JMIR Pediatrics and Parenting最新文献

{"title":"Touching Technology-Parents' Experiences of Remote Consultations for Children With Severe Congenital Cardiac Conditions: Quasi-Experimental Cohort Study.","authors":"Julie Elizabeth May McCullough, Marlene Sinclair, Jonathan Gillender, Brian McCrossan, Paul F Slater, Rosie Browne, Frank Casey","doi":"10.2196/54598","DOIUrl":"10.2196/54598","url":null,"abstract":"<p><strong>Background: </strong>Remote consultations (RCs) using videoconferencing was recommended by the General Medical Council as the method for clinicians to provide patient consultations during the COVID-19 pandemic. Facilitating this while providing high-quality care depends on the usability and acceptability of the technology.</p><p><strong>Objective: </strong>This project aimed to investigate parents' experiences of using videoconferencing technology for real-time RCs with children who had congenital heart defects during the COVID-19 pandemic lockdown.</p><p><strong>Methods: </strong>This study's design was quasi-experimental and was underpinned by the Unified Theory of Acceptance and Use of Technology model that seeks to explain and predict an individual's intention to use a technology. Parents were informed of this study by the medical team, posters were made available in the wards and clinics, and leaflets were left for browsing. Clinician screening of potential participants led to the identification of 33 children and parents who were enrolled on this study. The intervention was a web-based RC by medical staff using a secure, interactive videoconferencing platform (Pexip). Each child and their mother or father received 8 RCs with the same specialist doctor or nurse. Measurements were taken using web-based questionnaires pre and post consultation at the first, middle, and last events; questions were focused on the acceptability, usability, and clinical applicability of RCs. Parents' experiences were explored using recorded interviews and analyzed thematically.</p><p><strong>Results: </strong>In total, 29 children aged 4-1052 (mean 95, SD 191.14) days completed the project, receiving a total of 189 RCs as part of their routine care. Parents' prior experience of consultation via videoconference was low; however, as time progressed, their use and acceptance of the technology increased. The intervention was warmly received by all parents who found the face-to-face component particularly useful for discussion with their child's medical team. Furthermore, parents noted the savings on time, money, and childcare.</p><p><strong>Conclusions: </strong>While in-person consultations are considered the gold standard of patient care, increasing pressures on health services and staff reduce availability. Given the ease of access and additional benefits experienced by parents and their children, it is proposed that hybrid models of consultation and care provision are equal, if not superior, to in-person consultations in the management of children with severe congenital heart defects while reducing costs and pressure on the health service and parents.</p>","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"7 ","pages":"e54598"},"PeriodicalIF":2.1,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11521195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social Media Exposure and Other Correlates of Increased e-Cigarette Use Among Adolescents During Remote Schooling: Cross-Sectional Study.","authors":"Vira Pravosud, Pamela M Ling, Bonnie Halpern-Felsher, Valerie Gribben","doi":"10.2196/49779","DOIUrl":"10.2196/49779","url":null,"abstract":"<p><strong>Background: </strong>Little is known about the role of exposure to e-cigarette-related digital content, behavioral and mental health factors, and social environment on the change in adolescent e-cigarette use during COVID-19 shelter-in-place orders and remote schooling.</p><p><strong>Objective: </strong>The aim of the study was to examine changes in adolescent e-cigarette use during shelter-in-place and remote schooling in association with exposure to e-cigarette-related digital content and other correlates: stronger e-cigarette dependence, feeling lonely, inability to socialize, e-cigarette use to cope with shelter-in-place, and the number of family members aware of participants' e-cigarette use.</p><p><strong>Methods: </strong>A cross-sectional survey conducted between August 2020 and March 2021 included 85 California adolescents (mean age 16.7, SD 1.2 years; 39/85, 46% identified as female and 37/85, 44% as Hispanic) who reported e-cigarette use in the past 30 days. Multivariable penalized logistic regressions determined associations adjusted for age, race and ethnicity, and mother's education. The outcome of increased e-cigarette use was defined as more frequent use of e-cigarettes of the same or stronger nicotine or tetrahydrocannabinol concentration.</p><p><strong>Results: </strong>Almost all respondents (83/85, 98%) reported using social media more since shelter-in-place, and 74% (63/85) reported seeing e-cigarette digital content. More than half (46/85, 54%) reported increased e-cigarette use during shelter-in-place. Most individuals who increased use were exposed to e-cigarette digital content (38/46, 83%) compared to those who did not increase e-cigarette use (25/39, 64%), but the association was nonsignificant after adjusting for demographics (adjusted odds ratio [AOR] 2.34, 95% CI 0.71-8.46). Respondents who felt lonely (AOR 3.33, 95% CI 1.27-9.42), used e-cigarettes to cope with shelter-in-place (AOR 4.06, 95% CI 1.39-13.41), or had ≥2 family members aware of participants' e-cigarette use (AOR 6.42, 95% CI 1.29-39.49) were more likely to report increased e-cigarette use.</p><p><strong>Conclusions: </strong>Almost all participants reported using social media more during shelter-in-place, with many respondents reporting increased e-cigarette use, and significant associations with loneliness and use to cope with shelter-in-place. Future interventions should consider leveraging digital platforms for e-cigarette use prevention and cessation and address the mental health consequences of the COVID-19 pandemic.</p>","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"7 ","pages":"e49779"},"PeriodicalIF":2.1,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital Health as a Mechanism to Reduce Neonatal Intensive Care Unit Admissions: Retrospective Cohort Study.","authors":"Alison K Brinson, Hannah R Jahnke, Natalie Henrich, Christa Moss, Neel Shah","doi":"10.2196/56247","DOIUrl":"10.2196/56247","url":null,"abstract":"<p><strong>Background: </strong>Admission to the neonatal intensive care unit (NICU) is costly and has been associated with financial and emotional stress among families. Digital health may be well equipped to impact modifiable health factors that contribute to NICU admission rates.</p><p><strong>Objective: </strong>The aim of the study is to investigate how the use of a comprehensive prenatal digital health platform is associated with gestational age at birth and mechanisms to reduce the risk of admission to the NICU.</p><p><strong>Methods: </strong>Data were extracted from 3326 users who enrolled in a comprehensive digital health platform between January 2020 and May 2022. Multivariable linear and logistic regression models were used to estimate the associations between hours of digital health use and (1) gestational age at birth and (2) mechanisms to reduce the risk of a NICU admission. Multivariable logistic regression models estimated the associations between (1) gestational age at birth and (2) mechanisms to reduce the risk of a NICU admission and the likelihood of a NICU admission. All analyses were stratified by the presence of any gestational conditions during pregnancy.</p><p><strong>Results: </strong>For users both with and without gestational conditions, hours of digital health use were positively associated with gestational age at birth (in weeks; with gestational conditions: β=.01; 95% CI 0.0006-0.02; P=.04 and without gestational conditions: β=.01; 95% CI 0.0006-0.02; P=.04) and mechanisms that have the potential to reduce risk of a NICU admission, including learning medically accurate information (with gestational conditions: adjusted odds ratio [AOR] 1.05, 95% CI 1.03-1.07; P<.001 and without gestational conditions: AOR 1.04, 95% CI 1.02-1.06; P<.001), mental health management (with gestational conditions: AOR 1.06, 95% CI 1.04-1.08; P<.001 and without gestational conditions: AOR 1.03, 95% CI 1.02-1.05; P<.001), and understanding warning signs during pregnancy (with gestational conditions: AOR 1.08, 95% CI 1.06-1.11; P<.001 and without gestational conditions: AOR 1.09, 95% CI 1.07-1.11; P<.001). For users with and without gestational conditions, an increase in gestational age at birth was associated with a decreased likelihood of NICU admission (with gestational conditions: AOR 0.62, 95% CI 0.55-0.69; P<.001 and without gestational conditions: AOR 0.59, 95% CI 0.53-0.65; P<.001). Among users who developed gestational conditions, those who reported that the platform helped them understand warning signs during pregnancy had lower odds of a NICU admission (AOR 0.63, 95% CI 0.45-0.89; P=.01).</p><p><strong>Conclusions: </strong>Digital health use may aid in extending gestational age at birth and reduce the risk of NICU admission.</p>","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"7 ","pages":"e56247"},"PeriodicalIF":2.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11498062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital Health Innovations for Screening and Mitigating Mental Health Impacts of Adverse Childhood Experiences: Narrative Review.","authors":"Brianna M White, Rameshwari Prasad, Nariman Ammar, Jason A Yaun, Arash Shaban-Nejad","doi":"10.2196/58403","DOIUrl":"10.2196/58403","url":null,"abstract":"<p><strong>Background: </strong>Exposures to both negative and positive experiences in childhood have proven to influence cardiovascular, immune, metabolic, and neurologic function throughout an individual's life. As such, adverse childhood experiences (ACEs) could have severe consequences on health and well-being into adulthood.</p><p><strong>Objective: </strong>This study presents a narrative review of the use of digital health technologies (DHTs) and artificial intelligence to screen and mitigate risks and mental health consequences associated with ACEs among children and youth.</p><p><strong>Methods: </strong>Several databases were searched for studies published from August 2017 to August 2022. Selected studies (1) explored the relationship between digital health interventions and mitigation of negative health outcomes associated with mental health in childhood and adolescence and (2) examined prevention of ACE occurrence associated with mental illness in childhood and adolescence. A total of 18 search papers were selected, according to our inclusion and exclusion criteria, to evaluate and identify means by which existing digital solutions may be useful in mitigating the mental health consequences associated with the occurrence of ACEs in childhood and adolescence and preventing ACE occurrence due to mental health consequences. We also highlighted a few knowledge gaps or barriers to DHT implementation and usability.</p><p><strong>Results: </strong>Findings from the search suggest that the incorporation of DHTs, if implemented successfully, has the potential to improve the quality of related care provisions for the management of mental health consequences of adverse or traumatic events in childhood, including posttraumatic stress disorder, suicidal behavior or ideation, anxiety or depression, and attention-deficit/hyperactivity disorder.</p><p><strong>Conclusions: </strong>The use of DHTs, machine learning tools, natural learning processing, and artificial intelligence can positively help in mitigating ACEs and associated risk factors. Under proper legal regulations, security, privacy, and confidentiality assurances, digital technologies could also assist in promoting positive childhood experiences in children and young adults, bolstering resilience, and providing reliable public health resources to serve populations in need.</p>","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"7 ","pages":"e58403"},"PeriodicalIF":2.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11498064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives of Children and Adolescents on Engaging With a Web-Based Mental Health Program: Focus Group Study.","authors":"Christopher Cahill, Jennifer Connolly, Shelley Appleton, Melanie Jade White","doi":"10.2196/48910","DOIUrl":"10.2196/48910","url":null,"abstract":"<p><strong>Background: </strong>Despite accessibility and clinical benefits, open access trials of self-guided digital health interventions (DHIs) for young people have been plagued by high drop-out rates, with some DHIs recording completion rates of less than 3%.</p><p><strong>Objective: </strong>The aim of this study was to explore how young people motivate themselves to complete an unpleasant task and to explore perceived motivators and demotivators for engaging with a DHI.</p><p><strong>Methods: </strong>In this qualitative research study, 30 children and adolescents aged between 7 and 17 years were recruited to participate in 7 focus groups conducted over a 3-month period. Focus group activities and discussions explored sources of motivation to complete tasks and engage in a hypothetical 6-week DHI for anxiety.</p><p><strong>Results: </strong>Children (aged 7-11 years) reported greater reliance on external motivators such as following parent instruction to complete unpleasant tasks, while adolescents (aged 12-17 years) reported greater internal motivation such as self-discipline. Program factors, such as engaging content, were the most commonly mentioned motivators for engaging with a DHI across both age groups. After that, internal sources of motivation were most commonly mentioned, such as perceived future benefits. External factors were the most commonly mentioned demotivators across all ages, with time commitment being the most frequently mentioned.</p><p><strong>Conclusions: </strong>The study's findings have implications for enhancing adherence in future DHIs targeted to children and adolescents. Recommendations include the need for supportive parental involvement for children, while adolescents would likely benefit from mechanisms that promote autonomy, establish a supportive environment, and align with personal interests and values. Belief that a DHI will provide short-term benefits is important to both children and adolescents, as well as having confidence that future benefits will be realized.</p>","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"7 ","pages":"e48910"},"PeriodicalIF":2.1,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parenting-Related Social Networking Site Use and Psychological Distress in Parents of Infants: Cross-sectional Study Exploring the Moderating Effects of Loneliness and Parenting Anxiety.","authors":"Ryuta Onishi","doi":"10.2196/59029","DOIUrl":"10.2196/59029","url":null,"abstract":"<p><strong>Background: </strong>In the digital age, social networking sites (SNSs) have revolutionized the approach to parenting. These platforms, widely used to access parenting information and support, affect parents both positively and negatively, with negative effects potentially increasing for those experiencing loneliness or anxiety.</p><p><strong>Objective: </strong>This study examined the relationship between SNS use and psychological distress among parents of young children, controlling for the moderating effects of loneliness and parenting anxiety. We hypothesized that higher SNS use correlates to greater psychological distress, particularly among parents with elevated levels of loneliness or parenting anxiety.</p><p><strong>Methods: </strong>A cross-sectional survey design using a closed web-based questionnaire was employed. Participants included 429 parents (205 mothers and 224 fathers) of children aged 0-3 years recruited through a web-based survey company in Japan. The majority of the participants were couples, with some living with extended family members. The sample also encompassed individuals in cohabiting partnerships and single parents. The survey included measures of psychological distress, loneliness, parenting anxiety, frequency of SNS use for parenting, and covariates. Analytical models to explain psychological distress included interactions between loneliness or parenting anxiety and SNS use, individually for both fathers and mothers.</p><p><strong>Results: </strong>For mothers, a significant interaction effect was determined only between parenting anxiety and SNS use (b=0.247, SE 0.091; P=.008). Meanwhile, for fathers, significant interaction effects were observed for both loneliness (b=0.324, SE 0.127; P=.012) and parenting anxiety (b=0.144, SE 0.069; P=.038) with SNS use. A simple slope analysis for mothers indicated that SNS use was related to psychological distress only at higher levels of parenting anxiety (b=0.304, SE 0.090, β=.317; P<.001). Among fathers, SNS use was associated with psychological distress at higher levels of either parenting anxiety (b=0.330, SE 0.069, β=.346; P<.001) or loneliness (b=0.390, SE 0.098, β=.409; P<.001).</p><p><strong>Conclusions: </strong>The study concluded that the relationship between SNS use and psychological distress among parents of young children is moderated by loneliness and parenting anxiety. The findings highlight the need for tailored approaches to help parents manage SNS use, particularly focusing on those with higher levels of loneliness and parenting anxiety. It is imperative that health professionals provide nuanced guidance to parents on SNS use, considering individual psychological factors and potential gender differences in the impact of SNSs on mental well-being.</p>","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"7 ","pages":"e59029"},"PeriodicalIF":2.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Categorization of mHealth Coaching Technologies for Children or Adolescents With Type 1 Diabetes: Systematic Review.","authors":"Pavel Trnka, Tahmineh Aldaghi, Jan Muzik","doi":"10.2196/50370","DOIUrl":"10.2196/50370","url":null,"abstract":"<p><strong>Background: </strong>Managing type 1 diabetes in children and adolescents can be difficult for parents, health care professionals, and even patients. However, over the last decades, the quality of services provided to patients with diabetes has increased due to advances in IT.</p><p><strong>Objective: </strong>This study aims to comprehensively document the range of IT tools used in the management of diabetes among children and adolescents, with a focus on identifying the technologies most commonly used based on their frequency. In addition, the study aims to explore relevant methodologies for developing diabetes technology and provide valuable information to developers by delineating essential phases of the design process.</p><p><strong>Methods: </strong>The literature search was focused on MEDLINE (PubMed), Web of Science, and Google Scholar for relevant studies. Keywords such as \"type 1 diabetes,\" \"adolescents,\" \"kids,\" \"mHealth,\" \"children,\" and \"coaching\" were combined using Boolean operators. The inclusion criteria were open access, English-language papers published between 2012 and 2023 focusing on patients younger than 18 years and aligned with our research goal. The exclusion criteria included irrelevant topics and papers older than 18 years. By applying the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method, 2080 studies were recognized, and after selection, 33 papers were agreed upon between the researchers.</p><p><strong>Results: </strong>Four primary categories were defined: types of IT, methodology identification, purpose identification, and feature determination. Among these, mobile health (mHealth) apps emerged as the predominant type of information, garnering 27 mentions. In particular, user-centered design was identified as the most prevalent methodology, cited 22 times. The primary purpose of self-monitoring blood glucose values was mentioned 20 times, while patient education was the highest among common characteristics, with 23 mentions.</p><p><strong>Conclusions: </strong>Based on our research, we advocate for developers to focus on creating an mHealth app that integrates gamification techniques to develop innovative diabetes management solutions. This app should include vital functionalities such as blood glucose monitoring, strategies to improve hemoglobin A1c levels, carbohydrate tracking, and comprehensive educational materials for patients and caregivers. By prioritizing these features, developers can enhance the usability and effectiveness of the technology, thereby better supporting children or adolescents with diabetes in their daily management endeavors.</p>","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"7 ","pages":"e50370"},"PeriodicalIF":2.1,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11486482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Assessing the Racial and Socioeconomic Disparities in Postpartum Depression Using Population-Level Hospital Discharge Data: Longitudinal Retrospective Study.","authors":"Star Liu, Xiyu Ding, Anas Belouali, Haibin Bai, Kanimozhi Raja, Hadi Kharrazi","doi":"10.2196/66676","DOIUrl":"10.2196/66676","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2196/38879.].</p>","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"7 ","pages":"e66676"},"PeriodicalIF":2.1,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fact or Fiction-Accelerometry Versus Self-Report in Adherence to Pediatric Concussion Protocols: Prospective Longitudinal Cohort Study.","authors":"Carol DeMatteo, Sarah Randall, Josephine Jakubowski, Kathy Stazyk, Joyce Obeid, Michael Noseworthy, Michael Mazurek, Brian W Timmons, John Connolly, Lucia Giglia, Geoffrey Hall, Chia-Yu Lin, Samantha Perrotta","doi":"10.2196/57325","DOIUrl":"10.2196/57325","url":null,"abstract":"<p><strong>Background: </strong>Concussion, or mild traumatic brain injury, is a growing public health concern, affecting approximately 1.2% of the population annually. Among children aged 1-17 years, concussion had the highest weighted prevalence compared to other injury types, highlighting the importance of addressing this issue among the youth population.</p><p><strong>Objective: </strong>This study aimed to assess adherence to Return to Activity (RTA) protocols among youth with concussion and to determine if better adherence affected time to recovery and the rate of reinjury.</p><p><strong>Methods: </strong>Children and youth (N=139) aged 5-18 years with concussion were recruited. Self-reported symptoms and protocol stage of recovery were monitored every 48 hours until symptom resolution was achieved. Daily accelerometry was assessed with the ActiGraph. Data were collected to evaluate adherence to the RTA protocol based on physical activity cutoff points corresponding to RTA stages. Participants were evaluated using a battery of physical, cognitive, and behavioral measures at recruitment, upon symptom resolution, and 3 months post symptom resolution.</p><p><strong>Results: </strong>For RTA stage 1, a total of 13% of participants were adherent based on accelerometry, whereas 11% and 34% of participants were adherent for stage 2 and 3, respectively. The median time to symptom resolution was 13 days for participants who were subjectively reported adherent to the RTA protocol and 20 days for those who were subjectively reported as nonadherent (P=.03). No significant agreement was found between self-report of adherence and objective actigraphy adherence to the RTA protocol as well as to other clinical outcomes, such as depression, quality of life, and balance. The rate of reinjury among the entire cohort was 2% (n=3).</p><p><strong>Conclusions: </strong>Overall, adherence to staged protocols post concussion was minimal when assessed with accelerometers, but adherence was higher by self-report. More physical activity restrictions, as specified in the RTA protocol, resulted in lower adherence. Although objective adherence was low, reinjury rate was lower than expected, suggesting a protective effect of being monitored and increased youth awareness of protocols. The results of this study support the move to less restrictive protocols and earlier resumption of daily activities that have since been implemented in more recent protocols.</p>","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"7 ","pages":"e57325"},"PeriodicalIF":2.1,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11482736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moderators of the Effects of a Digital Parenting Intervention on Child Conduct and Emotional Problems Implemented During the COVID-19 Pandemic: Results From a Secondary Analysis of Data From the Supporting Parents and Kids Through Lockdown Experiences (SPARKLE) Randomized Controlled Trial.","authors":"Nikola Pokorna, Melanie Palmer, Oliver Pearson, Nicholas Beckley-Hoelscher, James Shearer, Katarzyna Kostyrka-Allchorne, Olly Robertson, Marta Koch, Petr Slovak, Crispin Day, Sarah Byford, Polly Waite, Cathy Creswell, Edmund J S Sonuga-Barke, Kimberley Goldsmith","doi":"10.2196/53864","DOIUrl":"10.2196/53864","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;A smartphone app, Parent Positive, was developed to help parents manage their children's conduct and emotional problems during the COVID-19 pandemic. A randomized controlled trial, Supporting Parents and Kids Through Lockdown Experiences (SPARKLE), found Parent Positive to be effective in reducing children's emotional problems. However, app effectiveness may be influenced by a range of child, family, socioeconomic, and pandemic-related factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study examined whether baseline factors related to the child, family, and socioeconomic status, as well as pandemic-related disruption circumstances, moderated Parent Positive's effects on child conduct and emotional problems at 1- and 2-month follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study was a secondary exploratory analysis of SPARKLE data. The data set included 646 children (4-10 years of age) with parents randomized to either Parent Positive (n=320) or follow-up as usual (n=326). Candidate baseline moderators included child age, gender, attention-deficit/hyperactivity disorder symptoms, parental psychological distress, family conflict, household income, employment status, household overcrowding, and pandemic-related disruption risk (ie, homeschooling, lockdown status, and isolation status). Child conduct and emotional problem outcomes measured at 1- (T2) and 2-months (T3) post randomization were analyzed using linear mixed-effects analysis of covariance models adjusting for baseline (T1) measure of outcome and including intervention and intervention by time point interaction terms allowing for different effects at the 2 time points. Moderation of intervention effects by baseline factors was assessed by replacing the intervention by time interaction terms with intervention by time point by baseline moderator interaction terms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Child gender was a significant moderator of the Parent Positive versus follow-up as usual effect on emotional problems (B=0.72, 95% CI 0.12-1.33; P=.02). Specifically, the effect of Parent Positive was close to significant (T2: B=-0.41, 95% CI -0.82 to 0.0004; P=.05) or significant (T3: B=-0.76, 95% CI -1.22 to -0.30; P&lt;.001) in males only when compared with females, and males experienced a significantly larger reduction in emotional problems than females in the Parent Positive arm at the 2-month post randomization time point. None of the other investigated baseline factors moderated effects on emotional problems, and no factors moderated effects on conduct problems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study highlights Parent Positive's potential for effectively reducing emotional problems in primary school-aged male children across a wide range of families. However, due to limited variability in the demographic background of the families, cautious interpretation is required, and replications are necessary in diverse samples with longer follow-up times.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;","PeriodicalId":36223,"journal":{"name":"JMIR Pediatrics and Parenting","volume":"7 ","pages":"e53864"},"PeriodicalIF":2.1,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11496916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}