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OBJECTIVE The aim of the study was to evaluate the effectiveness of an audio and animated cartoon questionnaire (AACQ) at improving consent process in child for biospecimen donation. METHODS A multi-center randomized and controlled survey was performed at two pediatric hospitals in China from 2019 to 2020. Children aged from 7 to 18 years in the pediatric surgery wards were invited to investigate the participants' willingness and attitudes for donating biospecimens. A total of 264 children, including 119 in the AACQ group and 145 in the TQ group, and 67 parents of children were analyzed. A separate knowledge test was acquired in the questionnaires. RESULTS Our findings showed that the response rate of the AACQ group (89.85%) was significantly higher than that of the TQ group (68.44%; p

In this study, to investigate whether infants showed face-specific brain activity to a cartoon human face, we conducted a functional near-infrared spectroscopy (fNIRS) experiment and a behavioral experiment. In the fNIRS experiment, we measured the hemodynamic responses of 5- and 6-month-old infants to cartoon female and cartoon character faces using fNIRS. The results showed that the concentration of oxy-Hb increased for cartoon female faces but not for cartoon character faces. This indicates that face-specific brain activity occurred for cartoon female faces but not cartoon character faces, despite the fact that both are faces. In the behavioral experiment, we examined whether the 5- and 6-month-old infants preferred cartoon female faces to cartoon character faces in the upright and inverted conditions. The results showed a preference for cartoon female faces in the upright but not in the inverted condition. This indicates that 5- and 6-month-old infants can perceive cartoon female faces, but not cartoon character faces, as faces. The results of the two experiments indicated that face-specific brain activity occurred for cartoon female faces. This indicates that infants can perceive cartoon female faces as faces.

This study aimed to assess the efficacy of two cartoons which depict autistic characters in improving attitudes towards autistic peers in two separate studies. Forty-six children participated in study 1 (4–7 years), and 47 children participated in study 2 (8–11 years). Both the conative (behavioural) component of attitudes and knowledge about autism were measured before and after the cartoon interventions. Knowledge of autism increased after watching the cartoons in both studies but attitudes to autism only improved in study 1. Knowledge was shown to correlate with change in some but not all attitude measures. The findings suggest that cartoons can improve attitudes to autism, but this may depend on how information is presented.

Children's math learning (N = 217; Mage = 4.87 years; 63% European American, 96% college-educated families) from an intelligent character game was examined via social meaningfulness (parasocial relationships [PSRs]) and social contingency (parasocial interactions, e.g., math talk). In three studies (data collected in the DC area: 12/2015-10/2017), children's parasocial relationships and math talk with the intelligent character predicted quicker, more accurate math responses during virtual game play. Children performed better on a math transfer task with physical objects when exposed to an embodied character (Study 2), and when the character used socially contingent replies, which was mediated by math talk (Study 3). Results suggest that children's parasocial relationships and parasocial interactions with intelligent characters provide new frontiers for 21st century learning.

Rationale Studies show that the presentation of healthy foods within media does not lead to healthier food choices in children. A persuasive strategy is needed. We investigated how healthy peer cues shown in an audiovisual cartoon influence children's food choice. Method In an experiment, we showed children a cartoon presenting no food (i.e., the control condition), one child eating raspberries (i.e., the minority condition), or all children eating raspberries (i.e., the majority condition). We measured children's majority awareness—that is, their awareness of peers' preference for raspberries—as a mediator variable. We assessed children's fruit choice as a dependent variable and tested the moderating role of food neophobia. Results Children in the majority condition did not show a higher majority awareness compared to the control condition. Compared to the control and majority conditions, however, the minority condition prompted children to conclude that most of their peers do not like raspberries, leading to a subsequent lower likelihood of choosing fruit. Children's levels of food neophobia did not moderate these results, but food neophobia moderated the direct effect of experimental conditions on food choice, independent of majority awareness. In particular, children with high levels of food neophobia refrained from choosing the healthy snack when the minority of peers ate raspberries in the cartoon. Conclusions This study has provided some indications into how healthy food presentations within an audiovisual stimulus can influence children's food choice. Prompting children's healthy eating behaviors by presenting healthy foods in media content is not as easy as prompting unhealthy food choices by presenting unhealthy foods. Children's natural preference for fruit is attenuated by peer cues shown in media when a peer is in a minority. Overall, content producers should be aware of the risks of minority peer cues.

This was to evaluate the effect of visual distraction on anxiety of children during dental treatment. This randomized, crossover clinical trial study was conducted on 28 children (aged 4–5 years) randomly divided into two groups of 14 each. Group 1, treatment procedure in the first visit was completed while the patients were watching a cartoon as a visual distraction tool, at the second visit, the procedure was carried out with conventional tell-show-do. Group 2, had visual distraction in their second visit and conventional tell-show-do during the first visit. Treatment procedures were similar in both groups during two sessions. The anxiety level was determined using Venham picture test and pulse rate (PR) at the beginning and the end of each appointment. Patient behaviour was also scored using Frankl behaviour rating scale (FBRS). Self-reported dental anxiety was reduced significantly by visual distraction (p-value

This study compared the following effects of two vaccine information flyers-one developed by the Centers for Disease Control and Prevention (CDC) versus one adapted from this information to a comic medium (comic)-on adults: (a) attitude toward the flyer; (b) perceived informativeness of the flyer; (c) intention to seek more information about adult immunizations after viewing the flyer; and (d) intention to get immunized after viewing the flyer. A between-group, randomized trial was used to randomly assign adults (age 18 years or older) at an ambulatory care center to review the CDC or comic flyer. Participants were asked to complete a survey to measure several outcome variables. Items were measured using a 7-point semantic differential scale. Independent-samples t-test was used for comparisons. A total of 265 surveys (CDC n = 132 vs comic n = 133) were analyzed. The comic flyer had a statistically significant effect on participants' attitudes and their perception of the flyer's informativeness compared to the CDC flyer. Flyer type did not have a statistically significant effect on intention-related variables. The study findings showed that the comic flyer was positively evaluated compared to the CDC flyer. These findings could provide a new direction for developing adult educational materials.

There are unaesthetic aspects in teaching people about the early detection of colorectal cancer using the fecal immunochemical test. Comics were seen as a way to overcome those unaesthetic aspects. This study used the Asian grocery store-based cancer education venue to pilot-test the clarity, cultural acceptability, and alignment of five colorectal cancer education comics intended for publication in Asian American and Pacific Islander (API) community newspapers. After developing the colorectal cancer education comics, API students asked shoppers to review a comic from their collection and provide feedback on how to make the comic clearer and more culturally pertinent to API readers. To evaluate viewers' responses, the students gathered such unobtrusive data as: (1) how many of the predetermined salient information points were discussed as the student educators interacted with shoppers and (2) how many comics the shoppers were willing to review. Shoppers were also asked to evaluate how effective the comics would be at motivating colorectal cancer screening among APIs. The students were able to cover all of the salient information points with the first comic. As evidence of the comics' capacity to engage shoppers' interest, shoppers willingly evaluated all five comics. Using multiple comics enabled the educators to repeatedly address the four salient colorectal cancer information points. Thus, the comics helped student educators to overcome the unesthetic elements of colorectal cancer discussions, while enabling them to engage shoppers in animated discussions, for far more time than with their conventional didactic educational methods.

Nowadays, entertainment-education (E-E) is often used as a persuasive strategy to stimulate prosocial behavior. Although E-E is mostly regarded as a persuasive strategy in itself, in an increasing number of E-E programs several persuasive strategies are used to communicate the educational message to the audience. This study investigates the effects of a strategy widely used in health communication, but not previously studied in the field of E-E: framing. To this means we examined the effect of two different ways an E-E message can be framed: by emphasizing either the losses of not performing the behavior in question or the gains of performing this behavior. A serial multiple mediation model showed that framing affected intention to refrain from drunk cycling via counterarguing and attitude toward drunk cycling; the use of a gain frame decreased counterarguing, which decreased the attitude toward drunk cycling. This subsequently resulted in a higher intention to refrain from this behavior. Implications of these results are discussed.

It is important for all professionals who work with individuals who have ASD to have sufficient knowledge of the disorder. The development of ASD knowledge may occur during preservice training and/or through professional development. Currently, there is no "gold standard" measure of ASD knowledge. A study focusing on the development of a reliable and valid measure of ASD knowledge for practitioners and preservice professionals is warranted. To address this need, the current study provides preliminary information on the development and preliminary validation of the Autism Spectrum Knowledge Scale Professional Version-Revised (ASKSP-R) with a sample of school-based professionals (N = 427). Results suggest the ASKSP-R is a univariate measure with good reliability. Implications and suggestions for future research are discussed.

Background Cartoon characters on processed food packaging increase the perception of product preference among children, but their effect among adults has rarely been examined. We evaluated the effect of a cartoon character on breakfast cereals on beliefs about buying them for children, as well as whether demographic characteristics modified this effect. Methods An experimental study was conducted with adults from online consumer panels in Mexico (n = 3755). Participants were randomly assigned to a “cartoon” condition (n = 1789), in which they viewed a breakfast cereal box with a Minion character on the front of the package, or the “control” condition (n = 1966), in which the same cereal box was displayed with no character on the package. Participants were asked: “Is this a good cereal to buy children?” with the response options “Yes”, “No”, or “Don’t know”. Multinomial adjusted logistic models regressed responses to this question (Yes = 0, No = 1, 2 = Don’t know) on experimental condition. Differences in the effect of the cartoon character across demographic characteristics were tested by introducing multiplicative interaction terms. Results The adjusted model showed that participants in the “cartoon character” condition were 1.67 (1.45–1.94) times more likely to consider the cereal as being “Not good to buy for children” than those in the control condition (p Conclusion Among this sample of Mexican adults, a cereal with a cartoon character on the packaging was more often perceived as “not good to buy for children” compared to a cereal without it. This effect was smaller among parents, potentially due to children influences of parental decisions during food purchasing.

BACKGROUND: During cancer treatment, children undergo potentially stressful hospitalizations and procedures. Animatronic devices are a promising means of distraction intervention. This study aimed to assess acceptability and feasibility of the My Special Aflac Duck® (MSAD) intervention among pediatric oncology patients and parents. We hypothesized that MSAD would be feasible to implement, have greater than 50% acceptance, and be useful distraction. PROCEDURES: This feasibility study enrolled oncology patients aged 3–11 years admitted to Children’s Healthcare of Atlanta between May and August 2018. Patients were exposed to MSAD for 3 days and completed quantitative and qualitative assessments of acceptability. Patient and hospital data were abstracted. RESULTS: Seventeen (80.9%) of 21 eligible patients enrolled; 64.7% were

espanolAntecedentes: La empatia es la capacidad de un individuo para entender al otro desde el punto de vista cognitivo y emocional. La empatia es un constructo complejo que representa un reto en su evaluacion, por lo cual es necesario contar con instrumentos validados en poblacion mexicana. Objetivo: Validacion de la prueba de Tiras comicas para evaluar empatia. Metodo: Muestreo por conveniencia, se midio la consistencia interna, la validez convergente con el coeficiente de empatia, la validez de constructo con analisis factorial y la capacidad de discriminar entre sujetos con deficit de empatia por psicopatologia con controles por medio de una curva Receiver Operating Characteristic (ROC) por sus siglas en ingles. Resultados: La escala de Tiras comicas se evaluo en 86 controles, 19 pacientes con esquizofrenia, α de Cronbach = 0.894. La correlacion con el coeficiente de empatia fue de 0.88, con una sensibilidad del 81.3% y la especificidad del 38%. Conclusiones: Se valido la prueba de Tiras comicas con adecuados parametros psicometricos. EnglishIntroduction: Empathy is the ability of an individual to understand it from another cognitive and emotional point of view. Empathy is a complex that represents a retouch in its evaluation, so, it is necessary to have instruments validated in the Mexican population. Objective: Validation of the Comic Strip Test to evaluate empathy. Method: Sampling for convenience, based on internal consistency, convergent validity with the Empathy coefficient, construct validity in the factorial analysis, and the ability to discriminate between subjects with lack of empathy (psychopathology) and the control subjects through a curve ROC. Results: The comic strips test was evaluated in 86 controls, 19 patients with schizophrenia (Cronbach’s alpha = 0.894). The correlation with the empathy coefficient was 0.88, with sensitivity of 81.3% and specificity of 38%. Conclusions: The Comic Strip Test was validated with parametric psychometric parameters.

Medical education is an arduous process with widespread study of very complex information across diverse subjects. The use of medical illustrations in schematic or cartoon-like appearances is an old method of conveying intricate information. They are relatively absent in medical classrooms today. The purpose of this study was to survey members of a medical university, students and teachers regarding their opinions of medical cartoons. Most respondents had favourable opinions of cartoons in medical education. More research is required to conclude what parameters make cartoons effective teaching aids. Moreover, many teachers may lack formal training in applying cartoons within their curriculum.

The objective of this study was to determine the feasibility of a comic education module in the Emergency Department setting. A convenience sample of 50 injured children and their caregivers were enrolled. The comic was found to be likeable, easy to read, and provided important information to both children and their caregivers. Total time to read the comic was three minutes (SD 1.4, range 1.4-7.1). Most children (60%) read the comic independently, including all children over age 14 years. At 72-hour phone follow-up, 86% of caregivers had accurate recall of all three comic teaching points. This innovative comic educational module is feasible for use for children ages 4-18 years in the Emergency Department. Though this comic was intended to educate children, caregivers recalled all three teaching points 72 hours after discharge.

Although domestic abuse of women by men has received significant media, police, and research attention, domestic violence directed toward men has been marginalized across the board and is still rarely treated seriously. The purpose of this research, then, is to examine and compare different anti-domestic violence messages in which the abuser's gender is not always clear. In Study 1, 200 U.K. participants (100 females and 100 males, aged 18-67, M = 28.98, SD = 9.613) evaluated posters that varied across three levels; in that the subject (male or female) was depicted as being silenced, bruised, or experiencing live abuse. The results showed that the posters featuring female victims were all rated as more effective than posters showing male victims. In Study 2, 140 different U.K. participants (95 females; 45 males) aged 18 to 59 ( M = 27.27, SD = 10.662) evaluated the cartoon facial images of Disney characters who had been altered to look like victims of violence and real-life corresponding photos of human models. The results showed that the realistic posters were found to be more believable, emotional, and effective than the cartoons. The implications of such perceptions are discussed.

Borderline personality disorder (BPD) is characterized by a range of interpersonal difficulties, which are, in part, related to adverse experiences during childhood. Unresponsive parenting and traumatization may cause functional impairment of mentalization, i.e. the ability to reflect upon own and others' mental states. However, the relationship of poor parenting, trauma and mentalization in BPD has not exhaustively been studied. Thirty patients diagnosed with BPD and 30 matched control subjects were asked to sequence a novel cartoon-based mentalization task involving complex emotions such as jealousy, shame, guilt etc. In addition, they were required to reason about cognitive and affective mental states of the cartoon characters. The quality of parental care was assessed using a self-report measure for recalled parental rearing style, and childhood trauma was measured in retrospect using the Childhood Trauma Questionnaire. Patients with BPD performed more poorly in all aspects of the cartoon task. Mentalizing skills, particularly relating to affective mental states, were uniquely associated with the quality of recalled parental care and childhood trauma. Together, the quality of parental care and the experience of childhood trauma negatively impact on mentalization in BPD, even in an experimental "offline" task.

This article reports on an experiment designed to test whether the cartoon manipulation leads to significant increases in aggressive thoughts and aggressive behaviors among Chinese children (n = 3,000). Results indicated that brief exposure to a violent cartoon triggered higher aggressive thoughts and aggressive behaviors than a nonviolent cartoon. Females displayed higher aggressive thoughts and aggressive behaviors than males in a nonviolent cartoon condition, while males displayed higher aggressive behaviors than females in a violent cartoon condition. Mediation analysis suggested that the effect on aggressive behaviors was mediated by aggressive thoughts. The findings imply that cartoon developers, parents, and teachers should develop cartoons that inhibit children's aggressive thoughts to avoid aggressive behaviors. Females are the key group for the prevention and intervention of aggression in a nonviolent cartoon context, while males are the key group for the prevention and intervention of aggression in a violent cartoon context.

Poor academic performance from extensive social media usage appears to be due to students’ inability to multitask between distractions and academic work. However, the degree to which visually distracted students can acquire lecture information presented aurally is unknown. This study examined the ability of students visually distracted by social media to acquire information presented during a voice-over PowerPoint lecture, and to compare performance on examination questions derived from information presented aurally vs. that presented visually. Students ( n = 20) listened to a 42-min cardiovascular pathophysiology lecture containing embedded cartoons while taking notes. The experimental group ( n = 10) was visually, but not aurally, distracted by social media during times when cartoon information was presented, ~40% of total lecture time. Overall performance among distracted students on a follow-up, open-note quiz was 30% poorer than that for controls ( P < 0.001). When the modality of presentation (visual vs. aural) was compared, performance decreased on examination questions from information presented visually. However, performance on questions from information presented aurally was similar to that of controls. Our findings suggest the ability to acquire information during lecture may vary, depending on the degree of competition between the modalities of the distraction and the lecture presentation. Within the context of current literature, our findings also suggest that timing of the distraction relative to delivery of material examined affects performance more than total distraction time. Therefore, when delivering lectures, instructors should incorporate organizational cues and active learning strategies that assist students in maintaining focus and acquiring relevant information.

Robots and virtual reality are gaining popularity in the intervention of children with autism spectrum disorder (ASD). To shed light on children's attitudes towards robots and characters in virtual reality, this study aims to examine whether children with ASD show the uncanny valley effect. We varied the realism of facial appearance by morphing a cartoon face into a human face, and induced perceptual mismatch by enlarging the eyes, which has previously been shown as an effective method to induce the uncanny valley effect in adults. Children with ASD and typically developing (TD) children participated in a two-alternative forced choice task that asked them to choose one they liked more from the two images presented on the screen. We found that TD children showed the effect, i.e., the enlargement of eye size and the approaching realism reduced their preference. In contrast, children with ASD did not show the uncanny valley effect. Our findings in TD children help resolve the controversy in the literature about the existence of the uncanny valley effect among young children. Meanwhile, the absence of the uncanny valley effect in children with ASD might be attributed to their reduced sensitivity to subtle changes of face features and their limited visual experience to faces caused by diminished social motivation. Last, our findings provide practical implications for designing robots and virtual characters for the intervention of children with ASD.

Background The number of active opioid analgesic prescriptions has risen steadily, causing increases in nonmedical opioid use, addiction, and overdose. Insufficient focus on patient discharge instructions has contributed to lack of patient awareness regarding dangers of opioids. This study examines whether an educational Khan Academy–style animation discharge instruction on the dangers and safe usage of opioid analgesics elicits higher knowledge acquisition than current standard of care. Additionally, it measures the feasibility of implementing this video discharge instruction in the emergency department (ED). Methods Fifty-two English-speaking patients aged 18 years or older receiving an opioid prescription were enrolled in this study. Patients were randomized into 2 groups. The standard of care group received verbal instruction and an informational sheet, whereas the video animation group received a 6-minute video on proper usage of opioids in addition to standard of care. Video content was sourced from samhsa.gov and administered within the ED prior to discharge. Both groups received a 26-question test regarding the dangers and safe usage of opioids immediately after education. An unpaired t test compared knowledge acquisition between the 2 groups. Results Fifty-four patients were approached, 52 patients enrolled; 27 in the standard group and 25 in the animation group. The standard of care group averaged 65% knowledge acquisition (16.8/26 correct), whereas the animation group averaged 82% acquisition (21.2/26 correct). The video animation significantly increased patient knowledge acquisition about opioid medications’ risks and proper usage and disposal ( P = .001). Conclusion It can be concluded that medical knowledge acquisition is improved in the video animation group compared with the current standard of care ( P = .001). It can also be concluded that it is feasible to implement a novel media platform to educate patients receiving opioid analgesics in the ED (96.1%).

Health literacy, the ability to acquire health-related knowledge and make appropriate health-related decisions, is regarded as a key barrier to meaningfully convey health information to children and can impact food choice. Emolabeling is an image-based labeling strategy aimed at addressing this problem by conveying health information using emotional correlates of health using emoticons (happy = healthy; sad = not healthy). To test the utility of such a method to promote healthy food choices among children, 64 children (59% girls

Two studies examined anger and shame, and their associated appraisals and behavioral intentions, in response to harm to an in-group's social-image. In Study 1, 37 British Muslims (18 men, 19 women) reported incidents in which they were devalued as Muslims. In Study 2, 108 British Muslims (57 females, 50 males, 1 undisclosed) were presented with objective evidence of their in-group's devaluation: the controversial cartoons about Prophet Muhammad The appraisal of harm to social-image predicted anger and shame (Studies 1 and 2), whereas the appraisal of offense only predicted anger (Study 2). Anger was a more empowering response than shame, as anger predicted willingness for public confrontation (Studies 12), institutional punishment (Study 2), and written disapproval (Study 2). In contrast, shame only predicted written disapproval (Study 2). Furthermore, independent of individual differences in identification as Muslim, a mediation model showed that individual differences in honor orientation predicted anger and shame via the appraisals (Study 2). Implications for theory and research are discussed.

Alcohol use among middle-aged and older adults (55 years and older) is increasingly becoming a public health concern. Despite this, there is relatively little research on the experiences of alcohol use and related concerns among people aged 55 and older to inform tailored and engaging health promotion activities. To address this gap, we aimed to develop an engaging alcohol-related health promotion resource for people aged 55 and older. We drew on a research-into-action approach, which involved: 1) thematic analysis of alcohol-related concerns in online counselling transcripts of 70 people aged 55 and older, 2) a review of health promotion literature, and 3) consultation with consumers of alcohol and other drug services, and carers. The research phase highlighted that people aged 55 and older were concerned that their reliance on alcohol use to manage stress had become a habit they wanted to shift. Alongside this, the literature showed that people aged 55 and older were often dismissive of conventional health promotion activities, and pointed to the benefits of conveying health promotion messages through animation. In response, we developed an animation to stimulate reflection and thought about other ways to relax and manage stress. We drew on health promotion principles to ensure that the animation had a positive message and was engaging without being ageist or paternalistic. It was further refined with input from consumers and carers, who thought the animation was appropriate, appealing and useful. Future activities will include further dissemination and evaluation of the animation and associated activities.

Background We investigated whether junior high school students could be educated regarding stroke with an animated cartoon and a Manga that we produced for the purpose of dissemination of this knowledge. Methods We produced a 10-minute animated cartoon and a Manga that provided information regarding stroke risk factors, stroke signs and symptoms, and awareness to immediately contact emergent medical service (EMS) on identification of stroke signs and symptoms. From December 2011 to March 2012, 493 students in 15 classes of the first grade (age 12-13 years) of 3 junior high schools were enrolled in the study. Each subject watched the animated cartoon and read the Manga; this was referred to as “training.” Lessons about stroke were not given. Questionnaires on stroke knowledge were evaluated at baseline, immediately after the training, and 3 months after the training. Results The proportion of correct answers given immediately after the training was higher for all questions, except those related to arrhythmia, compared with baseline. Percentage of correct answers given at 3 months was higher than that at baseline in questions related to facial palsy (75% versus 33%), speech disturbance (91% versus 60%), hemiplegia (79% versus 52%), numbness of 1 side (58% versus 51%), calling for EMS (90% versus 85%), alcohol intake (96% versus 72%), and smoking (69% versus 54%). At 3 months after the training, 56% of students answered the FAST (facial droop, arm weakness, speech disturbance, time to call for EMS) mnemonic correctly. Conclusions Stroke education using these teaching aids of the animated cartoon and the Manga improved stroke knowledge in junior high school students.

Few direct comparisons have been made between the responsiveness of children with autism to computer-generated or animated characters and their responsiveness to humans. Twelve 4- to 8-year-old children with autism interacted with a human therapist; a human-controlled, interactive avatar in a theme park; a human actor speaking like the avatar; and cartoon characters who sought social responses. We found superior gestural and verbal responses to the therapist; intermediate response levels to the avatar and the actor; and poorest responses to the cartoon characters, although attention was equivalent across conditions. These results suggest that even avatars that provide live, responsive interactions are not superior to human therapists in eliciting verbal and non-verbal communication from children with autism in this age range.

Background Previous reports suggest that adherence to patching is a major issue in amblyopia treatment. We tested with an unmasked randomised controlled clinical trial whether an intense educational/motivational intervention improves adherence when a high-dose regime is prescribed. Methods 62 children with newly diagnosed amblyopia were randomly allocated into two treatment arms with and without educational/motivational intervention material. Both were prescribed patching 10 h/day, 6 days/week for a fixed period of 12 weeks. The intervention arm received an educational/motivational intervention before patching which included information booklets, video, a cartoon story book, sticker charts and a dedicated session with a researcher. The control arm received the usual clinical information. The primary outcome measure was adherence measured using electronic occlusion dose monitors where a success/failure binary outcome was used to account for participants who dropped out of the study defined as patching >4 h/day. Visual outcome, expressed as percentage visual deficit, was measured as secondary outcome. Results The intervention increased adherence success rate from 45.2% in the control group to 80.6% in the intervention group (p=0.0027). However, visual outcome was not significantly better in the intervention group (p=0.190). Conclusions Our study shows that an intense educational/motivational intervention can improve adherence to patching to high prescribed doses although no significant improvement in visual outcome was observed. Trials registration number: ISRCTN05346737 (International Standard Randomised Controlled Trial Number Register).

Marketing of high-energy, low-nutrient foods is one of the contributing factors to the obesity-promoting environment. Licensed characters are typically used to market these foods to children because they increase brand recognition and sales, and data suggest that they affect the taste and snack preferences of children in high-income countries, but it has not yet been explored in low/middle income countries (LMICs). We sought to examine how licensed characters on food packaging influence children's taste and snack preferences in Guatemala, a LMIC.One hundred twenty-one children (mean ± s.d. age, 7.4 ± 1.9 years) from four (two preschool and two elementary) public schools in Guatemala tasted three food types: potato chips, crackers and carrots. Each was presented in two identical packages, except that one had a licensed character and the other did not. Children tasted the foods (six total) in each package and answered whether they tasted the same or one tasted better. Snack preference was also evaluated.Children were significantly (P0.001) more likely to prefer the taste of the foods inside the package with the licensed character compared with the one with no character (mean ± s.d., 0.24 ± 0.54). Most (66%) chose the food in the package with the character for a snack. Younger children (P0.001) were more likely to prefer the taste of the food inside the package with the character.Licensed characters on food packaging influence Guatemalan children's taste and snack preferences. Given that these characters are typically used to promote high-energy, low-nutrient foods, their influence could contribute toward overconsumption of these foods and consequently increased risk of obesity in Guatemalan children. Therefore, public health advocates, in Guatemala and elsewhere, might explore restricting the use of licensed characters on food packaging as a public health strategy.

Cleeren G, Quirynen M, Ozcelik O, Teughels W. Role of 3D animation inperiodontal patient education: a randomized controlled trial. J Clin Periodontol2014; 41: 38–45. doi: 10.1111/jcpe.12170.AbstractAim: This randomized controlled parallel trial investigates the effect of 3Danimation on the increase and recall of knowledge on periodontitis by patientswith periodontitis. The effects of a 3D animation (3D animation group) werecompared with narration and drawing (control group) for periodontal patienteducation.Material and Methods: A total of 68 periodontitis patients were stratified accord-ing to educational level and then randomly allocated to control or 3D animationgroups. All patients received: (1) a pre-test (baseline knowledge), (2) a patienteducation video (3D animation or control video), (3) a post-test (knowledgeimmediately after looking at the video), and (4) a follow-up test (knowledge recallafter 2 weeks). Each test contained 10 multiple-choice questions.Results: There was no significant difference in baseline knowledge. Patientsreceiving the 3D animations had significantly higher scores for both the post-testand the follow-up test, when compared with patients receiving sketch animations.Conclusion: 3D animations are more effective than real-time drawings for peri-odontal patient education in terms of knowledge recall. 3D animations may be apowerful tool for assisting in the information process.

Ralf König is the best-selling author of comic book novels, and his stories of gay men coming to terms with contemporary society have resonated with hundreds of thousands of German readers and film-goers. König's characters, like the author himself, have great difficulty adhering to the demand that condoms be used. The article describes how König develops this theme through a variety of works from 1985 through 1999, and analyzes the intertwined relationships among the author, his characters, and the society that is both portrayed in his works and that reads his works.

Undergoing voiding cystourethrogram (VCUG) can be distressing for children. To assess the efficacy of a cartoon and photograph montage storybook in preparing children for VCUG. Outpatient children (ages 2–14 years) who had VCUGs between December 2011 and June 2012 were randomly assigned to two groups; one group received the storybook a week before the procedure. Parents and guardians were asked to complete an anonymous survey rating their child’s tolerance of the exam from 1 to 5, worst to best, immediately after VCUG. The VCUG technologist also rated the child’s tolerance. Children prepared for VCUG with the storybook had less distress than those without. Results were analyzed by Cochran-Mantel-Haenszel and Cochran-Armitage Trend exact tests, a P value of both tests of 0.0092 indicating a statistically significant difference between the tolerance scores of children prepared with the storybook and those without. Effects of gender and history of VCUG were not statistically significant. Two-thirds of all children had no other source of information. The cartoon and photograph montage storybook format of preparing children for VCUG was effective in increasing their tolerance for the procedure. The storybook should be mailed out in advance because the majority of families did not pursue information on preparing their children for VCUG.

Aim The use of multimedia information provided preoperatively can potentially reduce anxiety in patients and improve the hospital experience. However, the use of two-dimensional (2D) animation (cartoon) to provide information to patients undergoing colorectal surgery has not been investigated. This study investigated the effect of preoperative 2D information on anxiety and knowledge retention in patients undergoing bowel surgery. Method Patients were randomized to one of two groups; the video group watched a 13-min cartoon animation whereas the nonvideo group did not. Anxiety levels were measured at the preadmission clinic, postvideo, on the day of admission for surgery, within 24-h after surgery and before discharge using the Spielberger state-trait anxiety inventory and visual analogue scale. Both groups completed a knowledge retention questionnaire and the video group completed a feedback questionnaire about the animation. Results Thirty-one patients (16 video, 15 nonvideo) participated in the study. There was no significant difference in baseline anxiety score between two groups. An immediate reduction (P = 0.03) in anxiety score was observed in the video group after watching the video compared with baseline. There was a significant reduction in anxiety score in the video group at discharge compared with the nonvideo group (P = 0.03). There was no significant difference in knowledge retention between two groups. Eighty-eight per cent of patients who watched the video found it beneficial. Conclusion 2D animation is an effective medium for delivering information to patients undergoing bowel surgery and can potentially reduce anxiety related to surgery and improve the hospital experience.

Soil-transmitted helminths are among the most prevalent sources of human infections globally. We determined the effect of an educational package at rural schools in Linxiang City District, Hunan province, China, where these worms are prevalent. The intervention aimed to increase knowledge about soil-transmitted helminths, induce behavioral change, and reduce the rate of infection.We conducted a single-blind, unmatched, cluster-randomized intervention trial involving 1718 children, 9 to 10 years of age, in 38 schools over the course of 1 school year. Schools were randomly assigned to the health-education package, which included a cartoon video, or to a control package, which involved only the display of a health-education poster. Infection rates, knowledge about soil-transmitted helminths (as assessed with the use of a questionnaire), and hand-washing behavior were assessed before and after the intervention. Albendazole was administered in all the participants at baseline and in all the children who were found to be positive for infection with soil-transmitted helminths at the follow-up assessment at the end of the school year.At the follow-up assessment, the mean score for the knowledge of helminths, calculated as a percentage of a total of 43 points on a questionnaire, was 90% higher in the intervention group than in the control group (63.3 vs. 33.4, P0.001), the percentage of children who washed their hands after using the toilet was nearly twice as high in the intervention group (98.9%, vs. 54.2% in the control group; P0.001), and the incidence of infection with soil-transmitted helminths was 50% lower in the intervention group than in the control group (4.1% vs. 8.4%, P0.001). No adverse events were observed immediately (within 15 minutes) after albendazole treatment.The health-education package increased students' knowledge about soil-transmitted helminths and led to a change in behavior and a reduced incidence of infection within 1 school year. (Funded by UBS Optimus Foundation, Zurich, Switzerland; Australian New Zealand Clinical Trials Registry number, ACTRN12610000048088.).

In order to identify unreliable data in a dataset of motility parameters obtained from a pilot study acquired by a veterinarian with experience in boar semen handling, but without experience in the operation of a computer assisted sperm analysis (CASA) system, a multivariate graphical and statistical analysis was performed. Sixteen boar semen samples were aliquoted then incubated with varying concentrations of progesterone from 0 to 3.33 µg/ml and analyzed in a CASA system. After standardization of the data, Chernoff faces were pictured for each measurement, and a principal component analysis (PCA) was used to reduce the dimensionality and pre-process the data before hierarchical clustering. The first twelve individual measurements showed abnormal features when Chernoff faces were drawn. PCA revealed that principal components 1 and 2 explained 63.08% of the variance in the dataset. Values of principal components for each individual measurement of semen samples were mapped to identify differences among treatment or among boars. Twelve individual measurements presented low values of principal component 1. Confidence ellipses on the map of principal components showed no statistically significant effects for treatment or boar. Hierarchical clustering realized on two first principal components produced three clusters. Cluster 1 contained evaluations of the two first samples in each treatment, each one of a different boar. With the exception of one individual measurement, all other measurements in cluster 1 were the same as observed in abnormal Chernoff faces. Unreliable data in cluster 1 are probably related to the operator inexperience with a CASA system. These findings could be used to objectively evaluate the skill level of an operator of a CASA system. This may be particularly useful in the quality control of semen analysis using CASA systems.

This article describes the development of two graphic novels as a new approach to mental health communication and coping strategies for the Navy and Marine Corps. The novels are intended to capture the attention of the younger target audience and provide vital teaching messages to better prepare personnel for deployment to combat zones. The novels were developed based on embedding the principles of combat and operational stress control (COSC) into realistic and relatable characters, stories, and images. Approaches used for development included (a) basing storylines on real-life service members and the situations they face in combat and their personal lives; (b) partnering with COSC experts to embed teaching points; (c) ensuring technical accuracy through research and target audience reviews of the storyboard and artwork; (d) developing characters that are representative of the target audience, with varied jobs, ages, backgrounds, and professional concerns; and (e) designing artwork in a manner sensitive to training objectives and the psychological effects on readers. Because technical accuracy, realism, and sensitivity were noted as essential components of an effective graphic novel tool, focus-group research and review of author drafts by the target audience and technical experts are strongly recommended.

The purpose of this study was to determine whether exposure to a manga comic (Japanese comic art) with messages promoting fruit consumption influenced psychosocial variables associated with increased fruit intake in middle-school youth. A three-group, randomized, single-session study was conducted in two public middle schools in central North Carolina. Participants were randomly assigned to one of three groups: (a) comic (manga comic promoting fruit consumption, (b) newsletter (newsletter about fruit), or (c) attention-control (newsletter about ancient Greece). Participants included N = 263 youth, with a mean age of 13.18 years (SD = 1.12). Outcome expectations, self-efficacy, and knowledge related to fruit intake were measured at baseline and immediately after reading. Secondary outcomes included transportation (degree to which participants are immersed in their media) and enjoyment, measured at posttest. Data were analyzed using regression analyses. Comic group participants tended to have greater change in outcome expectations related to fruit intake compared to the attention-control group and greater transportation and enjoyment than the newsletter and attention-control groups. Study results are promising and suggest that manga comics may be a useful format to promote positive health beliefs in youth.

Background: Bipolar affective disorder patients often show cognitive deficits that are similar to those found in schizophrenia patients. Theory of mind (the ability to understand others’ mental states) is compromised in currently ill schizophrenia patients. This study aimed to establish whether similar deficits are found in bipolar patients. Methods: We measured theory of mind ability in 20 bipolar-manic patients, 15 bipolar-depressed patients, 13 bipolar patients in remission and 15 normal controls. The task, which controlled for memory and comprehension, had previously been used in a study of schizophrenia patients. Results: Impaired performance on theory of mind was found for both bipolar-depressed and bipolar-manic patients, even when memory was controlled for. No impairment was observed in the remitted patients. Limitations: The manic patients scored lower than the remitted patients on a brief measure of intelligence; no other group differences in IQ were significant. Conclusions: Theory of mind deficits are found in currently symptomatic bipolar patients. These findings add to growing evidence that common mechanisms may contribute to bipolar affective disorder and schizophrenia.

Aim: Dental anxiety leads to undesirable distresses such as avoidance of dental treatment and increase stress among caregivers that consequently affect the treatment quality. The aim of this study was therefore to evaluate the effectiveness of viewing videotaped cartoons using an eyeglass system (i-theatre™) as an audiovisual (AV) distraction technique on behaviour and anxiety in children receiving dental restorative treatment. Methods: Fifty-six consecutive children patients who presented for treatment and met inclusion criteria were included and randomly divided into two groups; a control group without distraction (CTR-group) and a distraction-group (AV-group). Three dental treatment visits were provided for each patient. Anxiety and cooperative behaviour were assessed with the Facial Image Scale (FIS) and the Modified Venham’s clinical ratings of anxiety and cooperative behaviour scale (MVARS). The vital signs, blood pressure and pulse were also taken. Results: The AV-group showed significantly lower MVARS scores than the CTR-group (p = 0.029), and the scores decreased significantly during treatment in the AV-group (p = 0.04). Further, the pulse rate was significantly increased in the CTR-group during injection with local anaesthesia (p = 0.02), but not in the AV-group. Conclusion: AV distraction seems to be an effective method in reducing fear and anxiety in children during dental treatment. Further, children who used eyeglass goggle display as a distraction tool during dental treatment reported not only less anxiety than control groups but also showed more positive responses after injection with local anaesthesia. Hence, AV-distraction seems to be a useful tool to decrease the distress and dental anxiety during dental treatment.

a Medical Student, The University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX 77555-0144, USA b Clinical Associate Professor, Department of Anesthesiology and Perioperative Medicine, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA c Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, Case Western Reserve University School of Dental Medicine, 2124 Cornell Rd, Cleveland, OH 44106, USA d Honorary Curator, Wood Library-Museum of Anesthesiology, 1061 American Lane, Schaumburg, IL 60173-4973, USA

The objective of this study was to investigate the effectiveness of brain-based learning (BBL) and animated cartoons on video compact discs (VCDs) in enhancing the healthy habits of school children. A representative sample of 1085 school children in the first through the third grades at 16 schools was selected by multistage random sampling. Knowledge of healthy habits and self-reported adoption of practices were assessed by a questionnaire. BBL and VCD, either combined or as single-intervention techniques, led to improved knowledge and practice of healthy behavior, whereas conventional teaching did not. As a single-intervention technique, BBL on its own led to a greater improvement in healthy practices than VCD, but the addition of BBL to VCD made no difference, and there was no difference between BBL and VCD in terms of improvements in knowledge. In conclusion, both BBL and VCD are effective, but VCD requires fewer resources. Recommendations are made for further research

We performed this study to determine the beneficial effects of viewing an animated cartoon and playing with a favorite toy on preoperative anxiety in children aged 3 to 7 years in the operating room before anesthesia induction.One hundred thirty children aged 3 to 7 years with ASA physical status I or II were enrolled. Subjects were randomly assigned to 1 of 3 groups: group 1 (control), group 2 (toy), and group 3 (animated cartoon). The children in group 2 were asked to bring their favorite toy and were allowed to play with it until anesthesia induction. The children in group 3 watched their selected animated cartoon until anesthesia induction. Children's preoperative anxiety was determined by the modified Yale Preoperative Anxiety Scale (mYPAS) and parent-recorded anxiety Visual Analog Scale (VAS) the night before surgery, in the preanesthetic holding room, and just before anesthesia induction.In the preanesthetic holding room, the group 2 mYPAS and parent-recorded anxiety VAS scores were significantly lower than those of groups 1 and 3 (mYPAS: P = 0.007; parent-recorded anxiety VAS: P = 0.02). In the operating room, the children in group 3 had the lowest mYPAS and parent-recorded anxiety VAS scores among the 3 groups (mYPAS: P0.001; parent-recorded anxiety VAS: P0.001). In group 3, the mYPAS and parent-recorded anxiety VAS scores of only 3 and 5 children were increased in the operating room compared with their scores in the preanesthetic holding room, whereas the anxiety scores of 32 and 34 children in group 1 and 25 and 32 children in group 2 had increased (P0.001). The number of children whose scores indicated no anxiety (mYPAS score30) in the operating room was 3 (7%), 9 (23%), and 18 (43%) in groups 1, 2, and 3, respectively (P0.001).Allowing the viewing of animated cartoons by pediatric surgical patients is a very effective method to alleviate preoperative anxiety. Our study suggests that this intervention is an inexpensive, easy to administer, and comprehensive method for anxiety reduction in the pediatric surgical population.

Purpose: We showed previously that an educational cartoon that explains without words why amblyopic children should wear their eye patch improves compliance, especially in children of immigrant parents who speak Dutch poorly. We now implemented this cartoon in clinics in low socioeconomic status (SES) areas with a large proportion of immigrants and clinics elsewhere in the Netherlands. Design: Clinical, prospective, nonrandomized, preimplementation, and postimplementation study. Participants: Amblyopic children aged 3 to 6 years who started occlusion therapy. Methods: Preimplementation, children received standard orthoptic care. Postimplementation, children starting occlusion therapy received the cartoon in addition. At implementation, treating orthoptists followed a course on compliance. In low SES areas, compliance was measured electronically during 1 week. Main Outcome Measures: The clinical effects of the cartoon— electronically measured compliance, outpatient attendance rate, and speed of reduction in interocular-acuity difference (SRIAD)—averaged over 15 months of observation. Results: In low SES areas, 114 children were included preimplementation versus 65 children postimplementation; elsewhere in the Netherlands, 335 versus 249 children were included. In low SES areas, mean electronically measured compliance was 52.0% preimplementation versus 62.3% postimplementation (P0.146); 41.8% versus 21.6% (P0.043) of children occluded less than 30% of prescribed occlusion time. Attendance rates in low SES areas were 60.3% preimplementation versus 76.0% postimplementation (P0.141), and 82.7% versus 84.5%, respectively, elsewhere in the Netherlands. In low SES areas, the SRIAD was 0.215 log/year preimplementation versus 0.316 log/year postimplementation (P0.025), whereas elsewhere in the Netherlands, these were 0.244 versus 0.292 log/year, respectively (P0.005; the SRIAD’s improvement was significantly better in low SES areas than elsewhere, P0.0203). This advantage remained after adjustment for confounding factors. Overall, 25.1% versus 30.1% (P0.038) had completed occlusion therapy after 15 months. Conclusions: After implementation of the cartoon, electronically measured compliance improved, attendance improved, acuity increased more rapidly, and treatment was shorter. This may be due, in part, to additional measures such as the course on compliance. However, that these advantages were especially pronounced in children in low SES areas with a large proportion of immigrants who spoke Dutch poorly supports its use in such areas. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2012;119:2393–2401 © 2012 by the American Academy of Ophthalmology.

Background High-quality bowel preparation is a prerequisite for colonoscopy. Few studies have evaluated visual aids as a means of improving the quality of bowel preparation. Objective To assess the effect of patient education by using cartoon visual aids on the quality of bowel preparation. Design An endoscopist-blinded, randomized, controlled trial. Setting Tertiary referral center. Subjects Patients scheduled for screening colonoscopy in a health examination center. Interventions Patients were assigned to receive the existing verbal and written instructions (group A) or a new cartoon visual educational instruction (group B) for colonoscopy. Main Outcome Measurements The primary endpoint was the quality of bowel preparation, assessed by using the Boston Bowel Preparation Scale (BBPS). Secondary endpoints were the quality of bowel preparation assessed by using the Universal Preparation Assessment Scale; insertion, withdrawal, and workup times; and polyp detection rates in the 2 groups. Logistic regression analysis was performed to determine the factors associated with poor bowel preparation according to a BBPS score less than 5. Results Group B exhibited better bowel preparation than group A according to BBPS scores (mean BBPS score, 6.12 ± 2.19 vs 7.44 ± 1.87, P ≤ .01; median BBPS score, 6.00 ± 0.00 vs 9.00 ± 0.00, P ≤ .01; good bowel preparation for colonoscopy, BBPS score ≥5, 81.6% vs 93.1%, P = .02). Multivariate analysis revealed that older age (odds ratio 1.07, P ≤ .01) and no use of visual aids (odds ratio 3.08, P = .02) were independent factors associated with poor bowel preparation. Limitations Single-center study. Conclusions Patient education with cartoons effectively improved bowel preparation for colonoscopy.

Just as syntax differentiates coherent sentences from scrambled word strings, the comprehension of sequential images must also use a cognitive system to distinguish coherent narrative sequences from random strings of images. We conducted experiments analogous to two classic studies of language processing to examine the contributions of narrative structure and semantic relatedness to processing sequential images. We compared four types of comic strips: (1) Normal sequences with both structure and meaning, (2) Semantic Only sequences (in which the panels were related to a common semantic theme, but had no narrative structure), (3) Structural Only sequences (narrative structure but no semantic relatedness), and (4) Scrambled sequences of randomly-ordered panels. In Experiment 1, participants monitored for target panels in sequences presented panel-by-panel. Reaction times were slowest to panels in Scrambled sequences, intermediate in both Structural Only and Semantic Only sequences, and fastest in Normal sequences. This suggests that both semantic relatedness and narrative structure offer advantages to processing. Experiment 2 measured ERPs to all panels across the whole sequence. The N300/N400 was largest to panels in both the Scrambled and Structural Only sequences, intermediate in Semantic Only sequences and smallest in the Normal sequences. This implies that a combination of narrative structure and semantic relatedness can facilitate semantic processing of upcoming panels (as reflected by the N300/N400). Also, panels in the Scrambled sequences evoked a larger left-lateralized anterior negativity than panels in the Structural Only sequences. This localized effect was distinct from the N300/N400, and appeared despite the fact that these two sequence types were matched on local semantic relatedness between individual panels. These findings suggest that sequential image comprehension uses a narrative structure that may be independent of semantic relatedness. Altogether, we argue that the comprehension of visual narrative is guided by an interaction between structure and meaning.

Purpose The effects of animation on transparency, name agreement, and identification of graphic symbols for verbs and prepositions were evaluated in preschoolers of 3 age groups. Methods A mixed-group design was used; in each age group, half of the children were randomly allocated to 1 of 2 orders of symbol formats. The 52 children were asked to guess the meaning of symbols and to identify a target symbol among foils given the spoken label. Results Animated symbols were more transparent than static symbols, although this was more pronounced for verbs. Animated verbs were named more accurately than static verbs, but there was no difference between animated and static prepositions. Verbs were identified more accurately compared with prepositions, but there was no difference between symbol formats. Older children guessed, named, and identified symbols more effectively than younger children. Conclusion Animation enhances transparency and name agreement, especially for verbs, which reduces the instructional burden that comes with nontransparent symbols. Animation does not enhance identification accuracy. Verbs are easier to identify than prepositions. A developmental effect was observed for each measure. Limitations and implications for future research are discussed.

Community-based participatory research (CBPR) has garnered increasing interest over the previous two decades as researchers have tackled increasingly complex health problems. In academia, professional presentations and articles are major ways that research is disseminated. However, dissemination of research findings to the people and communities who participated in the research is many times forgotten. In addition, little scholarly literature is focused on creative dissemination of research findings to the community using CBPR methods. We seek to fill this gap in the literature by providing an exemplar of research dissemination and partnership strategies that were used to complete this project. In this paper, we present a novel approach to the dissemination of research findings to our targeted communities through digital animation. We also provide the foundational thinking and specific steps that were taken to select this specific dissemination product development and distribution strategy.