TY - JOUR AU - Algadi, S. Iman AU - AlRuthia, Yazed AU - Mujammami, H. Muhammad AU - Aburisheh, Hani Khaled AU - Alotaibi, Metib AU - Al Issa, Sharifah AU - Al-Saif, A. Amal AU - Seftel, David AU - Tsai, Cheng-Ting AU - Al Khalifah, A. Reem PY - 2025/4/14 TI - Early Detection of Type 1 Diabetes in First-Degree Relatives in Saudi Arabia (VISION-T1D): Protocol for a Pilot Implementation Study JO - JMIR Res Protoc SP - e70575 VL - 14 KW - islet autoimmunity KW - type 1 diabetes mellitus KW - T1D KW - screening program KW - antibody detection by agglutination?polymerase chain reaction KW - PCR KW - ADAP KW - human leukocyte antigen KW - genetic risk score N2 - Background: Type 1 diabetes (T1D) is a growing global health concern, with a notable rise in incidence in Saudi Arabia. Despite the potential benefits of early detection through screening programs, such initiatives are currently lacking in Saudi Arabia and other Arab countries. Objective: This study aims to evaluate the feasibility, acceptability, and cost-effectiveness of a T1D-screening program targeting high-risk individuals, specifically children with a first-degree relative diagnosed with T1D. Methods: The VISION-T1D program is a prospective cohort study focused on the early detection of presymptomatic T1D by screening children aged 2-18 years. The primary screening method involves testing for islet autoantibodies, including insulin autoantibodies, glutamic acid decarboxylase autoantibodies, insulinoma associated-2 autoantibodies, and zinc transporter-8 autoantibodies. Optional genetic testing, including human leukocyte antigen phenotyping and the genetic risk score, is offered. Outcomes include the feasibility of the screening process, prevalence of early-stage T1D, psychological impacts, educational intervention effectiveness, progression rates to stage-3 T1D, and economic viability. Results: The VISION-T1D program began in May 2024. As of December 2024, a total of 176 families have been enrolled. Data collection will continue until April 2025, with final data analysis projected for mid-2025. Conclusions: The VISION-T1D study provides a practical approach to T1D screening tailored to the health care landscape of Saudi Arabia. The insights gained from this pilot program will inform the development of a national, population-based screening initiative designed to reduce diabetic ketoacidosis at diagnosis, improve long-term outcomes, and alleviate the economic burden of T1D. The VISION-T1D initiative could also serve as a scalable and sustainable model that can be adopted internationally, contributing to global efforts to manage and prevent T1D. Trial Registration: ClinicalTrials.gov NCT06513247; https://clinicaltrials.gov/study/NCT06513247 International Registered Report Identifier (IRRID): DERR1-10.2196/70575 UR - https://www.researchprotocols.org/2025/1/e70575 UR - http://dx.doi.org/10.2196/70575 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/70575 ER - TY - JOUR AU - Jalaludin, Yazid Muhammad AU - Kiau, Bee Ho AU - Hasim, Suriati AU - Lee, Khew Wai AU - Low, Angie AU - Kazim, Nik Nik Harlina AU - Hoi, Tse Jia AU - Taher, Wahyu Sri PY - 2025/3/24 TI - A Noninvasive Approach to Assess the Prevalence of and Factors Associated With Anemia Risk in Malaysian Children Under Three Years of Age: Cross-Sectional Study JO - JMIR Pediatr Parent SP - e58586 VL - 8 KW - anemia KW - iron deficiency KW - children KW - Masimo Rad-67 KW - noninvasive assessment KW - Malaysia N2 - Background: Anemia remains a significant public health concern with adverse effects among children. Noninvasive screening assessments enable the early detection and prompt treatment of anemia. However, there is limited literature on the use of such screening assessments. Objective: The study aimed to assess the prevalence of and factors associated with being at risk of anemia among Malaysian children aged ?6 months to ?36 months by using a noninvasive hemoglobin assessment. Methods: This was a cross-sectional study (from July to December 2022) of outpatient Malaysian children, aged ?6 months to ?36 months, who were selected from five maternal-and-child health clinics by convenience sampling. At risk of anemia was defined as a total hemoglobin level of <12 g/dL, measured using the Masimo Rad-67, a noninvasive screening device for total hemoglobin levels. The ?2 and multiple logistic regression analyses were used to assess the prevalence and factors associated with being at risk of anemia, using R-Studio (version 4.0.0). Results: The study included 1201 participants, of whom 30% (95% CI 28?33) were at risk of anemia. Children aged 6?12 months (210/364, 57.7%, P<.001), those of Asian Malay race (238/364, 65.4%, P<.05), those residing in the Klang district (123/371, 33.9%, P<.05), those born via a normal vaginal delivery (275/364, 75.5%, P<.05), those without a family history of thalassemia (284/364, 78.0%, P<.05), and those with lower weight-for-age Z scores (P<.05) were associated with being at risk of anemia. Children aged 6?12 months (adjusted odds ratio=1.73; 95% CI 1.34?2.24) had higher odds of being at risk of anemia compared to children aged >12?36 months. However, weight-for-age (adjusted odds ratio=0.88; 95% CI 0.80?0.98) was associated with lower odds of being at risk of anemia. Conclusions: The current study revealed a substantial prevalence of Malaysian children being at risk of developing anemia. The study results therefore imply a need for more community education and awareness on anemia, including nutrition education, as well as targeted community screening to enable the early detection and prompt treatment of anemia cases. Anemia reduction strategies in Malaysia should consider the highlighted factors indicative of higher risk of anemia. Trial Registration: Clinicaltrials.gov NCT05181436, https://clinicaltrials.gov/study/NCT05181436 UR - https://pediatrics.jmir.org/2025/1/e58586 UR - http://dx.doi.org/10.2196/58586 ID - info:doi/10.2196/58586 ER - TY - JOUR AU - Dolón-Poza, María AU - Gabaldón-Pérez, Ana-Marta AU - Berrezueta-Guzman, Santiago AU - López Gracia, David AU - Martín-Ruiz, María-Luisa AU - Pau De La Cruz, Iván PY - 2025/3/14 TI - Enhancing Early Language Disorder Detection in Preschools: Evaluation and Future Directions for the Gades Platform JO - JMIR Hum Factors SP - e60424 VL - 12 KW - developmental language disorder KW - simple language delay KW - adaptive screening system KW - early childhood education KW - pervasive therapy N2 - Background: Language acquisition is a critical developmental milestone, with notable variability during the first 4 years of life. Developmental language disorder (DLD) often overlaps with other neurodevelopmental disorders or simple language delay (SLD), making early detection challenging, especially for primary caregivers. Objective: We aimed to evaluate the effectiveness of the Gades platform, an adaptive screening tool that enables preschool teachers to identify potential language disorders without direct support from nursery school language therapists (NSLTs). Methods: The study took place in a nursery school and an early childhood educational and psychopedagogical center in Madrid, Spain, involving 218 children aged 6 to 36 months, 24 preschool teachers, and 2 NSLTs. Initially, NSLTs conducted informational sessions to familiarize teachers with DLDs and how to identify them. Following this, the teachers used the Gades platform to conduct language screenings independently, without ongoing support from NSLTs. The Gades platform was enhanced to collect detailed profiles of each child and implemented an adaptive screening model tailored to account for variability in language development. This setup allowed preschool teachers, who are not language experts, to observe and assess language development effectively in natural, unsupervised educational environments. The study assessed the platform?s utility in guiding teachers through these observations and its effectiveness in such settings. Results: Gades identified language difficulties in 19.7% (43/218) of the children, with a higher prevalence in boys (29/218, 13.3%) than in girls (14/218, 6.4%). These challenges were most frequently observed in children aged 15 to 27 months. The platform demonstrated a high accuracy rate of 97.41%, with evaluators largely agreeing with its recommendations. Teachers also found Gades to be user friendly and a valuable tool for supporting language development observations in everyday educational settings. Conclusions: Gades demonstrates potential as a reliable and accessible tool for early detection of language disorders, empowering educators to identify DLD and SLD in the absence of NSLTs. However, further refinement of the platform is required to effectively differentiate between DLD and SLD. By integrating Gades into routine preschool assessments, educators can facilitate timely interventions, bridging gaps in early childhood education and therapy. Trial Registration: Pan-African Clinical Trial Registry (PACTR) PACTR202210657553944; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24051 UR - https://humanfactors.jmir.org/2025/1/e60424 UR - http://dx.doi.org/10.2196/60424 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60424 ER - TY - JOUR AU - Mirzaei, Venus AU - Wolstencroft, Jeanne AU - Lockwood Estrin, Georgia AU - Buckley, Eleanor AU - Sayani, Shermina AU - Katakis, Panos AU - Anand, Reena AU - Squire, Tessa AU - Short, Eleanor AU - Frankson, Paige AU - Skuse, David AU - Heys, Michelle PY - 2025/2/11 TI - Novel Procedures for Evaluating Autism Online in a Culturally Diverse Population of Children: Protocol for a Mixed Methods Pathway Development Study JO - JMIR Res Protoc SP - e55741 VL - 14 KW - autism KW - child KW - telehealth KW - co-development KW - feasibility KW - acceptability KW - assessment KW - diagnosis KW - online KW - evaluation KW - diagnostic KW - intervention KW - pilot implementation evaluation study N2 - Background: Current autism assessment procedures are costly and resource-intensive. The COVID-19 pandemic accelerated the adoption of telemedicine, highlighting the benefits of innovative diagnostic tools. Telemedicine-based pathways could enhance accessibility and equity in autism diagnostics. Objective: The Children with Autism Technology Enabled Assessment (CHATA) project aims to develop and pilot an open-source autism diagnostic pathway for children up to 5 years old, delivered through telemedicine. The pathway is designed to be culturally and linguistically adaptable, increasing its applicability to diverse populations and integrating with existing National Health Service digital systems. Methods: Initial pathway development was informed by systematic evidence reviews, coproduction, and mixed methods usability. CHATA comprises 2 key elements: online self-completed standardized autism questionnaires and a structured online interview and observation by a trained clinician. Out of 60 families near the top of the local waiting list will be invited to participate in the pilot evaluation, assessed using both the CHATA and usual assessment pathways. Sensitivity and specificity will be calculated by comparing the diagnosis of autism through CHATA with usual care. Quantitative usability assessment will be gathered from all families using the System Usability Scale (where a mean above 68 indicates above-average usability). A subset of CHATA assessments will be reviewed for interrater reliability (measured by the Cohen ? for categorical data [diagnosis present or absent], with values indicating the level of agreement; eg, <0 indicating no agreement, 0.61-0.80 indicating substantial agreement). Qualitative data on acceptability, feasibility, and usability will be gathered from semistructured interviews with a subset of families and health care providers. We will recruit 60 families for the main pilot study (including the usability testing) and 10-15 participants for the qualitative substudy. Data will estimate CHATA?s diagnostic accuracy, validity, reliability, usability, and acceptability. Patient and public involvement will be integral throughout. The study will take place in a socio-economically deprived, ethnically diverse inner-London Borough within a community-based child health National health service responsible for the Autism assessment of children and young people up to the age of 13 years. Results: Ethics approval was received in June 2023 (Research Ethics Committee reference 22/LO/0751; IRAS project ID 320499). Data collection commenced in April 2023 and completed in October 2024. Project end date is March 2025. As of November 2024, we had enrolled 57 participants to the pilot study and 12 to the qualitative substudy. Conclusions: The CHATA project aims to establish a novel, culturally sensitive, equitable, and accurate online autism assessment pathway. By addressing geographical and linguistic barriers, this pathway seeks to reduce service costs, shorten waiting times, and promote equity in autism diagnosis. The procedures developed are expected to be generalized to other populations nationwide. International Registered Report Identifier (IRRID): DERR1-10.2196/55741 UR - https://www.researchprotocols.org/2025/1/e55741 UR - http://dx.doi.org/10.2196/55741 UR - http://www.ncbi.nlm.nih.gov/pubmed/39932780 ID - info:doi/10.2196/55741 ER - TY - JOUR AU - Qin, Chenlong AU - Peng, Li AU - Liu, Yun AU - Zhang, Xiaoliang AU - Miao, Shumei AU - Wei, Zhiyuan AU - Feng, Wei AU - Zhang, Hongjian AU - Wan, Cheng AU - Yu, Yun AU - Lu, Shan AU - Huang, Ruochen AU - Zhang, Xin PY - 2024/12/30 TI - Development and Validation of a Nomogram-Based Model to Predict Primary Hypertension Within the Next Year in Children and Adolescents: Retrospective Cohort Study JO - J Med Internet Res SP - e58686 VL - 26 KW - independent risk factors KW - prediction model KW - primary hypertension KW - clinical applicability KW - development KW - validation KW - pediatrics KW - electronic health records N2 - Background: Primary hypertension (PH) poses significant risks to children and adolescents. Few prediction models for the risk of PH in children and adolescents currently exist, posing a challenge for doctors in making informed clinical decisions. Objective: This study aimed to investigate the incidence and risk factors of PH in Chinese children and adolescents. It also aimed to establish and validate a nomogram-based model for predicting the next year?s PH risk. Methods: A training cohort (n=3938, between January 1, 2008, and December 31, 2020) and a validation cohort (n=1269, between January 1, 2021, and July 1, 2023) were established for model training and validation. An independent cohort of 576 individuals was established for external validation of the model. The result of the least absolute shrinkage and selection operator regression technique was used to select the optimal predictive features, and multivariate logistic regression to construct the nomogram. The performance of the nomogram underwent assessment and validation through the area under the receiver operating characteristic curve, concordance index, calibration curves, decision curve analysis, clinical impact curves, and sensitivity analysis. Results: The PH risk factors that we have ultimately identified include gender (odds ratio [OR] 3.34, 95% CI 2.88 to 3.86; P<.001), age (OR 1.11, 95% CI 1.08 to 1.14; P<.001), family history of hypertension (OR 42.74, 95% CI 23.07 to 79.19; P<.001), fasting blood glucose (OR 6.07, 95% CI 4.74 to 7.78; P<.001), low-density lipoprotein cholesterol (OR 2.03, 95% CI 1.60 to 2.57; P<.001), and uric acid (OR 1.01, 95% CI 1.01 to 1.01; P<.001), while factor breastfeeding (OR 0.04, 95% CI 0.03 to 0.05; P<.001) has been identified as a protective factor. Subsequently, a nomogram has been constructed incorporating these factors. Areas under the receiver operating characteristic curves of the nomogram were 0.892 in the training cohort, 0.808 in the validation cohort, and 0.790 in the external validation cohort. Concordance indexes of the nomogram were 0.892 in the training cohort, 0.808 in the validation cohort, and 0.790 in the external validation cohort. The nomogram has been proven to have good clinical benefits and stability in calibration curves, decision curve analysis, clinical impact curves, and sensitivity analysis. Finally, we observed noteworthy differences in uric acid levels and family history of hypertension among various subgroups, demonstrating a high correlation with PH. Moreover, the web-based calculator of the nomogram was built online. Conclusions: We have developed and validated a stable and reliable nomogram that can accurately predict PH risk within the next year among children and adolescents in primary care and offer effective and cost-efficient support for clinical decisions for the risk prediction of PH. UR - https://www.jmir.org/2024/1/e58686 UR - http://dx.doi.org/10.2196/58686 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58686 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 - Miladinovi?, Aleksandar AU - Quaia, Christian AU - Kresevic, Simone AU - Aj?evi?, Milo? AU - Diplotti, Laura AU - Michieletto, Paola AU - Accardo, Agostino AU - Pensiero, Stefano PY - 2024/12/9 TI - High-Resolution Eye-Tracking System for Accurate Measurement of Short-Latency Ocular Following Responses: Development and Observational Study JO - JMIR Pediatr Parent SP - e64353 VL - 7 KW - ocular following response KW - stereopsis KW - video-oculography KW - ocular KW - tracker KW - vision KW - pediatric KW - children KW - youth KW - infrared KW - algorithm KW - eye tracking N2 - Background: Ocular following responses (OFRs)?small-amplitude, short-latency reflexive eye movements?have been used to study visual motion processing, with potential diagnostic applications. However, they are difficult to record with commercial, video-based eye trackers, especially in children. Objective: We aimed to design and develop a noninvasive eye tracker specialized for measuring OFRs, trading off lower temporal resolution and a smaller range for higher spatial resolution. Methods: We developed a high-resolution eye-tracking system based on a high-resolution camera operating in the near-infrared spectral range, coupled with infrared illuminators and a dedicated postprocessing pipeline, optimized to measure OFRs in children. To assess its performance, we: (1) evaluated our algorithm for compensating small head movements in both artificial and real-world settings, (2) compared OFRs measured simultaneously by our system and a reference scleral search coil eye-tracking system, and (3) tested the system?s ability to measure OFRs in a clinical setting with children. Results: The simultaneous measurement by our system and a reference system showed that our system achieved an in vivo resolution of approximately 0.06°, which is sufficient for recording OFRs. Head motion compensation was successfully tested, showing a displacement error of less than 5 ?m. Finally, robust OFRs were detected in 16 children during recording sessions lasting less than 5 minutes. Conclusions: Our high-resolution, noninvasive eye-tracking system successfully detected OFRs with minimal need for subject cooperation. The system effectively addresses the limits of other OFR measurement methods and offers a versatile solution suitable for clinical applications, particularly in children, where eye tracking is more challenging. The system could potentially be suitable for diagnostic applications, particularly in pediatric populations where early detection of visual disorders like stereodeficiencies is critical. UR - https://pediatrics.jmir.org/2024/1/e64353 UR - http://dx.doi.org/10.2196/64353 ID - info:doi/10.2196/64353 ER - TY - JOUR AU - Wang, Yipei AU - Zhang, Pei AU - Xing, Yan AU - Shi, Huifeng AU - Cui, Yunpu AU - Wei, Yuan AU - Zhang, Ke AU - Wu, Xinxia AU - Ji, Hong AU - Xu, Xuedong AU - Dong, Yanhui AU - Jin, Changxiao PY - 2024/11/19 TI - Telemedicine Integrated Care Versus In-Person Care Mode for Patients With Short Stature: Comprehensive Comparison of a Retrospective Cohort Study JO - J Med Internet Res SP - e57814 VL - 26 KW - telemedicine KW - telemedicine integrated care mode KW - short stature KW - clinical outcomes KW - health-seeking behaviors KW - cost analysis KW - in-person care KW - mobile health KW - mHealth KW - telehealth KW - eHealth KW - video virtual visit KW - access to care KW - children KW - pediatrics KW - China KW - accessibility KW - temporal KW - spatial constraints KW - chronic disease N2 - Background: Telemedicine has demonstrated efficacy as a supplement to traditional in-person care when treating certain diseases. Nevertheless, more investigation is needed to comprehensively assess its potential as an alternative to in-person care and its influence on access to care. The successful treatment of short stature relies on timely and regular intervention, particularly in rural and economically disadvantaged regions where the disease is more prevalent. Objective: This study evaluated the clinical outcomes, health-seeking behaviors, and cost of telemedicine integrated into care for children with short stature in China. Methods: Our study involved 1241 individuals diagnosed with short stature at the pediatric outpatient clinic of Peking University Third Hospital between 2012 and 2023. Patients were divided into in-person care (IPC; 1183 patients receiving only in-person care) and telemedicine integrated care (TIC; 58 patients receiving both in-person and virtual care) groups. For both groups, the initial 71.43% (average of 58 percentages, with each percentage representing the ratio of patients in the treatment group) of visits were categorized into the pretelemedicine phase. We used propensity score matching to select individuals with similar baseline conditions. We used 7 variables such as age, gender, and medical insurance for the 1:5 closest neighbor match. Eventually, 115 patients in the IPC group and 54 patients in the TIC group were selected. The primary clinical outcome was the change in the standard height percentage. Health-seeking behavior was described by visit intervals in the pre- and post-telemedicine phases. The cost analysis compared costs both between different groups and between different visit modalities of the TIC group in the post-telemedicine phase. Results: In terms of clinical effectiveness, we demonstrated that the increase in height among the TIC group (?zTIC=0.74) was more substantial than that for the IPC group (?zIPC=0.51, P=.01; paired t test), while no unfavorable changes in other endpoints such as BMI or insulin-like growth factor 1 (IGF-1) levels were observed. As for health-seeking behaviors, the results showed that, during the post-telemedicine phase, the IPC group had a visit interval of 71.08 (IQR 50.75-90.73) days, significantly longer than the prior period (51.25 [IQR 34.75-82.00] days, P<.001; U test), whereas the TIC group?s visit interval remained unchanged. As for the cost per visit, there was no difference in the average cost per visit between the 2 groups nor between the pre- and post-telemedicine phases. During the post-telemedicine phase, within the TIC group, in-person visits had a higher average total cost, elevated medical and labor expenses, and greater medical cost compared with virtual visits. Conclusions: We contend that the rise in medical visits facilitated by integrating telemedicine into care effectively restored the previously constrained number of medical visits to their usual levels, without increasing costs. Our research underscores that administering prompt treatment may enable physicians to seize a crucial treatment opportunity for children with short stature, thus attaining superior results. UR - https://www.jmir.org/2024/1/e57814 UR - http://dx.doi.org/10.2196/57814 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57814 ER - TY - JOUR AU - Zhu, Jinpu AU - Yang, Fushuang AU - Wang, Yang AU - Wang, Zhongtian AU - Xiao, Yao AU - Wang, Lie AU - Sun, Liping PY - 2024/11/18 TI - Accuracy of Machine Learning in Discriminating Kawasaki Disease and Other Febrile Illnesses: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e57641 VL - 26 KW - machine learning KW - artificial intelligence KW - Kawasaki disease KW - febrile illness KW - coronary artery lesions KW - systematic review KW - meta-analysis N2 - Background: Kawasaki disease (KD) is an acute pediatric vasculitis that can lead to coronary artery aneurysms and severe cardiovascular complications, often presenting with obvious fever in the early stages. In current clinical practice, distinguishing KD from other febrile illnesses remains a significant challenge. In recent years, some researchers have explored the potential of machine learning (ML) methods for the differential diagnosis of KD versus other febrile illnesses, as well as for predicting coronary artery lesions (CALs) in people with KD. However, there is still a lack of systematic evidence to validate their effectiveness. Therefore, we have conducted the first systematic review and meta-analysis to evaluate the accuracy of ML in differentiating KD from other febrile illnesses and in predicting CALs in people with KD, so as to provide evidence-based support for the application of ML in the diagnosis and treatment of KD. Objective: This study aimed to summarize the accuracy of ML in differentiating KD from other febrile illnesses and predicting CALs in people with KD. Methods: PubMed, Cochrane Library, Embase, and Web of Science were systematically searched until September 26, 2023. The risk of bias in the included original studies was appraised using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Stata (version 15.0; StataCorp) was used for the statistical analysis. Results: A total of 29 studies were incorporated. Of them, 20 used ML to differentiate KD from other febrile illnesses. These studies involved a total of 103,882 participants, including 12,541 people with KD. In the validation set, the pooled concordance index, sensitivity, and specificity were 0.898 (95% CI 0.874-0.922), 0.91 (95% CI 0.83-0.95), and 0.86 (95% CI 0.80-0.90), respectively. Meanwhile, 9 studies used ML for early prediction of the risk of CALs in children with KD. These studies involved a total of 6503 people with KD, of whom 986 had CALs. The pooled concordance index in the validation set was 0.787 (95% CI 0.738-0.835). Conclusions: The diagnostic and predictive factors used in the studies we included were primarily derived from common clinical data. The ML models constructed based on these clinical data demonstrated promising effectiveness in differentiating KD from other febrile illnesses and in predicting coronary artery lesions. Therefore, in future research, we can explore the use of ML methods to identify more efficient predictors and develop tools that can be applied on a broader scale for the differentiation of KD and the prediction of CALs. UR - https://www.jmir.org/2024/1/e57641 UR - http://dx.doi.org/10.2196/57641 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57641 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 - Oyovwi, Sr Mega Obukohwo AU - Ohwin, Peggy Ejiro AU - Rotu, Arientare Rume AU - Olowe, Gideon Temitope PY - 2024/10/16 TI - Internet-Based Abnormal Chromosomal Diagnosis During Pregnancy Using a Noninvasive Innovative Approach to Detecting Chromosomal Abnormalities in the Fetus: Scoping Review JO - JMIR Bioinform Biotech SP - e58439 VL - 5 KW - internet-based KW - abnormal chromosomal diagnosis KW - pregnancy KW - noninvasive KW - innovative approach KW - detecting KW - preventing KW - chromosomal abnormalities KW - fetus N2 - Background: Chromosomal abnormalities are genetic disorders caused by chromosome errors, leading to developmental delays, birth defects, and miscarriages. Currently, invasive procedures such as amniocentesis or chorionic villus sampling are mostly used, which carry a risk of miscarriage. This has led to the need for a noninvasive and innovative approach to detect and prevent chromosomal abnormalities during pregnancy. Objective: This review aims to describe and appraise the potential of internet-based abnormal chromosomal preventive measures as a noninvasive approach to detecting and preventing chromosomal abnormalities during pregnancy. Methods: A thorough review of existing literature and research on chromosomal abnormalities and noninvasive approaches to prenatal diagnosis and therapy was conducted. Electronic databases such as PubMed, Google Scholar, ScienceDirect, CENTRAL, CINAHL, Embase, OVID MEDLINE, OVID PsycINFO, Scopus, ACM, and IEEE Xplore were searched for relevant studies and articles published in the last 5 years. The keywords used included chromosomal abnormalities, prenatal diagnosis, noninvasive, and internet-based, and diagnosis. Results: The review of literature revealed that internet-based abnormal chromosomal diagnosis is a potential noninvasive approach to detecting and preventing chromosomal abnormalities during pregnancy. This innovative approach involves the use of advanced technology, including high-resolution ultrasound, cell-free DNA testing, and bioinformatics, to analyze fetal DNA from maternal blood samples. It allows early detection of chromosomal abnormalities, enabling timely interventions and treatment to prevent adverse outcomes. Furthermore, with the advancement of technology, internet-based abnormal chromosomal diagnosis has emerged as a safe alternative with benefits including its cost-effectiveness, increased accessibility and convenience, potential for earlier detection and intervention, and ethical considerations. Conclusions: Internet-based abnormal chromosomal diagnosis has the potential to revolutionize prenatal care by offering a safe and noninvasive alternative to invasive procedures. It has the potential to improve the detection of chromosomal abnormalities, leading to better pregnancy outcomes and reduced risk of miscarriage. Further research and development in this field is needed to make this approach more accessible and affordable for pregnant women. UR - https://bioinform.jmir.org/2024/1/e58439 UR - http://dx.doi.org/10.2196/58439 UR - http://www.ncbi.nlm.nih.gov/pubmed/39412876 ID - info:doi/10.2196/58439 ER - TY - JOUR AU - Grazioli, Silvia AU - Crippa, Alessandro AU - Buo, Noemi AU - Busti Ceccarelli, Silvia AU - Molteni, Massimo AU - Nobile, Maria AU - Salandi, Antonio AU - Trabattoni, Sara AU - Caselli, Gabriele AU - Colombo, Paola PY - 2024/7/29 TI - Use of Machine Learning Models to Differentiate Neurodevelopment Conditions Through Digitally Collected Data: Cross-Sectional Questionnaire Study JO - JMIR Form Res SP - e54577 VL - 8 KW - digital-aided clinical assessment KW - machine learning KW - random forest KW - logistic regression KW - computational psychometrics KW - telemedicine KW - neurodevelopmental conditions KW - parent-report questionnaires KW - attention-deficit/hyperactivity disorder KW - autism spectrum disorder KW - ASD KW - autism KW - autistic KW - attention deficit KW - hyperactivity KW - classification N2 - Background: Diagnosis of child and adolescent psychopathologies involves a multifaceted approach, integrating clinical observations, behavioral assessments, medical history, cognitive testing, and familial context information. Digital technologies, especially internet-based platforms for administering caregiver-rated questionnaires, are increasingly used in this field, particularly during the screening phase. The ascent of digital platforms for data collection has propelled advanced psychopathology classification methods such as supervised machine learning (ML) into the forefront of both research and clinical environments. This shift, recently called psycho-informatics, has been facilitated by gradually incorporating computational devices into clinical workflows. However, an actual integration between telemedicine and the ML approach has yet to be fulfilled. Objective: Under these premises, exploring the potential of ML applications for analyzing digitally collected data may have significant implications for supporting the clinical practice of diagnosing early psychopathology. The purpose of this study was, therefore, to exploit ML models for the classification of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) using internet-based parent-reported socio-anamnestic data, aiming at obtaining accurate predictive models for new help-seeking families. Methods: In this retrospective, single-center observational study, socio-anamnestic data were collected from 1688 children and adolescents referred for suspected neurodevelopmental conditions. The data included sociodemographic, clinical, environmental, and developmental factors, collected remotely through the first Italian internet-based screening tool for neurodevelopmental disorders, the Medea Information and Clinical Assessment On-Line (MedicalBIT). Random forest (RF), decision tree, and logistic regression models were developed and evaluated using classification accuracy, sensitivity, specificity, and importance of independent variables. Results: The RF model demonstrated robust accuracy, achieving 84% (95% CI 82-85; P<.001) for ADHD and 86% (95% CI 84-87; P<.001) for ASD classifications. Sensitivities were also high, with 93% for ADHD and 95% for ASD. In contrast, the DT and LR models exhibited lower accuracy (DT 74%, 95% CI 71-77; P<.001 for ADHD; DT 79%, 95% CI 77-82; P<.001 for ASD; LR 61%, 95% CI 57-64; P<.001 for ADHD; LR 63%, 95% CI 60-67; P<.001 for ASD) and sensitivities (DT: 82% for ADHD and 88% for ASD; LR: 62% for ADHD and 68% for ASD). The independent variables considered for classification differed in importance between the 2 models, reflecting the distinct characteristics of the 3 ML approaches. Conclusions: This study highlights the potential of ML models, particularly RF, in enhancing the diagnostic process of child and adolescent psychopathology. Altogether, the current findings underscore the significance of leveraging digital platforms and computational techniques in the diagnostic process. While interpretability remains crucial, the developed approach might provide valuable screening tools for clinicians, highlighting the significance of embedding computational techniques in the diagnostic process. UR - https://formative.jmir.org/2024/1/e54577 UR - http://dx.doi.org/10.2196/54577 UR - http://www.ncbi.nlm.nih.gov/pubmed/39073858 ID - info:doi/10.2196/54577 ER - TY - JOUR AU - Weile, Synne Kathrine AU - Mathiasen, René AU - Winther, Falck Jeanette AU - Hasle, Henrik AU - Henriksen, Tram Louise PY - 2024/7/25 TI - Hjernetegn.dk?The Danish Central Nervous System Tumor Awareness Initiative Digital Decision Support Tool: Design and Implementation Report JO - JMIR Med Inform SP - e58886 VL - 12 KW - digital health initiative KW - digital health initiatives KW - clinical decision support KW - decision support KW - decision support system KW - decision support systems KW - decision support tool KW - decision support tools KW - diagnostic delay KW - awareness initiative KW - pediatric neurology KW - pediatric CNS tumors KW - CNS tumor KW - CNS tumour KW - CNS tumours KW - co-creation KW - health systems and services KW - communication KW - central nervous system N2 - Background: Childhood tumors in the central nervous system (CNS) have longer diagnostic delays than other pediatric tumors. Vague presenting symptoms pose a challenge in the diagnostic process; it has been indicated that patients and parents may be hesitant to seek help, and health care professionals (HCPs) may lack awareness and knowledge about clinical presentation. To raise awareness among HCPs, the Danish CNS tumor awareness initiative hjernetegn.dk was launched. Objective: This study aims to present the learnings from designing and implementing a decision support tool for HCPs to reduce diagnostic delay in childhood CNS tumors. The aims also include decisions regarding strategies for dissemination and use of social media, and an evaluation of the digital impact 6 months after launch. Methods: The phases of developing and implementing the tool include participatory co-creation workshops, designing the website and digital platforms, and implementing a press and media strategy. The digital impact of hjernetegn.dk was evaluated through website analytics and social media engagement. Implementation (Results): hjernetegn.dk was launched in August 2023. The results after 6 months exceeded key performance indicators. The analysis showed a high number of website visitors and engagement, with a plateau reached 3 months after the initial launch. The LinkedIn campaign and Google Search strategy also generated a high number of impressions and clicks. Conclusions: The findings suggest that the initiative has been successfully integrated, raising awareness and providing a valuable tool for HCPs in diagnosing childhood CNS tumors. The study highlights the importance of interdisciplinary collaboration, co-creation, and ongoing community management, as well as broad dissemination strategies when introducing a digital support tool. UR - https://medinform.jmir.org/2024/1/e58886 UR - http://dx.doi.org/10.2196/58886 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58886 ER - TY - JOUR AU - Navaneethan, Praveena AU - Mohammed, Pasha Imran AU - Shenoy, P. Rekha AU - Junaid, Junaid AU - Amanna, Supriya AU - Alsughier, Zeyad AU - Kolarkodi, Hameed Shaul PY - 2024/7/23 TI - Evaluation of Staining Propensity of Silver Diamine Fluoride With and Without Potassium Iodide in Children (Project Healthy Smiles): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e51087 VL - 13 KW - silver diamine fluoride KW - SDF KW - potassium iodide KW - KI KW - tooth discoloration KW - dental caries KW - dental esthetics KW - dental KW - teeth KW - healthy smile KW - staining KW - treatment KW - oral health KW - child N2 - Background: Silver diamine fluoride (SDF) is becoming more widely recognized as a simple, cost-effective approach to minimize sensitivity and arrest caries. However, SDF results in caries that are stained black. Potassium iodide (KI) treatment with SDF may minimize or lessen the staining. However, the effectiveness of KI on staining has not been investigated. Studies demonstrating that potassium iodide reduces the black staining are still insufficient. This paper presents the study protocol for Healthy Smiles, a randomized controlled trial implemented to compare the staining propensity of SDF and SDF+KI. Objective: This study, Healthy Smiles, aims to evaluate the staining propensity of SDF and SDF+KI using a Nix Mini color sensor among children aged 4 to 6 years. Another objective of the study is to evaluate the caries-arresting effect of SDF and SDF+KI in the treatment of carious primary teeth. Methods: This study is a randomized controlled trial. A total of 60 children with caries that meet the criteria of the International Caries Detection and Assessment System (code 1 or above) will be randomly assigned to treatment groups, where group 1 will be treated with SDF and group 2 will be treated with SDF+KI. Discoloration of treated lesions will be assessed digitally using a Nix Mini color sensor. Participants will be followed up at 1, 3, and 6 months after treatment to digitally record the ?L and ?E values using the Nix Mini color sensor. Data will be analyzed using SPSS (version 28; IBM Corp). Independent sample t tests and the Mann-Whitney U test will be used to compare the 2 groups. Results: Enrollment started in October 2023. It is estimated that the enrollment period will be 12 months. Data collection is planned to be completed in 2024. Conclusions: The presented paper describes Happy Smiles, a project that provides an opportunity to address the aesthetic inconvenience of patients without compromising the effectiveness of the SDF treatment. The trial findings will contribute to the limited evidence base related to discoloration after SDF intervention to improve aesthetic appearances in child oral health. If the results from the trial are promising, it will lead to the development of a model for child oral health and pave the way for further research in child oral health. International Registered Report Identifier (IRRID): PRR1-10.2196/51087 UR - https://www.researchprotocols.org/2024/1/e51087 UR - http://dx.doi.org/10.2196/51087 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51087 ER - TY - JOUR AU - Neale, Shannon AU - Chrenka, Ella AU - Muthineni, Abhilash AU - Sharma, Rashmi AU - Hall, Layne Mallory AU - Tillema, Juliana AU - Kharbanda, O. Elyse PY - 2024/1/12 TI - An Electronic Teen Questionnaire, the eTeenQ, for Risk Behavior Screening During Adolescent Well Visits in an Integrated Health System: Development and Pilot Implementation JO - JMIR Pediatr Parent SP - e47355 VL - 7 KW - electronic data capture KW - data capture KW - privacy KW - security KW - adolescent health KW - risk behavior screening KW - screening KW - acceptance KW - primary care KW - adolescent KW - adolescents KW - electronic health record KW - risk behavior KW - risk KW - risky KW - behavior KW - behaviors KW - behaviour KW - behaviours KW - digital health KW - eHealth KW - teenage KW - teens KW - teen KW - teenager KW - teenagers KW - children KW - young adults KW - youth KW - online health KW - web data KW - online data KW - user experience KW - interview KW - interviews KW - qualitative N2 - Background: Screening for risk behaviors is a routine and essential component of adolescent preventive health visits. Early identification of risks can inform targeted counseling and care. If stored in discrete fields in the electronic health record (EHR), adolescent screening data can also be used to understand risk behaviors across a clinic or health system or to support quality improvement projects. Objective: Goals of this pilot study were to adapt and implement an existing paper adolescent risk behavior screening tool for use as an electronic data capture tool (the eTeenQ), to evaluate acceptance of the eTeenQ, and to describe the prevalence of the selected risk behaviors reported through the eTeenQ. Methods: The multidisciplinary project team applied an iterative process to develop the 29-item eTeenQ. Two unique data entry forms were created with attention to (1) user interface and user experience, (2) the need to maintain patient privacy, and (3) the potential to transmit and store data for future use in clinical care and research. Three primary care clinics within a large health system piloted the eTeenQ from August 17, 2020, to August 27, 2021. During preventive health visits for adolescents aged 12 to 18 years, the eTeenQ was completed on tablets and responses were converted to a provider display for teens and providers to review together. Responses to the eTeenQ were stored in a REDCap (Research Electronic Data Capture; Vanderbilt University) database, and for patients who agreed, responses were transferred to an EHR flowsheet. Responses to selected eTeenQ questions are reported for those consenting to research. At the conclusion of the pilot, the study team conducted semistructured interviews with providers and staff regarding their experience using the eTeenQ. Results: Among 2816 adolescents with well visits, 2098 (74.5%) completed the eTeenQ. Of these, 1811 (86.3%) agreed to store responses in the EHR. Of 1632 adolescents (77.8% of those completing the eTeenQ) who consented for research and remained eligible, 1472 (90.2%) reported having an adult they can really talk to and 1510 (92.5%) reported feeling safe in their community, yet 401 (24.6%) reported someone they lived with had a gun and 172 (10.5%) reported having had a stressful or scary event that still bothered them. In addition, 157 (9.6%) adolescents reported they were or wondered if they were gay, lesbian, bisexual, pansexual, asexual, or other, and 43 (2.6%) reported they were or wondered if they were transgender or gender diverse. Of 11 staff and 7 providers completing interviews, all felt that the eTeenQ improved confidentiality and willingness among adolescents to answer sensitive questions. All 7 providers preferred the eTeenQ over the paper screening tool. Conclusions: Electronic capture of adolescent risk behaviors is feasible in a busy clinic setting and well accepted among staff and clinicians. Most adolescents agreed for their responses to risk behavior screening to be stored in the EHR. UR - https://pediatrics.jmir.org/2024/1/e47355 UR - http://dx.doi.org/10.2196/47355 ID - info:doi/10.2196/47355 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 - Sadaka, Yair AU - Horwitz, Dana AU - Wolff, Leor AU - Sela, Tomer AU - Meyerovitch, Joseph AU - Peleg, Assaf AU - Bachmat, Eitan AU - Benis, Arriel PY - 2022/8/5 TI - Trends in the Prevalence of Chronic Medication Use Among Children in Israel Between 2010 and 2019: Protocol for a Retrospective Cohort Study JO - JMIR Res Protoc SP - e36756 VL - 11 IS - 8 KW - psychotropic drugs KW - central nervous system stimulants KW - mental health KW - medication therapy management KW - drug prescriptions KW - attention deficit hyperactivity disorder KW - ADHD, Israel KW - children KW - data mining KW - machine learning KW - electronic medical records KW - pediatrics KW - chronic disease KW - epidemiology N2 - Background: Prescription of psychostimulants has significantly increased in most countries worldwide for both preschool and school-aged children. Understanding the trends of chronic medication use among children in different age groups and from different sociodemographic backgrounds is essential. It is essential to distinguish between selected therapy areas to help decision-makers evaluate not only the relevant expected medication costs but also the specific services related to these areas. Objective: This study will analyze differences in trends regarding medications considered psychobehavioral treatments and medications considered nonpsychobehavioral treatments and will identify risk factors and predictors for chronic medication use among children. Methods: This is a retrospective study. Data will be extracted from the Clalit Health Services data warehouse. For each year between 2010 and 2019, there are approximately 1,500,000 children aged 0-18 years. All medication classes will be identi?ed using the Anatomical Therapeutic Chemical code. A time-trend analysis will be performed to investigate if there is a significant difference between the trends of children?s psychobehavioral and nonpsychobehavioral medication prescriptions. A logistic regression combined with machine learning models will be developed to identify variables that may increase the risk for specific chronic medication types and identify children likely to get such treatment. Results: The project was funded in 2019. Data analysis is currently underway, and the results are expected to be submitted for publication in 2022. Understanding trends regarding medications considered psychobehavioral treatments and medications considered nonpsychobehavioral treatments will support the identification of risk factors and predictors for chronic medication use among children. Conclusions: Analyzing the response of the patient (and their parents or caregivers) population over time will hopefully help improve policies for prescriptions and follow-up of chronic treatments in children. International Registered Report Identifier (IRRID): DERR1-10.2196/36756 UR - https://www.researchprotocols.org/2022/8/e36756 UR - http://dx.doi.org/10.2196/36756 UR - http://www.ncbi.nlm.nih.gov/pubmed/35775233 ID - info:doi/10.2196/36756 ER - TY - JOUR AU - Varma, Maya AU - Washington, Peter AU - Chrisman, Brianna AU - Kline, Aaron AU - Leblanc, Emilie AU - Paskov, Kelley AU - Stockham, Nate AU - Jung, Jae-Yoon AU - Sun, Woo Min AU - Wall, P. Dennis PY - 2022/2/15 TI - Identification of Social Engagement Indicators Associated With Autism Spectrum Disorder Using a Game-Based Mobile App: Comparative Study of Gaze Fixation and Visual Scanning Methods JO - J Med Internet Res SP - e31830 VL - 24 IS - 2 KW - mobile health KW - autism spectrum disorder KW - social phenotyping KW - computer vision KW - gaze KW - mobile diagnostics KW - pattern recognition KW - autism KW - diagnostic KW - pattern KW - engagement KW - gaming KW - app KW - insight KW - vision KW - video N2 - Background: Autism spectrum disorder (ASD) is a widespread neurodevelopmental condition with a range of potential causes and symptoms. Standard diagnostic mechanisms for ASD, which involve lengthy parent questionnaires and clinical observation, often result in long waiting times for results. Recent advances in computer vision and mobile technology hold potential for speeding up the diagnostic process by enabling computational analysis of behavioral and social impairments from home videos. Such techniques can improve objectivity and contribute quantitatively to the diagnostic process. Objective: In this work, we evaluate whether home videos collected from a game-based mobile app can be used to provide diagnostic insights into ASD. To the best of our knowledge, this is the first study attempting to identify potential social indicators of ASD from mobile phone videos without the use of eye-tracking hardware, manual annotations, and structured scenarios or clinical environments. Methods: Here, we used a mobile health app to collect over 11 hours of video footage depicting 95 children engaged in gameplay in a natural home environment. We used automated data set annotations to analyze two social indicators that have previously been shown to differ between children with ASD and their neurotypical (NT) peers: (1) gaze fixation patterns, which represent regions of an individual?s visual focus and (2) visual scanning methods, which refer to the ways in which individuals scan their surrounding environment. We compared the gaze fixation and visual scanning methods used by children during a 90-second gameplay video to identify statistically significant differences between the 2 cohorts; we then trained a long short-term memory (LSTM) neural network to determine if gaze indicators could be predictive of ASD. Results: Our results show that gaze fixation patterns differ between the 2 cohorts; specifically, we could identify 1 statistically significant region of fixation (P<.001). In addition, we also demonstrate that there are unique visual scanning patterns that exist for individuals with ASD when compared to NT children (P<.001). A deep learning model trained on coarse gaze fixation annotations demonstrates mild predictive power in identifying ASD. Conclusions: Ultimately, our study demonstrates that heterogeneous video data sets collected from mobile devices hold potential for quantifying visual patterns and providing insights into ASD. We show the importance of automated labeling techniques in generating large-scale data sets while simultaneously preserving the privacy of participants, and we demonstrate that specific social engagement indicators associated with ASD can be identified and characterized using such data. UR - https://www.jmir.org/2022/2/e31830 UR - http://dx.doi.org/10.2196/31830 UR - http://www.ncbi.nlm.nih.gov/pubmed/35166683 ID - info:doi/10.2196/31830 ER - TY - JOUR AU - Gehtland, M. Lisa AU - Paquin, S. Ryan AU - Andrews, M. Sara AU - Lee, M. Adam AU - Gwaltney, Angela AU - Duparc, Martin AU - Pfaff, R. Emily AU - Bailey Jr, B. Donald PY - 2022/2/10 TI - Using a Patient Portal to Increase Enrollment in a Newborn Screening Research Study: Observational Study JO - JMIR Pediatr Parent SP - e30941 VL - 5 IS - 1 KW - electronic health records KW - patient portals KW - patient selection KW - research subject recruitment KW - race factors KW - racial disparities N2 - Background: Many research studies fail to enroll enough research participants. Patient-facing electronic health record applications, known as patient portals, may be used to send research invitations to eligible patients. Objective: The first aim was to determine if receipt of a patient portal research recruitment invitation was associated with enrollment in a large ongoing study of newborns (Early Check). The second aim was to determine if there were differences in opening the patient portal research recruitment invitation and study enrollment by race and ethnicity, age, or rural/urban home address. Methods: We used a computable phenotype and queried the health care system?s clinical data warehouse to identify women whose newborns would likely be eligible. Research recruitment invitations were sent through the women?s patient portals. We conducted logistic regressions to test whether women enrolled their newborns after receipt of a patient portal invitation and whether there were differences by race and ethnicity, age, and rural/urban home address. Results: Research recruitment invitations were sent to 4510 women not yet enrolled through their patient portals between November 22, 2019, through March 5, 2020. Among women who received a patient portal invitation, 3.6% (161/4510) enrolled their newborns within 27 days. The odds of enrolling among women who opened the invitation was nearly 9 times the odds of enrolling among women who did not open their invitation (SE 3.24, OR 8.86, 95% CI 4.33-18.13; P<.001). On average, it took 3.92 days for women to enroll their newborn in the study, with 64% (97/161) enrolling their newborn within 1 day of opening the invitation. There were disparities by race and urbanicity in enrollment in the study after receipt of a patient portal research invitation but not by age. Black women were less likely to enroll their newborns than White women (SE 0.09, OR 0.29, 95% CI 0.16-0.55; P<.001), and women in urban zip codes were more likely to enroll their newborns than women in rural zip codes (SE 0.97, OR 3.03, 95% CI 1.62-5.67; P=.001). Black women (SE 0.05, OR 0.67, 95% CI 0.57-0.78; P<.001) and Hispanic women (SE 0.07, OR 0.73, 95% CI 0.60-0.89; P=.002) were less likely to open the research invitation compared to White women. Conclusions: Patient portals are an effective way to recruit participants for research studies, but there are substantial racial and ethnic disparities and disparities by urban/rural status in the use of patient portals, the opening of a patient portal invitation, and enrollment in the study. Trial Registration: ClinicalTrials.gov NCT03655223; https://clinicaltrials.gov/ct2/show/NCT03655223 UR - https://pediatrics.jmir.org/2022/1/e30941 UR - http://dx.doi.org/10.2196/30941 UR - http://www.ncbi.nlm.nih.gov/pubmed/35142618 ID - info:doi/10.2196/30941 ER - TY - JOUR AU - Poulin Herron, Alex AU - Agbadje, Tatiana Titilayo AU - Guay-Bélanger, Sabrina AU - Ngueta, Gérard AU - Roch, Geneviève AU - Rousseau, François AU - Légaré, France PY - 2022/1/25 TI - Web-Based Training for Nurses on Using a Decision Aid to Support Shared Decision-making About Prenatal Screening: Parallel Controlled Trial JO - JMIR Nursing SP - e31380 VL - 5 IS - 1 KW - shared decision-making KW - prenatal screening KW - training KW - nurses KW - nursing KW - behavioral intention KW - trisomy KW - Down syndrome KW - continuing professional development KW - continuing education KW - medical education KW - decision aid KW - screening KW - prenatal KW - pediatrics N2 - Background: Nurses play an important role in supporting pregnant women making decisions about prenatal screening for Down syndrome. We developed a web-based shared decision-making (SDM) training program for health professionals focusing on Down syndrome screening decisions. Objective: In this study, we aim to assess the impact of an SDM training program on nurses? intention to use a decision aid with pregnant women deciding on prenatal screening for Down syndrome. Methods: In this 2-arm, parallel controlled trial, French-speaking nurses working with pregnant women in the province of Quebec were recruited by a private survey firm. They were allocated by convenience either to the intervention group (web-based SDM course that included prenatal screening) or to the control group (web-based course focusing on prenatal screening alone, with no SDM content). The primary outcome was the intention to use a decision aid. Secondary outcomes were psychosocial variables of intention, knowledge, satisfaction, acceptability, perceived usefulness, and reaction to the pedagogical approach. All outcomes were self-assessed through web-based questionnaires, including the space for written comments. We used 2-tailed Student t test and Fisher exact test to compare continuous and categorical variables between groups, respectively. Results: Of the 57 participants assessed for eligibility, 40 (70%) were allocated to the intervention (n=20) or control group (n=20) and 36 (n=18 in each) completed the courses. The mean age of the participants was 41 (SD 9) years. Most were women (39/40, 98%), White (38/40, 95%), clinical nurses (28/40, 70%), and had completed at least a bachelor?s degree (30/40, 75%). After the intervention, the mean score of intention was 6.3 (SD 0.8; 95% CI 5.9-6.7) for the intervention group and 6.0 (SD 1.2; 95% CI 5.42-6.64) for the control group (scale 1-7). The differences in intention and other psychosocial variable scores between the groups were not statistically significant. Knowledge scores for SDM were significantly higher in the intervention group (79%, 95% CI 70-89 vs 64%, 95% CI 57-71; P=.009). The intervention was significantly more acceptable in the intervention group (4.6, 95% CI 4.4-4.8 vs 4.3, 95% CI 4.1-4.5; P=.02), and reaction to the pedagogical approach was also significantly more positive in the intervention group (4.7, 95% CI 4.5-4.8 vs 4.4, 95% CI 4.2-4.5; P=.02). There was no significant difference in overall satisfaction (or in perceived usefulness). Furthermore, 17 participants (9 in the intervention group and 8 in the control group) provided written comments on the intervention. Conclusions: This study focuses on web-based nursing education and its potential to support pregnant women?s decision-making needs. It shows that nurses? intention to use a decision aid to enhance SDM in prenatal care is high, with or without training, but that their knowledge about SDM can be improved with web-based training. International Registered Report Identifier (IRRID): RR2-10.2196/17878 UR - https://nursing.jmir.org/2022/1/e31380 UR - http://dx.doi.org/10.2196/31380 UR - http://www.ncbi.nlm.nih.gov/pubmed/34874274 ID - info:doi/10.2196/31380 ER - TY - JOUR AU - Piqueras, A. Jose AU - Vidal-Arenas, Verónica AU - Falcó, Raquel AU - Moreno-Amador, Beatriz AU - Marzo, C. Juan AU - Holcomb, M. Juliana AU - Murphy, Michael PY - 2021/12/1 TI - Short Form of the Pediatric Symptom Checklist-Youth Self-Report (PSC-17-Y): Spanish Validation Study JO - J Med Internet Res SP - e31127 VL - 23 IS - 12 KW - PSC-17-Y KW - psychometric properties KW - screening KW - mental problems KW - adolescents KW - adolescent health KW - adolescent medicine KW - psychiatry KW - psychology KW - psychosocial issues N2 - Background: The short form, 17-item version of the Pediatric Symptom Checklist-Youth Self-Report (PSC-17-Y) is a validated measure that assesses psychosocial problems overall (OVR) and in 3 major psychopathological domains (internalizing, externalizing, and attention-deficit/hyperactivity disorder), taking 5-10 min to complete. Prior research has established sound psychometric properties of the PSC-17-Y for English speakers. Objective: This study extends psychometric evidence for the acceptability of the PSC-17-Y in a large sample of Spanish adolescents, providing proof of its reliability and structure, convergent and discriminant validity, and longitudinal and gender invariance. Methods: Data were collected on 5430 adolescents, aged 12-18 years, who filled out the PSC-17-Y twice during 2018-2019 (7-month interval). We calculated the Cronbach alpha and the McDonald omega coefficients to test reliability, the Pearson correlation for convergent (distress) and criterion validity (well-being, quality of life, and socioemotional skills), confirmatory factor analysis (CFA) for structure validity, and multigroup and longitudinal measurement invariance analysis for longitudinal and gender stability. Results: Within structural analysis for the PSC-17-Y, CFA supported a correlated 3-factor solution, which was also invariant longitudinally and across gender. All 3 subscales showed evidence of reliability, with coefficients near or above .70. Moreover, scores of PSC-17-Y subscales were positively related with convergent measures and negatively related with criterion measures. Normative data for the PSC-17-Y are presented in the form of percentiles (75th and 90th). Conclusions: This work provides the first evidence of the reliability and validity of the Spanish version of the PSC-17-Y administered over the internet to assess mental health problems among adolescents, maintaining the same domains as the long version. UR - https://www.jmir.org/2021/12/e31127 UR - http://dx.doi.org/10.2196/31127 UR - http://www.ncbi.nlm.nih.gov/pubmed/34855614 ID - info:doi/10.2196/31127 ER - TY - JOUR AU - Slovak, Petr AU - Ford, Q. Brett AU - Widen, Sherri AU - Daudén Roquet, Claudia AU - Theofanopoulou, Nikki AU - Gross, J. James AU - Hankin, Benjamin AU - Klasnja, Predrag PY - 2021/11/9 TI - An In Situ, Child-Led Intervention to Promote Emotion Regulation Competence in Middle Childhood: Protocol for an Exploratory Randomized Controlled Trial JO - JMIR Res Protoc SP - e28914 VL - 10 IS - 11 KW - randomized controlled trial KW - children KW - emotion regulation KW - in situ intervention KW - intervention KW - emotion KW - protocol KW - exploratory KW - efficacy KW - model KW - prevention KW - treatment KW - risk factor N2 - Background: Emotion regulation is a key transdiagnostic risk factor for a range of psychopathologies, making it a prime target for both prevention and treatment interventions in childhood. Existing interventions predominantly rely on workshops or in-person therapy-based approaches, limiting the ability to promote emotion regulation competence for children in everyday settings and at scale. Purrble is a newly developed, inexpensive, socially assistive robot?in the form of an interactive plush toy?that uses haptic feedback to support in-the-moment emotion regulation. It is accessible to children as needed in their daily lives, without the need for a priori training. Although qualitative data from previous studies show high engagement in situ and anecdotal evidence of the robot being incorporated into children?s emotion regulation routines, there is no quantitative evidence of the intervention?s impact on child outcomes. Objective: The aim of this study is to examine the efficacy of a new intervention model for child-led emotion regulation?Purrble?that can be deployed across prevention and treatment contexts. Methods: Overall, 134 children aged 8 to 10 years will be selected from an enriched nonclinical North American population; for inclusion, the cutoff for the parents? rating of child dysregulation will be ?10 points in the total difficulties score on the Strengths and Difficulties Questionnaire. This cutoff was selected to obtain a measurable, but not necessarily clinical, level of the child?s emotion regulatory difficulties. The selected families will be randomly assigned with .5 probability to receive either a Purrble or an active control (noninteractive plush toy). The primary outcome will be a daily ecological momentary assessment measure of child emotion regulation capability (as reported by parents) over a period of 4 weeks. Exploratory analyses will investigate the intervention impact on secondary outcomes of child emotion regulation, collected weekly over the same 4-week period, with follow-ups at 1 month and 6 months postdeployment. Quantitative data will be analyzed on an intent-to-treat basis. A proportion of families (approximately 30% of the sample) will be interviewed after deployment as part of the process analysis. Results: The study is funded by the UKRI Future Leaders Fellowship (MR/T041897/1) and an in-kind contribution from the Committee for Children. This study received ethical approval from the Pearl institutional review board (#18-CFC-101). Participant recruitment started in February 2021, with the 1-month deployment in April-May 2021. The results of this analysis will be published in 2022. Conclusions: This study will be the first quantitative evaluation of the efficacy of an innovative, proof-of-concept intervention model for an in situ, child-led emotion regulation intervention. Insights into the trajectory of daily changes, complemented with weekly questionnaire batteries and postdeployment interviews, will result in an in-depth understanding of whether and how the hypothesized intervention logic model works, leading to further intervention optimization. Trial Registration: ClinicalTrials.gov NCT04810455; http://clinicaltrials.gov/ct2/show/NCT04810455 International Registered Report Identifier (IRRID): PRR1-10.2196/28914 UR - https://www.researchprotocols.org/2021/11/e28914 UR - http://dx.doi.org/10.2196/28914 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751666 ID - info:doi/10.2196/28914 ER - TY - JOUR AU - Chaudhari, Hanu AU - Schneeweiss, Michelle AU - Rebinsky, Reid AU - Rullo, Enrico AU - Eltorki, Mohamed PY - 2021/10/20 TI - An Advanced Nursing Directive for Children With Suspected Appendicitis: Protocol for a Quality Improvement Feasibility Study JO - JMIR Res Protoc SP - e33158 VL - 10 IS - 10 KW - quality improvement KW - pediatric KW - nursing KW - medical directive KW - appendicitis KW - emergency department flow KW - nursing directive N2 - Background: Pediatric appendicitis accounts for an estimated 7% to 10% of abdominal pain cases in the emergency department (ED). The diagnosis is time-consuming, and the investigative process depends on physician assessment, resulting in delays in diagnosis and therapeutic management. The utility of an advanced nursing directive (AND) to expedite this process is unclear and needs further exploration. Objective: This study aims to describe key components of ED flow in patients with suspected appendicitis seen at a pediatric ED and pilot a directive that allows ED nurses to perform an order set that includes blood work, urine tests, analgesics, fluids, and an abdominal-pelvis ultrasound prior to physician assessment. Methods: This study involves conducting a retrospective chart review alongside a quality improvement initiative to compare key ED flow metrics before and after AND implementation. Primary outcome measures include median time from ED triage assessment to ultrasound completion, analgesia administration, blood work results, and time to disposition (consult or discharge), alongside other key ED flow metrics for suspected appendicitis. Secondary outcomes will involve patient and caretaker satisfaction surveys. Descriptive statistics will be used to summarize the data. For differences in proportions, a chi-square test will be used. The Student t test will be used for continuous variables. A variable-controlled run chart will be performed to assess impact on ED flow metrics. Patient and family satisfaction surveys are administered immediately after the directive encounter and 7 days afterward. Results: There are currently 3900 patients who have been screened, 344 patients who have been enrolled, and 90 patients who have received the medical directive since implementation in June 2020. Interim results on reduction of time to diagnostic and therapeutic ED flow parameters and satisfaction surveys are expected to be published in February 2022. The final study endpoint will be in June 2022. Conclusions: This study proposes a novel protocol for improving the diagnosis and treatment of suspected pediatric appendicitis through implementation of an evidence-based AND. This model may provide a standardized, international pathway for management of common pediatric and adult emergencies. International Registered Report Identifier (IRRID): RR1-10.2196/33158 UR - https://www.researchprotocols.org/2021/10/e33158 UR - http://dx.doi.org/10.2196/33158 UR - http://www.ncbi.nlm.nih.gov/pubmed/34668867 ID - info:doi/10.2196/33158 ER - TY - JOUR AU - Pinilla, T. Yudi AU - Friessinger, Evelyn AU - Griesbaum, Marie Johanna AU - Berner, Lilith AU - Heinzel, Constanze AU - Elsner, Käthe AU - Fendel, Rolf AU - Held, Jana AU - Kreidenweiss, Andrea PY - 2021/10/8 TI - Prevalence of SARS-CoV-2 Infection in Children by Antibody Detection in Saliva: Protocol for a Prospective Longitudinal Study (Coro-Buddy) JO - JMIR Res Protoc SP - e27739 VL - 10 IS - 10 KW - SARS-CoV-2 KW - COVID-19 KW - antibody KW - saliva KW - children KW - epidemiology N2 - Background: The world has been confronted with the COVID-19 pandemic for more than one year. Severe disease is more often found among elderly people, whereas most young children and adolescents show mild symptoms or even remain asymptomatic, so that infection might be undiagnosed. Therefore, only limited epidemiological data on SARS-CoV-2 infection in children and young adults are available. Objective: This study aims to determine the prevalence of SARS-CoV-2 antibodies in children from the city of Tübingen, Germany, and to measure the incidence of new cases over 12 months. Methods: SARS-CoV-2 antibodies will be measured in saliva as a surrogate for a previous SARS-CoV-2 infection. Children will be sampled at their preschools, primary schools, and secondary schools at three time points: July 2020, October to December 2020, and April to July 2021. An adult cohort will be sampled at the same time points (ie, adult comparator group). The saliva-based SARS-CoV-2?antibody enzyme-linked immunosorbent assay will be validated using blood and saliva samples from adults with confirmed previous SARS-CoV-2 infections (ie, adult validation group). Results: The first study participant was enrolled in July 2020, and recruitment and enrollment continued until July 2021. We have recruited and enrolled 1850 children, 560 adults for the comparator group, and 83 adults for the validation group. We have collected samples from the children and the adults for the comparator group at the three time points. We followed up with participants in the adult validation group every 2 months and, as of the writing of this paper, we were at time point 7. We will conduct data analysis after the data collection period. Conclusions: Infection rates in children are commonly underreported due to a lack of polymerase chain reaction testing. This study will report on the prevalence of SARS-CoV-2 infections in infants, school children, and adolescents as well as the incidence change over 12 months in the city of Tübingen, Germany. The saliva sampling approach for SARS-CoV-2?antibody measurement allows for a unique, representative, population-based sample collection process. Trial Registration: ClinicalTrials.gov NCT04581889; https://clinicaltrials.gov/ct2/show/NCT04581889 International Registered Report Identifier (IRRID): DERR1-10.2196/27739 UR - https://www.researchprotocols.org/2021/10/e27739 UR - http://dx.doi.org/10.2196/27739 UR - http://www.ncbi.nlm.nih.gov/pubmed/34533472 ID - info:doi/10.2196/27739 ER - TY - JOUR AU - Alsafadi, Danyah AU - Ezzat, Aly AU - Altamimi, Fatima AU - ElBagoury, Marwan AU - Olfat, Mohammed AU - Saleh, Mohammed AU - Roushdy, Sherif AU - Aktham, Yahia PY - 2021/8/31 TI - Mucopolysaccharidosis Type I Disease Prevalence Among Patients With Idiopathic Short Stature in Saudi Arabia: Protocol for a Multicenter Cross-sectional Study JO - JMIR Res Protoc SP - e28619 VL - 10 IS - 8 KW - mucopolysaccharidosis KW - lysosomal storage disorders KW - epidemiology KW - Saudi Arabia N2 - Background: Since the underlying cause of idiopathic short stature can indeed be undiagnosed mucopolysaccharidosis type I, it is critical to identify patients with mucopolysaccharidosis type I among screened patients with idiopathic short stature. Objective: The primary objective of this study is to determine the prevalence of mucopolysaccharidosis type I disease in a high-risk group (ie, patients with idiopathic short stature). Methods: We plan to perform a multicenter, cross-sectional screening study to primarily assess the prevalence of mucopolysaccharidosis type I disease in patients with idiopathic short stature. All eligible patients will be tested after obtaining written informed consent from their parents and guardians. Eligible patients will be recruited over 18 months from specialty care centers for pediatrics and genetics. Results: This protocol was approved by the Institutional Review Board of King Fahd Medical City and funded by Sanofi Genzyme Saudi Arabia. We expect to collect data from ?800 patients, as determined by our sample size calculation. Conclusions: Saudi Arabia is the largest country in the Arabian Peninsula; it has a population of more than 28 million people. To date, there are no reliable data regarding the incidence and prevalence of mucopolysaccharidosis type I in Saudi Arabia; therefore, future multicenter studies will be needed. Further, the prevalence of an attenuated form of mucopolysaccharidosis type I is largely underestimated in Saudi Arabia due to the absence of an effective newborn screening program. Therefore, the implementation of a nationwide newborn screening program is essential for the accurate estimation of the burden of mucopolysaccharidosis and the early diagnosis of patients. International Registered Report Identifier (IRRID): PRR1-10.2196/28619 UR - https://www.researchprotocols.org/2021/8/e28619 UR - http://dx.doi.org/10.2196/28619 UR - http://www.ncbi.nlm.nih.gov/pubmed/34463634 ID - info:doi/10.2196/28619 ER - TY - JOUR AU - Kimmie-Dhansay, Faheema AU - Barrie, Robert AU - Roberts, Tina AU - Naidoo, Sudeshni PY - 2021/6/24 TI - Risk Indicators for Early Childhood Caries in South Africa: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e26701 VL - 10 IS - 6 KW - dmft KW - infant KW - risk factors KW - dental caries KW - South Africa KW - early childhood caries N2 - Background: Early childhood caries (ECC) is a common disorder characterized by the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces of primary teeth in children 71 months old or younger. South Africa has a diverse population in terms of culture, education, income, and occupation. This diversity is due to the consequences of historical racial discrimination, poverty, unemployment, lack of accessibility to health services, and quality of education. These factors make South Africa unique, and the disease and risk profiles for this country differ from those of other countries at similar stages of development. For these reasons, it is important to identify the unique maternal and infant risk factors for ECC in the South African context. Objective: The purpose of this study is to determine the risk factors associated with the incidence and prevalence of ECC in South Africa in children under the age of 6 years. Methods: All cross-sectional and cohort studies documenting risk factors associated with the prevalence and incidence of dental disease and severity (decayed, missing, and filled scores) will be included. We will search 7 databases for eligible studies, and those included will be based on prespecified inclusion criteria. Only studies conducted with South African children who are aged 6 years and younger in which dental caries risk factors are documented will be included. There is no restriction on the time or language of publication. Included articles will be scrutinized for quality by using a risk of bias tool developed by the Joanna Briggs Institute. The results will be presented narratively, and if possible, a meta-analysis will be performed. Results: The literature search was conducted in November 2020. Conclusions: The results of this study will provide a framework to inform medical and dental personnel to highlight mothers and infants at risk of developing ECC. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020216455; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216455 International Registered Report Identifier (IRRID): DERR1-10.2196/26701 UR - https://www.researchprotocols.org/2021/6/e26701/ UR - http://dx.doi.org/10.2196/26701 UR - http://www.ncbi.nlm.nih.gov/pubmed/34170258 ID - info:doi/10.2196/26701 ER - TY - JOUR AU - Zanetti, Michele AU - Clavenna, Antonio AU - Pandolfini, Chiara AU - Pansieri, Claudia AU - Calati, Grazia Maria AU - Cartabia, Massimo AU - Miglio, Daniela AU - Bonati, Maurizio PY - 2021/3/12 TI - Informatics Methodology Used in the Web-Based Portal of the NASCITA Cohort Study: Development and Implementation Study JO - J Med Internet Res SP - e23087 VL - 23 IS - 3 KW - internet KW - computer systems KW - cohort studies KW - pediatricians KW - infant KW - newborn N2 - Background: Many diseases occurring in adults can be pinned down to early childhood and birth cohorts are the optimal means to study this connection. Birth cohorts have contributed to the understanding of many diseases and their risk factors. Objective: To improve the knowledge of the health status of Italian children early on and how it is affected by social and health determinants, we set up a longitudinal, prospective, national-level, population-based birth cohort, the NASCITA study (NAscere e creSCere in ITAlia). The main aim of this cohort is to evaluate physical, cognitive, and psychological development; health status; and health resource use in the first 6 years of life in newborns, and potential associated factors. A web-based system was set up with the aim to host the cohort; provide ongoing information to pediatricians and to families; and facilitate accurate data input, monitoring, and analysis. This article describes the informatics methodology used to set up and maintain the NASCITA cohort with its web-based platform, and provides a general description of the data on children aged over 7 months. Methods: Family pediatricians were contacted for participation in the cohort and enrolled newborns from April 2019 to July 2020 at their first well-child visit. Information collected included basic data that are part of those routinely collected by the family pediatricians, but also parental data, such as medical history, characteristics and lifestyle, and indoor and outdoor environment. A specific web portal for the NASCITA cohort study was developed and an electronic case report form for data input was created and tested. Interactive data charts, including growth curves, are being made available to pediatricians with their patients? data. Newsletters covering the current biomedical literature on child cohorts are periodically being put up for pediatricians, and, for parents, evidence-based information on common illnesses and problems in children. Results: The entire cohort population consists of 5166 children, with 139 participating pediatricians, distributed throughout Italy. The number of children enrolled per pediatrician ranged from 1 to 100. The 5166 enrolled children represent 66.55% (5166/7763) of the children born in all of 2018 covered by the same pediatricians participating in the cohort. The number of children aged over 7 months at the time of these analyses, and for whom the most complete data were available upon initial analyses, was 4386 (2226/4381 males [50.81%] and 142/4370 twins [3.25%]). The age of the mothers at birth of the 4386 children ranged from 16 to 54 years. Most newborns? mothers (3758/4367, 86.05%) were born in Italy, followed by mothers born in Romania (101/4367, 2.31%), Albania (75/4367, 1.72%), and Morocco (60/4367, 1.37%). Concerning the newborns, 138/4386 (3.15%) were born with malformations and 352/4386 (8.03%) had a disease, most commonly neonatal respiratory distress syndrome (n=52), neonatal jaundice (n=46), and neonatal hypoglycemia (n=45). Conclusions: The NASCITA cohort is well underway and the population size will permit significant conclusions to be drawn. The key role of pediatricians in obtaining clinical data directly, along with the national-level representativity, will make the findings even more solid. In addition to promoting accurate data input, the multiple functions of the web portal, with its interactive platform, help maintain a solid relationship with the pediatricians and keep parents informed and interested in participating. Trial Registration: ClinicalTrials.gov NCT03894566; https://clinicaltrials.gov/ct2/show/NCT03894566 UR - https://www.jmir.org/2021/3/e23087 UR - http://dx.doi.org/10.2196/23087 UR - http://www.ncbi.nlm.nih.gov/pubmed/33709930 ID - info:doi/10.2196/23087 ER - TY - JOUR AU - Weijers, Miriam AU - Bastiaenen, Caroline AU - Feron, Frans AU - Schröder, Kay PY - 2021/2/9 TI - Designing a Personalized Health Dashboard: Interdisciplinary and Participatory Approach JO - JMIR Form Res SP - e24061 VL - 5 IS - 2 KW - visualization design model KW - dashboard KW - evaluation KW - personalized health care KW - International Classification of Functioning, Disability and Health (ICF) KW - patient access to records KW - human?computer interaction KW - health information visualization N2 - Background: Within the Dutch Child Health Care (CHC), an online tool (360° CHILD-profile) is designed to enhance prevention and transformation toward personalized health care. From a personalized preventive perspective, it is of fundamental importance to timely identify children with emerging health problems interrelated to multiple health determinants. While digitalization of children?s health data is now realized, the accessibility of data remains a major challenge for CHC professionals, let alone for parents/youth. Therefore, the idea was initiated from CHC practice to develop a novel approach to make relevant information accessible at a glance. Objective: This paper describes the stepwise development of a dashboard, as an example of using a design model to achieve visualization of a comprehensive overview of theoretically structured health data. Methods: Developmental process is based on the nested design model with involvement of relevant stakeholders in a real-life context. This model considers immediate upstream validation within 4 cascading design levels: Domain Problem and Data Characterization, Operation and Data Type Abstraction, Visual Encoding and Interaction Design, and Algorithm Design. This model also includes impact-oriented downstream validation, which can be initiated after delivering the prototype. Results: A comprehensible 360° CHILD-profile is developed: an online accessible visualization of CHC data based on the theoretical concept of the International Classification of Functioning, Disability and Health. This dashboard provides caregivers and parents/youth with a holistic view on children?s health and ?entry points? for preventive, individualized health plans. Conclusions: Describing this developmental process offers guidance on how to utilize the nested design model within a health care context. UR - https://formative.jmir.org/2021/2/e24061 UR - http://dx.doi.org/10.2196/24061 UR - http://www.ncbi.nlm.nih.gov/pubmed/33560229 ID - info:doi/10.2196/24061 ER - TY - JOUR AU - Bernie, Charmaine AU - Williams, Katrina AU - Graham, Fiona AU - May, Tamara PY - 2021/1/7 TI - Coaching While Waiting for Autism Spectrum Disorder Assessment: Protocol of a Pilot Feasibility Study for a Randomized Controlled Trial on Occupational Performance Coaching and Service Navigation Support JO - JMIR Res Protoc SP - e20011 VL - 10 IS - 1 KW - coaching KW - Occupational Performance Coaching KW - feasibility KW - parents KW - caregivers KW - ASD KW - autism KW - waiting list KW - referral KW - service navigation N2 - Background: In Australia, the average time between a first concern of autism spectrum disorder (ASD) and diagnosis is over 2 years. After referral for assessment, families often wait 6-12 months before their appointment. This can be a time of uncertainty and stress for families. For some families, other forms of assistance are not accessible and thus timely intervention opportunities are missed. There is little evidence about how to provide the best support for children or caregivers while on assessment waiting lists. Objective: The aim of this study is to determine whether use of a coaching intervention called Occupational Performance Coaching (OPC) combined with service navigation support is feasible for families waiting for ASD assessment, as a crucial first step in planning a randomized controlled trial. Methods: A pilot and feasibility study will be conducted using recommended constructs and associated measures, which will be reported using CONSORT (Consolidated Standards or Reporting Trials) guidance. Participants will be child and caregiver dyads or triads, recruited within 4 months of their child (aged 1-7 years) being referred to one of two services for an ASD assessment in Victoria, Australia. A blinded randomization procedure will be used to allocate participants to one of three trial arms: (1) coaching and support intervention delivered face to face, (2) coaching and support intervention via videoconference, and (3) usual care. Descriptive statistics will be used to describe the sample characteristics of parents and children, inclusive of service access at baseline and follow up. Recruitment rates will be reported, and retention rates will be evaluated against a predicted rate of 70%-80% in each intervention arm. Goal attainment, using the Canadian Occupational Performance Measure, will indicate preliminary evidence for efficacy within the intervention arms, with an increase of 2 or more points on a 10-point performance and satisfaction scale considered clinically significant. Results: The study was approved by The Royal Children?s Hospital Research Ethics and Governance Department in September 2018. As of October 2020, 16 families have been recruited to the study. Data analysis is ongoing and results are expected to be published in 2021. Conclusions: Study findings will support planning for a future randomized controlled trial to assess the efficacy of OPC and service navigation support for caregivers of children awaiting ASD assessment. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000164998; www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378793&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/20011 UR - https://www.researchprotocols.org/2021/1/e20011 UR - http://dx.doi.org/10.2196/20011 UR - http://www.ncbi.nlm.nih.gov/pubmed/33410761 ID - info:doi/10.2196/20011 ER - TY - JOUR AU - Ma, Shuoxin AU - Guan, Yongqing AU - Yuan, Yazhen AU - Tai, Yuan AU - Wang, Tan PY - 2020/7/13 TI - A One-Step, Streamlined Children?s Vision Screening Solution Based on Smartphone Imaging for Resource-Limited Areas: Design and Preliminary Field Evaluation JO - JMIR Mhealth Uhealth SP - e18226 VL - 8 IS - 7 KW - vision screening KW - resource-limited application KW - photorefraction KW - strabismus KW - myopia KW - anisometropia KW - mHealth KW - screening N2 - Background: Young children?s vision screening, as part of a preventative health care service, produces great value for developing regions. Besides yielding a high return on investment from forestalling surgeries using a low-cost intervention at a young age, it improves school performance and thus boosts future labor force quality. Leveraging low-skilled health care workers with smartphones and automated diagnosis to offer such programs can be a scalable model in resource-limited areas. Objective: This study aimed to develop and evaluate an effective, efficient, and comprehensive vision screening solution for school children in resource-limited areas. First, such an exam would need to cover the major risk factors of amblyopia and myopia, 2 major sources of vision impairment effectively preventable at a young age. Second, the solution must be integrated with digital patient record-keeping for long-term monitoring and popular statistical analysis. Last, it should utilize low-skilled technicians and only low-cost tools that are available in a typical school in developing regions, without compromising quality or efficiency. Methods: A workflow for the screening program was designed and a smartphone app was developed to implement it. In the standardized screening procedure, a young child went through the smartphone-based photoscreening in a dark room. The child held a smartphone in front of their forehead, displaying pre-entered personal information as a quick response code that duplexed as a reference of scale. In one 10-second procedure, the child?s personal information and interpupillary distance, relative visual axis alignment, and refractive error ranges were measured and analyzed automatically using image processing and artificial intelligence algorithms. The child?s risk for strabismus, myopia, and anisometropia was then derived and consultation given. Results: A preliminary evaluation of the solution was conducted alongside yearly physical exams in Luoyang, Henan, People?s Republic of China. It covered 20 students with suspected strabismus and 80 randomly selected students, aged evenly between 8 and 10. Each examinee took about 1 minute, and a streamlined workflow allowed 3 exams to run in parallel. The 1-shot and 2-shot measurement success rates were 87% and 100%, respectively. The sensitivity and specificity of strabismus detection were 0.80 and 0.98, respectively. The sensitivity and specificity of myopia detection were 0.83 and 1.00, respectively. The sensitivity and specificity of anisometropia detection were 0.80 and 1.00, respectively. Conclusions: The proposed vision screening program is effective, efficient, and scalable. Compared with previously published studies on utilizing a smartphone for an automated Hirschberg test and photorefraction screening, this comprehensive solution is optimized for practicality and robustness, and is thus better ready-to-deploy. Our evaluation validated the achievement of the program?s design specifications. UR - http://mhealth.jmir.org/2020/7/e18226/ UR - http://dx.doi.org/10.2196/18226 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673243 ID - info:doi/10.2196/18226 ER - TY - JOUR AU - Baker, Jess AU - Kohlhoff, Jane AU - Onobrakpor, Se-Inyenede AU - Woolfenden, Sue AU - Smith, Rebecca AU - Knebel, Constanze AU - Eapen, Valsamma PY - 2020/4/23 TI - The Acceptability and Effectiveness of Web-Based Developmental Surveillance Programs: Rapid Review JO - JMIR Mhealth Uhealth SP - e16085 VL - 8 IS - 4 KW - public health surveillance KW - mass screening KW - developmental disabilities KW - neurodevelopmental disorders KW - review literature as topic KW - health care disparities N2 - Background: Web-based developmental surveillance programs may be an innovative solution to improving the early detection of childhood developmental difficulties, especially within disadvantaged populations. Objective: This review aimed to identify the acceptability and effectiveness of web-based developmental surveillance programs for children aged 0 to 6 years. Methods: A total of 6 databases and gray literature were searched using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses?informed protocol. Data extraction included variables related to health equity. Results: In total, 20 studies were identified. Most papers implemented web-based versions of the Modified Checklist for Autism in Toddlers, Revised with Follow-Up screener for autism spectrum disorder or Parent Evaluation of Developmental Status screeners for broad developmental delay. Caregivers and practitioners indicated a preference for web-based screeners, primarily for user-friendliness, improved follow-up accuracy, time, and training efficiencies. Conclusions: Although evidence is limited as to the necessity of web- versus face-to-face?based developmental screening, there are clear efficiencies in its use. Trial Registration: PROSPERO CRD42019127894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=127894 UR - http://mhealth.jmir.org/2020/4/e16085/ UR - http://dx.doi.org/10.2196/16085 UR - http://www.ncbi.nlm.nih.gov/pubmed/32324149 ID - info:doi/10.2196/16085 ER - TY - JOUR AU - Hsu, Chen-Fang AU - Chien, Tsair-Wei AU - Chow, Chi Julie AU - Yeh, Yu-Tsen AU - Chou, Willy PY - 2020/4/16 TI - An App for Identifying Children at Risk for Developmental Problems Using Multidimensional Computerized Adaptive Testing: Development and Usability Study JO - JMIR Pediatr Parent SP - e14632 VL - 3 IS - 1 KW - computer adaptive testing KW - developmental delay KW - multidimensional KW - mobile phone KW - screening N2 - Background: The use of multidomain developmental screening tools is a viable strategy for pediatric professionals to identify children at risk for developmental problems. However, a specialized multidimensional computer adaptive testing (MCAT) tool has not been developed to date. Objective: We developed an app using MCAT, combined with Multidimensional Screening in Child Development (MuSiC) for toddlers, to help patients and their family members or clinicians identify developmental problems at an earlier stage. Methods: We retrieved 75 item parameters from the MuSiC literature item bank for 1- to 3-year-old children, and simulated 1000 person measures from a normal standard distribution to compare the efficiency and precision of MCAT and nonadaptive testing (NAT) in five domains (ie, cognitive skills, language skills, gross motor skills, fine motor skills, and socioadaptive skills). The number of items saved and the cutoff points for the tool were determined and compared. We then developed an app for a Web-based assessment. Results: MCAT yielded significantly more precise measurements and was significantly more efficient than NAT, with 46.67% (=(75-40)/75) saving in item length when measurement differences less than 5% were allowed. Person-measure correlation coefficients were highly consistent among the five domains. Significantly fewer items were answered on MCAT than on NAT without compromising the precision of MCAT. Conclusions: Developing an app as a tool for parents that can be implemented with their own computers, tablets, or mobile phones for the online screening and prediction of developmental delays in toddlers is useful and not difficult. UR - http://pediatrics.jmir.org/2020/1/e14632/ UR - http://dx.doi.org/10.2196/14632 UR - http://www.ncbi.nlm.nih.gov/pubmed/32297867 ID - info:doi/10.2196/14632 ER - TY - JOUR AU - Fernandez-Luque, Luis AU - Labarta, I. José AU - Palmer, Ella AU - Koledova, Ekaterina PY - 2020/2/18 TI - Content Analysis of Apps for Growth Monitoring and Growth Hormone Treatment: Systematic Search in the Android App Store JO - JMIR Mhealth Uhealth SP - e16208 VL - 8 IS - 2 KW - growth hormone KW - telemedicine KW - growth monitoring KW - mobile app KW - mobile health N2 - Background: The use of mobile apps for health is growing. This rapid growth in the number of health apps can make it hard to assess their quality and features. The increased demand for and availability of mobile health apps highlights the importance of regular publication of reviews to identify potential areas of unmet needs and concern. The focus of this review is mobile apps for monitoring growth for health care professionals, caregivers, and patients. Monitoring growth as a part of healthy physical development is important across different periods of childhood and adolescence. Objective: The goal of this content analysis is to map and understand the types of apps that currently exist that are related to growth monitoring and growth hormone treatment. Methods: A semiautomated search was undertaken using the app search engine 42Matters, complemented by a manual search for growth apps using the web search tool of Google Play (Android App Store). Apps were rated on their relevance to growth monitoring and categorized by independent raters. Results: In total, 76 apps were rated relevant to growth monitoring or growth hormone treatment. The level of agreement was measured for the semiautomated search and was very high (?=0.97). The target audience for 87% of the apps (66/76) was patients and relatives, followed by health care professionals (11%; 8/76) and both (3%; 2/76). Apps in the category ?growth tracking tools for children and babies? were retrieved most often (46%; 35/76) followed by ?general baby care apps? (32%; 24/76), ?nonpharmacological solutions for growth? (12%; 9/76) and ?growth hormone?related? (11%; 8/76). Overall, 19/76 apps (25%) tracked a precise location. Conclusions: This study mapped the type of apps currently available for growth monitoring or growth hormone treatment that can be used as a foundation for more detailed evaluations of app quality. The popularity of care apps for children and growth monitoring apps should provide a great channel for potential intervention in childhood health in the future. UR - http://mhealth.jmir.org/2020/2/e16208/ UR - http://dx.doi.org/10.2196/16208 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130162 ID - info:doi/10.2196/16208 ER - TY - JOUR AU - Johnson, Ryden Pamela AU - Bushar, Jessica AU - Dunkle, Margaret AU - Leyden, Sharon AU - Jordan, T. Elizabeth PY - 2019/01/30 TI - Usability and Acceptability of a Text Message-Based Developmental Screening Tool for Young Children: Pilot Study JO - JMIR Pediatr Parent SP - e10814 VL - 2 IS - 1 KW - developmental screening KW - EPSDT KW - ITP KW - low income KW - Medicaid KW - mHealth KW - mobile health KW - Text4baby KW - text messaging KW - PEDS:DM KW - WIC N2 - Background: Only 30% of parents of children aged 9-35 months report that their child received a developmental screening in the previous year. Screening rates are even lower in low-income households, where the rates of developmental delays are typically higher than those in high-income households. Seeking to evaluate ways to increase developmental screening, Text4baby, a national perinatal texting program, created an interactive text message-based version of a validated developmental screening tool for parents. Objective: This study aimed to assess whether a text message-based developmental screening tool is usable and acceptable by low-income mothers. Methods: Low-income mothers of infants aged 8-10 months were recruited from the Women, Infants and Children Program clinics in Prince George?s County, MD. Once enrolled, participants used text messages to receive and respond to six developmental screening questions from the Parents? Evaluation of Developmental Status: Developmental Milestones. After confirming their responses, participants received the results and feedback. Project staff conducted a follow-up phone survey and invited a subset of survey respondents to attend focus groups. A representative of the County?s Infants and Toddlers Program met with or called participants whose results indicated that their infants ?may be behind.? Results: Eighty-one low-income mothers enrolled in the study, 93% of whom reported that their infants received Medicaid (75/81). In addition, 49% of the mothers were Hispanic/Latina (40/81) and 42% were African American (34/81). A total of 80% participated in follow-up surveys (65/81), and 14 mothers attended focus groups. All participants initiated the screening and responded to all six screening questions. Of the total, 79% immediately confirmed their responses (64/81), and 21% made one or more changes (17/81). Based on the final responses, 63% of participants received a text that the baby was ?doing well? in all six developmental domains (51/81); furthermore, 37% received texts listing domains where their baby was ?doing well? and one or more domains where their baby ?may be behind? (30/81). All participants received a text with resources for follow-up. In a follow-up survey reaching 65 participants, all respondents said that they would like to answer screening questions again when their baby was older. All but one participant would recommend the tool to a friend and rated the experience of answering questions and receiving feedback by text as ?very good? or ?good.? Conclusions: A mobile text version of a validated developmental screening tool was both usable and acceptable by low-income mothers, including those whose infants ?may be behind.? Our results may inform further research on the use of the tool at older ages and options for a scalable, text-based developmental screening tool such as that in Text4baby. UR - http://pediatrics.jmir.org/2019/1/e10814/ UR - http://dx.doi.org/10.2196/10814 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518329 ID - info:doi/10.2196/10814 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 -