses. Female GIM patients were more likely than males to ask to be involved (median 4 vs 3, P=.003). During follow-up phone interviews, 90% (45/50) of adult patients and all pediatric parents (50/50) remembered the comic. Almost half of all participants (GIM 23/50, 46%; PPC 21/50, 42%) recalled at least one best-practice behavior. At subsequent visits, adult patients reported increases in asking to see the screen (median 3 vs 4, P=.006), and pediatric parents reported increases in asking to see the screen and calling for physician attention (median 3 vs 4, Ps<.001 for both). Pediatric parents also felt that the comic had encouraged them to speak up and get more involved with physician computer use since the index visit (median 4 vs 4, P=.02) and that it made them feel more empowered to get involved with computer use at future visits (median 3 vs 4, P<.001). Conclusions: Our study found that an educational comic may improve patient advocacy for enhanced patient-physician-EHR engagement, with higher impacts on African American and Hispanic patients and patients with low educational attainment. %M 33908891 %R 10.2196/25054 %U https://humanfactors.jmir.org/2021/2/e25054 %U https://doi.org/10.2196/25054 %U http://www.ncbi.nlm.nih.gov/pubmed/33908891 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23087 %T Informatics Methodology Used in the Web-Based Portal of the NASCITA Cohort Study: Development and Implementation Study %A Zanetti,Michele %A Clavenna,Antonio %A Pandolfini,Chiara %A Pansieri,Claudia %A Calati,Maria Grazia %A Cartabia,Massimo %A Miglio,Daniela %A Bonati,Maurizio %+ Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milan, 20156, Italy, 39 02 3901 4478, chiara.pandolfini@marionegri.it %K internet %K computer systems %K cohort studies %K pediatricians %K infant %K newborn %D 2021 %7 12.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many diseases occurring in adults can be pinned down to early childhood and birth cohorts are the optimal means to study this connection. Birth cohorts have contributed to the understanding of many diseases and their risk factors. Objective: To improve the knowledge of the health status of Italian children early on and how it is affected by social and health determinants, we set up a longitudinal, prospective, national-level, population-based birth cohort, the NASCITA study (NAscere e creSCere in ITAlia). The main aim of this cohort is to evaluate physical, cognitive, and psychological development; health status; and health resource use in the first 6 years of life in newborns, and potential associated factors. A web-based system was set up with the aim to host the cohort; provide ongoing information to pediatricians and to families; and facilitate accurate data input, monitoring, and analysis. This article describes the informatics methodology used to set up and maintain the NASCITA cohort with its web-based platform, and provides a general description of the data on children aged over 7 months. Methods: Family pediatricians were contacted for participation in the cohort and enrolled newborns from April 2019 to July 2020 at their first well-child visit. Information collected included basic data that are part of those routinely collected by the family pediatricians, but also parental data, such as medical history, characteristics and lifestyle, and indoor and outdoor environment. A specific web portal for the NASCITA cohort study was developed and an electronic case report form for data input was created and tested. Interactive data charts, including growth curves, are being made available to pediatricians with their patients’ data. Newsletters covering the current biomedical literature on child cohorts are periodically being put up for pediatricians, and, for parents, evidence-based information on common illnesses and problems in children. Results: The entire cohort population consists of 5166 children, with 139 participating pediatricians, distributed throughout Italy. The number of children enrolled per pediatrician ranged from 1 to 100. The 5166 enrolled children represent 66.55% (5166/7763) of the children born in all of 2018 covered by the same pediatricians participating in the cohort. The number of children aged over 7 months at the time of these analyses, and for whom the most complete data were available upon initial analyses, was 4386 (2226/4381 males [50.81%] and 142/4370 twins [3.25%]). The age of the mothers at birth of the 4386 children ranged from 16 to 54 years. Most newborns’ mothers (3758/4367, 86.05%) were born in Italy, followed by mothers born in Romania (101/4367, 2.31%), Albania (75/4367, 1.72%), and Morocco (60/4367, 1.37%). Concerning the newborns, 138/4386 (3.15%) were born with malformations and 352/4386 (8.03%) had a disease, most commonly neonatal respiratory distress syndrome (n=52), neonatal jaundice (n=46), and neonatal hypoglycemia (n=45). Conclusions: The NASCITA cohort is well underway and the population size will permit significant conclusions to be drawn. The key role of pediatricians in obtaining clinical data directly, along with the national-level representativity, will make the findings even more solid. In addition to promoting accurate data input, the multiple functions of the web portal, with its interactive platform, help maintain a solid relationship with the pediatricians and keep parents informed and interested in participating. Trial Registration: ClinicalTrials.gov NCT03894566; https://clinicaltrials.gov/ct2/show/NCT03894566 %M 33709930 %R 10.2196/23087 %U https://www.jmir.org/2021/3/e23087 %U https://doi.org/10.2196/23087 %U http://www.ncbi.nlm.nih.gov/pubmed/33709930 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e22948 %T Extreme Prematurity and Pulmonary Outcomes Program in Saitama: Protocol for a Prospective Multicenter Cohort Study in Japan %A Namba,Fumihiko %A Tanaka,Kosuke %A Omori,Sayu %A Ikeda,Kazushige %A Kawabata,Ken %A Sato,Hiroaki %A Honda,Masakazu %A Ichikawa,Tomonori %A Minosaki,Yoshihiro %A Michikawa,Takehiro %A Oka,Shuntaro %A Kabe,Kazuhiko %+ Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Saitama, 350-8550, Japan, 81 49 228 3727, nambaf@saitama-med.ac.jp %K prematurity %K preterm infant %K bronchopulmonary dysplasia %K respiratory outcome %D 2021 %7 5.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Because of the improvements in survival rates for preterm infants, not only the rates of bronchopulmonary dysplasia (BPD) but also those of long-term respiratory complications of premature birth are increasing, resulting in financial and health burdens in developed countries. Thus far, the risk factors of respiratory morbidities in extremely preterm infants remain unknown. Furthermore, the definition and the predictive ability of BPD for long-term respiratory outcomes are yet to be determined. Objective: The objective of our study, Extreme Prematurity and Pulmonary Outcomes Program in Saitama, is to develop the diagnostic criteria for BPD and to determine the prognostic factors contributing to the long-term pulmonary outcomes manifesting in extremely preterm infants. Methods: The Extreme Prematurity and Pulmonary Outcomes Program in Saitama is an observational prospective cohort study performed by a consortium of six neonatal intensive care units (NICUs) in Saitama, Japan. The subjects included in this study are infants (from each clinical center) with gestational ages 22 to 27 weeks. The target is 400 subjects. This study aims to determine the definition of BPD and other perinatal factors that accurately predict the long-term pulmonary outcomes in survivors of extreme prematurity. Moreover, the association between BPD and postprematurity respiratory disease will be investigated using generalized linear models. Results: The protocol and consent forms were evaluated and approved on September 5, 2019, by the Ethics Committee of Saitama Medical Center, Saitama Medical University. Enrollment began on April 1, 2020. It is expected to end on March 31, 2023. The follow-up for 1 year corrected age is expected to continue through the middle of 2024. Conclusions: The Extreme Prematurity and Pulmonary Outcomes Program in Saitama incorporates aspects of neonatal care in secondary- and tertiary-level NICUs to develop existing research studies on the definition of BPD, objective biomarkers, and outcome measures of respiratory morbidity in extremely preterm infants beyond NICU hospitalization, thereby leading to a novel understanding of the nature and natural history of BPD and potential mechanistic and therapeutic targets in at-risk subjects. International Registered Report Identifier (IRRID): DERR1-10.2196/22948 %M 33666556 %R 10.2196/22948 %U https://www.researchprotocols.org/2021/3/e22948 %U https://doi.org/10.2196/22948 %U http://www.ncbi.nlm.nih.gov/pubmed/33666556 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 4 %P e21855 %T Health Care Providers’ Performance, Mindset, and Attitudes Toward a Neonatal Resuscitation Computer-Based Simulator: Empirical Study %A Cutumisu,Maria %A Ghoman,Simran K %A Lu,Chang %A Patel,Siddhi D %A Garcia-Hidalgo,Catalina %A Fray,Caroline %A Brown,Matthew R G %A Greiner,Russell %A Schmölzer,Georg M %+ Department of Educational Psychology, Faculty of Education, University of Alberta, 6-102 Education North, Edmonton, AB, T6G2G5, Canada, 1 7804925211, cutumisu@ualberta.ca %K infant %K newborn %K delivery room %K neonatal resuscitation %K performance %K neonatal resuscitation program %K serious games %K computer-based game simulation %K mindset %D 2020 %7 21.12.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Neonatal resuscitation involves a complex sequence of actions to establish an infant’s cardiorespiratory function at birth. Many of these responses, which identify the best action sequence in each situation, are taught as part of the recurrent Neonatal Resuscitation Program training, but they have a low incidence in practice, which leaves health care providers (HCPs) less prepared to respond appropriately and efficiently when they do occur. Computer-based simulators are increasingly used to complement traditional training in medical education, especially in the COVID-19 pandemic era of mass transition to digital education. However, it is not known how learners’ attitudes toward computer-based learning and assessment environments influence their performance. Objective: This study explores the relation between HCPs’ attitudes toward a computer-based simulator and their performance in the computer-based simulator, RETAIN (REsuscitation TrAINing), to uncover the predictors of performance in computer-based simulation environments for neonatal resuscitation. Methods: Participants were 50 neonatal HCPs (45 females, 4 males, 1 not reported; 16 respiratory therapists, 33 registered nurses and nurse practitioners, and 1 physician) affiliated with a large university hospital. Participants completed a demographic presurvey before playing the game and an attitudinal postsurvey after completing the RETAIN game. Participants’ survey responses were collected to measure attitudes toward the computer-based simulator, among other factors. Knowledge on neonatal resuscitation was assessed in each round of the game through increasingly difficult neonatal resuscitation scenarios. This study investigated the moderating role of mindset on the association between the perceived benefits of understanding the terminology used in the computer-based simulator, RETAIN, and their performance on the neonatal resuscitation tasks covered by RETAIN. Results: The results revealed that mindset moderated the relation between participants’ perceived terminology used in RETAIN and their actual performance in the game (F3,44=4.56, R2=0.24, adjusted R2=0.19; P=.007; estimate=–1.19, SE=0.38, t44=–3.12, 95% CI –1.96 to –0.42; P=.003). Specifically, participants who perceived the terminology useful also performed better but only when endorsing more of a growth mindset; they also performed worse when endorsing more of a fixed mindset. Most participants reported that they enjoyed playing the game. The more the HCPs agreed that the terminology in the tutorial and in the game was accessible, the better they performed in the game, but only when they reported endorsing a growth mindset exceeding the average mindset of all the participants (F3,44=6.31, R2=0.30, adjusted R2=0.25; P=.001; estimate=–1.21, SE=0.38, t44=−3.16, 95% CI –1.99 to –0.44; P=.003). Conclusions: Mindset moderates the strength of the relationship between HCPs’ perception of the role that the terminology employed in a game simulator has on their performance and their actual performance in a computer-based simulator designed for neonatal resuscitation training. Implications of this research include the design and development of interactive learning environments that can support HCPs in performing better on neonatal resuscitation tasks. %M 33346741 %R 10.2196/21855 %U http://games.jmir.org/2020/4/e21855/ %U https://doi.org/10.2196/21855 %U http://www.ncbi.nlm.nih.gov/pubmed/33346741 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e20913 %T Trends in Web Searches About the Causes and Treatments of Autism Over the Past 15 Years: Exploratory Infodemiology Study %A Saposnik,Florencia E %A Huber,Joelene F %+ Paediatric Medicine, The Hospital for Sick Children, Rm 10214, 10th floor Black Wing, 555 University Avenue, Toronto, ON, M5G 1X8, Canada, 1 416 813 8422 ext 208422, joelene.huber@sickkids.ca %K autism %K infodemiology %K infoveillance %K informatics %K Google Trends %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Ninety percent of adults in the United States use the internet, and the majority of internet users report looking on the web for health information using search engines. The rising prevalence of autism spectrum disorder (ASD), uncertainty surrounding its etiology, and variety of intervention approaches contribute to questions about its causes and treatments. It is not known which terms people search most frequently about ASD and whether web search queries have changed over time. Infodemiology is an area of health informatics research using big data analytics to understand web search behavior. Objective: The objectives were to (1) use infodemiological data to analyze trends in web-based searches about the causes and treatments of ASD over time and (2) inform clinicians and ASD organizations about web queries regarding ASD. Methods: Google Trends was used to analyze web searches about the causes and treatments of ASD in the United States from 2004 to 2019. The search terms analyzed for queries about causes of ASD included vaccines, genetics, environmental factors, and microbiome and those for therapies included applied behavior analysis (ABA), gluten-free diet, chelation therapy, marijuana, probiotics, and stem cell therapy. Results: Google Trends results are normalized on a scale ranging from 0 to 100 to represent the frequency and relative interest of search topics. For searches about ASD causes, vaccines had the greatest frequency compared to other terms, with an initial search peak observed in 2008 (scaled score of 81), reaching the highest frequency in 2015 (scaled score of 100), and a current upward trend. In comparison, searches about genetics, environmental factors, and microbiome occurred less frequently. For web searches about ASD therapies, ABA consistently had a high frequency of search interest since 2004, reaching a maximum scaled score of 100 in 2019. The analyses of chelation therapy and gluten-free diet showed trending interest in 2005 (scaled score of 68) and 2007 (scaled score of 100), respectively, followed by a steady decline since (scaled scores of only 10 and 16, respectively, in 2019). Searches related to ASD and marijuana showed a rise in 2009 (scaled score of 35), and they continue to trend upward. Searches about probiotics and stem cell therapy have been relatively low (scaled scores of 22 and 18, respectively), but are gradually gaining interest. Web search volumes for stem cell therapy in 2019 surpassed both gluten-free diet and chelation therapy as web-searched interventions for ASD. Conclusions: Google Trends is an effective infodemiology tool to analyze large-scale web search trends about ASD. The results showed informative variation in search trends over 15 years. These data are useful to inform clinicians and organizations about web queries on topics related to ASD, identify knowledge gaps, and target web-based education and knowledge translation strategies. %M 33284128 %R 10.2196/20913 %U http://pediatrics.jmir.org/2020/2/e20913/ %U https://doi.org/10.2196/20913 %U http://www.ncbi.nlm.nih.gov/pubmed/33284128 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e23496 %T Perspectives of Child Life Specialists After Many Years of Working With a Humanoid Robot in a Pediatric Hospital: Narrative Design %A Beran,Tanya %A Pearson,Jacqueline Reynolds %A Lashewicz,Bonnie %A Baggott,Sandy %+ Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada, 1 403 220 5667, tnaberan@ucalgary.ca %K child life %K support %K pediatric %K distraction %K robotics %K human-robot interaction %D 2020 %7 19.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Child life specialists (CLSs) play an important role in supporting patients and their families during their visits to a children’s hospital. Although CLSs are equipped with considerable expertise to support families during some of the most difficult moments of their lives, we introduced an additional resource to them in the form of a humanoid robot named MEDi. Objective: The aim of this study is to explore the experiences of CLSs using a robot to support children. Methods: We interviewed 7 CLSs who had worked with this robot for several years. The transcribed interviews were analyzed using open and axial coding. Results: The first main theme that emerged was the process of navigating from fear to friendship in learning to use a humanoid robot for therapeutic support. The second major theme was MEDi as a source of connection and support to children. CLSs’ perceptions of MEDi as an adaptable resource and working with the limits of MEDi constituted the last 2 themes. Conclusions: These descriptions show how CLSs can incorporate a robot into their practice. %M 33211014 %R 10.2196/23496 %U http://www.jmir.org/2020/11/e23496/ %U https://doi.org/10.2196/23496 %U http://www.ncbi.nlm.nih.gov/pubmed/33211014 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e19070 %T Development and Usability of a Novel Interactive Tablet App (PediAppRREST) to Support the Management of Pediatric Cardiac Arrest: Pilot High-Fidelity Simulation-Based Study %A Corazza,Francesco %A Snijders,Deborah %A Arpone,Marta %A Stritoni,Valentina %A Martinolli,Francesco %A Daverio,Marco %A Losi,Maria Giulia %A Soldi,Luca %A Tesauri,Francesco %A Da Dalt,Liviana %A Bressan,Silvia %+ Division of Pediatric Emergency Medicine, Department of Women’s and Children’s Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy, 39 0498218015, francesco.corazza@unipd.it %K cardiac arrest %K resuscitation %K mobile app %K high-fidelity simulation training %K cognitive aid %K pediatrics %K emergency medicine %D 2020 %7 1.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pediatric cardiac arrest (PCA), although rare, is associated with high mortality. Deviations from international management guidelines are frequent and associated with poorer outcomes. Different strategies/devices have been developed to improve the management of cardiac arrest, including cognitive aids. However, there is very limited experience on the usefulness of interactive cognitive aids in the format of an app in PCA. No app has so far been tested for its usability and effectiveness in guiding the management of PCA. Objective: To develop a new audiovisual interactive app for tablets, named PediAppRREST, to support the management of PCA and to test its usability in a high-fidelity simulation-based setting. Methods: A research team at the University of Padova (Italy) and human–machine interface designers, as well as app developers, from an Italian company (RE:Lab S.r.l.) developed the app between March and October 2019, by applying an iterative design approach (ie, design–prototyping–evaluation iterative loops). In October–November 2019, a single-center nonrandomized controlled simulation–based pilot study was conducted including 48 pediatric residents divided into teams of 3. The same nonshockable PCA scenario was managed by 11 teams with and 5 without the app. The app user’s experience and interaction patterns were documented through video recording of scenarios, debriefing sessions, and questionnaires. App usability was evaluated with the User Experience Questionnaire (UEQ) (scores range from –3 to +3 for each scale) and open-ended questions, whereas participants’ workload was measured using the NASA Raw-Task Load Index (NASA RTLX). Results: Users’ difficulties in interacting with the app during the simulations were identified using a structured framework. The app usability, in terms of mean UEQ scores, was as follows: attractiveness 1.71 (SD 1.43), perspicuity 1.75 (SD 0.88), efficiency 1.93 (SD 0.93), dependability 1.57 (SD 1.10), stimulation 1.60 (SD 1.33), and novelty 2.21 (SD 0.74). Team leaders’ perceived workload was comparable (P=.57) between the 2 groups; median NASA RTLX score was 67.5 (interquartile range [IQR] 65.0-81.7) for the control group and 66.7 (IQR 54.2-76.7) for the intervention group. A preliminary evaluation of the effectiveness of the app in reducing deviations from guidelines showed that median time to epinephrine administration was significantly longer in the group that used the app compared with the control group (254 seconds versus 165 seconds; P=.015). Conclusions: The PediAppRREST app received a good usability evaluation and did not appear to increase team leaders’ workload. Based on the feedback collected from the participants and the preliminary results of the evaluation of its effects on the management of the simulated scenario, the app has been further refined. The effectiveness of the new version of the app in reducing deviations from guidelines recommendations in the management of PCA and its impact on time to critical actions will be evaluated in an upcoming multicenter simulation-based randomized controlled trial. %M 32788142 %R 10.2196/19070 %U https://mhealth.jmir.org/2020/10/e19070 %U https://doi.org/10.2196/19070 %U http://www.ncbi.nlm.nih.gov/pubmed/32788142 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18519 %T Understanding the Steps Toward Mobile Early Intervention for Mothers and Their Infants Exiting the Neonatal Intensive Care Unit: Descriptive Examination %A Baggett,Kathleen M %A Davis,Betsy %A Landry,Susan H %A Feil,Edward G %A Whaley,Anna %A Schnitz,Alana %A Leve,Craig %+ Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State Universtiy, 14th Marietta Street NW, Suite 100&200, GA 30303, Atlanta, GA, 30303, United States, 1 4044131571, kbaggett@gsu.edu %K early intervention %K equity %K NICU %K low birthweight %K transition %K mobile internet intervention %K infants %K mothers %D 2020 %7 22.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Neonatal intensive care unit (NICU) history, combined with systemic inequities for mothers of nondominant cultures and mothers who are socioeconomically disadvantaged, places infants at an extraordinary risk for poor developmental outcomes throughout life. Although receipt of early intervention (EI) is the best single predictor of developmental outcomes among children with and at risk for early developmental delays, mothers and infants with the greatest needs are least likely to receive EI. Mobile internet-based interventions afford substantial advantages for overcoming logistical challenges that often prevent mothers who are economically disadvantaged from accessing EI. However, the bridge from the NICU to a mobile internet intervention has been virtually unexplored. Objective: This study aims to examine progression flow from NICU exit referral to an early mobile internet intervention to increase EI access and promote parent mediation of infant social-emotional and communication development. Methods: Three NICUs serving the urban poor in a Midwestern city were provided support in establishing an electronic NICU exit referral mechanism into a randomized controlled trial of a mobile internet intervention for mothers and their infants. Measurement domains to reflect the bridge to service included each crucial gateway required for navigating the path into Part C EI, including referral, screening, assessment, and intervention access. An iterative process was used and documented to facilitate each NICU in establishing an individualized accountability plan for sharing referral materials with mothers before their NICU exit. Subsequent to the referral, progression flow was documented on the basis of a real-time electronic recording of service receipt and contact records. Mother and infant risk characteristics were also assessed. Descriptive analyses were conducted to summarize and characterize each measurement domain. Results: NICU referral rates for EI were 3 to 4 times higher for open-shared versus closed-single gatekeeper referral processes. Of 86 referred dyads, 67 (78%) were screened, and of those screened, 51 (76%) were eligible for assessment. Of the 51 assessment-eligible mothers and infants, 35 dyads (69%) completed the assessment and 31 (89%) went on to complete at least one remote coaching intervention session. The dyads who accessed and engaged in intervention were racially and ethnically diverse and experiencing substantial adversity. Conclusions: The transition from the NICU to home was fraught with missed opportunities for an EI referral. Beyond the referral, the most prominent reason for not participating in screening was that mothers could not be located after exiting the NICU. Stronger NICU referral mechanisms for EI are needed. It may be essential to initiate mobile interventions before exiting the NICU for maintaining post-NICU contact with some mothers. In contrast to a closed, single point of referral gatekeeper systems in NICUs, open, shared referral gating systems may be less stymied by individual service provider biases and disruptions. %M 32960178 %R 10.2196/18519 %U http://www.jmir.org/2020/9/e18519/ %U https://doi.org/10.2196/18519 %U http://www.ncbi.nlm.nih.gov/pubmed/32960178 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 3 %P e18427 %T Applying a Human-Centered Design to Develop a Patient Prioritization Tool for a Pediatric Emergency Department: Detailed Case Study of First Iterations %A Schiro,Jessica %A Pelayo,Sylvia %A Martinot,Alain %A Dubos,François %A Beuscart-Zéphir,Marie-Catherine %A Marcilly,Romaric %+ Inserm, CIC-IT 1403/Evalab, F-59000, Institut Coeur-Poumon, 3ème étage est, Boulevard du Pr Jules Leclerc, CS70001, Lille, 59037, France, 33 0362943935, romaric.marcilly@univ-lille.fr %K emergency department %K triage systems %K ergonomics %K design %K human-centered design %K patients %D 2020 %7 4.9.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Overcrowding in the emergency departments has become an increasingly significant problem. Patient triage strategies are acknowledged to help clinicians manage patient flow and reduce patients’ waiting time. However, electronic patient triage systems are not developed so that they comply with clinicians’ workflow. Objective: This case study presents the development of a patient prioritization tool (PPT) and of the related patient prioritization algorithm (PPA) for a pediatric emergency department (PED), relying on a human-centered design process. Methods: We followed a human-centered design process, wherein we (1) performed a work system analysis through observations and interviews in an academic hospital’s PED; (2) deduced design specifications; (3) designed a mock PPT and the related PPA; and (4) performed user testing to assess the intuitiveness of the icons, the effectiveness in communicating patient priority, the fit between the prioritization model implemented and the participants’ prioritization rules, and the participants’ satisfaction. Results: The workflow analysis identified that the PPT interface should meet the needs of physicians and nurses, represent the stages of patient care, and contain patient information such as waiting time, test status (eg, prescribed, in progress), age, and a suggestion for prioritization. The mock-up developed gives the status of patients progressing through the PED; a strip represents the patient and the patient’s characteristics, including a delay indicator that compares the patient’s waiting time to the average waiting time of patients with a comparable reason for emergency. User tests revealed issues with icon intuitiveness, information gaps, and possible refinements in the prioritization algorithm. Conclusions: The results of the user tests have led to modifications to improve the usability and usefulness of the PPT and its PPA. We discuss the value of integrating human factors into the design process for a PPT for PED. The PPT/PPA has been developed and installed in Lille University Hospital's PED. Studies are carried out to evaluate the use and impact of this tool on clinicians’ situation awareness and prioritization-related cognitive load, prioritization of patients, waiting time, and patients’ experience. %M 32886071 %R 10.2196/18427 %U http://humanfactors.jmir.org/2020/3/e18427/ %U https://doi.org/10.2196/18427 %U http://www.ncbi.nlm.nih.gov/pubmed/32886071 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e19752 %T Synthesizing Multiple Stakeholder Perspectives on Using Virtual Reality to Improve the Periprocedural Experience in Children and Adolescents: Survey Study %A Ahmadpour,Naseem %A Weatherall,Andrew David %A Menezes,Minal %A Yoo,Soojeong %A Hong,Hanyang %A Wong,Gail %+ Design Lab, School of Architecture, Design and Planning, The University of Sydney, 148 City Road, Darlington, NSW, 2006, Australia, 61 286275649, naseem.ahmadpour@sydney.edu.au %K virtual reality %K periprocedural anxiety %K children %K adolescents %K stakeholder perspective %K design %K VR %K pediatrics %K patient experience %K app %K eHealth %D 2020 %7 17.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual reality (VR) technology is a powerful tool for augmenting patient experience in pediatric settings. Incorporating the needs and values of stakeholders in the design of VR apps in health care can contribute to better outcomes and meaningful experiences for patients. Objective: We used a multiperspective approach to investigate how VR apps can be designed to improve the periprocedural experiences of children and adolescents, particularly those with severe anxiety. Methods: This study included a focus group (n=4) and a survey (n=56) of clinicians. Semistructured interviews were conducted with children and adolescents in an immunization clinic (n=3) and perioperative setting (n=65) and with parents and carers in an immunization clinic (n=3) and perioperative setting (n=35). Results: Qualitative data were examined to determine the experience and psychological needs and intervention and design strategies that may contribute to better experiences for children in three age groups (4-7, 8-11, and 12-17 years). Quantitative data were used to identify areas of priority for future VR interventions. Conclusions: We propose a set of ten design considerations for the creation of future VR experiences for pediatric patients. Enhancing patient experience may be achieved by combining multiple VR solutions through a holistic approach considering the roles of clinicians and carers and the temporality of the patient’s experience. These situations require personalized solutions to fulfill the needs of pediatric patients before and during the medical procedure. In particular, communication should be placed at the center of preprocedure solutions, while emotional goals can be embedded into a procedure-focused VR app to help patients shift their focus in a meaningful way to build skills to manage their anxiety. %M 32706671 %R 10.2196/19752 %U http://www.jmir.org/2020/7/e19752/ %U https://doi.org/10.2196/19752 %U http://www.ncbi.nlm.nih.gov/pubmed/32706671 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e15896 %T Users’ Experiences of a Mobile Health Self-Management Approach for the Treatment of Cystic Fibrosis: Mixed Methods Study %A Floch,Jacqueline %A Vilarinho,Thomas %A Zettl,Annabel %A Ibanez-Sanchez,Gema %A Calvo-Lerma,Joaquim %A Stav,Erlend %A Haro,Peter Halland %A Aalberg,Asbjørn Lein %A Fides-Valero,Alvaro %A Bayo Montón,José Luis %+ SINTEF, Strindveien 4, Trondheim, 7465, Norway, 47 93008536, jacqueline.floch@sintef.no %K mobile health %K mHealth %K self-management %K user experience %K user acceptance %K mixed methods study %K cystic fibrosis %K pediatrics %D 2020 %7 8.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite a large number of clinical trials aiming at evaluating the digital self-management of chronic diseases, there is little discussion about users’ experiences with digital approaches. However, a good user experience is a critical factor for technology adoption. Understanding users’ experiences can inform the design of approaches toward increased motivation for digital self-management. Objective: This study aimed to evaluate the self-management of cystic fibrosis (CF) with a focus on gastrointestinal concerns and the care of young patients. Following a user-centered design approach, we developed a self-management app for patients and parents and a web tool for health care professionals (HCPs). To evaluate the proposed solutions, a 6-month clinical trial was conducted in 6 European CF competence centers. This paper analyzes the user acceptance of the technology and the benefits and disadvantages perceived by the trial participants. Methods: A mixed methods approach was applied. Data were collected through 41 semistructured qualitative interviews of patients, parents, and HCPs involved in the clinical trial. In addition, data were collected through questionnaires embedded in the self-management app. Results: Support for enzyme dose calculation and nutrition management was found to be particularly useful. Patients and parents rapidly strengthened their knowledge about the treatment and increased their self-efficacy. Reported benefits include reduced occurrence of symptoms and enhanced quality of life. Patients and parents had different skills, requiring follow-up by HCPs in an introductory phase. HCPs valued obtaining precise information about the patients, allowing for more personalized advice. However, the tight follow-up of several patients led to an increased workload. Over time, as patient self-efficacy increased, patient motivation for using the app decreased and the quality of the reported data was reduced. Conclusions: Self-management enfolds a collaboration between patients and HCPs. To be successful, a self-management approach should be accepted by both parties. Through understanding behaviors and experiences, this study defines recommendations for a complex case—the demanding treatment of CF. We identify target patient groups and situations for which the app is most beneficial and suggest focusing on these rather than motivating for regular app usage over a long time. We also advise the personalized supervision of patients during the introduction of the approach. Finally, we propose to develop guidance for HCPs to facilitate changes in practice. As personalization and technology literacy are factors found to influence the acceptance of digital self-management of other chronic diseases, it is relevant to consider the proposed recommendations beyond the case of CF. %M 32673237 %R 10.2196/15896 %U https://mhealth.jmir.org/2020/7/e15896 %U https://doi.org/10.2196/15896 %U http://www.ncbi.nlm.nih.gov/pubmed/32673237 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e17943 %T Interactive Guidance Intervention to Address Sustained Social Withdrawal in Preterm Infants in Chile: Protocol for a Randomized Controlled Trial %A Bustamante Loyola,Jorge %A Perez Retamal,Marcela %A Morgues Nudman,Monica Isabel %A Maturana,Andres %A Salinas Gonzalez,Ricardo %A Cox,Horacio %A González Mas,José Miguel %A Muñoz,Lucia %A Lopez,Lilian %A Mendiburo-Seguel,Andrés %A Simó,Sandra %A Palau Subiela,Pascual %A Guedeney,Antoine %+ Neonatology Unit, Clinica Alemana de Santiago, Av Manquehue Norte 1499, 5th Fl, Santiago, Chile, 56 999691389, jorbuslo@alumni.uv.es %K social withdrawal %K preterm %K early detection %K interactive guidance %K emotional stress %K social development %K postnatal depression %K posttraumatic stress %D 2020 %7 26.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Preterm newborns can be exposed early to significant perinatal stress, and this stress can increase the risk of altered socioemotional development. Sustained social withdrawal in infants is an early indicator of emotional distress which is expressed by low reactivity to the environment, and if persistent, is frequently associated with altered psychological development. Infants born prematurely have a higher probability of developing sustained social withdrawal (adjusted odds ratio 1.84, 95% CI 1.04-3.26) than infants born full term, and there is a correlation between weight at birth and sustained social withdrawal at 12 months of age. Objective: The aims of this study are to compare the effect of the interactive guidance intervention to that of routine pediatric care on sustained social withdrawal in infants born moderately or late preterm and to explore the relationship between sustained social withdrawal in these infants and factors such as neonatal intensive care unit hospitalization variables, parental depression, and posttraumatic stress symptoms. Methods: This study is designed as a multicenter randomized controlled trial. Moderate and late preterm newborns and their parents were recruited and randomized (1:1 allocation ratio) to control and experimental groups. During neonatal intensive care unit hospitalization, daily duration of skin-to-skin contact, breastfeeding, and parental visits were recorded. Also, a daily score for neonatal pain and painful invasive procedures were recorded. After discharge from neonatal intensive care, for the duration of the study, both groups will attend follow-up consultations with neonatologists at 2, 6, and 12 months of age (corrected for gestational age) and will receive routine pediatric care. Every consultation will be recorded and assessed with the Alarm Distress Baby Scale to detect sustained social withdrawal (indicated by a score of 5 or higher). The neonatologists will perform an interactive guidance intervention if an infant in the intervention group exhibits sustained social withdrawal. In each follow-up consultation, parents will fill out the Edinburgh Postnatal Depression Scale, the modified Perinatal Posttraumatic Stress Disorder Questionnaire, and the Impact of Event Scale–revised. Results: Recruitment for this trial started in September 2017. As of May 2020, we have completed enrollment (N=110 infants born moderately or late preterm). We aim to publish the results by mid-2021. Conclusions: This is the first randomized controlled trial with a sample of infants born moderately or late preterm infants who will attend pediatric follow-up consultations during their first year (corrected for gestational age at birth) with neonatologists trained in the Alarm Distress Baby Scale and who will receive this interactive guidance intervention. If successful, this early intervention will show significant potential to be implemented in both public and private health care, given its low cost of training staff and that the intervention takes place during routine pediatric follow-up. Trial Registration: ClinicalTrials.gov NCT03212547; https://clinicaltrials.gov/ct2/show/NCT03212547. International Registered Report Identifier (IRRID): DERR1-10.2196/17943 %M 32589156 %R 10.2196/17943 %U http://www.researchprotocols.org/2020/6/e17943/ %U https://doi.org/10.2196/17943 %U http://www.ncbi.nlm.nih.gov/pubmed/32589156 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 1 %P e17517 %T Families’ Degree of Satisfaction With Pediatric Telehomecare: Interventional Prospective Pilot Study in Catalonia %A López Seguí,Francesc %A Batlle Boada,Astrid %A García García,Juan José %A López Ulldemolins,Ana %A Achotegui del Arco,Ane %A Adroher Mas,Cristina %A García Cuyàs,Francesc %+ Sant Joan de Déu Hospital, Catalan Ministry of Health, Passeig de Sant Joan de Déu, 2, Barcelona, 08950, Spain, 34 932 53 21 00, fgarciac@sjdhospitalbarcelona.org %K home health monitoring %K pediatrics %K telehomecare %K videoconferencing %K satisfaction with care %K remote sensing technology %K telemedicine %K telehealth %D 2020 %7 26.3.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Pediatric home hospitalization improves the quality of life of children and their families, involving them in their children’s care, while favoring the work-life balance of the family. In this context, technology guarantees accessibility to assistance, which provides security to users. From the perspective of the health care system, this could lower the demand for hospital services and reduce hospitalization costs. Objective: This study aimed to assess families’ degree of satisfaction and acceptability of pediatric telehomecare and explore the clinical characteristics of children benefiting from the program. Methods: A total of 95 children and their families participated in the home-hospitalization pilot program operated by Sant Joan de Déu Hospital in Barcelona, Spain. Families were visited once a day and patients were monitored using a kit consisting of a scale, a thermometer, a pulse oximeter, and a blood pressure monitor. Data on parental experience, satisfaction, safety, and preference for care was collected by means of a questionnaire. Data about the children’s characteristics were collected from medical records. Descriptive and comparative statistics were used to analyze the data. Results: A total of 65 survey respondents expressed very high levels of satisfaction. Families reported their experiences as being very positive, preferring home hospitalization in 94% (61/65) of cases, and gave high scores regarding the use of telemonitoring devices. The program did not record any readmissions after 72 hours and reported a very low number of adverse incidents. The user profile was very heterogeneous, highlighting a large number of respiratory patients and patients with infections that required endovenous antibiotic therapy. Conclusions: Pediatric home hospitalization through telemonitoring is a feasible and desirable alternative to traditional hospitalization, both from the perspective of families and the hospital. The results of this analysis showed a very high degree of satisfaction with the care received and that the home-based telemonitoring system resulted in few adverse incidents. %M 32213471 %R 10.2196/17517 %U http://pediatrics.jmir.org/2020/1/e17517/ %U https://doi.org/10.2196/17517 %U http://www.ncbi.nlm.nih.gov/pubmed/32213471 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e16248 %T Home-Based Pediatric Palliative Care and Electronic Health: Systematic Mixed Methods Review %A Holmen,Heidi %A Riiser,Kirsti %A Winger,Anette %+ Oslo Metropolitan University, Postboks 4 St. Olavs plass, Oslo, N-0130, Norway, 47 67236241, heidiho@oslomet.no %K eHealth %K home-based %K pediatric palliative care %K pediatric %K children %K family %K communication %K palliative care %D 2020 %7 28.2.2020 %9 Review %J J Med Internet Res %G English %X Background: Children and families in pediatric palliative care depend on close contact with health care personnel, and electronic health (eHealth) is suggested to support care at home by facilitating their remote interactions. Objective: This study aimed to identify and review the use of eHealth to communicate and support home-based pediatric palliative care and appraise the methodological quality of the published research. Methods: We conducted a convergent, systematic mixed methods review and searched Medical Literature Analysis and Retrieval System Online (Medline), EMBASE, PsycINFO, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Scopus for eligible papers. Studies evaluating 2-way communication technology for palliative care for children aged ≤18 years and applying quantitative, qualitative, or mixed methods from 2012 to 2018 were eligible for inclusion. Quantitative and qualitative studies were equally valued during the search, screening, extraction, and analysis. Quantitative data were transformed into qualitative data and analyzed using a thematic analysis. Overall, 2 independent researchers methodologically appraised all included studies. Results: We identified 1277 citations. Only 7 papers were eligible for review. Evaluating eHealth interventions in pediatric palliative care poses specific methodological and ethical challenges. eHealth to facilitate remote pediatric palliative care was acknowledged both as an intrusion and as a support at home. Reluctance toward eHealth was mainly identified among professionals. Conclusions: The strengths of the conclusions are limited by the studies’ methodological challenges. Despite the limitless possibilities held by new technologies, research on eHealth in home-based pediatric palliative care is scarce. The affected children and families appeared to hold positive attitudes toward eHealth, although their views were less apparent compared with those of the professionals. Trial Registration: PROSPERO CRD42018119051; https://tinyurl.com/rtsw5ky %M 32130127 %R 10.2196/16248 %U http://www.jmir.org/2020/2/e16248/ %U https://doi.org/10.2196/16248 %U http://www.ncbi.nlm.nih.gov/pubmed/32130127 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e16426 %T Feasibility of a Mobile Health Tool for Mothers to Identify Neonatal Illness in Rural Uganda: Acceptability Study %A Matin,Shababa B %A Wallingford,Allison %A Xu,Shicheng %A Ng,Natalie %A Ho,Anthony %A Vanosdoll,Madison %A Waiswa,Peter %A Labrique,Alain B %A Acharya,Soumyadipta %+ Center for Bioengineering Innovation and Design, Department of Biomedical Engineering, Johns Hopkins University, , Baltimore, MD, , United States, 1 4105167074, acharya@jhu.edu %K newborn %K neonatal health %K community health workers %K maternal behavior %K Uganda %K World Health Organization %K mobile apps %K telemedicine %D 2020 %7 18.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A shortage of community health workers to triage sick neonates and poor recognition of neonatal illness by mothers contribute significantly toward neonatal deaths in low- and middle-income countries. Providing low-resource communities with the tools and knowledge to recognize signs of neonatal distress can lead to early care-seeking behavior. To empower and educate mothers to recognize signs of neonatal illness, we developed a neonatal health assessment device consisting of a smartphone app and a wearable sensor (the NeMo system). Objective: The aim of this study was to determine if mothers in rural Uganda were willing and able to use the NeMo system during the first week of their infant’s life. We also assessed mothers’ responses to the device’s recommendation to seek care. Methods: A total of 20 mothers were enrolled in the study after giving birth in the Iganga District Hospital. Each mother was trained to use the NeMo system to assess her infant for signs of illness before leaving the hospital and was given the NeMo system to use at home for 1 week. Throughout the week, the smartphone tracked the mothers’ usage of NeMo, and the study team visited twice to observe mothers’ ability to use NeMo. Each mother was interviewed at the end of 1 week to gather qualitative feedback on her experience with the NeMo system. Results: In total, 18 mothers completed the study; 2 mothers were withdrawn during the week because of extenuating health circumstances. Moreover, 1 day after enrollment and training, 75% (15/20) of mothers used NeMo properly with no mistakes. Three days after enrollment and training, only 1 mother placed the wearable sensor improperly on her infant. On the final study day, only 1 mother connected the device improperly. Mothers used NeMo an average of 11.67 (SD 5.70) times on their own at home during the 5 full study days. Although the frequency of use per day decreased from day 1 to day 5 of the study (P=.04), 72% (13/18) of mothers used NeMo at least once per day. In total, 64% (9/14) of mothers who received an alert from the NeMo system to seek care for their infants either called the health care professional working with the study team or reused the system immediately and found no danger signs. All 18 mothers agreed or strongly agreed that the NeMo system was easy to use and helped them know when to seek care for their babies. Conclusions: NeMo is a feasible and acceptable tool to aid mothers in rural Uganda to assess their infant’s health. %M 32130174 %R 10.2196/16426 %U https://mhealth.jmir.org/2020/2/e16426 %U https://doi.org/10.2196/16426 %U http://www.ncbi.nlm.nih.gov/pubmed/32130174 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e16208 %T Content Analysis of Apps for Growth Monitoring and Growth Hormone Treatment: Systematic Search in the Android App Store %A Fernandez-Luque,Luis %A Labarta,José I %A Palmer,Ella %A Koledova,Ekaterina %+ Merck KGaA, Frankfurter Str. 250, Darmstadt, 64293, Germany, 49 6151 72 20915, ekaterina.koledova@merckgroup.com %K growth hormone %K telemedicine %K growth monitoring %K mobile app %K mobile health %D 2020 %7 18.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of mobile apps for health is growing. This rapid growth in the number of health apps can make it hard to assess their quality and features. The increased demand for and availability of mobile health apps highlights the importance of regular publication of reviews to identify potential areas of unmet needs and concern. The focus of this review is mobile apps for monitoring growth for health care professionals, caregivers, and patients. Monitoring growth as a part of healthy physical development is important across different periods of childhood and adolescence. Objective: The goal of this content analysis is to map and understand the types of apps that currently exist that are related to growth monitoring and growth hormone treatment. Methods: A semiautomated search was undertaken using the app search engine 42Matters, complemented by a manual search for growth apps using the web search tool of Google Play (Android App Store). Apps were rated on their relevance to growth monitoring and categorized by independent raters. Results: In total, 76 apps were rated relevant to growth monitoring or growth hormone treatment. The level of agreement was measured for the semiautomated search and was very high (Κ=0.97). The target audience for 87% of the apps (66/76) was patients and relatives, followed by health care professionals (11%; 8/76) and both (3%; 2/76). Apps in the category “growth tracking tools for children and babies” were retrieved most often (46%; 35/76) followed by “general baby care apps” (32%; 24/76), “nonpharmacological solutions for growth” (12%; 9/76) and “growth hormone–related” (11%; 8/76). Overall, 19/76 apps (25%) tracked a precise location. Conclusions: This study mapped the type of apps currently available for growth monitoring or growth hormone treatment that can be used as a foundation for more detailed evaluations of app quality. The popularity of care apps for children and growth monitoring apps should provide a great channel for potential intervention in childhood health in the future. %M 32130162 %R 10.2196/16208 %U http://mhealth.jmir.org/2020/2/e16208/ %U https://doi.org/10.2196/16208 %U http://www.ncbi.nlm.nih.gov/pubmed/32130162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e16204 %T PediTools Electronic Growth Chart Calculators: Applications in Clinical Care, Research, and Quality Improvement %A Chou,Joseph H %A Roumiantsev,Sergei %A Singh,Rachana %+ Massachusetts General Hospital, 55 Fruit Street, Founders 526E, Boston, MA, 02114-2696, United States, 1 6177249040, jchou2@mgh.harvard.edu %K growth charts %K pediatrics %K infant, newborn %K infant, premature %K failure to thrive %K internet %K software %D 2020 %7 30.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Parameterization of pediatric growth charts allows precise quantitation of growth metrics that would be difficult or impossible with traditional paper charts. However, limited availability of growth chart calculators for use by clinicians and clinical researchers currently restricts broader application. Objective: The aim of this study was to assess the deployment of electronic calculators for growth charts using the lambda-mu-sigma (LMS) parameterization method, with examples of their utilization for patient care delivery, clinical research, and quality improvement projects. Methods: The publicly accessible PediTools website of clinical calculators was developed to allow LMS-based calculations on anthropometric measurements of individual patients. Similar calculations were applied in a retrospective study of a population of patients from 7 Massachusetts neonatal intensive care units (NICUs) to compare interhospital growth outcomes (change in weight Z-score from birth to discharge [∆Z weight]) and their association with gestational age at birth. At 1 hospital, a bundle of quality improvement interventions targeting improved growth was implemented, and the outcomes were assessed prospectively via monitoring of ∆Z weight pre- and postintervention. Results: The PediTools website was launched in January 2012, and as of June 2019, it received over 500,000 page views per month, with users from over 21 countries. A retrospective analysis of 7975 patients at 7 Massachusetts NICUs, born between 2006 and 2011, at 23 to 34 completed weeks gestation identified an overall ∆Z weight from birth to discharge of –0.81 (P<.001). However, the degree of ∆Z weight differed significantly by hospital, ranging from –0.56 to –1.05 (P<.001). Also identified was the association between inferior growth outcomes and lower gestational age at birth, as well as that the degree of association between ∆Z weight and gestation at birth also differed by hospital. At 1 hospital, implementing a bundle of interventions targeting growth resulted in a significant and sustained reduction in loss of weight Z-score from birth to discharge. Conclusions: LMS-based anthropometric measurement calculation tools on a public website have been widely utilized. Application in a retrospective clinical study on a large dataset demonstrated inferior growth at lower gestational age and interhospital variation in growth outcomes. Change in weight Z-score has potential utility as an outcome measure for monitoring clinical quality improvement. We also announce the release of open-source computer code written in R to allow other clinicians and clinical researchers to easily perform similar analyses. %M 32012066 %R 10.2196/16204 %U https://www.jmir.org/2020/1/e16204 %U https://doi.org/10.2196/16204 %U http://www.ncbi.nlm.nih.gov/pubmed/32012066 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 1 %P e15093 %T Web-Based Technology to Improve Disease Knowledge Among Adolescents With Sickle Cell Disease: Pilot Study %A Saulsberry,Anjelica C %A Hodges,Jason R %A Cole,Audrey %A Porter,Jerlym S %A Hankins,Jane %+ Department of Hematology, St Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN, , United States, 1 9015954153, jane.hankins@stjude.org %K sickle cell anemia %K eHealth %K transition to adult care %D 2020 %7 7.1.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Advancements in treatment have contributed to increased survivorship among children with sickle cell disease (SCD). Increased transition readiness, encompassing disease knowledge and self-management skills before transfer to adult care, is necessary to ensure optimal health outcomes. The Sickle Cell Transition E-Learning Program (STEP) is a public, Web-based, 6-module tool designed to increase transition readiness for youth with SCD. Objective: The objective of our study was to investigate the participation rate of youth with SCD in STEP and its association with transition readiness. Methods: This was a single-center, Institution Review Board–approved, retrospective cohort review. A total of 183 youths with SCD, aged between 12 and 15 years, were offered STEP as an adjunct to in-clinic disease education sessions. Participation rate (number of patients who used at least one STEP module divided by those approached) was calculated. The association among the number of STEP modules completed, disease knowledge, and self-management was explored. Results: Overall, 53 of the 183 approached adolescents completed at least one STEP module, yielding a participation rate in STEP of 29.0%. Of the 53 participants, 37 and 39 adolescents had disease knowledge and self-management confidence rating available, respectively. A positive correlation (r=0.47) was found between the number of STEP modules completed and disease knowledge scores (P=.003). No association was found between the number of modules completed and self-management confidence ratings. Disease knowledge scores were significantly higher among participants who completed ≥3 STEP modules compared with those who completed <3 STEP modules (U=149.00; P=.007). Conclusions: Improvement in disease knowledge in adolescence is critical to ensure the youth’s ability to self-care during the period of transition to adult care. Despite low participation, the cumulative exposure to the STEP program suggested greater promotion of disease knowledge among adolescents with SCD before transfer to adult care. %M 31909718 %R 10.2196/15093 %U https://pediatrics.jmir.org/2020/1/e15093 %U https://doi.org/10.2196/15093 %U http://www.ncbi.nlm.nih.gov/pubmed/31909718 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 2 %P e15106 %T Use of Synchronous Digital Health Technologies for the Care of Children With Special Health Care Needs and Their Families: Scoping Review %A Bird,Marissa %A Li,Lin %A Ouellette,Carley %A Hopkins,Kylie %A McGillion,Michael H %A Carter,Nancy %+ School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada, 1 9055259140 ext 22407, birdm3@mcmaster.ca %K pediatrics %K scoping review %K digital health %K children with special health care needs %K asthma %K congenital heart disease %K palliative care %K co-design %D 2019 %7 21.11.2019 %9 Review %J JMIR Pediatr Parent %G English %X Background: Use of synchronous digital health technologies for care delivery to children with special health care needs (having a chronic physical, behavioral, developmental, or emotional condition in combination with high resource use) and their families at home has shown promise for improving outcomes and increasing access to care for this medically fragile and resource-intensive population. However, a comprehensive description of the various models of synchronous home digital health interventions does not exist, nor has the impact of such interventions been summarized to date. Objective: We aim to describe the various models of synchronous home digital health that have been used in pediatric populations with special health care needs, their outcomes, and implementation barriers. Methods: A systematic scoping review of the literature was conducted, guided by the Arksey and O’Malley Scoping Review Framework. MEDLINE, CINAHL, and EMBASE databases were searched from inception to June 2018, and the reference lists of the included systematic reviews and high-impact journals were hand-searched. Results: A total of 38 articles were included in this review. Interventional articles are described as feasibility studies, studies that aim to provide direct care to children with special health care needs, and studies that aim to support family members to deliver care to children with special health care needs. End-user involvement in the design and implementation of studies is evaluated using a human-centered design framework, and factors affecting the implementation of digital health programs are discussed in relation to technological, human, and systems factors. Conclusions: The use of digital health to care for children with special health care needs presents an opportunity to leverage the capacity of technology to connect patients and their families to much-needed care from expert health care providers while avoiding the expenses and potential harms of the hospital-based care system. Strategies to scale and spread pilot studies, such as involving end users in the co-design techniques, are needed to optimize digital health programs for children with special health care needs. %M 31750840 %R 10.2196/15106 %U http://pediatrics.jmir.org/2019/2/e15106/ %U https://doi.org/10.2196/15106 %U http://www.ncbi.nlm.nih.gov/pubmed/31750840 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14247 %T An Interactive Parent-Targeted Text Messaging Intervention to Improve Oral Health in Children Attending Urban Pediatric Clinics: Feasibility Randomized Controlled Trial %A Borrelli,Belinda %A Henshaw,Michelle %A Endrighi,Romano %A Adams,William G %A Heeren,Timothy %A Rosen,Rochelle K %A Bock,Beth %A Werntz,Scott %+ Center for Behavioral Science Research, Boston University Henry M Goldman School of Dental Medicine, 560 Harrison Ave, 3rd floor, Boston, MA, 02118, United States, 1 617 358 3358, belindab@bu.edu %K oral health %K mHealth %K text message %K dental caries %K health behavior %D 2019 %7 11.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Effective preventive treatments for dental decay exist, but caries experience among preschoolers has not changed, with marked disparities in untreated decay. Despite near-universal use of SMS text messaging, there are no studies using text messages to improve the oral health of vulnerable children. Objective: This randomized controlled feasibility trial aimed to test the effects of oral health text messages (OHT) versus a control (child wellness text messages or CWT). OHT was hypothesized to outperform CWT on improving pediatric oral health behaviors and parent attitudes. Methods: Parents with a child aged <7 years were recruited at urban clinics during pediatric appointments (79% [41/52] below poverty line; 66% [36/55] black) and randomized to OHT (text messages on brushing, dental visits, bottle and sippy cups, healthy eating and sugary beverages, and fluoride) or CWT (text messages on reading, safety, physical activity and development, secondhand smoke, and stress) groups. Automated text messages based on Social Cognitive Theory were sent twice each day for 8-weeks. Groups were equivalent on the basis of the number of text messages sent, personalization, interactivity, and opportunity to earn electronic badges and unlock animated characters. Assessments were conducted at baseline and 8 weeks later. Data were analyzed with linear mixed–effects models. Results: A total of 55 participants were randomized (28 OHT and 27 CWT). Only one participant dropped out during the text message program and 47 (24 OHT and 23 CWT) completed follow up surveys. Response rates exceeded 68.78% (1040/1512) and overall program satisfaction was high (OHT mean 6.3; CWT mean 6.2; 1-7 scale range). Of the OHT group participants, 84% (21/25) would recommend the program to others. Overall program likeability scores were high (OHT mean 5.90; CWT mean 6.0; 1-7 scale range). Participants reported high perceived impact of the OHT program on brushing their child’s teeth, motivation to address their child's oral health, and knowledge of their child's oral health needs (mean 4.7, 4.6, and 4.6, respectively; 1-5 scale range). At follow up, compared with CWT, OHT group participants were more likely to brush their children’s teeth twice per day (odds ratio [OR] 1.37, 95% CI 0.28-6.50) and demonstrated improved attitudes regarding the use of fluoride (OR 3.82, 95% CI 0.9-16.8) and toward getting regular dental checkups for their child (OR 4.68, 95% CI 0.24-91.4). There were modest, but not significant, changes in motivation (F1,53=0.60; P=.45) and self–efficacy (F1,53=0.24; P=.63) to engage in oral health behaviors, favoring OHT (d=0.28 and d=0.16 for motivation and self–efficacy, respectively). Conclusions: The OHT program demonstrated feasibility was well utilized and appealing to the target population and showed promise for efficacy. %M 31710306 %R 10.2196/14247 %U https://mhealth.jmir.org/2019/11/e14247 %U https://doi.org/10.2196/14247 %U http://www.ncbi.nlm.nih.gov/pubmed/31710306 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 6 %N 2 %P e13966 %T Pediatric Speech-Language Pathologists’ Use of Mobile Health Technology: Qualitative Questionnaire Study %A Thompson,Kelsey %A Zimmerman,Emily %+ Communication Sciences & Disorders, Northeastern University, 525E Behrakis Building, 360 Huntington Ave, Boston, MA, 02115, United States, 1 617 373 5140, e.zimmerman@neu.edu %K mHealth %K speech-language pathology %K surveys %K assessment %K pediatric %K treatment %K technology %D 2019 %7 26.9.2019 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: While technology use in pediatric therapies is increasing, there is so far no research available focusing on how pediatric speech-language pathologists (SLPs) in the United States use technology. Objective: This paper sought to determine if, and to what extent, pediatric SLPs are using mobile apps, to determine what purpose they are using them for, and to identify gaps in available technology to provide guidance for future technological development. Methods: Pediatric SLPs completed an online survey containing five sections: demographics, overall use, use in assessment, use in intervention, barriers, and future directions. Results: Mobile app use by 485 pediatric SLPs in the clinical setting was analyzed. Most (364/438; 83.1%) pediatric SLPs reported using technology ≤50% of the time in their clinical work, with no differences evident by age group (<35 years and ≥35 years; P=.97). Pediatric SLPs are currently using apps for intervention (399/1105; 36.1%), clinical information (241/1105; 21.8%), parent education (151/1105; 13.7%), assessment (132/1105; 12%), client education (108/1105; 9.8%), and other uses (55/1105; 5.0%). Cost (46/135; 34.1%) and lack of an evidence base (36/135; 26.7%) were the most frequently reported barriers. Most SLPs (268/380; 70.7%) desired more technology use, with no difference evident by age group (P=.81). Conclusions: A majority of pediatric SLPs are using mobile apps less than 50% of the time in a pediatric setting and they use them more during intervention compared to assessment. While pediatric SLPs are hesitant to add to their client’s screen time, they would like more apps to be developed that are supported by research and are less expensive. Implications for future research and app development are also discussed. %M 31573922 %R 10.2196/13966 %U https://rehab.jmir.org/2019/2/e13966 %U https://doi.org/10.2196/13966 %U http://www.ncbi.nlm.nih.gov/pubmed/31573922 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 8 %P e13400 %T Noncontact Heart and Respiratory Rate Monitoring of Preterm Infants Based on a Computer Vision System: Protocol for a Method Comparison Study %A Gibson,Kim %A Al-Naji,Ali %A Fleet,Julie-Anne %A Steen,Mary %A Chahl,Javaan %A Huynh,Jasmine %A Morris,Scott %+ School of Nursing and Midwifery, University of South Australia, North Terrace, City East, Adelaide, 5000, Australia, 61 83022706, kim.gibson@unisa.edu.au %K heart rate %K respiratory rate %K infant %K electrocardiography %K computers %D 2019 %7 29.08.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Biomedical research in the application of noncontact methods to measure heart rate (HR) and respiratory rate (RR) in the neonatal population has produced mixed results. This paper describes and discusses a protocol for conducting a method comparison study, which aims to determine the accuracy of a proposed noncontact computer vision system to detect HR and RR relative to the HR and RR obtained by 3-lead electrocardiogram (ECG) in preterm infants in the neonatal unit. Objective: The aim of this preliminary study is to determine the accuracy of a proposed noncontact computer vision system to detect HR and RR relative to the HR and RR obtained by 3-lead ECG in preterm infants in the neonatal unit. Methods: A single-center cross-sectional study was planned to be conducted in the neonatal unit at Flinders Medical Centre, South Australia, in May 2018. A total of 10 neonates and their ECG monitors will be filmed concurrently for 10 min using digital cameras. Advanced image processing techniques are to be applied later to determine their physiological data at 3 intervals. These data will then be compared with the ECG readings at the same points in time. Results: Study enrolment began in May 2018. Results of this study were published in July 2019. Conclusions: The study will analyze the data obtained by the noncontact system in comparison to data obtained by ECG, identify factors that may influence data extraction and accuracy when filming infants, and provide recommendations for how this noncontact system may be implemented into clinical applications. International Registered Report Identifier (IRRID): RR1-10.2196/13400 %M 31469077 %R 10.2196/13400 %U https://www.researchprotocols.org/2019/8/e13400 %U https://doi.org/10.2196/13400 %U http://www.ncbi.nlm.nih.gov/pubmed/31469077 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e14540 %T A Novel Mobile Health Tool for Home-Based Identification of Neonatal Illness in Uganda: Formative Usability Study %A Vanosdoll,Madison %A Ng,Natalie %A Ho,Anthony %A Wallingford,Allison %A Xu,Shicheng %A Matin,Shababa Binte %A Verma,Neha %A Farzin,Azadeh %A Golden,W Christopher %A Yazdi,Youseph %A Waiswa,Peter %A Labrique,Alain %A Acharya,Soumyadipta %+ Center for Bioengineering Innovation and Design, Department of Biomedical Engineering, Johns Hopkins University, 3400 N Charles Street, Baltimore, MD, 21218, United States, 1 4105167074, acharya@jhu.edu %K neonatal %K community health workers %K maternal %K Uganda %K World Health Organization %K smartphone app %K digital health %K mobile health %K telemedicine %D 2019 %7 15.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: While early identification of neonatal illness can impact neonatal mortality rates and reduce the burden of treatment, identifying subtle clinical signs and symptoms of possible severe illness is especially challenging in neonates. The World Health Organization and the United Nations Children’s Fund developed the Integrated Management of Neonatal Childhood Illness guidelines, an evidence-based tool highlighting seven danger signs to assess neonatal health. Currently, many mothers in low-resource settings rely on home visits from community health workers (CHWs) to determine if their baby is sick. However, CHWs visit infrequently, and illness is often detected too late to impact survival. Thus, delays in illness identification pose a significant barrier to providing expedient and effective care. Neonatal Monitoring (NeMo), a novel neonatal assessment tool, seeks to increase the frequency of neonatal screening by task-shifting identification of neonatal danger signs from CHWs to mothers. Objective: This study aimed to explore the usability and acceptability of the NeMo system among target users and volunteer CHWs by assessing ease of use and learnability. Methods: Simulated device use and semistructured interviews were conducted with 32 women in the Iganga-Mayuge districts in eastern Uganda to evaluate the usability of the NeMo system, which involves a smartphone app paired with a low cost, wearable band to aid in identification of neonatal illness. Two versions of the app were evaluated using a mixed methods approach, and version II of the app contained modifications based on observations of the first cohort’s use of the system. During the posed scenario simulations, participants were offered limited guidance from the study team in order to probe the intuitiveness of the NeMo system. The ability to complete a set of tasks with the system was tested and recorded for each participant and closed- and open-ended questions were used to elicit user feedback. Additionally, focus groups with 12 CHWs were conducted to lend additional context and insight to the usability and feasibility assessment. Results: A total of 13/22 subjects (59%) using app version I and 9/10 subjects (90%) using app version II were able to use the phone and app with no difficulty, despite varying levels of smartphone experience. Following modifications to the app’s audio instructions in version II, participants’ ability to accurately answer qualitative questions concerning neonatal danger signs improved by at least 200% for each qualitative danger sign. All participants agreed they would trust and use the NeMo system to assess the health of their babies. Furthermore, CHWs emphasized the importance of community sensitization towards the system to encourage its adoption and regular use, as well as the decision to seek care based on its recommendations. Conclusions: The NeMo system is an intuitive platform for neonatal assessment in a home setting and was found to be acceptable to women in rural Uganda. %M 31418428 %R 10.2196/14540 %U http://mhealth.jmir.org/2019/8/e14540/ %U https://doi.org/10.2196/14540 %U http://www.ncbi.nlm.nih.gov/pubmed/31418428 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e11684 %T A Free Virtual Reality Experience to Prepare Pediatric Patients for Magnetic Resonance Imaging: Cross-Sectional Questionnaire Study %A Ashmore,Jonathan %A Di Pietro,Jerome %A Williams,Kelly %A Stokes,Euan %A Symons,Anna %A Smith,Martina %A Clegg,Louise %A McGrath,Cormac %+ Department of Medical Physics and Bioengineering, NHS Highland, Old Perth Road, Inverness,, United Kingdom, 44 07760712289, jonathan.ashmore@nhs.net %K virtual reality %K MRI %K anxiety %D 2019 %7 18.04.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: A magnetic resonance image (MRI) is a diagnostic test that requires patients to lie still for prolonged periods within a claustrophobic and noisy environment. This can be difficult for children to tolerate, and often general anesthetic (GA) is required at considerable cost and detriment to patient safety. Virtual reality (VR) is a newly emerging technology that can be implemented at low cost within a health care setting. It has been shown to reduce fear associated with a number of high-anxiety situations and medical procedures. Objective: The goal of the research was to develop a VR resource to prepare pediatric patients for MRI, helping to reduce anxieties in children undergoing the procedure. Methods: A freely accessible VR preparation resource was developed to prepare pediatric patients for their upcoming MRI. The resource consists of an app and supporting preparation book and used a series of panoramic 360 degree videos of the entire MRI journey, including footage from within the bore of the scanner. The app, deployed via the Android Play Store and iOS App Store, can be viewed on most mobile phones, allowing a child to experience an MRI in VR using an inexpensive Google Cardboard headset. The app contains 360 degree videos within an animated, interactive VR interface designed for 4 to 12-year-olds. The resource was evaluated as part of a clinical audit on 23 patients (aged 4 to 12 years), and feedback was obtained from 10 staff members. In 5 patients, the resource was evaluated as a tool to prepare patients for an awake MRI who otherwise were booked to have an MRI under GA. Results: The VR preparation resource has been successfully implemented at 3 UK institutions. Of the 23 patients surveyed, on a scale of 1 to 10, the VR resource was rated with a median score of 8.5 for enjoyment, 8 for helpfulness, and 10 for ease of use. All patients agreed that it made them feel more positive about their MRI, and all suggested they would recommend the resource to other children. When considering their experiences using the resource with pediatric patients, on a scale of 1 to 10, the staff members rated the VR resource a median score of 8.5 for enjoyment, 9 for helpfulness, and 9 for ease of use. All staff believed it could help prepare children for an awake MRI, thus avoiding GA. A successful awake MRI was achieved in 4 of the 5 children for whom routine care would have resulted in an MRI under GA. Conclusions: Our VR resource has the potential to relieve anxieties and better prepare patients for an awake MRI. The resource has potential to avoid GA through educating the child about the MRI process. %M 31518319 %R 10.2196/11684 %U http://pediatrics.jmir.org/2019/1/e11684/ %U https://doi.org/10.2196/11684 %U http://www.ncbi.nlm.nih.gov/pubmed/31518319 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 1 %P e11653 %T Barriers to Implementation of Perinatal Death Audit in Maternity and Pediatric Hospitals in Jordan: Cross-Sectional Study %A Khader,Yousef %A Alyahya,Mohammad %A Batieha,Anwar %+ Department of Public Health and Community Medicine, Jordan University of Science and Technology, Al-Ramtha-Amman Street, Irbid, 22110, Jordan, 962 0796802040, yskhader@just.edu.jo %K perinatal death %K quality of health care %K cause of death %K Jordan %D 2019 %7 06.03.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Perinatal death audit is a feasible and cost-effective quality improvement tool that helps to improve the quality of health care and reduce perinatal deaths. Perinatal death audit is not implemented in almost all hospitals in Jordan. Objective: This study aimed to assess health professionals’ attitude toward perinatal death auditing and determine the main barriers for effective implementation of perinatal death auditing as perceived by health professionals in Jordanian hospitals. Methods: A cross-sectional study was conducted among health professionals in 4 hospitals in Jordan. All physicians (pediatricians and obstetricians) and nurses working in these hospitals were invited to participate in the study. The study questionnaire assessed the attitude of health professionals toward perinatal death audit and assessed barriers for implementation of perinatal death audit in their hospitals. Results: This study included a total of 84 physicians and 218 nurses working in the 4 selected maternity hospitals. Only 35% (29/84) of physicians and 36.2% (79/218) of nurses reported that perinatal death audit would help to improve the quality of prenatal health care services to a great or very great extent. Lack of time was the first-mentioned barrier for implementing perinatal death audit by both physicians (35/84, 42%) and nurses (80/218, 36.7%). Almost the same proportions of health professionals reported inadequate patient information being documented in hospital records as a barrier. Lack of a health information system was the third-mentioned barrier by health professionals. Fear of having conflicts with the family of the dead baby was reported by almost one-third of physicians and nurses. Only 28% (23/83) of physicians and 16.9% (36/213) of nurses reported that they would like to be involved in perinatal death audit in their health facilities. Conclusions: Health professionals in Jordan had poor attitude toward perinatal death audit. The main barriers for implementing perinatal death audit in Jordanian hospitals were lack of time, inadequate patient information being documented in hospital records, and lack of health information systems. %M 30839277 %R 10.2196/11653 %U http://publichealth.jmir.org/2019/1/e11653/ %U https://doi.org/10.2196/11653 %U http://www.ncbi.nlm.nih.gov/pubmed/30839277 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e10804 %T Assessing the Usability of an Automated Continuous Temperature Monitoring Device (iThermonitor) in Pediatric Patients: Non-Randomized Pilot Study %A Kakarmath,Sujay S %A de Redon,Emily %A Centi,Amanda Jayne %A Palacholla,Ramya %A Kvedar,Joseph %A Jethwani,Kamal %A Agboola,Stephen %+ Partners Connected Health, 25 New Chardon Street, 3rd Floor, Suite 300, Boston, MA, 02114, United States, 1 6177242158, acenti@partners.org %K connected health %K continuous monitoring %K mobile phone %K pediatric %K temperature %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Fever is an important vital sign and often the first one to be assessed in a sick child. In acutely ill children, caregivers are expected to monitor a child’s body temperature at home after an initial medical consult. Fever literacy of many caregivers is known to be poor, leading to fever phobia. In children with a serious illness, the responsibility of periodically monitoring temperature can add substantially to the already stressful experience of caring for a sick child. Objective: The objective of this pilot study was to assess the feasibility of using the iThermonitor, an automated temperature measurement device, for continuous temperature monitoring in postoperative and postchemotherapy pediatric patients. Methods: We recruited 25 patient-caregiver dyads from the Pediatric Surgery Department at the Massachusetts General Hospital (MGH) and the Pediatric Cancer Centers at the MGH and the Dana Farber Cancer Institute. Enrolled dyads were asked to use the iThermonitor device for continuous temperature monitoring over a 2-week period. Surveys were administered to caregivers at enrollment and at study closeout. Caregivers were also asked to complete a daily event-monitoring log. The Generalized Anxiety Disorder-7 item questionnaire was also used to assess caregiver anxiety at enrollment and closeout. Results: Overall, 19 participant dyads completed the study. All 19 caregivers reported to have viewed temperature data on the study-provided iPad tablet at least once per day, and more than a third caregivers did so six or more times per day. Of all participants, 74% (14/19) reported experiencing an out-of-range temperature alert at least once during the study. Majority of caregivers reported that it was easy to learn how to use the device and that they felt confident about monitoring their child’s temperature with it. Only 21% (4/9) of caregivers reported concurrently using a device other than the iThermonitor to monitor their child’s temperature during the study. Continuous temperature monitoring was not associated with an increase in caregiver anxiety. Conclusions: The study results reveal that the iThermonitor is a highly feasible and easy-to-use device for continuous temperature monitoring in pediatric oncology and surgery patients. Trial Registration: ClinicalTrials.gov NCT02410252; https://clinicaltrials.gov/ct2/show/NCT02410252 (Archived by WebCite at http://www.webcitation.org/73LnO7hel) %M 31518304 %R 10.2196/10804 %U http://pediatrics.jmir.org/2018/2/e10804/ %U https://doi.org/10.2196/10804 %U http://www.ncbi.nlm.nih.gov/pubmed/31518304 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e10647 %T How Returning Aggregate Research Results Impacts Interest in Research Engagement and Planned Actions Relevant to Health Care Decision Making: Cohort Study %A Weitzman,Elissa R %A Magane,Kara M %A Wisk,Lauren E %+ Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, BCH 3187, Boston, MA, 02115, United States, 1 617 355 3538, elissa.weitzman@childrens.harvard.edu %K aggregate research results %K decision making %K juvenile idiopathic arthritis %K patient engagement %K patient-reported outcome measures %K rheumatic disease %D 2018 %7 21.12.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Collection of patient-reported outcomes measures (PROs) may augment clinical data and inform health research, improving care, yet approaches to sustaining interest among patient cohorts in research participation are needed. One approach may involve returning aggregate research results (ARRs), which may help patients contextualize personal experiences, prompt conversations with providers or family, and encourage information seeking. This model has been demonstrated for Web-based patient-centered registries. Studies with clinical cohorts may further elucidate the model, its impacts on interest in research participation and planned actions, and potential for participants to experience this as helpful or harmful—gap areas. Objective: We sought to investigate the impacts of returning ARRs comprising summaries of PROs and clinical metrics to parents of children with rheumatic disease, assessing interest in future research participation among parents who viewed ARRs and plans for acting on returned information. Further, we sought to investigate reactions to viewing ARRs and how these reactions impacted planned actions. Methods: Clinical and PRO data were obtained about children in a national clinical disease registry, summarized, and processed into annotated infographics, comprising ARRs for children’s parents. Parents who viewed ARRs (n=111) were surveyed about the information’s perceived value and their reactions. Reaction patterns were summarized using principal components analysis (PCA), and associations among reaction patterns and interest in research participation and planned actions were estimated using multivariate logistic regression. Results: Parental endorsement of the value of ARRs for understanding their child’s condition and making care decisions was high (across 10 topics for which ARRs were shared, 42.2%-77.3% of the parents reported information was “very valuable”). Most (58/111, 52.3%) parents reported being more interested in participating in research after viewing ARRs, with the remainder reporting that their interest levels were unchanged. Reactions to viewing ARRs reflected experiencing validation/affirmation and information burden based on PCA. Reactions were not associated with child demographic or clinical characteristics and PROs, except that parents from households with less education reported greater information burden than those from more educated households (P=.007). In adjusted models, parents with higher validation/affirmation scores had increased odds of reporting heightened interest in research participation (adjusted odds ratio [AOR] 1.97, 95% CI 1.18-3.30), while higher information burden scores were associated with decreased odds of planned discussions with their child (AOR 0.59, 95% CI 0.36-0.95) and increased odds of planned discussions with providers (AOR 1.75, 95% CI 1.02-3.00). Conclusions: Returning ARRs may foster a “virtuous cycle” of research engagement, especially where ARRs are experienced favorably and affect plans to share and discuss ARRs in support of a child’s chronic disease care and treatment. Reactions to ARRs vary with education level, underscoring the need for attention to equity for this model. %M 30578228 %R 10.2196/10647 %U http://www.jmir.org/2018/12/e10647/ %U https://doi.org/10.2196/10647 %U http://www.ncbi.nlm.nih.gov/pubmed/30578228 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 12 %P e10363 %T A Novel Smartphone App to Support Learning and Maintaining Competency With Bier Blocks for Pediatric Forearm Fracture Reductions: Protocol for a Mixed-Methods Study %A Burstein,Brett %A Bretholz,Adam %+ Division of Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada, 1 514 412 4400 ext 24757, adambretholzmd@gmail.com %K intravenous regional anesthesia %K lidocaine %K procedural sedation %K mobile phone %D 2018 %7 21.12.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Distal forearm fractures are among the most common injuries presenting to the pediatric emergency department (PED). Bier block (BB), or intravenous regional anesthesia, is a safe and effective alternative to procedural sedation for closed reduction of forearm fractures; it is associated with fewer adverse events, a shorter length of stay, and reduced costs. BB has long remained relatively underutilized; however, with an increasing emphasis on efficient resource use and patient-centered care, there is renewed interest in this technique. Objective: Our tertiary PED recently became the first in Canada to successfully implement an active BB program. Subsequently, we developed a mobile BB smartphone app designed to support the sustained departmental use of BB. The app can be used for training and maintenance of competency and incorporates instructional material, as well as our institutional BB protocol, printable medication order sheets, and monitoring forms. The present report describes the development and functionality of the BB smartphone app. Methods: We have described app development and content. App dissemination metrics will be tracked, and user feedback will be analyzed using a self-administered electronic survey. Additionally, app utilization in our PED will be compared with real-world clinical use of BB for fracture reductions. Results: The first iteration of the BB app was launched in 2015, with the most recent update in September 2018. App metric tracking is planned for January 2020 until December 2021. Conclusions: We have highlighted how the BB app serves as a paradigm of an educational tool designed not only for individual users but also for supporting the department-wide implementation and dissemination of a new technique. App dissemination and use metrics will be tracked and correlated with clinical use of BB in the PED. International Registered Report Identifier (IRRID): PRR1-10.2196/10363 %M 30578214 %R 10.2196/10363 %U http://www.researchprotocols.org/2018/12/e10363/ %U https://doi.org/10.2196/10363 %U http://www.ncbi.nlm.nih.gov/pubmed/30578214 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11447 %T An Analytics Platform to Evaluate Effective Engagement With Pediatric Mobile Health Apps: Design, Development, and Formative Evaluation %A Pham,Quynh %A Graham,Gary %A Lalloo,Chitra %A Morita,Plinio P %A Seto,Emily %A Stinson,Jennifer N %A Cafazzo,Joseph A %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, Suite 425, 155 College Street, Toronto, ON, M5T 3M6, Canada, 1 (416) 340 4800 ext 4765, q.pham@mail.utoronto.ca %K analytics %K engagement %K log data %K mobile health %K mobile apps %K chronic disease %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps for pediatric chronic conditions are growing in availability and challenge investigators to conduct rigorous evaluations that keep pace with mHealth innovation. Traditional research methods are poorly suited to operationalize the agile, iterative trials required to evidence and optimize these digitally mediated interventions. Objective: We sought to contribute a resource to support the quantification, analysis, and visualization of analytic indicators of effective engagement with mHealth apps for chronic conditions. Methods: We applied user-centered design methods to design and develop an Analytics Platform to Evaluate Effective Engagement (APEEE) with consumer mHealth apps for chronic conditions and implemented the platform to analyze both retrospective and prospective data generated from a smartphone-based pain self-management app called iCanCope for young people with chronic pain. Results: Through APEEE, we were able to automate the process of defining, operationalizing, and evaluating effective engagement with iCanCope. Configuring the platform to integrate with the app was feasible and provided investigators with a resource to consolidate, analyze, and visualize engagement data generated by participants in real time. Preliminary efforts to evaluate APEEE showed that investigators perceived the platform to be an acceptable evaluative resource and were satisfied with its design, functionality, and performance. Investigators saw potential in APEEE to accelerate and augment evidence generation and expressed enthusiasm for adopting the platform to support their evaluative practice once fully implemented. Conclusions: Dynamic, real-time analytic platforms may provide investigators with a powerful means to characterize the breadth and depth of mHealth app engagement required to achieve intended health outcomes. Successful implementation of APEEE into evaluative practice may contribute to the realization of effective and evidence-based mHealth care. %M 30578179 %R 10.2196/11447 %U http://mhealth.jmir.org/2018/12/e11447/ %U https://doi.org/10.2196/11447 %U http://www.ncbi.nlm.nih.gov/pubmed/30578179 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e295 %T Remote Patient Monitoring and Telemedicine in Neonatal and Pediatric Settings: Scoping Literature Review %A Sasangohar,Farzan %A Davis,Elise %A Kash,Bita A %A Shah,Sohail R %+ Industrial and Systems Engineering, Department of Environmental and Occupational Health, Texas A&M University, 101 Bizzell Street, College Station, TX, 77843, United States, 1 979 458 2337, sasangohar@tamu.edu %K neonatal %K pediatric %K remote patient monitoring %K telehealth %K telemedicine %D 2018 %7 20.12.2018 %9 Review %J J Med Internet Res %G English %X Background: Telemedicine and telehealth solutions are emerging rapidly in health care and have the potential to decrease costs for insurers, providers, and patients in various settings. Pediatric populations that require specialty care are disadvantaged socially or economically or have chronic health conditions that will greatly benefit from results of studies utilizing telemedicine technologies. This paper examines the emerging trends in pediatric populations as part of a systematic literature review and provides a scoping review of the type, extent, and quantity of research available. Objective: This paper aims to examine the role of remote patient monitoring (RPM) and telemedicine in neonatal and pediatric settings. Findings can be used to identify strengths, weaknesses, and gaps in the field. The identification of gaps will allow for interventions or research to improve health care quality and costs. Methods: A systematic literature review is being conducted to gather an adequate amount of relevant research for telehealth in pediatric populations. The fields of RPM and telemedicine are not yet very well established by the health care services sector, and definitions vary across health care systems; thus, the terms are not always defined similarly throughout the literature. Three databases were scoped for information for this specific review, and 56 papers were included for review. Results: Three major telemedicine trends emerged from the review of 45 relevant papers—RPM, teleconsultation, and monitoring patients within the hospital, but without contact—thus, decreasing the likelihood of infection or other adverse health effects. Conclusions: While the current telemedicine approaches show promise, limited studied conditions and small sample sizes affect generalizability, therefore, warranting further research. The information presented can inform health care providers of the most widely implemented, studied, and effective forms of telemedicine for patients and their families and the telemedicine initiatives that are most cost efficient for health systems. While the focus of this review is to summarize some telehealth applications in pediatrics, we have also presented research studies that can inform providers about the importance of data sharing of remote monitoring data between hospitals. Further reports will be developed to inform health systems as the systematic literature review continues. %M 30573451 %R 10.2196/jmir.9403 %U http://www.jmir.org/2018/12/e295/ %U https://doi.org/10.2196/jmir.9403 %U http://www.ncbi.nlm.nih.gov/pubmed/30573451 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e10165 %T Pediatric Web-Based Chat Services for Caregivers of Children: Descriptive Study %A Kaskinen,Anu %A Ayeboa-Sallah,Benjamin %A Teivaanmäki,Tiina %A Wärnhjelm,Elina %A Korhonen,Liisa %A Helve,Otto %+ Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, PB 347, Helsinki, 00029 HUS, Finland, 358 94711, anu.kaskinen@helsinki.fi %K chat service %K health information %K internet %K Web-based resources %K pediatrics %K social media %D 2018 %7 14.12.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Pediatric physician-led Web-based chat services offer a novel, low-threshold communication channel between caregivers and physicians. Objective: Our aim was to describe chat conversations between caregivers and physicians in a Web-based chat service to determine the factors that should be considered when planning a similar chat service. We also aimed to evaluate whether caregivers considered the consultations helpful, whether physicians considered they could answer caregivers’ questions, and whether further face-to-face medical contact was needed. Methods: In September 2015, a private medical center for children in the greater Helsinki area initiated a Web-based chat service, accessible via any device with an internet connection, open from 9 am to 9 pm local time. Four residents in pediatrics, who had performed at least 60% of their 6-year residency program, served as the physicians responsible for chat consultations with caregivers of children. Between October 2015 and March 2016, 343 consecutive consultations were immediately evaluated by a chat physician. On average, caregivers were followed up by email questionnaire 7-14 days later, which 98 caregivers answered a median of 11 (interquartile range, IQR, 7-20) days later. Results: The age of the children whose caregivers contacted the chat service was a median of 2.1 (IQR 0.83-4.69) years, and 29.8% (102/342) of the children were less than 1 year old. The majority (119/343, 34.7%) of the chat conversations took place from 9 am to noon, and infections were the most common concern in over half of cases (189/343, 55.1%). Chat physicians recommended a face-to-face appointment with a physician for that same day in 13.7% (47/343) of the cases. A face-to-face exam was recommended for that same day more often if the chat concerned infection (36/189, 19.0% cases) compared with other reasons (11/154, 7.1%, cases; P=.001). Physicians felt capable of answering caregivers’ questions in 72.6% (249/343) of the cases, whereas 93% (91/98) of caregivers considered physicians’ answers helpful. Whether caregivers had to take their children to see a physician that same day or whether caregivers’ main concern was infection was not found to be associated with whether caregivers considered physicians’ answers helpful or not. However, physicians felt more capable of answering caregivers’ questions when the main concern was infection. Conclusions: Parental consultations via Web-based chat service often take place before noon and focus on infection-related issues as well as on the health and illness of very young children. These factors should be considered when planning or setting up such a service. Based on the high satisfaction with the chat service by both physicians and caregivers, Web-based chat services may be a useful way to help caregivers with concerns about their child’s health or illness. %M 30552087 %R 10.2196/10165 %U https://www.jmir.org/2018/12/e10165/ %U https://doi.org/10.2196/10165 %U http://www.ncbi.nlm.nih.gov/pubmed/30552087 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e10463 %T Fertility Preservation in Children and Adolescents With Cancer: Pilot of a Decision Aid for Parents of Children and Adolescents With Cancer %A Allingham,Catherine %A Gillam,Lynn %A McCarthy,Maria %A Zacharin,Margaret %A Jayasuriya,Sadunee %A Heloury,Yves %A Orme,Lisa %A Sullivan,Michael %A Peate,Michelle %A Jayasinghe,Yasmin %+ Department of Obstetrics & Gynaecology, The Royal Women’s Hospital, University of Melbourne, 20 Flemington Road, Parkville, 3152, Australia, 61 38345 3721, yasmin.jayasinghe@unimelb.edu.au %K adolescent %K cancer %K decision aid %K fertility preservation %K pediatric %K shared decision making %K Values Clarification Exercise %D 2018 %7 28.11.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Future infertility is a significant concern for survivors of childhood and adolescent cancer. Children and adolescents may have the opportunity to undergo fertility preservation (FP) procedures (which preserve gonadal tissue or gametes for future use) prior to the cancer treatment. However, the decision is very complex, as it is often made by parents as proxy decision makers at the time of cancer diagnosis, and is time-sensitive (needing to occur before the cancer treatment begins). Furthermore, FP procedures in children and adolescents are experimental and cannot guarantee future fertility. An uninformed decision may result in future decision regret. Objective: This study aimed to assess the acceptability, usability, and feasibility of a Web-based FP decision aid (DA) in parents of children and adolescents with cancer and clinicians. Fertility knowledge and decision regret were compared in families who reviewed the DA compared with those who did not. Methods: The Web-based DA was developed according to the International Patient Decision Aid Standards. A cross-sectional study of parents of patients with cancer, who discussed fertility, and clinicians at a tertiary children’s hospital was undertaken. The acceptability, usability, and feasibility of the DA were assessed using a pre-post survey design. Measures included the validated Decision Regret Scale, a purpose-designed fertility-related knowledge scale, questions regarding satisfaction with the DA, and open-ended responses for additional feedback. Furthermore, clinicians involved in FP were also invited to review the DA. Results: We enrolled 34 parents and 11 clinicians in this study. Participants who reviewed the DA (15 parents and 11 clinicians) expressed satisfaction with its content and functionality. Parents reported an improved understanding of cancer treatments, infertility, and FP procedures and did not report greater decision regret after DA review. Most parents (13/15, 86%) would recommend the DA to other parents. All clinicians had a consensus that this was a valid and relevant information source for all involved in fertility care. Conclusions: It is an international standard of care to discuss the impact of cancer treatment on fertility before cancer treatment. This is the first fertility DA for parents of children and adolescents with cancer and is found to be relevant and acceptable by parents and clinicians. This DA has the potential to help support parents to make informed fertility-related decisions for their children and adolescents. However, future research is needed to assess the impact of the DA on prospective decision making. %M 31518288 %R 10.2196/10463 %U http://pediatrics.jmir.org/2018/2/e10463/ %U https://doi.org/10.2196/10463 %U http://www.ncbi.nlm.nih.gov/pubmed/31518288 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 5 %N 2 %P e10307 %T A Tablet-Based Interactive Movement Tool for Pediatric Rehabilitation: Development and Preliminary Usability Evaluation %A Levac,Danielle %A Dumas,Helene M %A Meleis,Waleed %+ Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, United States, 1 6173735198, d.levac@northeastern.edu %K equipment design %K rehabilitation %K pediatrics %K tablets %K software %D 2018 %7 26.11.2018 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Motivating interactive tools may increase adherence to repetitive practice for children with disabilities, but many virtual reality and active video gaming systems are too challenging for children with significant needs. Objective: The objective of this study was to develop and conduct a usability evaluation of the Fun, Interactive Therapy Board (FITBoard), a movement toy bridging digital and physical interactions for children with disabilities. Methods: The FITBoard is a tablet app involving games controlled by hand, head, or foot touch of configurable, wired surfaces. Usability evaluation involved a cognitive walkthrough and think-aloud processes. Participants verbalized aloud while completing a series of 26 task actions involved in selecting a game and configuring the FITBoard to achieve the therapeutic goal. Therapists then responded to questions about usability perceptions. Unsuccessful actions were categorized as goal or action failures. Qualitative content analysis supported understanding of usability problems. Results: Participants included 5 pediatric physical therapists and 2 occupational therapists from 2 clinical sites. Goal failure was experienced by all participants in 2 tasks, and action failure was experienced by all participants in 2 tasks. For 14 additional tasks, 1 or more patients experienced goal or action failure, with an overall failure rate of 69% (18 of 26 tasks). Content analysis revealed 4 main categories: hardware usability, software usability, facilitators of therapy goals, and improvement suggestions. Conclusions: FITBoard hardware and software changes are needed to address goal and action failures to rectify identified usability issues. Results highlight potential FITBoard applications to address therapeutic goals and outline important practical considerations for product use by therapists. Subsequent research will evaluate therapist, parent, and child perspectives on FITBoard clinical utility when integrated within regular therapy interventions. %M 30478025 %R 10.2196/10307 %U http://rehab.jmir.org/2018/2/e10307/ %U https://doi.org/10.2196/10307 %U http://www.ncbi.nlm.nih.gov/pubmed/30478025 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e11402 %T Telehealth Services for Children With Autism Spectrum Disorders in Rural Areas of the Kingdom of Saudi Arabia: Overview and Recommendations %A Alkhalifah,Shahad %A Aldhalaan,Hesham %+ Centre for Autism Research, King Faisal Specialist Hospital & Research Centre, Riyadh, 11211, Saudi Arabia, 966 14647272 ext 70723, shahad.alkh@gmail.com %K autism spectrum disorders %K intervention %K Saudi Arabia %K telehealth %D 2018 %7 15.11.2018 %9 Viewpoint %J JMIR Pediatr Parent %G English %X Autism spectrum disorders (ASD) are the most-prevalent neurodevelopmental disorders. However, each child diagnosed with ASD presents with a unique range of behavioral and communication problems and issues with social skills. Many studies have highlighted the importance of early interventions for children with ASD to improve their skills and provide their families with the necessary support. However, in the Kingdom of Saudi Arabia (KSA), the earliest that a child with ASD in the major cities receives an intervention is at the age of 4 years, owing to limited services and a lack of awareness of the importance and benefits of early interventions. Families who live in rural areas of KSA arguably have a greater need for these services, as they have to travel to cities such as Riyadh for help. The use of telehealth services may be effective for ASD intervention among children living in rural areas, since such services use technology to provide consultations, interventions, diagnosis, training, and education. Research indicates that telehealth services are as valuable as traditional face-to-face treatment, allow families to obtain support from their homes, and help them improve their quality of life. This review will discuss the application of telehealth services to support families in rural areas of KSA who are dealing with issues of ASD, considering the cultural and religious contexts. In addition, it will examine ways in which technology can be employed to suit KSA’s culture and needs. %M 31518306 %R 10.2196/11402 %U http://pediatrics.jmir.org/2018/2/e11402/ %U https://doi.org/10.2196/11402 %U http://www.ncbi.nlm.nih.gov/pubmed/31518306 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 4 %P e10498 %T Appropriateness of Hospital Admission for Emergency Department Patients with Bronchiolitis: Secondary Analysis %A Luo,Gang %A Johnson,Michael D %A Nkoy,Flory L %A He,Shan %A Stone,Bryan L %+ Department of Biomedical Informatics and Medical Education, University of Washington, University of Washington Medicine South Lake Union, 850 Republican Street, Building C, Box 358047, Seattle, WA, 98195, United States, 1 206 221 4596, gangluo@cs.wisc.edu %K appropriate hospital admission %K bronchiolitis %K emergency department %K operational definition %D 2018 %7 05.11.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: Bronchiolitis is the leading cause of hospitalization in children under 2 years of age. Each year in the United States, bronchiolitis results in 287,000 emergency department visits, 32%-40% of which end in hospitalization. Frequently, emergency department disposition decisions (to discharge or hospitalize) are made subjectively because of the lack of evidence and objective criteria for bronchiolitis management, leading to significant practice variation, wasted health care use, and suboptimal outcomes. At present, no operational definition of appropriate hospital admission for emergency department patients with bronchiolitis exists. Yet, such a definition is essential for assessing care quality and building a predictive model to guide and standardize disposition decisions. Our prior work provided a framework of such a definition using 2 concepts, one on safe versus unsafe discharge and another on necessary versus unnecessary hospitalization. Objective: The goal of this study was to determine the 2 threshold values used in the 2 concepts, with 1 value per concept. Methods: Using Intermountain Healthcare data from 2005-2014, we examined distributions of several relevant attributes of emergency department visits by children under 2 years of age for bronchiolitis. Via a data-driven approach, we determined the 2 threshold values. Results: We completed the first operational definition of appropriate hospital admission for emergency department patients with bronchiolitis. Appropriate hospital admissions include actual admissions with exposure to major medical interventions for more than 6 hours, as well as actual emergency department discharges, followed by an emergency department return within 12 hours ending in admission for bronchiolitis. Based on the definition, 0.96% (221/23,125) of the emergency department discharges were deemed unsafe. Moreover, 14.36% (432/3008) of the hospital admissions from the emergency department were deemed unnecessary. Conclusions: Our operational definition can define the prediction target for building a predictive model to guide and improve emergency department disposition decisions for bronchiolitis in the future. %M 30401659 %R 10.2196/10498 %U http://medinform.jmir.org/2018/4/e10498/ %U https://doi.org/10.2196/10498 %U http://www.ncbi.nlm.nih.gov/pubmed/30401659 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e186 %T A Tablet-Based Mobile Hearing Screening System for Preschoolers: Design and Validation Study %A Yimtae,Kwanchanok %A Israsena,Pasin %A Thanawirattananit,Panida %A Seesutas,Sangvorn %A Saibua,Siwat %A Kasemsiri,Pornthep %A Noymai,Anukool %A Soonrach,Tharapong %+ National Electronics and Computer Technology Center, National Science and Technology Development Agency, 112 Thailand Science Park, Klong Luang, Pathumthani, Thailand, 66 5646900, pasin.israsena@nectec.or.th %K hearing screening %K mobile health %K speech audiometry %K hearing loss %D 2018 %7 23.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hearing ability is important for children to develop speech and language skills as they grow. After a mandatory newborn hearing screening, group or mass screening of children at later ages, such as at preschool age, is often practiced. For this practice to be effective and accessible in low-resource countries such as Thailand, innovative enabling tools that make use of pervasive mobile and smartphone technology should be considered. Objective: This study aims to develop a cost-effective, tablet-based hearing screening system that can perform a rapid minimal speech recognition level test. Methods: An Android-based screening app was developed. The screening protocol involved asking children to choose pictures corresponding to a set of predefined words heard at various sound levels offered in a specifically designed sequence. For the app, the set of words was validated, and their corresponding speech power levels were calibrated. We recruited 122 children, aged 4-5 years, during the development phase. Another 63 children of the same age were screened for their hearing abilities using the app in version 2. The results in terms of the sensitivity and specificity were compared with those measured using the conventional audiometric equipment. Results: For screening purposes, the sensitivity of the developed screening system version 2 was 76.67% (95% CI 59.07-88.21), and the specificity was 95.83% (95% CI 89.77-98.37) for screening children with mild hearing loss (pure-tone average threshold at 1, 2, and 4 kHz, >20 dB). The time taken for the screening of each child was 150.52 (SD 19.07) seconds (95% CI 145.71-155.32 seconds). The average time used for conventional play audiometry was 11.79 (SD 3.66) minutes (95% CI 10.85-12.71 minutes). Conclusions: This study shows the potential use of a tablet-based system for rapid and mobile hearing screening. The system was shown to have good overall sensitivity and specificity. Overall, the idea can be easily adopted for systems based on other languages. %M 30355558 %R 10.2196/mhealth.9560 %U http://mhealth.jmir.org/2018/10/e186/ %U https://doi.org/10.2196/mhealth.9560 %U http://www.ncbi.nlm.nih.gov/pubmed/30355558 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 10 %N 3 %P e10655 %T Phase I of the Detecting and Evaluating Childhood Anxiety and Depression Effectively in Subspecialties (DECADES) Study: Development of an Integrated Mental Health Care Model for Pediatric Gastroenterology %A Hullmann,Stephanie E %A Keller,Stacy A %A Lynch,Dustin O %A Jenkins,Kelli %A Moore,Courtney %A Cockrum,Brandon %A Wiehe,Sarah E %A Carroll,Aaron E %A Bennett Jr,William E %+ Center for Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th Street, HITS Building, Indianapolis, IN, 46202, United States, 1 3172786928, webjr@iu.edu %K qualitative research %K patient-reported outcomes %K depression %K anxiety %D 2018 %7 10.09.2018 %9 Original Paper %J J Participat Med %G English %X Background: Children with gastrointestinal symptoms have a very high rate of anxiety and depression. Rapid identification of comorbid anxiety and depression is essential for effective treatment of a wide variety of functional gastrointestinal disorders. Objective: The objective of our study was to determine patient and parent attitudes toward depression, anxiety, and mental health screening during gastroenterology (GI) visits and to determine patient and parent preferences for communication of results and referral to mental health providers after a positive screen. Methods: We augmented standard qualitative group session methods with patient-centered design methods to assess patient and parent preferences. We used a variety of specific design methods in these sessions, including card sorting, projective methods, experience mapping, and constructive methods. Results: Overall, 11 families (11 patients and 14 parents) participated in 2 group sessions. Overall, patients and their parents found integrated mental health care to be acceptable in the subspecialty setting. Patients’ primary concerns were for the privacy and confidentiality of their screening results. Patients and their parents emphasized the importance of mental health services not interfering with the GI visit and collaboration between the GI physician, psychologist, and primary care provider. Conclusions: Patients and their families are open to integrated mental health care in the pediatric subspecialty clinic. The next phase of the DECADES study will translate patient and parent preferences into an integrated mental health care system and test its efficacy in the pediatric GI office. %R 10.2196/10655 %U http://jopm.jmir.org/2018/3/e10655/ %U https://doi.org/10.2196/10655 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 2 %P e13 %T Use of Electronic Entertainment and Communication Devices Among a Saudi Pediatric Population: Cross-Sectional Study %A Amawi,Sami Omar %A Subki,Ahmed Hussein %A Khatib,Hazim Abdulkarim %A Alkhateeb,Omer Sameer %A Fida,Rida Hashim %A Saggaf,Omar Mohammed %A Jan,Mohammed Mohammed %+ Department of Pediatrics, College of Medicine, King Abdulaziz University, , Jeddah,, Saudi Arabia, 966 560662735, ahs.subki@gmail.com %K television %K tablet %K mobile phone %K computers %K devices %K entertainment %K use %K Saudi Arabia %K children %K population %K behavior %K parental impression %D 2018 %7 06.09.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: Excessive use of various electronic entertainment and communication devices, particularly among children, has been associated with increased behavioral problems. Despite children’s escalating use of these devices, parents’ awareness about the impact thereof is still lacking. Objective: The objective of this study was to assess the use of electronic entertainment and communication devices among children attending a health care facility in Jeddah, Saudi Arabia, as well as the parental impression regarding the impact of electronic devices use on the behavior of their child. Methods: A focused 15-item questionnaire was designed for this cross-sectional study involving mothers of children attending the Well Baby Clinic of King Abdulaziz University Hospital, Jeddah, Saudi Arabia from July 1, 2016 to November 30, 2016. Results: This study included 190 mothers. The mean ages of the children, mothers, and fathers were 7.3 (SD 3.5), 35 (SD 6.5), and 43 (SD 8.3) years, respectively. Most children were of Saudi Arabian nationality (106/190, 55.8%). The most used device in this study was television (154/190, 81.0%), followed by mobile phones (134/190, 70.5%), and tablets (116/190, 61.0%). Computers were the least used device in this study (59/190, 31.0%). In total, 24.7% (47/190) of children in this study used electronic entertainment and communication devices for more than 4 hours per day. Most mothers (129/190, 67.9%) felt that their child spends too much time on electronic devices. Hyperactivity or behavioral problems were reported by 20.0% (38/190) of mothers in this study. Children spending longer hours on electronic devices were much more likely to be perceived to suffer from hyperactivity or behavioral problems (P=.01). Conclusions: Parental awareness is necessary to counteract the harmful effects of using electronic devices for a prolonged period. Parents require help to cope with this problem effectively. %M 30190254 %R 10.2196/ijmr.9103 %U http://www.i-jmr.org/2018/2/e13/ %U https://doi.org/10.2196/ijmr.9103 %U http://www.ncbi.nlm.nih.gov/pubmed/30190254 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e169 %T Implementing eHealth Technology to Address Gaps in Early Infant Diagnosis Services: Qualitative Assessment of Kenyan Provider Experiences %A Wexler,Catherine %A Brown,Melinda %A Hurley,Emily A %A Ochieng,Martin %A Goggin,Kathy %A Gautney,Brad %A Maloba,May %A Lwembe,Raphael %A Khamadi,Samoel %A Finocchario-Kessler,Sarah %+ Department of Family Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS,, United States, 1 913 945 7077, cwexler@kumc.edu %K early infant diagnosis (EID) %K HIV/AIDS %K eHealth %K mHealth %K implementation science %K Kenya %D 2018 %7 22.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Literature suggests that electronic health (eHealth) interventions can improve the efficiency and accuracy of health service delivery and improve health outcomes and are generally well received by patients; however, there are limited data on provider experiences using eHealth interventions in resource-limited settings. The HIV Infant Tracking System (HITSystem) is an eHealth intervention designed to improve early infant diagnosis (EID) outcomes among HIV-exposed infants. Objective: We aimed to compare provider experiences with standard EID and HITSystem implementation at 6 Kenyan hospitals and 3 laboratories. The objective of this study was to better understand provider experiences implementing and using the HITSystem in order to assess facilitators and barriers that may impact adoption and sustainability of this eHealth intervention. Methods: As part of a randomized controlled trial to evaluate the HITSystem, we conducted semistructured interviews with 17 EID providers at participating intervention and control hospitals and laboratories. Results: Providers emphasized the perceived usefulness of the HITSystem, including improved efficiency in sample tracking and patient follow-up, strengthened communication networks among key stakeholders, and improved capacity to meet patient needs compared to standard EID. These advantages were realized from an intervention that providers saw as easy to use and largely compatible with workflow. However, supply stock outs and patient psychosocial factors (including fear of HIV status disclosure and poverty) provided ongoing challenges to EID service provision. Furthermore, slow or sporadic internet access and heavy workload prevented real-time HITSystem data entry for some clinicians. Conclusions: Provider experiences with the HITSystem indicate that the usefulness of the HITSystem, along with the ease with which it is able to be incorporated into hospital workflows, contributes to its sustained adoption and use in Kenyan hospitals. To maximize implementation success, care should be taken in intervention design and implementation to ensure that end users see clear advantages to using the technology and to account for variations in workflows, patient populations, and resource levels by allowing flexibility to suit user needs. Trial Registration: ClinicalTrials.gov NCT02072603; https://clinicaltrials.gov/ct2/show/NCT02072603 (Archived by WebCite at http://www.webcitation.org/71NgMCrAm) %M 30135052 %R 10.2196/mhealth.9725 %U http://mhealth.jmir.org/2018/8/e169/ %U https://doi.org/10.2196/mhealth.9725 %U http://www.ncbi.nlm.nih.gov/pubmed/30135052 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e239 %T Creating Low-Cost 360-Degree Virtual Reality Videos for Hospitals: A Technical Paper on the Dos and Don’ts %A O’Sullivan,Benjamin %A Alam,Fahad %A Matava,Clyde %+ Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, 555 University Ave, Toronto, ON,, Canada, 1 8137445, clyde.matava@sickkids.ca %K 360-degree video %K VR %K virtual reality %K video production %K anesthetic preparation %K preoperative anxiety %K preoperative preparation %D 2018 %7 16.07.2018 %9 Tutorial %J J Med Internet Res %G English %X This article will provide a framework for producing immersive 360-degree videos for pediatric and adult patients in hospitals. This information may be useful to hospitals across the globe who may wish to produce similar videos for their patients. Advancements in immersive 360-degree technologies have allowed us to produce our own “virtual experience” where our children can prepare for anesthesia by “experiencing” all the sights and sounds of receiving and recovering from an anesthetic. We have shown that health care professionals, children, and their parents find this form of preparation valid, acceptable and fun. Perhaps more importantly, children and parents have self-reported that undertaking our virtual experience has led to a reduction in their anxiety when they go to the operating room. We provide definitions, and technical aspects to assist other health care professionals in the development of low-cost 360-degree videos. %M 30012545 %R 10.2196/jmir.9596 %U http://www.jmir.org/2018/7/e239/ %U https://doi.org/10.2196/jmir.9596 %U http://www.ncbi.nlm.nih.gov/pubmed/30012545 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e10958 %T Online Peer-to-Peer Mentoring Support for Youth with Hemophilia: Qualitative Needs Assessment %A Breakey,Vicky R %A Bouskill,Vanessa %A Nguyen,Cynthia %A Luca,Stephanie %A Stinson,Jennifer N %A Ahola Kohut,Sara %+ Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children’s Hospital, HSC 3N27a, 1280 Main Street W, Hamilton, ON, L8S 4K1, Canada, 1 905 521 2100 ext 73080, breakev@mcmaster.ca %K hemophilia %K adolescents %K transition %K self-management %K education %K internet %K mentoring %D 2018 %7 10.07.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: To support adolescents through transition from pediatrics to adult care, health care providers and families help teens gain knowledge and develop self-management skills. Peer mentoring can provide meaningful support and has been associated with improved health outcomes in patients with other chronic conditions. Peer mentoring is an appealing way to provide support, but it is imperative to consider the unique needs of adolescents to ensure its success. Objective: The objective of our study was to identify the peer mentoring wants and needs of youth with hemophilia in order to guide the development of a new program. Methods: In this qualitative study, we interviewed a convenience sample of youth with hemophilia from 2 Canadian hemophilia treatment centers. Two iterative cycles of audiorecorded, semistructured individual interviews were conducted. Descriptive statistics and content analyses were used to organize data into categories that reflected emerging themes. Results: In total, we recruited 23 participants aged 12-20 years, with a mean age of 14.91 (2.57) years. When asked about program design, participants weighed the importance of flexibility in delivery (eg, Web-based, in person, text messaging [short message service]), content (eg, structured vs unstructured), frequency of sessions, and length of the program. Participants identified some potential challenges such as scheduling issues, comfort level for disease discussion, and discordant mentor-mentee personality types. The program was viewed as a positive medium for connecting peers with hemophilia. Conclusions: Adolescents with hemophilia expressed interest in a peer mentoring program and provided valuable insight that will be applied in the development of a peer mentoring program for youth with hemophilia. %M 31518296 %R 10.2196/10958 %U http://pediatrics.jmir.org/2018/2/e10958/ %U https://doi.org/10.2196/10958 %U http://www.ncbi.nlm.nih.gov/pubmed/31518296 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e68 %T Patient and Family Engagement in the Design of a Mobile Health Solution for Pediatric Asthma: Development and Feasibility Study %A McWilliams,Andrew %A Reeves,Kelly %A Shade,Lindsay %A Burton,Elizabeth %A Tapp,Hazel %A Courtlandt,Cheryl %A Gunter,Andrew %A Dulin,Michael F %+ Center for Outcomes Research and Evaluation, Carolinas HealthCare System, Research Office Building, 1540 Garden Terrace, Suite 406, Charlotte, NC, 28203, United States, 1 704 351 6835, andrew.mcwilliams@carolinas.org %K engagement %K pediatric asthma %K shared decision-making %K health information technology %D 2018 %7 22.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Asthma is a highly prevalent, chronic disease with significant morbidity, cost, and disparities in health outcomes. While adherence to asthma treatment guidelines can improve symptoms and decrease exacerbations, most patients receive care that is not guideline-based. New approaches that incorporate shared decision-making (SDM) and health information technology (IT) are needed to positively impact asthma management. Despite the promise of health IT to improve efficiency and outcomes in health care, new IT solutions frequently suffer from a lack of widespread adoption and do not achieve desired results, as a consequence of not involving end-users in design. Objective: To describe a case study of a pediatric asthma SDM health IT solution’s development and demonstrate a methodology for engaging actual patients and families in IT development. Perspectives are shared from the vantage point of the research team and a parent of a child with asthma, who participated on the development team. Methods: We adapted user-centric design principles to engage actual users across three main development phases: project initiation, ideation, and usability testing. To facilitate the necessary level of user engagement, our approach included: (1) a Development Workgroup consisting of patients, caregivers, and providers who met regularly with the research team; and (2) “real-world users” consisting of patients, caregivers, and providers recruited from a variety of care locations, including safety-net clinics. Results: Using this methodology, we successful partnered with asthma patients and families to create an interactive, digital solution called Carolinas Asthma Coach. Carolinas Asthma Coach incorporates SDM principles to elicit patient information, including goals and preferences, and provides health-literate, tailored education with specific guideline-based recommendations for patients and their providers. Of the patients, caregivers, and providers surveyed, 100% (n=60) said they would recommend Carolinas Asthma Coach to a friend or colleague. Qualitative feedback from users provided support for the usability and engaging nature of the app. Conclusions: This project demonstrates the feasibility and benefits of deploying user-centric design methods that engage real patients and caregivers throughout the health IT design process. %M 29567637 %R 10.2196/mhealth.8849 %U http://mhealth.jmir.org/2018/3/e68/ %U https://doi.org/10.2196/mhealth.8849 %U http://www.ncbi.nlm.nih.gov/pubmed/29567637