TY - JOUR AU - Ginsberg, Harrison Kristin AU - Alsweiler, Jane AU - Rogers, Jenny AU - Ross, Phoebe AU - Serlachius, Anna PY - 2025/4/2 TI - Exploring Stress and Stress-Reduction With Caregivers and Clinicians in the Neonatal Intensive Care Unit to Inform Intervention Development: Qualitative Interview Study JO - JMIR Pediatr Parent SP - e66401 VL - 8 KW - neonatal intensive care unit KW - NICU KW - parents KW - preterm infants KW - stress KW - stress reduction KW - intervention development KW - digital KW - neonatology KW - pediatric KW - infants KW - babies KW - neonatal KW - toddler KW - children KW - caregiver KW - telemedicine KW - telehealth KW - virtual care KW - virtual health KW - virtual medicine KW - remote consultation KW - qualitative study N2 - 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. UR - https://pediatrics.jmir.org/2025/1/e66401 UR - http://dx.doi.org/10.2196/66401 ID - info:doi/10.2196/66401 ER - TY - JOUR AU - Kahhan, A. Nicole AU - Fox, A. Larry AU - Benson, Matthew AU - Patton, R. Susana PY - 2025/2/6 TI - Implementing Diabetes Distress Screening in a Pediatric Endocrinology Clinic Using a Digital Health Platform: Quantitative Secondary Data Analysis JO - JMIR Pediatr Parent SP - e65107 VL - 8 KW - type 1 diabetes KW - diabetes mellitus, type 1 KW - pediatric KW - child KW - children KW - youth KW - parents KW - diabetes distress KW - eHealth KW - screening KW - digital health KW - diabetes KW - diabetic KW - type 1 KW - DM KW - T1D KW - endocrinology KW - alert KW - best practice alert KW - BPA KW - patient education N2 - 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 UR - https://pediatrics.jmir.org/2025/1/e65107 UR - http://dx.doi.org/10.2196/65107 ID - info:doi/10.2196/65107 ER - TY - JOUR AU - Khaksar, Sajjad AU - Jafari-Oori, Mehdi AU - Sarhangi, Forogh AU - Moayed, Sadat Malihe PY - 2025/1/28 TI - Pediatric Sleep Quality and Parental Stress in Neuromuscular Disorders: Descriptive Analytical Study JO - Asian Pac Isl Nurs J SP - e56667 VL - 9 KW - spinal muscular atrophy KW - neuromuscular disorders KW - sleep quality KW - pediatrics KW - parental stress KW - children KW - parents KW - muscular atrophy KW - muscular disorders N2 - 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 ? 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. UR - https://apinj.jmir.org/2025/1/e56667 UR - http://dx.doi.org/10.2196/56667 ID - info:doi/10.2196/56667 ER - TY - JOUR AU - Erika, Ayu Kadek AU - Fadilah, Nur AU - Latif, Insani Aulia AU - Hasbiah, Nurhikmawaty AU - Juliaty, Aidah AU - Achmad, Harun AU - Bustamin, Anugrayani PY - 2024/12/17 TI - Stunting Super App as an Effort Toward Stunting Management in Indonesia: Delphi and Pilot Study JO - JMIR Hum Factors SP - e54862 VL - 11 KW - stunting KW - stunting prevention KW - mobile app N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e54862 UR - http://dx.doi.org/10.2196/54862 ID - info:doi/10.2196/54862 ER - TY - JOUR AU - Sada, Fatos AU - Chivers, Paola AU - Cecelia, Sokol AU - Statovci, Sejdi AU - Ukperaj, Kujtim AU - Hughes, Jeffery AU - Hoti, Kreshnik PY - 2024/12/3 TI - Parental Assessment of Postsurgical Pain in Infants at Home Using Artificial Intelligence?Enabled and Observer-Based Tools: Construct Validity and Clinical Utility Evaluation Study JO - JMIR Pediatr Parent SP - e64669 VL - 7 KW - PainChek Infant KW - Observer-Administered Visual Analog Scale KW - parents KW - infant pain KW - pain assessment KW - circumcision KW - infant home assessment KW - clinical utility KW - construct validity KW - artificial intelligence N2 - 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 (?22=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 (?21=7.2, P=.007) and intervention (?22=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. UR - https://pediatrics.jmir.org/2024/1/e64669 UR - http://dx.doi.org/10.2196/64669 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64669 ER - TY - JOUR AU - Garikipati, Anurag AU - Ciobanu, Madalina AU - Singh, Preet Navan AU - Barnes, Gina AU - Dinenno, A. Frank AU - Geisel, Jennifer AU - Mao, Qingqing AU - Das, Ritankar PY - 2024/10/30 TI - Parent-Led Applied Behavior Analysis to Impact Clinical Outcomes for Individuals on the Autism Spectrum: Retrospective Chart Review JO - JMIR Pediatr Parent SP - e62878 VL - 7 KW - applied behavior analysis KW - autism spectrum disorder KW - parent training KW - patient outcomes KW - skill acquisition KW - pediatrics N2 - 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. UR - https://pediatrics.jmir.org/2024/1/e62878 UR - http://dx.doi.org/10.2196/62878 ID - info:doi/10.2196/62878 ER - TY - JOUR AU - Sahyouni, Amal AU - Zoukar, Imad AU - Dashash, Mayssoon PY - 2024/10/28 TI - Evaluating the Effectiveness of an Online Course on Pediatric Malnutrition for Syrian Health Professionals: Qualitative Delphi Study JO - JMIR Med Educ SP - e53151 VL - 10 KW - effectiveness KW - online course KW - pediatric KW - malnutrition KW - essential competencies KW - e-learning KW - health professional KW - Syria KW - pilot study KW - acquisition knowledge N2 - 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. UR - https://mededu.jmir.org/2024/1/e53151 UR - http://dx.doi.org/10.2196/53151 ID - info:doi/10.2196/53151 ER - TY - JOUR AU - Kvestad, Ingrid AU - Adolfsen, Frode AU - Angeles, Corinne Renira AU - Brandseth, Lekve Oda AU - Breivik, Kyrre AU - Evertsen, Grete Janne AU - Foer, Kvåle Irene AU - Haaland, Morten AU - Homola, Millerjord Birgit AU - Hoseth, Elisabeth Gro AU - Jonsson, Josefine AU - Kjerstad, Egil AU - Kyrrestad, Henriette AU - Martinussen, Monica AU - Moberg, Annelene AU - Moberg, Karianne AU - Skogstrand, Anita AU - Solberg, Remme Line AU - Aasheim, Merete PY - 2024/10/24 TI - Effectiveness of a Bullying Intervention (Be-Prox) in Norwegian Early Childhood and Education Care Centers: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e60626 VL - 13 KW - peer bullying in early childhood education and care KW - The Bernese Program KW - cluster randomized controlled trial KW - bullying KW - child KW - preschool KW - program evaluation N2 - 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 UR - https://www.researchprotocols.org/2024/1/e60626 UR - http://dx.doi.org/10.2196/60626 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60626 ER - TY - JOUR AU - Deribe, Leul AU - Girma, Eshetu AU - Lindström, Nataliya AU - Gidey, Abdulkadir AU - Teferra, Solomon AU - Addissie, Adamu PY - 2024/10/4 TI - Parent Education and Counseling (PairEd-C) Intervention to Improve Family-Centered Care: Protocol for a Prospective Acceptability Study Using the Theoretical Framework of Acceptability JO - JMIR Res Protoc SP - e54914 VL - 13 KW - family-centered care KW - child cancer KW - theoretical framework of acceptability KW - education and counseling KW - acceptability KW - parent education KW - family centered KW - care service KW - theoretical framework KW - study protocol KW - family KW - health care KW - well-being KW - children KW - implementation KW - design intervention N2 - 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 UR - https://www.researchprotocols.org/2024/1/e54914 UR - http://dx.doi.org/10.2196/54914 UR - http://www.ncbi.nlm.nih.gov/pubmed/39365661 ID - info:doi/10.2196/54914 ER - TY - JOUR AU - Taylor, Marin AU - Bondi, Christina Bianca AU - Andrade, F. Brendan AU - Au-Young, H. Stephanie AU - Chau, Vann AU - Danguecan, Ashley AU - Désiré, Naddley AU - Guo, Ting AU - Ostojic-Aitkens, Dragana AU - Wade, Shari AU - Miller, Steven AU - Williams, Samantha Tricia PY - 2024/10/4 TI - Stepped-Care Web-Based Parent Support Following Congenital Heart Disease: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e64216 VL - 13 KW - congenital heart disease KW - neurodevelopmental outcomes KW - web-based mental health care KW - stepped care KW - positive parenting KW - family well-being KW - mental health KW - I-InTERACT-North N2 - 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 UR - https://www.researchprotocols.org/2024/1/e64216 UR - http://dx.doi.org/10.2196/64216 UR - http://www.ncbi.nlm.nih.gov/pubmed/39365658 ID - info:doi/10.2196/64216 ER - TY - JOUR AU - Marelli, Ariane AU - Rozenblum, Ronen AU - Bolster-Foucault, Clara AU - Via-Dufresne Ley, Alicia AU - Maynard, Noemie AU - Amaria, Khush AU - Galuppi, Barb AU - Strohm, Sonya AU - Nguyen, Linda AU - Dawe-McCord, Claire AU - Putterman, Connie AU - Kovacs, H. Adrienne AU - Gorter, Willem Jan PY - 2024/10/1 TI - 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 JO - JMIR Pediatr Parent SP - e51606 VL - 7 KW - patient-centered care KW - patient engagement KW - mobile app KW - health IT KW - health care transition KW - mobile phone N2 - 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 UR - https://pediatrics.jmir.org/2024/1/e51606 UR - http://dx.doi.org/10.2196/51606 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51606 ER - TY - JOUR AU - Wang, Xiaoling AU - Rao, Rui AU - Li, Hua AU - Lei, Xiaoping AU - Dong, Wenbin PY - 2024/9/18 TI - Red Blood Cell Transfusion for Incidence of Retinopathy of Prematurity: Prospective Multicenter Cohort Study JO - JMIR Pediatr Parent SP - e60330 VL - 7 KW - red blood cell transfusion KW - retinopathy of prematurity KW - VPI KW - very preterm infants KW - ROP KW - visual impairment KW - blindness KW - RBC KW - red blood cell N2 - 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. UR - https://pediatrics.jmir.org/2024/1/e60330 UR - http://dx.doi.org/10.2196/60330 ID - info:doi/10.2196/60330 ER - TY - JOUR AU - Murgueitio, Nicolas AU - Tate, Maresa AU - Lurie, Lucy AU - Priddy, Zoe AU - Boda, Sneha AU - Shipkova, Michelle AU - Rodriguez, Micaela AU - Machlin, Laura AU - Furlong, Sarah AU - Mitchell, Amanda AU - McLaughlin, Katie AU - Sheridan, Margaret PY - 2024/9/17 TI - Testing a Conceptual Model of Early Adversity, Neural Function, and Psychopathology: Protocol for a Retrospective Observational Cohort Study JO - JMIR Res Protoc SP - e59636 VL - 13 KW - early adversity KW - psychopathology KW - neurodevelopment KW - adverse childhood events KW - child development N2 - 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 UR - https://www.researchprotocols.org/2024/1/e59636 UR - http://dx.doi.org/10.2196/59636 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59636 ER - TY - JOUR AU - Braddock, Amy AU - Ghosh, Parijat AU - Montgomery, Emma AU - Lim, Crystal AU - Ghosh, Jaya AU - Henry, Nicole AU - Popescu, Mihail AU - Kimchi, Kimberly AU - Guo, Congyu AU - Bosworth, Taylor K. AU - Koopman, J. Richelle PY - 2024/9/10 TI - 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 JO - JMIR Res Protoc SP - e63505 VL - 13 KW - mHealth KW - adolescents KW - apps KW - caregivers KW - obesity KW - healthy lifestyle KW - CommitFit KW - mobile health N2 - 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 UR - https://www.researchprotocols.org/2024/1/e63505 UR - http://dx.doi.org/10.2196/63505 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63505 ER - TY - JOUR AU - Werner, E. Nicole AU - Morgen, Makenzie AU - Kooiman, Sophie AU - Jolliff, Anna AU - Warner, Gemma AU - Feinstein, James AU - Chui, Michelle AU - Katz, Barbara AU - Storhoff, Brittany AU - Sodergren, Kristan AU - Coller, Ryan PY - 2024/9/9 TI - Effectiveness of a Mobile App (Meds@HOME) to Improve Medication Safety for Children With Medical Complexity: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e60621 VL - 13 KW - medication safety KW - children with medical complexity KW - caregiving KW - polypharmacy KW - medication management N2 - 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 UR - https://www.researchprotocols.org/2024/1/e60621 UR - http://dx.doi.org/10.2196/60621 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60621 ER - TY - JOUR AU - Piris-Borregas, Salvador AU - Bellón-Vaquerizo, Beatriz AU - Velasco-Echeburúa, Leticia AU - Niño-Díaz, Lidia AU - Sánchez-Aparicio, Susana AU - López-Maestro, María AU - Pallás-Alonso, Rosa Carmen PY - 2024/8/30 TI - Parental Autonomy in the Care of Premature Newborns and the Experience of a Neonatal Team: Observational Prospective Study JO - JMIR Pediatr Parent SP - e55411 VL - 7 KW - family-centered care KW - neonatal intensive care unit KW - kangaroo mother care KW - mother KW - mothers KW - parent KW - parents KW - parental KW - ICU KW - intensive care KW - training KW - education KW - educational KW - premature KW - pediatric KW - pediatrics KW - paediatric KW - paediatrics KW - infant KW - infants KW - infancy KW - baby KW - babies KW - neonate KW - neonates KW - neonatal KW - newborn KW - newborns KW - intensive care unit N2 - 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. UR - https://pediatrics.jmir.org/2024/1/e55411 UR - http://dx.doi.org/10.2196/55411 ID - info:doi/10.2196/55411 ER - TY - JOUR AU - Kapp, M. Julie AU - Dicke, Rachel AU - Quinn, Kathleen PY - 2024/8/7 TI - Online Delivery of Interprofessional Adverse Childhood Experiences Training to Rural Providers: Usability Study JO - JMIR Pediatr Parent SP - e56722 VL - 7 KW - adverse childhood experiences KW - ACE KW - training KW - trauma-informed care KW - provider KW - rural KW - adverse KW - trauma KW - traumatic KW - providers KW - teaching KW - curriculum KW - curricula KW - education KW - educational KW - social work KW - social worker KW - social workers KW - psychologist KW - psychologists KW - counselor KW - counselors KW - interprofessional KW - pediatric KW - pediatrics KW - paediatric KW - paediatrics KW - child KW - children KW - experience KW - experiences KW - continuing education N2 - 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. UR - https://pediatrics.jmir.org/2024/1/e56722 UR - http://dx.doi.org/10.2196/56722 ID - info:doi/10.2196/56722 ER - TY - JOUR AU - Lau, Nancy AU - Palermo, M. Tonya AU - Zhou, Chuan AU - Badillo, Isabel AU - Hong, Shannon AU - Aalfs, Homer AU - Yi-Frazier, P. Joyce AU - McCauley, Elizabeth AU - Chow, J. Eric AU - Weiner, J. Bryan AU - Ben-Zeev, Dror AU - Rosenberg, R. Abby PY - 2024/7/30 TI - Mobile App Promoting Resilience in Stress Management for Adolescents and Young Adults With Cancer: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e57950 VL - 13 KW - adolescents KW - young adult KW - cancer KW - mHealth KW - psychosocial intervention KW - stress management KW - coping KW - resilience KW - health-related quality of life KW - randomized controlled trial KW - mobile phone N2 - 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 UR - https://www.researchprotocols.org/2024/1/e57950 UR - http://dx.doi.org/10.2196/57950 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57950 ER - TY - JOUR AU - Li, K. Brian S. AU - Fereday, Brendan AU - Wang, Ellen AU - Rodriguez, Samuel AU - Forssell, Karin AU - Bollaert, N. André AU - Menendez, Maria AU - Caruso, J. Thomas PY - 2024/7/30 TI - Enhancement of Immersive Technology Use in Pediatric Health Care With Accessible, Context-Specific Training: Descriptive Feasibility Study JO - JMIR XR Spatial Comput SP - e56447 VL - 1 KW - immersive technology KW - implementation KW - adult learning KW - education KW - pediatric KW - accessibility KW - training KW - therapeutic KW - pediatric care KW - utilization KW - virtual reality KW - VR KW - monitoring KW - license KW - development KW - software KW - monitoring software N2 - 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. UR - https://xr.jmir.org/2024/1/e56447 UR - http://dx.doi.org/10.2196/56447 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56447 ER - TY - JOUR AU - Haeri Mazanderani, Ahmad AU - Radebe, Lebohang AU - Sherman, G. Gayle PY - 2024/5/14 TI - 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 JO - JMIR Public Health Surveill SP - e40796 VL - 10 KW - HIV KW - monitoring KW - viral load KW - suppression KW - overdue KW - retention KW - VL test KW - attrition KW - child KW - youth KW - pediatric KW - paediatric KW - sexually transmitted KW - sexual transmission KW - virological failure KW - South Africa KW - infant KW - adolescent KW - big data KW - descriptive analysis KW - laboratory data N2 - 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. UR - https://publichealth.jmir.org/2024/1/e40796 UR - http://dx.doi.org/10.2196/40796 UR - http://www.ncbi.nlm.nih.gov/pubmed/38743934 ID - info:doi/10.2196/40796 ER - TY - JOUR AU - Hrynyschyn, Robert AU - Guldager, Dalgaard Julie AU - Schulze, Daniel AU - Lyk, Bianca Patricia AU - Majgaard, Gunver AU - Stock, Christiane PY - 2024/5/6 TI - Factors Associated With Risky Drinking Decisions in a Virtual Reality Alcohol Prevention Simulation: Structural Equation Model JO - JMIR XR Spatial Comput SP - e56188 VL - 1 KW - alcohol KW - prevention KW - virtual reality KW - risk behavior KW - structural equation model N2 - 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. UR - https://xr.jmir.org/2024/1/e56188 UR - http://dx.doi.org/10.2196/56188 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56188 ER - TY - JOUR AU - Pretorius, Kelly AU - Kang, Sookja AU - Choi, Eunju PY - 2024/4/23 TI - Photos Shared on Facebook in the Context of Safe Sleep Recommendations: Content Analysis of Images JO - JMIR Pediatr Parent SP - e54610 VL - 7 KW - SUID KW - SIDS KW - parenting KW - safe sleep KW - photo analysis KW - pediatric KW - pediatrics KW - paediatric KW - paediatrics KW - infant KW - infants KW - infancy KW - baby KW - babies KW - neonate KW - neonates KW - neonatal KW - newborn KW - newborns KW - sleep KW - safety KW - death KW - mortality KW - social media KW - picture KW - pictures KW - photo KW - photos KW - photographs KW - image KW - images KW - Facebook KW - mother KW - mothers KW - parent KW - co-sleeping KW - sudden infant death KW - sudden unexpected infant death KW - adherence KW - parent education KW - parents' education KW - awareness N2 - 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. UR - https://pediatrics.jmir.org/2024/1/e54610 UR - http://dx.doi.org/10.2196/54610 ID - info:doi/10.2196/54610 ER - TY - JOUR AU - Avila-Montiel, Diana AU - Vilchis-Gil, Jenny AU - Miranda-Lora, Liliana América AU - Velázquez-López, Lubia AU - Klünder-Klünder, Miguel PY - 2024/4/1 TI - 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 JO - JMIR Res Protoc SP - e54783 VL - 13 KW - e-Health nutrition education KW - ultraprocessed foods KW - malnutrition KW - children KW - Mexico KW - intervention KW - obesity KW - food KW - food selection KW - labeling KW - package labeling N2 - 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 UR - https://www.researchprotocols.org/2024/1/e54783 UR - http://dx.doi.org/10.2196/54783 UR - http://www.ncbi.nlm.nih.gov/pubmed/38557591 ID - info:doi/10.2196/54783 ER - TY - JOUR AU - Weidner, Jens AU - Glauche, Ingmar AU - Manuwald, Ulf AU - Kern, Ivana AU - Reinecke, Ines AU - Bathelt, Franziska AU - Amin, Makan AU - Dong, Fan AU - Rothe, Ulrike AU - Kugler, Joachim PY - 2024/3/25 TI - Correlation of Socioeconomic and Environmental Factors With Incidence of Crohn Disease in Children and Adolescents: Systematic Review and Meta-Regression JO - JMIR Public Health Surveill SP - e48682 VL - 10 KW - Crohn?s disease KW - inflammatory bowel disease KW - pediatric KW - children KW - adolescents KW - environmental factors KW - Crohn disease KW - gastroenteritis KW - inflammatory bowel diseases KW - bowel disease KW - digestive system KW - gastrointestinal disease N2 - 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 UR - https://publichealth.jmir.org/2024/1/e48682 UR - http://dx.doi.org/10.2196/48682 UR - http://www.ncbi.nlm.nih.gov/pubmed/38526534 ID - info:doi/10.2196/48682 ER - TY - JOUR AU - Secor, M. Andrew AU - Célestin, Kemar AU - Jasmin, Margareth AU - Honoré, Guy Jean AU - Wagner, D. Anjuli AU - Beima-Sofie, Kristin AU - Pintye, Jillian AU - Puttkammer, Nancy PY - 2024/3/6 TI - Electronic Medical Record Data Missingness and Interruption in Antiretroviral Therapy Among Adults and Children Living With HIV in Haiti: Retrospective Longitudinal Study JO - JMIR Pediatr Parent SP - e51574 VL - 7 KW - HIV KW - Haiti KW - pediatrics KW - combination antiretroviral therapy KW - electronic medical record KW - data quality KW - child KW - children KW - antiretroviral KW - therapy KW - longitudinal study KW - HIV diagnosis KW - diagnosis KW - HIV care KW - patient records KW - quality of care KW - treatment KW - engagement N2 - 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. UR - https://pediatrics.jmir.org/2024/1/e51574 UR - http://dx.doi.org/10.2196/51574 ID - info:doi/10.2196/51574 ER - @Article{info:doi/10.2196/55560, author="Lawrence-Sidebottom, Darian and Huffman, Goodgame Landry and Beam, Brenna Aislinn and Guerra, Rachael and Parikh, Amit and Roots, Monika and Huberty, Jennifer", title="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", journal="JMIR Pediatr Parent", year="2024", month="Feb", day="27", volume="7", pages="e55560", keywords="collaborative care model", keywords="telehealth", keywords="childhood trauma", keywords="DMHI", keywords="digital health", keywords="mental health", keywords="telemedicine", keywords="trauma", keywords="traumatic", keywords="pediatric", keywords="pediatrics", keywords="paediatric", keywords="paediatrics", keywords="child", keywords="children", keywords="youth", keywords="adolescent", keywords="adolescents", keywords="teen", keywords="teens", keywords="teenager", keywords="teenagers", keywords="retrospective", keywords="anxiety", keywords="depression", keywords="depressive", keywords="co-occurring", keywords="comorbid", keywords="comorbidity", keywords="comorbidities", keywords="association", keywords="associations", keywords="correlation", keywords="correlations", keywords="correlate", abstract="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. ", doi="10.2196/55560", url="https://pediatrics.jmir.org/2024/1/e55560", url="http://www.ncbi.nlm.nih.gov/pubmed/38412001" } TY - JOUR AU - McElwain, L. Nancy AU - Fisher, C. Meghan AU - Nebeker, Camille AU - Bodway, M. Jordan AU - Islam, Bashima AU - Hasegawa-Johnson, Mark PY - 2024/2/8 TI - Evaluating Users? Experiences of a Child Multimodal Wearable Device: Mixed Methods Approach JO - JMIR Hum Factors SP - e49316 VL - 11 KW - wearable devices KW - multimodal sensing KW - user experience KW - usability KW - privacy KW - children KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e49316 UR - http://dx.doi.org/10.2196/49316 UR - http://www.ncbi.nlm.nih.gov/pubmed/38329785 ID - info:doi/10.2196/49316 ER - TY - JOUR AU - Aldridge, Grace AU - Tomaselli, Alessandra AU - Nowell, Clare AU - Reupert, Andrea AU - Jorm, Anthony AU - Yap, Hui Marie Bee PY - 2024/1/19 TI - Engaging Parents in Technology-Assisted Interventions for Childhood Adversity: Systematic Review JO - J Med Internet Res SP - e43994 VL - 26 KW - systematic review KW - intervention KW - digital technology KW - parenting KW - children KW - technology KW - parenting program KW - engagement KW - support KW - adverse childhood experiences N2 - 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 UR - https://www.jmir.org/2024/1/e43994 UR - http://dx.doi.org/10.2196/43994 UR - http://www.ncbi.nlm.nih.gov/pubmed/38241066 ID - info:doi/10.2196/43994 ER - TY - JOUR AU - Zvulunov, Alex AU - Lenevich, Stepan AU - Migacheva, Natalia PY - 2023/12/13 TI - A Mobile Health App for Facilitating Disease Management in Children With Atopic Dermatitis: Feasibility and Impact Study JO - JMIR Dermatol SP - e49278 VL - 6 KW - atopic dermatitis KW - eczema KW - Atopic App mobile health application KW - artificial intelligence KW - dermatitis KW - dermatology KW - skin KW - disease management KW - child KW - children KW - pediatric KW - pediatrics KW - feasibility KW - mHealth KW - mobile health KW - app KW - apps KW - applications N2 - 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. UR - https://derma.jmir.org/2023/1/e49278 UR - http://dx.doi.org/10.2196/49278 UR - http://www.ncbi.nlm.nih.gov/pubmed/38090787 ID - info:doi/10.2196/49278 ER - TY - JOUR AU - Castor, Charlotte AU - Lindkvist, Rose-Marie AU - Hallström, Kristensson Inger AU - Holmberg, Robert PY - 2023/10/18 TI - Health Care Professionals? Experiences and Views of eHealth in Pediatric Care: Qualitative Interview Study Applying a Theoretical Framework for Implementation JO - JMIR Pediatr Parent SP - e47663 VL - 6 KW - communication KW - digital KW - experiences KW - eHealth KW - health care professionals KW - implementation KW - NASSS KW - pediatric care N2 - 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 UR - https://pediatrics.jmir.org/2023/1/e47663 UR - http://dx.doi.org/10.2196/47663 UR - http://www.ncbi.nlm.nih.gov/pubmed/37851500 ID - info:doi/10.2196/47663 ER - TY - JOUR AU - Labarta, I. José AU - Dimitri, Paul AU - Keiser, Matthew AU - Koledova, Ekaterina AU - Rivera-Romero, Octavio PY - 2023/8/2 TI - 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 JO - JMIR Hum Factors SP - e46893 VL - 10 KW - connected health KW - growth hormone deficiency KW - participatory health informatics KW - recombinant human growth hormone KW - technology acceptance KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e46893 UR - http://dx.doi.org/10.2196/46893 UR - http://www.ncbi.nlm.nih.gov/pubmed/37531173 ID - info:doi/10.2196/46893 ER - TY - JOUR AU - Edgcomb, Beni Juliet AU - Tseng, Chi-hong AU - Pan, Mengtong AU - Klomhaus, Alexandra AU - Zima, T. Bonnie PY - 2023/7/21 TI - Assessing Detection of Children With Suicide-Related Emergencies: Evaluation and Development of Computable Phenotyping Approaches JO - JMIR Ment Health SP - e47084 VL - 10 KW - child mental health KW - suicide KW - self-harm KW - machine learning KW - phenotyping N2 - 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. UR - https://mental.jmir.org/2023/1/e47084 UR - http://dx.doi.org/10.2196/47084 UR - http://www.ncbi.nlm.nih.gov/pubmed/37477974 ID - info:doi/10.2196/47084 ER - TY - JOUR AU - Lichtner, Gregor AU - Haese, Thomas AU - Brose, Sally AU - Röhrig, Larissa AU - Lysyakova, Liudmila AU - Rudolph, Stefanie AU - Uebe, Maria AU - Sass, Julian AU - Bartschke, Alexander AU - Hillus, David AU - Kurth, Florian AU - Sander, Erik Leif AU - Eckart, Falk AU - Toepfner, Nicole AU - Berner, Reinhard AU - Frey, Anna AU - Dörr, Marcus AU - Vehreschild, Janne Jörg AU - von Kalle, Christof AU - Thun, Sylvia PY - 2023/7/18 TI - 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 JO - JMIR Med Inform SP - e45496 VL - 11 KW - interoperability KW - research data set KW - Fast Healthcare Interoperability Resources KW - FHIR KW - FAIR principle KW - COVID-19 KW - interoperable KW - SARS-CoV-2 KW - pediatric KW - immunization KW - cardiology KW - standard N2 - 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. UR - https://medinform.jmir.org/2023/1/e45496 UR - http://dx.doi.org/10.2196/45496 ID - info:doi/10.2196/45496 ER - TY - JOUR AU - Darien, Kaja AU - Lee, Susan AU - Knowles, Kayla AU - Wood, Sarah AU - Langer, D. Miriam AU - Lazar, Nellie AU - Dowshen, Nadia PY - 2023/7/18 TI - Health Information From Web Search Engines and Virtual Assistants About Pre-Exposure Prophylaxis for HIV Prevention in Adolescents and Young Adults: Content Analysis JO - JMIR Pediatr Parent SP - e41806 VL - 6 KW - pre-exposure prophylaxis KW - PrEP KW - prophylaxis KW - internet use KW - search engine KW - adolescent KW - youth KW - pediatric KW - adolescence KW - young adult KW - readability KW - human immunodeficiency virus KW - HIV KW - virtual assistant KW - health information KW - information quality KW - accuracy KW - credibility KW - patient education KW - comprehension KW - comprehensible KW - web-based KW - online information KW - sexual health KW - reading level N2 - 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. UR - https://pediatrics.jmir.org/2023/1/e41806 UR - http://dx.doi.org/10.2196/41806 UR - http://www.ncbi.nlm.nih.gov/pubmed/37463044 ID - info:doi/10.2196/41806 ER - TY - JOUR AU - Azzolina, Danila AU - Bressan, Silvia AU - Lorenzoni, Giulia AU - Baldan, Andrea Giulia AU - Bartolotta, Patrizia AU - Scognamiglio, Federico AU - Francavilla, Andrea AU - Lanera, Corrado AU - Da Dalt, Liviana AU - Gregori, Dario PY - 2023/7/12 TI - Pediatric Injury Surveillance From Uncoded Emergency Department Admission Records in Italy: Machine Learning?Based Text-Mining Approach JO - JMIR Public Health Surveill SP - e44467 VL - 9 KW - machine learning KW - pediatrics KW - child and adolescent health KW - text mining KW - injury KW - death KW - surveillance KW - pediatric admission KW - hospitalization KW - patient record KW - unintentional injury KW - emergency department KW - emergency KW - epidemiological surveillance N2 - 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. UR - https://publichealth.jmir.org/2023/1/e44467 UR - http://dx.doi.org/10.2196/44467 UR - http://www.ncbi.nlm.nih.gov/pubmed/37436799 ID - info:doi/10.2196/44467 ER - TY - JOUR AU - Rathgeb, Chiara AU - Pawellek, Maja AU - Behrends, Uta AU - Alberer, Martin AU - Kabesch, Michael AU - Gerling, Stephan AU - Brandstetter, Susanne AU - Apfelbacher, Christian PY - 2023/4/11 TI - The Evaluation of Health Care Services for Children and Adolescents With Post?COVID-19 Condition: Protocol for a Prospective Longitudinal Study JO - JMIR Res Protoc SP - e41010 VL - 12 KW - post-COVID KW - long COVID KW - post?COVID-19 condition KW - PCC KW - post?COVID-19 syndrome KW - PCS KW - CFS/ME KW - children and adolescents KW - health care services KW - EQ-5D KW - SDQ KW - PROMIS KW - DSQ-PEM KW - COVID-19 KW - pediatrics KW - child KW - adolescent KW - service delivery KW - healthcare delivery KW - healthcare service KW - care network KW - healthcare KW - therapeutic service KW - healthcare utilization KW - patient reported outcome N2 - 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 UR - https://www.researchprotocols.org/2023/1/e41010 UR - http://dx.doi.org/10.2196/41010 UR - http://www.ncbi.nlm.nih.gov/pubmed/36867709 ID - info:doi/10.2196/41010 ER - TY - JOUR AU - Gilano, Girma AU - Hailegebreal, Samuel AU - Sako, Sewunet AU - Haile, Firehiwot AU - Gilano, Kasarto AU - Seboka, Tariku Binyam AU - Kashala, Kefita PY - 2023/2/8 TI - Understanding Child Wasting in Ethiopia: Cross-sectional Analysis of 2019 Ethiopian Demographic and Health Survey Data Using Generalized Linear Latent and Mixed Models JO - JMIR Public Health Surveill SP - e39744 VL - 9 KW - wasting KW - Generalized Linear Latent and Mixed Models KW - GLLAMM KW - under-five children KW - factors KW - Ethiopia N2 - 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. UR - https://publichealth.jmir.org/2023/1/e39744 UR - http://dx.doi.org/10.2196/39744 UR - http://www.ncbi.nlm.nih.gov/pubmed/36753309 ID - info:doi/10.2196/39744 ER - TY - JOUR AU - Ugalde, T. Irma AU - Chaudhari, P. Pradip AU - Badawy, Mohamed AU - Ishimine, Paul AU - McCarten-Gibbs, A. Kevan AU - Yen, Kenneth AU - Atigapramoj, S. Nisa AU - Sage, Allyson AU - Nielsen, Donovan AU - Adelson, David P. AU - Upperman, Jeffrey AU - Tancredi, Daniel AU - Kuppermann, Nathan AU - Holmes, F. James PY - 2022/11/24 TI - 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 JO - JMIR Res Protoc SP - e43027 VL - 11 IS - 11 KW - pediatric trauma KW - intra-abdominal injury KW - traumatic brain injury KW - clinical prediction rules KW - emergency medicine N2 - 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 UR - https://www.researchprotocols.org/2022/11/e43027 UR - http://dx.doi.org/10.2196/43027 UR - http://www.ncbi.nlm.nih.gov/pubmed/36422920 ID - info:doi/10.2196/43027 ER - TY - JOUR AU - Dunn, Abigail AU - Alvarez, James AU - Arbon, Amy AU - Bremner, Stephen AU - Elsby-Pearson, Chloe AU - Emsley, Richard AU - Jones, Christopher AU - Lawrence, Peter AU - Lester, J. Kathryn AU - Majdand?i?, Mirjana AU - Morson, Natalie AU - Perry, Nicky AU - Simner, Julia AU - Thomson, Abigail AU - Cartwright-Hatton, Sam PY - 2022/11/10 TI - Effectiveness of a Web-Based Intervention to Prevent Anxiety in the Children of Parents With Anxiety: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e40707 VL - 11 IS - 11 KW - anxiety KW - parenting KW - online KW - RCT KW - child KW - parent KW - randomized controlled trial KW - youth KW - pediatric KW - mental health KW - mental well-being KW - online intervention KW - digital intervention N2 - 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 UR - https://www.researchprotocols.org/2022/11/e40707 UR - http://dx.doi.org/10.2196/40707 UR - http://www.ncbi.nlm.nih.gov/pubmed/36355406 ID - info:doi/10.2196/40707 ER - TY - JOUR AU - Gutierrez, Robert AU - McCrady, Allison AU - Masterson, Chelsea AU - Tolman, Sarah AU - Boukhechba, Mehdi AU - Barnes, Laura AU - Blemker, Silvia AU - Scharf, Rebecca PY - 2022/10/27 TI - Upper Extremity Examination for Neuromuscular Diseases (U-EXTEND): Protocol for a Multimodal Feasibility Study JO - JMIR Res Protoc SP - e40856 VL - 11 IS - 10 KW - mHealth KW - ubiquitous computing KW - neuromuscular disorders KW - inertial measurement unit KW - motor function KW - specific torque KW - cross-sectional area KW - echogenicity N2 - 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 UR - https://www.researchprotocols.org/2022/10/e40856 UR - http://dx.doi.org/10.2196/40856 UR - http://www.ncbi.nlm.nih.gov/pubmed/36301603 ID - info:doi/10.2196/40856 ER - TY - JOUR AU - Lieser, Tyler AU - Huang, Yungui AU - Sezgin, Emre PY - 2022/10/6 TI - 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 JO - JMIR Pediatr Parent SP - e38940 VL - 5 IS - 4 KW - pediatric KW - child KW - hospital KW - mobile app KW - mobile health KW - mHealth KW - health app KW - digital health KW - eHealth KW - hospital-owned app KW - telehealth KW - review KW - app feature KW - accessibility KW - patient experience KW - functionality N2 - 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. UR - https://pediatrics.jmir.org/2022/4/e38940 UR - http://dx.doi.org/10.2196/38940 UR - http://www.ncbi.nlm.nih.gov/pubmed/36201385 ID - info:doi/10.2196/38940 ER - TY - JOUR AU - Johnson, W. Rowan AU - White, K. Becky AU - Gucciardi, F. Daniel AU - Gibson, Noula AU - Williams, A. Sian PY - 2022/8/9 TI - Intervention Mapping of a Gamified Therapy Prescription App for Children With Disabilities: User-Centered Design Approach JO - JMIR Pediatr Parent SP - e34588 VL - 5 IS - 3 KW - neurodevelopmental disability KW - mobile health KW - self-determination theory KW - gamification KW - physiotherapy KW - occupational therapy KW - speech pathology KW - behavior change KW - mobile phone N2 - 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. UR - https://pediatrics.jmir.org/2022/3/e34588 UR - http://dx.doi.org/10.2196/34588 UR - http://www.ncbi.nlm.nih.gov/pubmed/35943782 ID - info:doi/10.2196/34588 ER - TY - JOUR AU - Reyes, McNaughton H. Luz AU - Langoni, Armora Eliana Gabriela AU - Sharpless, Laurel AU - Blackburn, Natalie AU - McCort, Agnieszka AU - Macy, J. Rebecca AU - Moracco, E. Kathryn AU - Foshee, A. Vangie PY - 2022/8/5 TI - 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 JO - JMIR Res Protoc SP - e35487 VL - 11 IS - 8 KW - dating violence KW - adolescents KW - family-based prevention KW - web-based delivery KW - feasibility and acceptability KW - mobile phone N2 - 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 UR - https://www.researchprotocols.org/2022/8/e35487 UR - http://dx.doi.org/10.2196/35487 UR - http://www.ncbi.nlm.nih.gov/pubmed/35930332 ID - info:doi/10.2196/35487 ER - TY - JOUR AU - Burns, Joy AU - Rivers, Patrick AU - LeClair, B. Lindsay AU - Jovel, S. Krystal AU - Rai, P. Ramona AU - Lowe, A. Ashley AU - Edwards, J. Laura AU - Khan, M. Sana AU - Mathenge, Clare AU - Ferraris, Maria AU - Kuntz, L. Jennifer AU - Lamberte, Mayo Julie AU - Hegmann, T. Kurt AU - Odean, J. Marilyn AU - McLeland-Wieser, Hilary AU - Beitel, Shawn AU - Odame-Bamfo, Leah AU - Schaefer Solle, Natasha AU - Mak, Josephine AU - Phillips, L. Andrew AU - Sokol, E. Brian AU - Hollister, James AU - Ochoa, S. Jezahel AU - Grant, Lauren AU - Thiese, S. Matthew AU - Jacoby, B. Keya AU - Lutrick, Karen AU - Pubillones, A. Felipe AU - Yoo, M. Young AU - Rentz Hunt, Danielle AU - Ellingson, Katherine AU - Berry, C. Mark AU - Gerald, K. Joe AU - Lopez, Joanna AU - Gerald, B. Lynn AU - Wesley, G. Meredith AU - Krupp, Karl AU - Herring, K. Meghan AU - Madhivanan, Purnima AU - Caban-Martinez, J. Alberto AU - Tyner, L. Harmony AU - Meece, K. Jennifer AU - Yoon, K. Sarang AU - Fowlkes, L. Ashley AU - Naleway, L. Allison AU - Gwynn, Lisa AU - Burgess, L. Jefferey AU - Thompson, G. Mark AU - Olsho, EW Lauren AU - Gaglani, Manjusha PY - 2022/7/28 TI - Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT): Protocol for a Multisite Longitudinal Cohort Study JO - JMIR Res Protoc SP - e37929 VL - 11 IS - 7 KW - COVID-19 KW - SARS-CoV-2 KW - vaccine effectiveness KW - vaccine KW - efficacy KW - effectiveness KW - cohort study KW - pediatric KW - child KW - inoculation KW - vaccination KW - public health KW - children KW - health care professional KW - health care KW - caregiver KW - health data KW - online survey KW - incidence N2 - 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 UR - https://www.researchprotocols.org/2022/7/e37929 UR - http://dx.doi.org/10.2196/37929 UR - http://www.ncbi.nlm.nih.gov/pubmed/35635842 ID - info:doi/10.2196/37929 ER - TY - JOUR AU - Wood, D. Michael AU - Correa, Kim AU - Ding, Peijia AU - Sreepada, Rama AU - Loftsgard, C. Kent AU - Jordan, Isabel AU - West, C. Nicholas AU - Whyte, D. Simon AU - Portales-Casamar, Elodie AU - Görges, Matthias PY - 2022/7/15 TI - Identification of Requirements for a Postoperative Pediatric Pain Risk Communication Tool: Focus Group Study With Clinicians and Family Members JO - JMIR Pediatr Parent SP - e37353 VL - 5 IS - 3 KW - eHealth KW - risk communication KW - risk KW - decision aid KW - pain KW - individualized risk KW - surgery KW - anesthesia KW - anesthetic KW - anesthesiology KW - focus group KW - requirement definition KW - prototyping KW - prototype KW - pediatrics KW - pediatric KW - child KW - postoperative KW - prediction KW - digital health KW - development KW - user feedback KW - patient feedback KW - user-centered design N2 - 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. UR - https://pediatrics.jmir.org/2022/3/e37353 UR - http://dx.doi.org/10.2196/37353 UR - http://www.ncbi.nlm.nih.gov/pubmed/35838823 ID - info:doi/10.2196/37353 ER - TY - JOUR AU - Kelly, Jennifer Katherine AU - Doucet, Shelley AU - Luke, Alison AU - Azar, Rima AU - Montelpare, William PY - 2022/7/6 TI - 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 JO - JMIR Pediatr Parent SP - e33172 VL - 5 IS - 3 KW - caregiver experiences KW - peer-to-peer support KW - social support KW - social media KW - children with complex care needs KW - Facebook group N2 - 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. UR - https://pediatrics.jmir.org/2022/3/e33172 UR - http://dx.doi.org/10.2196/33172 UR - http://www.ncbi.nlm.nih.gov/pubmed/35793139 ID - info:doi/10.2196/33172 ER - TY - JOUR AU - Veldscholte, Karlien AU - Cramer, G. Arnout B. AU - de Jonge, J. Rogier C. AU - Eveleens, D. Renate AU - Joosten, M. Koenraad F. AU - Verbruggen, T. Sascha C. A. PY - 2022/6/23 TI - Continuous Versus Intermittent Nutrition in Pediatric Intensive Care Patients: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e36229 VL - 11 IS - 6 KW - pediatric intensive care unit KW - PICU KW - pediatric critical illness KW - time-restricted feeding KW - intermittent fasting KW - feeding intolerance KW - ketones KW - circadian rhythm N2 - 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 UR - https://www.researchprotocols.org/2022/6/e36229 UR - http://dx.doi.org/10.2196/36229 UR - http://www.ncbi.nlm.nih.gov/pubmed/35737448 ID - info:doi/10.2196/36229 ER - TY - JOUR AU - Smith, Arnott Catherine AU - Kelly, M. Michelle PY - 2022/5/30 TI - In Anticipation of Sharing Pediatric Inpatient Notes: Focus Group Study With Stakeholders JO - J Particip Med SP - e37759 VL - 14 IS - 1 KW - medical informatics KW - information sharing KW - electronic health records KW - patient portals KW - hospitals KW - pediatrics KW - focus group KW - inpatient care KW - caregivers N2 - 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. UR - https://jopm.jmir.org/2022/1/e37759 UR - http://dx.doi.org/10.2196/37759 UR - http://www.ncbi.nlm.nih.gov/pubmed/35635743 ID - info:doi/10.2196/37759 ER - TY - JOUR AU - Fuchs-Neuhold, Bianca AU - Staubmann, Wolfgang AU - Peterseil, Marie AU - Rath, Anna AU - Schweighofer, Natascha AU - Kronberger, Anika AU - Riederer, Monika AU - van der Kleyn, Moenie AU - Martin, Jochen AU - Hörmann-Wallner, Marlies AU - Waldner, Irmgard AU - Konrad, Manuela AU - Aufschnaiter, Lena Anna AU - Siegmund, Barbara AU - Berghold, Andrea AU - Holasek, Sandra AU - Pail, Elisabeth PY - 2022/4/27 TI - 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 JO - JMIR Res Protoc SP - e37279 VL - 11 IS - 4 KW - taste KW - preferences KW - nutrition KW - biomarkers KW - body composition KW - air displacement plethysmography KW - Baby Facial Actions Coding System KW - mother KW - infant KW - parenting KW - pediatrics KW - prenatal KW - postnatal N2 - 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 UR - https://www.researchprotocols.org/2022/4/e37279 UR - http://dx.doi.org/10.2196/37279 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475790 ID - info:doi/10.2196/37279 ER - TY - JOUR AU - El Tantawi, Maha AU - Folayan, O. Morenike AU - Bhayat, Ahmed PY - 2022/4/27 TI - Oral Health Status and Practices, and Anthropometric Measurements of Preschool Children: Protocol for a Multi-African Country Survey JO - JMIR Res Protoc SP - e33552 VL - 11 IS - 4 KW - oral health KW - early childhood caries KW - oral hygiene KW - dietary intake KW - Africa KW - preschool children KW - dentistry KW - oral disease N2 - 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 ?>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 UR - https://www.researchprotocols.org/2022/4/e33552 UR - http://dx.doi.org/10.2196/33552 UR - http://www.ncbi.nlm.nih.gov/pubmed/35476047 ID - info:doi/10.2196/33552 ER - TY - JOUR AU - Vanden Bempt, Femke AU - Economou, Maria AU - Dehairs, Ward AU - Vandermosten, Maaike AU - Wouters, Jan AU - Ghesquière, Pol AU - Vanderauwera, Jolijn PY - 2022/3/23 TI - Feasibility, Enjoyment, and Language Comprehension Impact of a Tablet- and GameFlow-Based Story-Listening Game for Kindergarteners: Methodological and Mixed Methods Study JO - JMIR Serious Games SP - e34698 VL - 10 IS - 1 KW - serious gaming KW - language comprehension KW - enjoyment KW - feasibility KW - GameFlow N2 - 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 (?=.35; P<.001), and lower initial story ratings significantly slackened the training duration (?=?0.16; P=.003). In-game QRA was positively predicted by game phase (?=1.44; P=.004), baseline listening comprehension (?=1.56; P=.002), and vocabulary (?=.16; P=.01), with larger QRA growth over game phases in children with lower baseline listening comprehension skills (?=?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. UR - https://games.jmir.org/2022/1/e34698 UR - http://dx.doi.org/10.2196/34698 UR - http://www.ncbi.nlm.nih.gov/pubmed/35319480 ID - info:doi/10.2196/34698 ER - TY - JOUR AU - Larrinaga-Undabarrena, Arkaitz AU - Albisua, Neritzel AU - Río, Xabier AU - Angulo-Garay, Garazi AU - González-Santamaria, Xabier AU - Etxeberria Atxa, Iker AU - Martínez de Lahidalga Aguirre, Gorka AU - Ruiz de Azua Larrinaga, Malen AU - Martínez Aguirre-Betolaza, Aitor AU - Gorostegi-Anduaga, Ilargi AU - Maldonado-Martín, Sara AU - Aldaz Arregui, Juan AU - Guerra-Balic, Myriam AU - Bringas, Mikel AU - Sánchez Isla, Ramón José AU - Coca, Aitor PY - 2022/3/11 TI - 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 JO - JMIR Res Protoc SP - e31325 VL - 11 IS - 3 KW - physical activity KW - sedentary behavior KW - sleep KW - Basque Autonomous Community KW - accelerometry KW - adolescents KW - children KW - healthy behavior KW - mobility N2 - 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 UR - https://www.researchprotocols.org/2022/3/e31325 UR - http://dx.doi.org/10.2196/31325 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275088 ID - info:doi/10.2196/31325 ER - TY - JOUR AU - Brussoni, Mariana AU - Han, S. Christina AU - Jacob, John AU - Munday, Fritha AU - Zeni, Megan AU - Walters, Melanie AU - Cheng, Tina AU - Schneeberg, Amy AU - Fox, Emily AU - Oberle, Eva PY - 2021/11/18 TI - 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 JO - JMIR Res Protoc SP - e31041 VL - 10 IS - 11 KW - early years KW - risky play KW - teacher KW - childcare KW - early learning KW - risk perception KW - outdoor play N2 - 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 UR - https://www.researchprotocols.org/2021/11/e31041 UR - http://dx.doi.org/10.2196/31041 UR - http://www.ncbi.nlm.nih.gov/pubmed/34792479 ID - info:doi/10.2196/31041 ER - @Article{info:doi/10.2196/29049, author="Ennab, Farah and ElSaban, Mariam and Khalaf, Eman and Tabatabaei, Hanieh and Khamis, Hassan Amar and Devi, Radha Bindu and Hanif, Kashif and Elhassan, Hiba and Saravanan, Ketharanathan and Cremonesini, David and Popatia, Rizwana and Malik, Zainab and Ho, B. Samuel and Abusamra, Rania", title="Clinical Characteristics of Children With COVID-19 in the United Arab Emirates: Cross-sectional Multicenter Study", journal="JMIR Pediatr Parent", year="2021", month="Nov", day="5", volume="4", number="4", pages="e29049", keywords="pediatrics", keywords="children", keywords="COVID-19", keywords="SARS-CoV-2", keywords="United Arab Emirates", keywords="viral shedding", keywords="pandemic", keywords="treatment", keywords="outcomes", keywords="clinical", keywords="public heath", abstract="Background: COVID-19 has infected over 123 million people globally. The first confirmed case in the United Arab Emirates (UAE)\thinspacewas reported on January 29, 2020. According to studies conducted in the early epicenters of the pandemic, COVID-19 has fared mildly in the pediatric population. To date, there is a lack of published data about COVID-19 infection among children in the Arabian region. Objective: This study aims to investigate the clinical characteristics, laboratory findings, treatment, and outcomes of children with COVID-19. Methods: This cross-sectional, multicenter study included children with confirmed COVID-19 infection admitted to 3 large hospitals in Dubai, UAE, between March 1 and June 15, 2020. Serial COVID-19 polymerase chain reaction (PCR) testing data were collected, and patients' demographics, premorbid clinical characteristics, and inpatient hospital courses were examined. Results: In all, 111 children were included in our study and represented 22 nationalities. Of these, 59 (53.2\%) were boys. The mean age of the participants was 7 (SD 5.3) years. About 15.3\% of children were younger than 1 year. Only 4 (3.6\%) of them had pre-existing asthma, all of whom had uneventful courses. At presentation, of the 111 children, 43 (38.7\%) were asymptomatic, 68 (61.2\%) had mild or moderate symptoms, and none (0\%) had severe illness requiring intensive care. Fever (23/111, 20.7\%), cough (22/111, 19.8\%), and rhinorrhea (17/111, 15.3\%) were the most common presenting symptoms, and most reported symptoms resolved by day 5 of hospitalization. Most patients had no abnormality on chest x-ray. The most common laboratory abnormalities on admission included variations in neutrophil count (22/111, 24.7\%), aspartate transaminase (18/111, 22.5\%), alkaline phosphatase (29/111, 36.7\%), and lactate dehydrogenase (31/111, 42.5\%). Children were infrequently prescribed targeted medications, with only 4 (3.6\%) receiving antibiotics. None of the 52 patients tested for viral coinfections were positive. COVID-19 PCR testing turned negative at a median of 10 days (IQR: 6-14) after the first positive test. Overall, there was no significant difference of time to negative PCR results between symptomatic and asymptomatic children. Conclusions: This study of COVID-19 presentations and characteristics presents a first look into the burden of COVID-19 infection in the pediatric population in the UAE. We conclude that a large percentage of children experienced no symptoms and that severe COVID-19 disease is uncommon in the UAE. Various laboratory abnormalities were observed despite clinical stability. Ongoing surveillance, contact tracing, and public health measures will be important to contain future outbreaks. ", doi="10.2196/29049", url="https://pediatrics.jmir.org/2021/4/e29049", url="http://www.ncbi.nlm.nih.gov/pubmed/34643535" } TY - JOUR AU - Benoit, James AU - Hartling, Lisa AU - Chan, Michelle AU - Scott, Shannon PY - 2021/10/19 TI - Characteristics of Acute Childhood Illness Apps for Parents: Environmental Scan JO - J Med Internet Res SP - e29441 VL - 23 IS - 10 KW - internet KW - mHealth KW - mobile health KW - digital health KW - ehealth KW - app KW - mobile application KW - Android KW - Apple KW - marketplace KW - environmental scan KW - review KW - acute childhood illness KW - knowledge translation KW - child KW - parent KW - caregiver KW - mobile phone N2 - 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. UR - https://www.jmir.org/2021/10/e29441 UR - http://dx.doi.org/10.2196/29441 UR - http://www.ncbi.nlm.nih.gov/pubmed/34665144 ID - info:doi/10.2196/29441 ER - TY - JOUR AU - Zorko, David AU - McNally, Dayre James AU - Rochwerg, Bram AU - Pinto, Neethi AU - Couban, Rachel AU - O?Hearn, Katie AU - Choong, Karen PY - 2021/10/1 TI - Pediatric Chronic Critical Illness: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e30582 VL - 10 IS - 10 KW - pediatrics KW - critical care KW - intensive care units KW - chronic critical illness KW - research design N2 - 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 UR - https://www.researchprotocols.org/2021/10/e30582 UR - http://dx.doi.org/10.2196/30582 UR - http://www.ncbi.nlm.nih.gov/pubmed/34596576 ID - info:doi/10.2196/30582 ER - TY - JOUR AU - Schmucker, Michael AU - Haag, Martin PY - 2021/9/20 TI - Automated Size Recognition in Pediatric Emergencies Using Machine Learning and Augmented Reality: Within-Group Comparative Study JO - JMIR Form Res SP - e28345 VL - 5 IS - 9 KW - resuscitation KW - emergency medicine KW - mobile applications KW - mobile phone KW - user-computer interface KW - augmented reality KW - machine learning N2 - 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; ?=.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. UR - https://formative.jmir.org/2021/9/e28345 UR - http://dx.doi.org/10.2196/28345 UR - http://www.ncbi.nlm.nih.gov/pubmed/34542416 ID - info:doi/10.2196/28345 ER - TY - JOUR AU - Fang, Heping AU - Xian, Ruoling AU - Ma, Zhuoying AU - Lu, Mingyue AU - Hu, Yan PY - 2021/8/26 TI - Comparison of the Differences Between Web-Based and Traditional Questionnaire Surveys in Pediatrics: Comparative Survey Study JO - J Med Internet Res SP - e30861 VL - 23 IS - 8 KW - pediatrics KW - survey KW - questionnaire KW - web survey KW - comparative study N2 - 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 (?²4=16.509, P=.002 and ?²4=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. UR - https://www.jmir.org/2021/8/e30861 UR - http://dx.doi.org/10.2196/30861 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319240 ID - info:doi/10.2196/30861 ER - TY - JOUR AU - Siedlikowski, Maia AU - Curiale, Lianna AU - Rauch, Frank AU - Tsimicalis, Argerie PY - 2021/8/10 TI - 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 JO - JMIR Pediatr Parent SP - e22784 VL - 4 IS - 3 KW - child health KW - symptom assessment KW - communication KW - mobile applications KW - software N2 - 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. UR - https://pediatrics.jmir.org/2021/3/e22784 UR - http://dx.doi.org/10.2196/22784 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383677 ID - info:doi/10.2196/22784 ER - TY - JOUR AU - Maleki, Arash AU - Qoreishy, Mohammad Seyyed AU - Bahrami, Nabi Mohammad PY - 2021/5/3 TI - Surgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review JO - Interact J Med Res SP - e27075 VL - 10 IS - 2 KW - surgical treatment KW - Legg-Calvé-Perthes disease KW - pediatric KW - hip KW - treatment outcome N2 - 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. UR - https://www.i-jmr.org/2021/2/e27075 UR - http://dx.doi.org/10.2196/27075 UR - http://www.ncbi.nlm.nih.gov/pubmed/33938444 ID - info:doi/10.2196/27075 ER - TY - JOUR AU - Alkureishi, A. Maria AU - Johnson, Tyrone AU - Nichols, Jacqueline AU - Dhodapkar, Meera AU - Czerwiec, K. M. AU - Wroblewski, Kristen AU - Arora, M. Vineet AU - Lee, Wei Wei PY - 2021/4/28 TI - Impact of an Educational Comic to Enhance Patient-Physician?Electronic Health Record Engagement: Prospective Observational Study JO - JMIR Hum Factors SP - e25054 VL - 8 IS - 2 KW - electronic health records KW - patient KW - comic KW - education KW - engagement N2 - 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 (?=?0.18, P=.003; ?=?0.19, P<.001, respectively) and in adults calling for physician attention (?=?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. UR - https://humanfactors.jmir.org/2021/2/e25054 UR - http://dx.doi.org/10.2196/25054 UR - http://www.ncbi.nlm.nih.gov/pubmed/33908891 ID - info:doi/10.2196/25054 ER - TY - JOUR AU - Namba, Fumihiko AU - Tanaka, Kosuke AU - Omori, Sayu AU - Ikeda, Kazushige AU - Kawabata, Ken AU - Sato, Hiroaki AU - Honda, Masakazu AU - Ichikawa, Tomonori AU - Minosaki, Yoshihiro AU - Michikawa, Takehiro AU - Oka, Shuntaro AU - Kabe, Kazuhiko PY - 2021/3/5 TI - Extreme Prematurity and Pulmonary Outcomes Program in Saitama: Protocol for a Prospective Multicenter Cohort Study in Japan JO - JMIR Res Protoc SP - e22948 VL - 10 IS - 3 KW - prematurity KW - preterm infant KW - bronchopulmonary dysplasia KW - respiratory outcome N2 - 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 UR - https://www.researchprotocols.org/2021/3/e22948 UR - http://dx.doi.org/10.2196/22948 UR - http://www.ncbi.nlm.nih.gov/pubmed/33666556 ID - info:doi/10.2196/22948 ER - TY - JOUR AU - Saposnik, E. Florencia AU - Huber, F. Joelene PY - 2020/12/7 TI - Trends in Web Searches About the Causes and Treatments of Autism Over the Past 15 Years: Exploratory Infodemiology Study JO - JMIR Pediatr Parent SP - e20913 VL - 3 IS - 2 KW - autism KW - infodemiology KW - infoveillance KW - informatics KW - Google Trends N2 - 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. UR - http://pediatrics.jmir.org/2020/2/e20913/ UR - http://dx.doi.org/10.2196/20913 UR - http://www.ncbi.nlm.nih.gov/pubmed/33284128 ID - info:doi/10.2196/20913 ER - TY - JOUR AU - Beran, Tanya AU - Pearson, Reynolds Jacqueline AU - Lashewicz, Bonnie AU - Baggott, Sandy PY - 2020/11/19 TI - Perspectives of Child Life Specialists After Many Years of Working With a Humanoid Robot in a Pediatric Hospital: Narrative Design JO - J Med Internet Res SP - e23496 VL - 22 IS - 11 KW - child life KW - support KW - pediatric KW - distraction KW - robotics KW - human-robot interaction N2 - 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. UR - http://www.jmir.org/2020/11/e23496/ UR - http://dx.doi.org/10.2196/23496 UR - http://www.ncbi.nlm.nih.gov/pubmed/33211014 ID - info:doi/10.2196/23496 ER - TY - JOUR AU - Corazza, Francesco AU - Snijders, Deborah AU - Arpone, Marta AU - Stritoni, Valentina AU - Martinolli, Francesco AU - Daverio, Marco AU - Losi, Giulia Maria AU - Soldi, Luca AU - Tesauri, Francesco AU - Da Dalt, Liviana AU - Bressan, Silvia PY - 2020/10/1 TI - Development and Usability of a Novel Interactive Tablet App (PediAppRREST) to Support the Management of Pediatric Cardiac Arrest: Pilot High-Fidelity Simulation-Based Study JO - JMIR Mhealth Uhealth SP - e19070 VL - 8 IS - 10 KW - cardiac arrest KW - resuscitation KW - mobile app KW - high-fidelity simulation training KW - cognitive aid KW - pediatrics KW - emergency medicine N2 - 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. UR - https://mhealth.jmir.org/2020/10/e19070 UR - http://dx.doi.org/10.2196/19070 UR - http://www.ncbi.nlm.nih.gov/pubmed/32788142 ID - info:doi/10.2196/19070 ER - TY - JOUR AU - Baggett, M. Kathleen AU - Davis, Betsy AU - Landry, H. Susan AU - Feil, G. Edward AU - Whaley, Anna AU - Schnitz, Alana AU - Leve, Craig PY - 2020/9/22 TI - Understanding the Steps Toward Mobile Early Intervention for Mothers and Their Infants Exiting the Neonatal Intensive Care Unit: Descriptive Examination JO - J Med Internet Res SP - e18519 VL - 22 IS - 9 KW - early intervention KW - equity KW - NICU KW - low birthweight KW - transition KW - mobile internet intervention KW - infants KW - mothers N2 - 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. UR - http://www.jmir.org/2020/9/e18519/ UR - http://dx.doi.org/10.2196/18519 UR - http://www.ncbi.nlm.nih.gov/pubmed/32960178 ID - info:doi/10.2196/18519 ER - TY - JOUR AU - Schiro, Jessica AU - Pelayo, Sylvia AU - Martinot, Alain AU - Dubos, François AU - Beuscart-Zéphir, Marie-Catherine AU - Marcilly, Romaric PY - 2020/9/4 TI - Applying a Human-Centered Design to Develop a Patient Prioritization Tool for a Pediatric Emergency Department: Detailed Case Study of First Iterations JO - JMIR Hum Factors SP - e18427 VL - 7 IS - 3 KW - emergency department KW - triage systems KW - ergonomics KW - design KW - human-centered design KW - patients N2 - 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. UR - http://humanfactors.jmir.org/2020/3/e18427/ UR - http://dx.doi.org/10.2196/18427 UR - http://www.ncbi.nlm.nih.gov/pubmed/32886071 ID - info:doi/10.2196/18427 ER - TY - JOUR AU - Floch, Jacqueline AU - Vilarinho, Thomas AU - Zettl, Annabel AU - Ibanez-Sanchez, Gema AU - Calvo-Lerma, Joaquim AU - Stav, Erlend AU - Haro, Halland Peter AU - Aalberg, Lein Asbjørn AU - Fides-Valero, Alvaro AU - Bayo Montón, Luis José PY - 2020/7/8 TI - Users? Experiences of a Mobile Health Self-Management Approach for the Treatment of Cystic Fibrosis: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e15896 VL - 8 IS - 7 KW - mobile health KW - mHealth KW - self-management KW - user experience KW - user acceptance KW - mixed methods study KW - cystic fibrosis KW - pediatrics N2 - 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. UR - https://mhealth.jmir.org/2020/7/e15896 UR - http://dx.doi.org/10.2196/15896 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673237 ID - info:doi/10.2196/15896 ER - TY - JOUR AU - Bustamante Loyola, Jorge AU - Perez Retamal, Marcela AU - Morgues Nudman, Isabel Monica AU - Maturana, Andres AU - Salinas Gonzalez, Ricardo AU - Cox, Horacio AU - González Mas, Miguel José AU - Muñoz, Lucia AU - Lopez, Lilian AU - Mendiburo-Seguel, Andrés AU - Simó, Sandra AU - Palau Subiela, Pascual AU - Guedeney, Antoine PY - 2020/6/26 TI - Interactive Guidance Intervention to Address Sustained Social Withdrawal in Preterm Infants in Chile: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e17943 VL - 9 IS - 6 KW - social withdrawal KW - preterm KW - early detection KW - interactive guidance KW - emotional stress KW - social development KW - postnatal depression KW - posttraumatic stress N2 - 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 UR - http://www.researchprotocols.org/2020/6/e17943/ UR - http://dx.doi.org/10.2196/17943 UR - http://www.ncbi.nlm.nih.gov/pubmed/32589156 ID - info:doi/10.2196/17943 ER - TY - JOUR AU - López Seguí, Francesc AU - Batlle Boada, Astrid AU - García García, José Juan AU - López Ulldemolins, Ana AU - Achotegui del Arco, Ane AU - Adroher Mas, Cristina AU - García Cuyàs, Francesc PY - 2020/3/26 TI - Families? Degree of Satisfaction With Pediatric Telehomecare: Interventional Prospective Pilot Study in Catalonia JO - JMIR Pediatr Parent SP - e17517 VL - 3 IS - 1 KW - home health monitoring KW - pediatrics KW - telehomecare KW - videoconferencing KW - satisfaction with care KW - remote sensing technology KW - telemedicine KW - telehealth N2 - 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. UR - http://pediatrics.jmir.org/2020/1/e17517/ UR - http://dx.doi.org/10.2196/17517 UR - http://www.ncbi.nlm.nih.gov/pubmed/32213471 ID - info:doi/10.2196/17517 ER - TY - JOUR AU - Holmen, Heidi AU - Riiser, Kirsti AU - Winger, Anette PY - 2020/2/28 TI - Home-Based Pediatric Palliative Care and Electronic Health: Systematic Mixed Methods Review JO - J Med Internet Res SP - e16248 VL - 22 IS - 2 KW - eHealth KW - home-based KW - pediatric palliative care KW - pediatric KW - children KW - family KW - communication KW - palliative care N2 - 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 UR - http://www.jmir.org/2020/2/e16248/ UR - http://dx.doi.org/10.2196/16248 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130127 ID - info:doi/10.2196/16248 ER - TY - JOUR AU - Chou, H. Joseph AU - Roumiantsev, Sergei AU - Singh, Rachana PY - 2020/1/30 TI - PediTools Electronic Growth Chart Calculators: Applications in Clinical Care, Research, and Quality Improvement JO - J Med Internet Res SP - e16204 VL - 22 IS - 1 KW - growth charts KW - pediatrics KW - infant, newborn KW - infant, premature KW - failure to thrive KW - internet KW - software N2 - 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. UR - https://www.jmir.org/2020/1/e16204 UR - http://dx.doi.org/10.2196/16204 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012066 ID - info:doi/10.2196/16204 ER - TY - JOUR AU - Saulsberry, C. Anjelica AU - Hodges, R. Jason AU - Cole, Audrey AU - Porter, S. Jerlym AU - Hankins, Jane PY - 2020/1/7 TI - Web-Based Technology to Improve Disease Knowledge Among Adolescents With Sickle Cell Disease: Pilot Study JO - JMIR Pediatr Parent SP - e15093 VL - 3 IS - 1 KW - sickle cell anemia KW - eHealth KW - transition to adult care N2 - 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. UR - https://pediatrics.jmir.org/2020/1/e15093 UR - http://dx.doi.org/10.2196/15093 UR - http://www.ncbi.nlm.nih.gov/pubmed/31909718 ID - info:doi/10.2196/15093 ER - TY - JOUR AU - Bird, Marissa AU - Li, Lin AU - Ouellette, Carley AU - Hopkins, Kylie AU - McGillion, H. Michael AU - Carter, Nancy PY - 2019/11/21 TI - Use of Synchronous Digital Health Technologies for the Care of Children With Special Health Care Needs and Their Families: Scoping Review JO - JMIR Pediatr Parent SP - e15106 VL - 2 IS - 2 KW - pediatrics KW - scoping review KW - digital health KW - children with special health care needs KW - asthma KW - congenital heart disease KW - palliative care KW - co-design N2 - Background: Use of synchronous digital health technologies for care delivery to children with special health care needs (having achronic 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. UR - http://pediatrics.jmir.org/2019/2/e15106/ UR - http://dx.doi.org/10.2196/15106 UR - http://www.ncbi.nlm.nih.gov/pubmed/31750840 ID - info:doi/10.2196/15106 ER - TY - JOUR AU - Borrelli, Belinda AU - Henshaw, Michelle AU - Endrighi, Romano AU - Adams, G. William AU - Heeren, Timothy AU - Rosen, K. Rochelle AU - Bock, Beth AU - Werntz, Scott PY - 2019/11/11 TI - An Interactive Parent-Targeted Text Messaging Intervention to Improve Oral Health in Children Attending Urban Pediatric Clinics: Feasibility Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e14247 VL - 7 IS - 11 KW - oral health KW - mHealth KW - text message KW - dental caries KW - health behavior N2 - 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. UR - https://mhealth.jmir.org/2019/11/e14247 UR - http://dx.doi.org/10.2196/14247 UR - http://www.ncbi.nlm.nih.gov/pubmed/31710306 ID - info:doi/10.2196/14247 ER - TY - JOUR AU - Thompson, Kelsey AU - Zimmerman, Emily PY - 2019/9/26 TI - Pediatric Speech-Language Pathologists? Use of Mobile Health Technology: Qualitative Questionnaire Study JO - JMIR Rehabil Assist Technol SP - e13966 VL - 6 IS - 2 KW - mHealth KW - speech-language pathology KW - surveys KW - assessment KW - pediatric KW - treatment KW - technology N2 - 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. UR - https://rehab.jmir.org/2019/2/e13966 UR - http://dx.doi.org/10.2196/13966 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573922 ID - info:doi/10.2196/13966 ER - @Article{info:doi/10.2196/10804, author="Kakarmath, S. Sujay and de Redon, Emily and Centi, Jayne Amanda and Palacholla, Ramya and Kvedar, Joseph and Jethwani, Kamal and Agboola, Stephen", title="Assessing the Usability of an Automated Continuous Temperature Monitoring Device (iThermonitor) in Pediatric Patients: Non-Randomized Pilot Study", journal="JMIR Pediatr Parent", year="2018", month="Dec", day="21", volume="1", number="2", pages="e10804", keywords="connected health", keywords="continuous monitoring", keywords="mobile phone", keywords="pediatric", keywords="temperature", abstract="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) ", doi="10.2196/10804", url="http://pediatrics.jmir.org/2018/2/e10804/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518304" } TY - JOUR AU - Weitzman, R. Elissa AU - Magane, M. Kara AU - Wisk, E. Lauren PY - 2018/12/21 TI - How Returning Aggregate Research Results Impacts Interest in Research Engagement and Planned Actions Relevant to Health Care Decision Making: Cohort Study JO - J Med Internet Res SP - e10647 VL - 20 IS - 12 KW - aggregate research results KW - decision making KW - juvenile idiopathic arthritis KW - patient engagement KW - patient-reported outcome measures KW - rheumatic disease N2 - 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. UR - http://www.jmir.org/2018/12/e10647/ UR - http://dx.doi.org/10.2196/10647 UR - http://www.ncbi.nlm.nih.gov/pubmed/30578228 ID - info:doi/10.2196/10647 ER - TY - JOUR AU - Sasangohar, Farzan AU - Davis, Elise AU - Kash, A. Bita AU - Shah, R. Sohail PY - 2018/12/20 TI - Remote Patient Monitoring and Telemedicine in Neonatal and Pediatric Settings: Scoping Literature Review JO - J Med Internet Res SP - e295 VL - 20 IS - 12 KW - neonatal KW - pediatric KW - remote patient monitoring KW - telehealth KW - telemedicine N2 - 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. UR - http://www.jmir.org/2018/12/e295/ UR - http://dx.doi.org/10.2196/jmir.9403 UR - http://www.ncbi.nlm.nih.gov/pubmed/30573451 ID - info:doi/10.2196/jmir.9403 ER - TY - JOUR AU - Levac, Danielle AU - Dumas, M. Helene AU - Meleis, Waleed PY - 2018/11/26 TI - A Tablet-Based Interactive Movement Tool for Pediatric Rehabilitation: Development and Preliminary Usability Evaluation JO - JMIR Rehabil Assist Technol SP - e10307 VL - 5 IS - 2 KW - equipment design KW - rehabilitation KW - pediatrics KW - tablets KW - software N2 - 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. UR - http://rehab.jmir.org/2018/2/e10307/ UR - http://dx.doi.org/10.2196/10307 UR - http://www.ncbi.nlm.nih.gov/pubmed/30478025 ID - info:doi/10.2196/10307 ER - TY - JOUR AU - Alkhalifah, Shahad AU - Aldhalaan, Hesham PY - 2018/11/15 TI - Telehealth Services for Children With Autism Spectrum Disorders in Rural Areas of the Kingdom of Saudi Arabia: Overview and Recommendations JO - JMIR Pediatr Parent SP - e11402 VL - 1 IS - 2 KW - autism spectrum disorders KW - intervention KW - Saudi Arabia KW - telehealth UR - http://pediatrics.jmir.org/2018/2/e11402/ UR - http://dx.doi.org/10.2196/11402 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518306 ID - info:doi/10.2196/11402 ER - TY - JOUR AU - Luo, Gang AU - Johnson, D. Michael AU - Nkoy, L. Flory AU - He, Shan AU - Stone, L. Bryan PY - 2018/11/05 TI - Appropriateness of Hospital Admission for Emergency Department Patients with Bronchiolitis: Secondary Analysis JO - JMIR Med Inform SP - e10498 VL - 6 IS - 4 KW - appropriate hospital admission KW - bronchiolitis KW - emergency department KW - operational definition N2 - 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. UR - http://medinform.jmir.org/2018/4/e10498/ UR - http://dx.doi.org/10.2196/10498 UR - http://www.ncbi.nlm.nih.gov/pubmed/30401659 ID - info:doi/10.2196/10498 ER - TY - JOUR AU - Yimtae, Kwanchanok AU - Israsena, Pasin AU - Thanawirattananit, Panida AU - Seesutas, Sangvorn AU - Saibua, Siwat AU - Kasemsiri, Pornthep AU - Noymai, Anukool AU - Soonrach, Tharapong PY - 2018/10/23 TI - A Tablet-Based Mobile Hearing Screening System for Preschoolers: Design and Validation Study JO - JMIR Mhealth Uhealth SP - e186 VL - 6 IS - 10 KW - hearing screening KW - mobile health KW - speech audiometry KW - hearing loss N2 - 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. UR - http://mhealth.jmir.org/2018/10/e186/ UR - http://dx.doi.org/10.2196/mhealth.9560 UR - http://www.ncbi.nlm.nih.gov/pubmed/30355558 ID - info:doi/10.2196/mhealth.9560 ER - TY - JOUR AU - Hullmann, E. Stephanie AU - Keller, A. Stacy AU - Lynch, O. Dustin AU - Jenkins, Kelli AU - Moore, Courtney AU - Cockrum, Brandon AU - Wiehe, E. Sarah AU - Carroll, E. Aaron AU - Bennett Jr, E. William PY - 2018/09/10 TI - 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 JO - J Participat Med SP - e10655 VL - 10 IS - 3 KW - qualitative research KW - patient-reported outcomes KW - depression KW - anxiety N2 - 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. UR - http://jopm.jmir.org/2018/3/e10655/ UR - http://dx.doi.org/10.2196/10655 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/10655 ER - TY - JOUR AU - Amawi, Omar Sami AU - Subki, Hussein Ahmed AU - Khatib, Abdulkarim Hazim AU - Alkhateeb, Sameer Omer AU - Fida, Hashim Rida AU - Saggaf, Mohammed Omar AU - Jan, Mohammed Mohammed PY - 2018/09/06 TI - Use of Electronic Entertainment and Communication Devices Among a Saudi Pediatric Population: Cross-Sectional Study JO - Interact J Med Res SP - e13 VL - 7 IS - 2 KW - television KW - tablet KW - mobile phone KW - computers KW - devices KW - entertainment KW - use KW - Saudi Arabia KW - children KW - population KW - behavior KW - parental impression N2 - 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. UR - http://www.i-jmr.org/2018/2/e13/ UR - http://dx.doi.org/10.2196/ijmr.9103 UR - http://www.ncbi.nlm.nih.gov/pubmed/30190254 ID - info:doi/10.2196/ijmr.9103 ER -