COVID-19 and Dr. Google: Parents' changing experience using online health information about their children's health during the pandemic

Aims

To identify how the COVID-19 pandemic influences parents' use of the internet, including social media, when seeking health-related information about the pandemic relevant to their children.

Methods

This study employed semi-structured interviews to explore the factors affecting parents of young children when information-seeking online about their children's health related to the COVID-19 pandemic. Parents of children with and without chronic health conditions were interviewed in July and August 2020. Interviews were audio-recorded and transcribed verbatim, then analysed using theoretical thematic analysis, based on Social Cognitive Theory.

Results

Through interviews with 13 parents, we identified a myriad of factors that affected parents' internet searching. The decision to access online health information and the regulation of its usage was multifaceted and relied upon the interactions between environmental triggers and parents' information needs, personal attitudes, and circumstances. Overall, parents felt supported by online health information during the COVID-19 pandemic, and the majority were confident in their ability to navigate the plethora of online health information. However, parents of children with chronic conditions had unmet information needs in relation to COVID-19 and their children's condition.

Conclusions

Understanding parents' attitudes and behaviours when seeking online health information that is relevant to their children during a global pandemic can inform the optimisation of online health content delivery to parents.     

Editorial: COVID-19: lessons learned for suicide prevention

This editorial discusses lessons learned from the COVID-19 public health emergency as they relate to the prevention of suicide, the second leading cause of death in adolescents and young adults globally. Recognizing that COVID-19 impact and response varied across nations, we offer a US perspective, addressing two questions: (a) what have we learned from this pandemic and mitigation strategies used to reduce cases of COVID-19 illness and deaths; and (b) how can our research advance knowledge and be advanced by work aimed at understanding the impact of this ‘unusual’ period? Provisional data indicate that during the pandemic and lockdown period, there were some declines in suicide rates for the total US population and no change in youth. However, data also indicate increases in reported suicidal ideation and behavior, mental health-related ED visits, and ED visits for suicidal ideation and behavior in youth. Heterogeneity of pandemic effects is noteworthy, with ethnic and racial minority populations suffering the most from COVID-19, COVID-19-related risk factors, and possibly suicide deaths. As vaccinations can prevent severe COVID-19 cases and deaths, we also have demonstrations of effective ‘psychological inoculations’ such as community-based interventions for reducing suicide attempts and deaths. During COVID-19, we mobilized to provide clinical care through telehealth and digital interventions. The challenge now is to continue to put our science to work to mitigate the adverse impacts of the pandemic on suicide and suicide risk factors, our children’s mental health, and enhance mental health and well-being in our communities.     

Digital-driven service improvement during the COVID-19 pandemic

COVID-19 brought a lot of children's routine clinical services in the UK to a complete halt in March 2020. The NHS had to radically change the way clinical services are provided with the rapid introduction of telemedicine, virtual consultations, and video conferencing facilities to support team working. This paper describes how Peterborough Child Development Centre rapidly redesigned the services with digital tools to continue offering neurodevelopmental and neurodisability services more virtually. We demonstrate how we adapted our approaches to assess and manage complex long-term conditions with improved quality and outcomes by using digital tools. The changes to the clinical processes and systems are here to stay beyond the COVID-19 pandemic and have the potential to revolutionise the services.     

Measuring Training Disruptions Using an Informatics Based Tool

ObjectiveTraining disruptions, such as planned curricular adjustments or unplanned global pandemics, impact residency training in ways that are difficult to quantify. Informatics-based medical education tools can help measure these impacts. We tested the ability of a software platform driven by electronic health record data to quantify anticipated changes in trainee clinical experiences during the COVID-19 pandemic.MethodsWe previously developed and validated the Trainee Individualized Learning System (TRAILS) to identify pediatric resident clinical experiences (i.e. shifts, resident provider-patient interactions (rPPIs), and diagnoses). We used TRAILS to perform a year-over-year analysis comparing pediatrics residents at a large academic children's hospital during March 15–June 15 in 2018 (Control #1), 2019 (Control #2), and 2020 (Exposure).ResultsResidents in the exposure cohort had fewer shifts than those in both control cohorts (P < .05). rPPIs decreased an average of 43% across all PGY levels, with interns experiencing a 78% decrease in Continuity Clinic. Patient continuity decreased from 23% to 11%. rPPIs with common clinic and emergency department diagnoses decreased substantially during the exposure period.ConclusionsInformatics tools like TRAILS may help program directors understand the impact of training disruptions on resident clinical experiences and target interventions to learners’ needs and development.     

Editorial Perspective: Perils and promise for child and adolescent sleep and associated psychopathology during the COVID-19 pandemic

It is anticipated that the novel coronavirus disease 2019 (COVID-19) pandemic and associated societal response will have wide-ranging impacts on youth development and mental health. Sleep is crucial for child and adolescent health and well-being, and the potential for sleep problems to emerge or worsen during and following the pandemic is high. This may be particularly true for children and adolescents who are at heightened risk for the onset of sleep and mental health disturbances and for those whom developmental changes impacting sleep are rapidly occurring. Youth with preexisting psychopathologies (including anxiety and depression) and neurodevelopmental conditions (including attention-deficit/hyperactivity disorder and autism spectrum disorder) could be especially vulnerable to disturbed sleep during this period of change and uncertainty. It is thus imperative that sleep considerations be part of research and clinical initiatives aimed at understanding and mitigating the impact of the COVID-19 pandemic in children and adolescents. This article considers ways in which the pandemic may impact sleep, including research and clinical implications.     

European and United Kingdom COVID-19 pandemic experience: The same but different

The global healthcare landscape has changed dramatically and rapidly in 2020. This has had an impact upon paediatricians and in particular respiratory paediatricians. The effects in Europe, with its mature healthcare system, have been far faster and greater than most authorities anticipated. Within six weeks of COVID-19 being declared a public health emergency by the World Health Organisation [WHO] in China, Europe had become the new epicentre of disease. A pandemic was finally declared by the WHO on March 11th 2020. Continued international travel combined with the slow response of some political leaders and a variable focus on economic rather than health consequences resulted in varying containment strategies in response to the threat of the initial wave of the pandemic. It is likely that this variation has contributed to widely differing outcomes across Europe. Common to all countries was the stark lack of preparations and initial poor co-ordination of responses between levels of government to this unforeseen but not unheralded global health crisis. In this article we highlight the impact of the first wave of the COVID-19 pandemic in Italy, Austria, Germany, and the United Kingdom.     

Developing an Entrustable Professional Activity to Improve the Care of LGBTQ+ Youth

Despite the multitude of health inequities often experienced by lesbian, gay, bisexual, transgender, and queer (LGBTQ)+ youth, few training programs consistently and comprehensively address these disparities through education and assessment of learners. Over the past decade, programs have begun to incrementally increase the number of hours dedicated to LGBTQ+ health training; however, the lack of standardization for curricula and assessment remains a significant barrier. As medical education shifts to a competency-based approach, focusing on patient outcomes and the competencies trainees must achieve to meet those outcomes, we must take this opportunity to develop curricula and assessment tools that emphasize inclusive, affirming, equitable, and culturally humble care for LGBTQ+ youth. Entrustable professional activities (EPA) are increasingly used to educate and assess trainees on their progression from full supervision to unsupervised practice. Given their multifaceted use to standardize curricula, assess learners, and highlight programmatic gaps in education, we believe an EPA is the ideal tool to systematically improve LGBTQ+ health training in graduate medical education. Our team of national experts in this field developed an LGBTQ+ health EPA. We describe our methods of development, the functions and curricular components of the EPA, and the many applications for widespread program use.     

The impact of COVID-19 on the pediatric solid organ transplant population

The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has significantly impacted all aspects of healthcare including solid organ transplantation. In this review, we discuss the specific impact of COVID-19 on the pediatric solid organ transplant population including access to grafts for pediatric transplant candidates as well as COVID-19 disease manifestations in pediatric transplant recipients. We address the current knowledge of prevention and management of COVID-19 in pediatric transplant recipients and provide additional information regarding social distancing, infection prevention and return to school.     

The Impact of the COVID-19 Pandemic on Children/Youth With Special Health Care Needs: A School Nurse's Perspective

School nurses repeatedly have been stretched to the limits over the past few years with the COVID-19 pandemic—managing not only routine daily care of students but also juggling those unique needs of children and youth with special health care needs, especially for those who also lost a parent/caregiver from COVID-19. This article provides background demographic information on how the COVID-19 pandemic affected these children, along with a specific case report of a middle school student with attention deficit hyperactivity disorder who also experienced the loss of a parent from COVID-19. Specific practical suggestions are discussed on how school nurses proactively and collaboratively can assist these students whose lives were permanently changed by the life-changing event of losing a parent/caregiver from COVID-19.     

Perinatal care and breastfeeding education during the COVID-19 pandemic: Perspectives from Kenyan mothers and healthcare workers

The impact of the COVID-19 pandemic on breastfeeding (BF) practices in low- and middle-income countries (LMICs) is not well understood. Modifications in BF guidelines and delivery platforms for breastfeeding education during the COVID-19 pandemic are hypothesised to have affected BF practices. We aimed to understand the experiences with perinatal care, BF education and practice among Kenyan mothers who delivered infants during the COVID-19 pandemic. We conducted in-depth key informant interviews with 45 mothers who delivered infants between March 2020 and December 2021, and 26 health care workers (HCW) from four health facilities in Naivasha, Kenya. While mothers noted that HCWs provided quality care and BF counselling, individual BF counselling was cited to be less frequent than before the pandemic due to altered conditions in health facilities and COVID-19 safety protocols. Mothers stated that some HCW messages emphasised the immunologic importance of BF. However, knowledge among mothers about the safety of BF in the context of COVID-19 was limited, with few participants reporting specific counselling or educational materials on topics such as COVID-19 transmission through human milk and the safety of nursing during a COVID-19 infection. Mothers described COVID-19-related income loss and lack of support from family and friends as the major challenge to practising exclusive breastfeeding (EBF) as they wished or planned. COVID-19 restrictions limited or prevented mothers’ access to familial support at facilities and at home, causing them stress and fatigue. In some cases, mothers reported job loss, time spent seeking new means of employment and food insecurity as causes for milk insufficiency, which contributed to mixed feeding before 6 months. The COVID-19 pandemic created changes to the perinatal experience for mothers. While messages about the importance of practising EBF were provided, altered HCW education delivery methods, reduced social support and food insecurity limit EBF practices for mothers in this context.     

Rapid Development and Testing of a COVID-19 Vaccine Curriculum for Pediatricians

Background and ObjectivesAs the coronavirus disease 2019 (COVID-19) pandemic evolves and vaccines become available to children, pediatricians must navigate vaccination discussions in the setting of rapidly changing vaccine recommendations and approvals. We developed and evaluated an educational curriculum for pediatricians to improve their knowledge about COVID-19 vaccines and confidence in communicating with patients and families about COVID-19 vaccines.MethodsFive institutions collaborated to develop an online educational curriculum. Utilizing the collaboration's multidisciplinary expertise, we developed a 3-module curriculum focused on the SARS-CoV-2 virus and vaccine basics, logistics and administration of COVID-19 vaccine, and COVID-19 vaccine communication principles. Surveys administered to clinician participants before and after completion of the curriculum assessed knowledge and confidence; a follow-up survey 1 month after the post-survey assessed persistence of initial findings.ResultsA total of 152 pediatric providers participated; 72 completed both pre- and post-surveys. The median knowledge score improved from the pre-survey to the post-survey (79%–93%, P < .001). There was an increase in providers’ confidence after completing the curriculum, which persisted in the follow-up survey. In the post-survey, 98% of participants had had the opportunity to discuss the COVID-19 vaccine with patients, and most clinicians reported that the modules decreased apprehension some or significantly.ConclusionsThis project demonstrates rapid and feasible deployment of a curriculum providing up-to-date information to front-line clinicians responsible for having complex conversations about COVID-19 vaccine decision-making. Clinicians who completed this curriculum had sustained increased confidence and decreased levels of apprehension when discussing the COVID-19 vaccine.     

Ethics in the Era of COVID-19

The COVID-19 pandemic has led to new ethical challenges and exposed or exacerbated others that were already present. Through the lens of pediatric surgery, this article aims to discuss issues that have been impacted by the pandemic including triage of care and allocation of scarce resources, equity and access to care, and a physician's competing responsibilities to their patients, families, and selves.     

Utilization of Core Values and Branding to Recruit the Best Trainees for Your Program

Branding is a tactic which has been well described in the business literature as a way to enhance a company's reputation, promote a sense of high quality and value, and influence an individual's perception and behavior. Branding has not traditionally been explicitly used by training programs for recruitment. However, it can be used as a powerful tool to help recruit and retain candidates who will thrive in your program. Branding has become even more important since the COVID-19 pandemic with the absence of in-person experiences for most applicants and a transition to virtual interview platforms. This article discusses how to develop and use your core values to understand your brand identity, create a clear and memorable message to your applicants, and ensure a brand experience that will allow applicants to understand the essence of your training program.     

A Resident-Led Initiative to Advance Diversity,Equity, Inclusion,and Antiracism in a Pediatrics Residency Program

A racially and ethnically diverse physician workforce is critical to meeting the needs of the United States’ increasingly diverse patient population. Unfortunately, Black, Latinx, American Indian, and Alaska Native communities remain underrepresented in medicine. The disproportionate impact of the COVID-19 pandemic by race/ethnicity and increased public attention to anti-Black and anti-Asian racism have inspired a growing national discourse on addressing systemic racism. Within academic medicine, there has been a call for the fundamental incorporation of antiracism into medical training and professional competency. From the perspective of a group primarily led by residents who are women of color, we describe our 6 years of experience leading a Diversity Committee that catalyzed sustained and systemic efforts to advance diversity, equity, inclusion (DEI), and antiracism at a large urban pediatrics residency program. We outline the implementation and key outcomes of the Diversity Committee's ongoing initiatives to increase resident diversity, foster an inclusive learning environment, develop a resident curriculum on DEI and antiracism, and center the needs and wisdom of the communities that our institution serves. Finally, we highlight challenges and lessons learned to inform other institutions striving to advance DEI and antiracism in academic medicine.     

Role of modelling in COVID-19 policy development

Models have played an important role in policy development to address the COVID-19 outbreak from its emergence in China to the current global pandemic. Early projections of international spread influenced travel restrictions and border closures. Model projections based on the virus’s infectiousness demonstrated its pandemic potential, which guided the global response to and prepared countries for increases in hospitalisations and deaths. Tracking the impact of distancing and movement policies and behaviour changes has been critical in evaluating these decisions. Models have provided insights into the epidemiological differences between higher and lower income countries, as well as vulnerable population groups within countries to help design fit-for-purpose policies. Economic evaluation and policies have combined epidemic models and traditional economic models to address the economic consequences of COVID-19, which have informed policy calls for easing restrictions. Social contact and mobility models have allowed evaluation of the pathways to safely relax mobility restrictions and distancing measures. Finally, models can consider future end-game scenarios, including how suppression can be achieved and the impact of different vaccination strategies.     

Pediatric Program Directors Should Have an Active Presence on Twitter

For academic pediatricians, social media has become an important avenue for professional development through continuing education, professional networking, and academic collaboration. Pediatric residency program directors have recognized additional benefits of social media engagement via program promotion and resident recruitment. The novel coronavirus disease 2019 (COVID-19) pandemic and subsequent move to virtual interviews for the 2020–2021 residency interview season have created a new urgency for pediatric program directors to establish an active social media presence, primarily as a means to engage applicants and provide them with information in lieu of cancelled away rotations and in-person interviews. Twitter is a free microblogging and social networking platform that allows real-time engagement among academic pediatricians. Here, we make the case that all pediatric program directors should have an active presence on Twitter.     

Emotional status of children aged 7 to 17 of health workers and in the general population during the COVID-19 pandemic: A cross-sectional comparative study in Belgium

BackgroundWe assessed the mental health of children and adolescents aged 7 to 17 and their parents immediately after the first wave of the COVID-19 pandemic.MethodA survey online was conducted in Belgium between May 29th and August 31st 2020.Results(1) Anxious and depressive symptoms were self-reported by one out of four children and hetero-reported by parents for one out of five children; (2) Anxiety scores were higher in children compared to adolescents; (3) Social introversion scores were significantly higher in adolescents compared to children; (4) No significant differences for anxio-depressive symptoms were found between healthcare worker parents and the other parents. Children's self- or hetero-reported symptoms were not found to be connected to parents’ professional activities.ConclusionsThis cross-sectional survey adds evidence to the impact the COVID-19 pandemic has had on children's and adolescents’ emotional state, in particular on their levels of anxiety and depression.