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A critical element of neurological function is eye–hand coordination: the ability of our vision system to coordinate the information received through the eyes to control, guide, and direct the hands to accomplish a task. Recent evidence shows that this ability can be disturbed by strokes or other neurological disorders, with critical consequences for motor behaviour. This paper presents a system based on serious games and multimodal devices aimed at improving the assessment of eye–hand coordination. The system implements gameplay that involves drawing specific patterns (labyrinths) to capture hand trajectories. The user can draw the path using multimodal devices such as a mouse, a stylus with a tablet, or robotic devices. Multimodal input devices can allow for the evaluation of complex coordinated movements of the upper limb that involve the synergistic motion of arm joints, depending on the device. A preliminary test of technological validation with healthy volunteers was conducted in the laboratory. The Dynamic Time Warping (DTW) index was used to compare hand trajectories without considering time-series lag. The results suggest that this multimodal framework allows for measuring differences between fine and gross motor skills. Moreover, the results support the viability of this system for developing a high-resolution metric for measuring eye–hand coordination in neurorehabilitation. [ABSTRACT FROM AUTHOR]

The document discusses the development and potential benefits of a computerized cognitive remediation program called NeuroFlex for older adults experiencing post-COVID neurocognitive dysfunction (PCND). PCND is characterized by cognitive symptoms and impairment in executive functions, particularly in older adults. Preliminary data from a study on NeuroFlex showed promising results in improving cognitive and emotional functioning in older adults with PCND. The treatment was found to be highly acceptable, credible, and usable, with participants showing good adherence to the program. Further research is needed to explore the efficacy and potential wide distribution of this treatment. [Extracted from the article]

Developing games is time-consuming and costly. Overly clinical therapy games run the risk of being boring, which defeats the purpose of using games to motivate healing in the first place [ 10 , 23 ]. In this work, we adapt and repurpose an existing immersive virtual reality (iVR) game, Spellcasters, originally designed purely for entertainment for use as a stroke rehabilitation game—which is particularly relevant in the wake of COVID-19, where telehealth solutions are increasingly needed [ 4 ]. In preparation for participatory design sessions with stroke survivors, we collaborate with 14 medical professionals to ensure Spellcasters is safe and therapeutically valid for clinical adoption. We present our novel VR sandbox implementation that allows medical professionals to customize appropriate gestures and interactions for each patient’s unique needs. Additionally, we share a co-designed companion app prototype based on clinicians’ preferred data reporting mechanisms for telehealth. We discuss insights about adapting and repurposing entertainment games as serious games for health, features that clinicians value, and the potential broader impacts of applications like Spellcasters for stroke management.

Introduction: Sleep hygiene education (SHE) consists of environmental and behavioral practices primarily intended to reduce sleep problems. Currently considered ineffective as a stand-alone treatment, the manner in which the education is typically delivered may be ineffective for the acquisition of new knowledge. The purpose of this study was to determine if a more engaging teaching medium may improve the efficacy of sleep hygiene education. This study examined the use of game-based learning to teach SHE to individuals with sleep problems. Methods: 35 participants played the SHE games for 30 days. Differences in preand post-state anxiety and sleep quality measures were examined. Results: Participants had significant improvements in sleep quality and state anxiety after using the app for 30 days, although scores for the majority of patients remained elevated. Discussion: This pilot investigation provides initial evidence for the efficacy of a game-based approach to SHE. [ABSTRACT FROM AUTHOR]

A critical element of neurological function is eye–hand coordination: the ability of our vision system to coordinate the information received through the eyes to control, guide, and direct the hands to accomplish a task. Recent evidence shows that this ability can be disturbed by strokes or other neurological disorders, with critical consequences for motor behaviour. This paper presents a system based on serious games and multimodal devices aimed at improving the assessment of eye–hand coordination. The system implements gameplay that involves drawing specific patterns (labyrinths) to capture hand trajectories. The user can draw the path using multimodal devices such as a mouse, a stylus with a tablet, or robotic devices. Multimodal input devices can allow for the evaluation of complex coordinated movements of the upper limb that involve the synergistic motion of arm joints, depending on the device. A preliminary test of technological validation with healthy volunteers was conducted in the laboratory. The Dynamic Time Warping (DTW) index was used to compare hand trajectories without considering time-series lag. The results suggest that this multimodal framework allows for measuring differences between fine and gross motor skills. Moreover, the results support the viability of this system for developing a high-resolution metric for measuring eye–hand coordination in neurorehabilitation.

IntroductionSleep hygiene education (SHE) consists of environmental and behavioral practices primarily intended to reduce sleep problems. Currently considered ineffective as a stand-alone treatment, the manner in which the education is typically delivered may be ineffective for the acquisition of new knowledge. The purpose of this study was to determine if a more engaging teaching medium may improve the efficacy of sleep hygiene education. This study examined the use of game-based learning to teach SHE to individuals with sleep problems.Methods35 participants played the SHE games for 30 days. Differences in pre- and post-state anxiety and sleep quality measures were examined.ResultsParticipants had significant improvements in sleep quality and state anxiety after using the app for 30 days, although scores for the majority of patients remained elevated.DiscussionThis pilot investigation provides initial evidence for the efficacy of a game-based approach to SHE.

Background: Smartphone apps are a convenient, low-cost approach to delivering smoking cessation support to large numbers of individuals. Yet, the apps are susceptible to low rates of user engagement and retention. Objective: This study aims to test the effects of a new game module (called Inner Dragon) integrated into Smoke Free (23 Limited), a leading smoking cessation app with established efficacy. The primary outcomes measured user engagement with the app. Methods: A 2-arm, parallel-group, randomized controlled trial was conducted in the United States with an 8-week follow-up. Adult individuals who smoked ≥1 cigarettes daily and planned to quit smoking within 7 days were recruited and randomized (N=500), with equal allocation. Both groups received free access to the original Smoke Free app with "core" features of its smoking cessation program (eg, a diary and craving log). The treated group received additional access to the integrated Inner Dragon game that incorporated several game mechanics designed to increase user engagement. User engagement outcomes were the number of unique app sessions, average minutes per session, days with a session, and program adherence. Self-reported and verified smoking abstinence and app satisfaction were also assessed. The main analysis estimated the intention-to-treat effect of access to Inner Dragon on each outcome. Further analyses assessed effect modification by participant characteristics and the association of intensity of game use with program adherence and abstinence. Results: Overall, user engagement was greater for treated versus control participants: they had 5.3 more sessions of Smoke Free (mean 29.6, SD 36.5 sessions vs mean 24.3, SD 37.9 sessions; P =.06), 0.8 more minutes per session (mean 6.9, SD 5.4 min vs mean 6.1, SD 5.2 min; P =.047), and 3.4 more days with a session (mean 14.3, SD 15.3 days vs mean 11.9, SD 14.3 days; P =.03). Program adherence, based on the number of times core features of the original Smoke Free app were used, was higher for treated versus control participants (mean 29.4, SD 41.3 times vs mean 22.6, SD 35.6 times; P =.03). Self-reported 7-day and 30-day point-prevalence abstinence and verified 7-day point-prevalence abstinence at 8 weeks did not significantly differ by study group. The mean repeated 1-day prevalence of quitting was higher among the treated group versus the control group (mean 17.3%, SD 25.6 vs mean 12.4%, SD 21.3; P =.01). App satisfaction and the motivation to (stay) quit did not differ by study group. Higher intensity of game use was associated with increased program adherence and self-reported abstinence. Conclusions: Findings suggest that the Inner Dragon game increased user engagement and program adherence. Additional refinements to the game design may clarify whether the game increases abstinence rates. Overall, it is feasible to deploy games and gamification to enhance user engagement in existing smoking cessation interventions. Trial Registration: ClinicalTrials.gov NCT05227027; https://clinicaltrials.gov/study/NCT05227027 [ABSTRACT FROM AUTHOR]

PurposeAccidents and unintentional injuries account for the greatest number of adolescent deaths, often involving use of alcohol and other substances. This article describes the iterative design and development of Interactive Narrative System for Patient-Individualized Reflective Exploration (INSPIRE), a narrative-centered behavior change environment for adolescents focused on reducing alcohol use. INSPIRE is designed to serve as an extension to clinical preventive care, engaging adolescents in a theoretically grounded intervention for health behavior change by leveraging 3D game engine and interactive narrative technologies.MethodsAdolescents were engaged in all aspects of the iterative, multiyear development process of INSPIRE through over 20 focus groups and iterative pilot testing involving more than 145 adolescents. Qualitative findings from focus groups are reported, as well as quantitative findings from small-scale pilot sessions investigating adolescent engagement with a prototype version of INSPIRE using a combination of questionnaire and interaction trace log data.ResultsAdolescents reported that they found INSPIRE to be engaging, believable, and relevant to their lives. The majority of participants indicated that the narrative's protagonist character was like them (84%) and that the narrative featured virtual characters that they could relate to (79%). In the interactive narrative, the goals most frequently chosen by adolescents were "stay in control" (60%) and "do not get in trouble" (55%).ConclusionsWith a strong theoretical framework (social-cognitive behavior change theory) and technology advances (narrative-centered learning environments), the field is well positioned to design health behavior change systems that can realize significant impacts on behavior change for adolescent preventive health.

Immersive virtual reality (IVR) uses customized and advanced software and hardware to create a digital 3D reality in which all of the user's senses are stimulated with computer-generated sensations and feedback. This technology is a promising tool that has already proven useful in Parkinson's disease (PD). The risk of falls is very high in people with PD, and reaction times and processing speed may be markers of postural instability and functionality, cognitive impairment and disease progression. An exploratory study was conducted to explore the feasibility of reaction time tests performed in IVR as predictors of falls. A total of 26 volunteers (79.2% male; 69.73 ± 6.32 years) diagnosed with PD (1.54 ± 0.90 H&Y stage; 26.92 ± 2.64 MMSE) took part in the study. IVR intervention was feasible, with no adverse effects (no Simulator Sickness Questionnaire symptoms). IVR reaction times were related (Spearman's rho) to functionality (timed up and go test (TUG) (rho = 0.537, p = 0.005); TUG-Cognitive (rho = 0.576, p = 0.020); cognitive impairment mini mental state exam (MMSE) (rho = −0.576, p = 0.002)) and the years of the patients (rho = 0.399, p = 0.043) but not with the first PD symptom or disease stage. IVR test is a complementary assessment tool that may contribute to preventing falls in the proposed sample. Additionally, based on the relationship between TUG and reaction times, a cut-off time is suggested that would be effective at predicting the risk of suffering a fall in PD patients using a simple and quick IVR test. [ABSTRACT FROM AUTHOR]

Background: The use of videogames as a public health tool is rapidly expanding. Accurate assessment of the efficacy of such games is complicated by many factors. We describe challenges associated with measuring the impact of playing a videogame with information about human sexual anatomy and reproduction and discuss motivations for, and solutions to, these challenges. Methods: The My Future Family Game (MFF) is a validated tool for collecting data about family planning intentions which includes information about human anatomy and sexual reproduction. We sought to assess the efficacy of the game as a tool for teaching sexual education using a pre-post model which was deployed in three schools in and around Chennai, India in summer of 2018. Results: The MFF game was successfully modified to collect data about players pre-gameplay knowledge of sexual anatomy and processes. The post gameplay assessment process we used did not effectively assess knowledge gain. Designing assessments for games dealing with sexuality presents challenges including: effectively communicating about biological parts and processes, designing usable and intuitive interfaces with minimal text, ensuring that all parts of the process are fun, and integrating assessments into the game in a way that makes them invisible. Conclusion: Games can be an effective means of gathering data about knowledge of sex and reproduction that it is difficult to obtain through other means. Assessing knowledge about human sexual reproduction is complicated by cultural norms and taboos, and technical hurdles which can be addressed through careful design. This study adds to the sparse literature in the field by providing information about pitfalls to avoid and best practices in this evolving area.

Given its promising role in public health to address hard to reach population groups, game-based interventions (i.e., Games for Health, G4H) have experienced growing interest in recent years. Therefore, it is surprising that they have played only a minor role during the COVID-19 pandemic. Hence, the aim of this paper is to reflect the opportunities and challenges of G4H especially during the pandemic but also with regard to future health crises. As commercial video games (i.e., those that primarily aim to entertain its users) were often used to deal with the containment measures during the COVID-19 pandemic, we call for greater cooperation with commercial game makers to distribute health-related messages via entertainment games. With regard to G4H we see a need to (i) strengthen the intervention theory underlying game-based applications, (ii) to enhance the appeal of games in order to maintain the interest of users in the long term, and (iii) to improve the evidence base using appropriate study designs. Finally, we argue for (iv) greater user involvement, both in terms of developing game-based approaches and as co-researchers in solving complex health problems.

Background: Research on digital games designed to increase physical activity (PA), also known as exergames or active video games (AVGs), has proliferated over the past 2 decades. As a result, reviews of literature in this field can become outdated, revealing the need for updated high-quality reviews that identify overarching insights. Furthermore, given the significant heterogeneity in AVG research, study inclusion criteria may significantly influence conclusions. To the best of our knowledge, no prior systematic review or meta-analysis has specifically focused on studies of longitudinal AVG interventions targeting increases in PA behaviors. Objective: The aim of this study was to obtain insights into when and why longitudinal AVG interventions are more or less successful for sustained increases in PA, especially for public health. Methods: Six databases (PubMed, PsycINFO, SPORTDiscus, MEDLINE, Web of Science, and Google Scholar) were reviewed until December 31, 2020. This protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020204191). For inclusion, randomized controlled trials had to prominently (>50% of intervention) feature AVG technology, involve repeated AVG exposure, and target changes in PA behavior. Experimental designs had to include ≥2 within- or between-participant conditions with ≥10 participants per condition. Results: A total of 25 studies published in English between 1996 and 2020 were identified, with 19 studies providing sufficient data for inclusion in the meta-analysis. Our findings indicated that AVG interventions had a moderately positive effect, thereby increasing overall PA (Hedges g =0.525, 95% CI 0.322-0.728). Our analysis showed substantial heterogeneity (I 2=87.7%; Q=154.1). The main findings were consistent across all subgroup analyses. The comparison between PA assessment type groups showed a moderate effect for objective measures (Hedges g =0.586, 95% CI 0.321-0.852) and a small effect for subjective measures (Hedges g =0.301, 95% CI 0.049-0.554) but no significant difference between the groups (P =.13). The platform subgroup analysis indicated a moderate effect for stepping devices (Hedges g =0.303, 95% CI 0.110-0.496), combination of handheld and body-sensing devices (Hedges g =0.512, 95% CI 0.288-0.736), and other devices (Hedges g =0.694, 95% CI 0.350-1.039). The type of control group showed a wide range of effects sizes, ranging from a small effect size (Hedges g =0.370, 95% CI 0.212-0.527) for the passive control group (nothing) to a moderate effect size for the conventional PA intervention group (Hedges g =0.693, 95% CI 0.107-1.279) and ultimately to a large effect size for sedentary game as control groups (Hedges g =0.932, 95% CI 0.043-1.821). There was no significant difference among the groups (P =.29). Conclusions: AVGs represent a promising tool for PA promotion among the general population and clinical subpopulations. However, significant variabilities in AVG quality, study design, and impact were also detected. Suggestions for improving AVG interventions and related research will be discussed. Trial Registration: PROSPERO CRD42020204191; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=204191 [ABSTRACT FROM AUTHOR]

Background: The stigma faced by people living with HIV causes difficulties in the treatment of HIV/AIDS. Decreasing this stigma is thus no less urgent than implementing behavioral interventions. Serious games are being increasingly adopted as an intervention mechanism to control HIV/AIDS around the world. However, the development and evaluation of these games in China are far from adequate. Objective: This research aimed to help decrease HIV-related stigma in China via the development and evaluation of a serious game, as well as promote a participatory gamification culture for health interventions. Methods: Initially, a serious game was developed using free resources from a user-generated content website. Then, quantitative and qualitative methods were employed for game evaluation. A randomized controlled trial was conducted to explore the game's effect on HIV-related stigma. The trial included 167 university students, who were randomly allocated to game and control groups. After the experimental evaluation, focus group discussions were held with 64 participants, who were invited to form 16 groups. Results: The game was called The Second Kind of Life with HIV (SKLWH), which is a free online game that can be played on computers and smartphones. This game hopes to publicize that people living with HIV can live a normal life, that is, a second life different from that imagined by the public. Based on the gamification practice of SKLWH, the participatory serious game development model (PSGDM) was proposed, which guided the development of 3 other HIV-themed games. The trial showed that intimacy stigma was much more severe than morality stigma and personal interaction stigma. Females were more tolerant of morality stigma than males (mean score: 1.29 vs 1.50; P=.01). The game intervention showed an advantage in decreasing intimacy stigma (mean score [game vs control]: 2.43 vs 2.73; P=.04). The group discussions validated the quantitative results and provided further in-depth information. The game intervention was largely preferred by participants, and the belief in intimacy impossibility was commonly expressed by participants when considering their relationship with people living with HIV. Conclusions: HIV/AIDS education should adopt appropriate media interventions to mitigate different dimensions of HIV-related stigma. Serious games should be used to decrease intimacy stigma, which is the hardest form to diminish. It is expected that the PSGDM can promote the development of more health games. Furthermore, HIV/AIDS intervention requires interdisciplinary efforts and cooperation that will allow more people to participate and share the responsibility of promoting health. [ABSTRACT FROM AUTHOR]

One of the pillars which underpins active aging is found in the performance of physical activity. While adherence to physical activity programs has traditionally been low in older people, immersive virtual reality (IVR) could provide an alternative and complementary training mode. A randomized clinical trial was conducted to explore the feasibility and effects of a 10-week IVR exergame program on physical functions of 24 institutionalized older adults who were allocated to an experimental group (EG n = 13; 85.08 ± 8.48 years) and control group (CG n = 11; 84.82 ± 8.10 years). The IVR intervention was feasible, with no adverse effects being reported (no Simulator Sickness Questionnaire symptoms; low negative experience scores on the Game Experience Questionnaire < 0.34/4), no dropouts, high adherence, and good post-gaming usability (System Usability Scale > 73.96%). The EG showed significant improvements: Tinetti scores for balance (1.84 ± 1.06; p < 0.001), gait (1.00 ± 1.08; p < 0.001), total score (2.84 ± 1.67; p < 0.001), and handgrip (4.96 ± 4.22; p < 0.001) (pre–post assessment). The CG showed significantly worsened compared to the EG: Five times sit-to-stand test, Tinetti scores for balance, gait, and total score, and the Timed Up and Go test total score (post-assessment). The findings show that the IVR intervention is a feasible method to approach a personalized exercise program and an effective way by which to improve physical function in the target population. [ABSTRACT FROM AUTHOR]

The paper presents a conceptual framework and a metric instrument for assisting design and evaluating serious games for dementia family carers as the first step towards designing a game specifically designed to cater for their needs. The paper starts with a literature survey on dementia, dementia family carers and existing games for health issues. From this survey, three components of the carers’ needs (health, education and social), three platforms (social marketing, social media and games) and six game contents (game play, avatar portrayal, game world graphics, sound / music and storyline) were identified, and engagement as the metric of interaction was also identified. With these, a conceptual framework was constructed, identifying the relationship amongst these elements. Based on these, the metric instrument is devised using the Goal Question Metric (GQM) method. An exploratory experiment was conducted with six health-related games and five game professionals to assess the effectiveness of the instrument. It is found that the instrument can identify the successfulness of the games in terms of satisfying the three categories of needs of the carer, i.e., health, education and social, though it was suggested that a further experiment with more participants and focusing on one game would be needed to further verify the effectiveness of the instrument. [ABSTRACT FROM AUTHOR]

Background: In response to a Grand Challenges in Global Health call for action to collect data about family planning intentions and increase the uptake of family planning methods in India, our team designed, developed, and piloted the My Future Family video game in Karnataka Province. The game educates adolescents about human sexuality and reproduction while asking players when they would like to achieve five important family planning milestones.  Participants were also asked to report who influences them the most when making family planning decisions. Methods: Focus groups were conducted and the resulting data used to design the game which was iteratively tested and then piloted in 11 schools in rural and urban areas of southern India. Data was collected throughout gameplay and cross-checked with paper questionnaires.  Results: In August 2017, we successfully piloted the game with 382 adolescents and validated its efficacy both as an educational tool and as an innovative means of accurate data collection.  Conclusion: It has historically been problematic to gather accurate data about adolescents in India on this culturally sensitive topic for a variety of reasons. These include difficulties obtaining consent, developing appropriate survey methods, and framing questions in language that young people can understand. Our game met these challenges by working within a single school system with approval from senior administration, delivering information via a game environment which freed players from societal constraints, and communicating information via images and audio in addition to text in both English and Kannada (the local language).

Game jams are collaborative competitions where participants make games from scratch within a short period of time. Occasionally, these games aim to promote meaningful learning outcomes by embedding functional knowledge into entertaining and engaging gameplay. We wanted to understand if a game jam during a global pandemic could be used as an effective method to facilitate a collaborative, multidisciplinary team's ability to design, develop, and implement a serious game on a health-related topic (i.e., COVID-19). We examined the 2020 game jam hosted by the National Academy of Sciences to evaluate one method to organize a serious virtual game jam and provide a roadmap for implementation using qualitative and quantitative data collection methods to evaluate its efficacy. In addition to identifying best practices and lessons learned from our tools and processes, our results demonstrate that a virtual game jam can in fact be a powerful tool for creating a scientifically sound, population-level, big picture-thinking serious game used for health education, facilitate collaborative multidisciplinary teams and be a practical learning experience for game jammers. [ABSTRACT FROM AUTHOR]

Background: Immersive virtual reality (VR) is a promising therapy to improve the experience of patients with critical illness and may help avoid postdischarge functional impairments. However, the determinants of interest and usability may vary locally and reports of uptake in the literature are variable., Objective: The aim of this mixed methods feasibility study was to assess the acceptability and potential utility of immersive VR in critically ill patients at a single institution., Methods: Adults without delirium who were admitted to 1 of 2 intensive care units were offered the opportunity to participate in 5-15 minutes of immersive VR delivered by a VR headset. Patient vital signs, heart rate variability, mood, and pain were assessed before and after the VR experience. Pre-post comparisons were performed using paired 2-sided t tests. A semistructured interview was administered after the VR experience. Patient descriptions of the experience, issues, and potential uses were summarized with thematic analysis., Results: Of the 35 patients offered the chance to participate, 20 (57%) agreed to partake in the immersive VR experience, with no difference in participation rate by age. Improvements were observed in overall mood (mean difference 1.8 points, 95% CI 0.6-3.0; P=.002), anxiety (difference of 1.7 points, 95% CI 0.8-2.7; P=.001), and pain (difference of 1.3 points, 95% CI 0.5-2.1; P=.003) assessed on 1-10 scales. The heart rate changed by a mean of -1.1 (95% CI -0.3 to -1.9; P=.008) beats per minute (bpm) from a baseline of 86.1 (SD 11.8) bpm and heart rate variability, assessed by the stress index (SI), changed by a mean of -5.0 (95% CI -1.5 to -8.5; P=.004) seconds -2 from a baseline SI of 40.0 (SD 23) seconds -2 . Patients commented on the potential for the therapy to address pain, lessen anxiety, and facilitate calmness. Technical challenges were minimal and there were no adverse effects observed., Conclusions: Patient acceptance of immersive VR was high in a mostly medical intensive care population with little prior VR experience. Patients commented on the potential of immersive VR to ameliorate cognitive and emotional symptoms. Investigators can consider integrating minimally modified commercial VR headsets into the existing intensive care unit workflow to further assess VR's efficacy for a variety of endpoints., (©Brian W Locke, Te-yi Tsai, C Mahony Reategui-Rivera, Aileen S Gabriel, Aref Smiley, Joseph Finkelstein. Originally published in JMIR Serious Games (https://games.jmir.org), 09.08.2024.)

IntroductionThe present study assessed if an exercise session in an innovative exergame can modulate hemodynamic reactivity to a cold pressor test (CPT) to a similar extent as a typical moderate endurance training (ET). Furthermore, cardiorespiratory, and affective responses of an exergame session and an ET were compared.MethodsTwenty-seven healthy participants aged 25 ± 4 years (48% female; BMI 23.0 ± 2.1 kg/m2) participated in this cross-sectional study. All participants completed both an ET on a treadmill and training in the ExerCube (ECT). HR and oxygen consumption were recorded during both training sessions. Before and after both exercise sessions, the hemodynamic reactivity to a CPT was determined.ResultsDuring ECT, HR, oxygen consumption, energy expenditure, and the metabolic equivalent of the task were significantly higher than those obtained during ET (p < 0.001). With regard to the CPT, the participants showed significantly lower responses in peripheral systolic (p = 0.004) and diastolic blood pressure (p = 0.009) as well as central systolic (p = 0.002) and diastolic BP (P = 0.01) after ECT compared to ET. The same was true for pulse wave velocity (p = 0.039).ConclusionThe ECT induced a significantly higher exercise stimulus compared to the ET. At the same time, it attenuated hemodynamic stress reactivity. The ECT presents a relevant training stimulus that modulates cardiovascular reactivity to stress, which has been proven as a predictor for the development of hypertension.Trial RegistrationISRCTN registry, ISRCTN43067716, 14 April 2020, Trial number: 38154.

The paper presents a conceptual framework and a metric instrument for assisting design and evaluating serious games for dementia family carers as the first step towards designing a game specifically designed to cater for their needs. The paper starts with a literature survey on dementia, dementia family carers and existing games for health issues. From this survey, three components of the carers' needs (health, education and social), three platforms (social marketing, social media and games) and six game contents (game play, avatar portrayal, game world graphics, sound / music and storyline) were identified, and engagement as the metric of interaction was also identified. With these, a conceptual framework was constructed, identifying the relationship amongst these elements. Based on these, the metric instrument is devised using the Goal Question Metric (GQM) method. An exploratory experiment was conducted with six health-related games and five game professionals to assess the effectiveness of the instrument. It is found that the instrument can identify the successfulness of the games in terms of satisfying the three categories of needs of the carer, i.e., health, education and social, though it was suggested that a further experiment with more participants and focusing on one game would be needed to further verify the effectiveness of the instrument. [ABSTRACT FROM AUTHOR]

To describe the participatory approach used to inform the development of a video game designed to increase children's nutrition knowledge. The objectives were to (1) assess children's nutrition areas of focus, (2) explore parents' and children's perceptions of video games for nutrition education, and (3) collect information on children's video game preferences. Qualitative research design using 10 focus group interviews and 5 workshops. Children's nutrition knowledge and game player type were assessed by questionnaires. South Island, New Zealand. Sixty-two primary school children, aged 7–11 years. Ten parents completed an online questionnaire. Participatory approach in designing digital nutrition education resources. A general inductive approach was used to develop the themes. The following 3 themes were identified through thematic analysis: (1) positive impacts associated with video games for nutrition education, (2) factors for engagement, and (3) barriers for sustained use. Both children and parents perceived that video games offered an avenue to increase nutrition knowledge. However, negative views such as screen time usage need to be addressed before widespread adoption. The participatory design approach provided information about game mechanics that will inspire the game design and enhance engagement of video games for nutrition education. [ABSTRACT FROM AUTHOR]

Life expectancy has increased in recent years. Physical activity has been postulated as a key element in active aging strategies. However, adherence to physical exercise programs has traditionally been low among the elderly, and the current situation of the COVID-19 pandemic has added extra impediments. Immersive virtual reality (IVR) devices could motivate this population to practice exercise. This study aimed to analyse the use of IVR exergames as a tool to facilitate physical exercise in older people. Four healthy older adults (males, 65-77 years) participated in the study. They carried out two exergaming sessions with HTC Vive ProTM. Outcomes were evaluated using the Simulator Sickness Questionnaire (SSQ), System Usability Scale (SUS), Game Experience Questionnaire (GEQ post-game module), an ad hoc satisfaction questionnaire, and perceived effort. All participants completed the sessions without adverse effects, with no SSQ symptoms reported. SUS scores were high in both sessions (SUS > 85/100). Post-game GEQ scores were 3.08-3.41/4 (positive experiences) and 0.08-0.16/4 (negative experiences). Opinions showed high levels of satisfaction with the experience. Exergaming programs, based on commercial head-mounted displays, are a feasible alternative to traditional senior exercise, and could be a solution to the current situation that has arisen from the impact of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

This paper presents an intelligent assistant for preventing the injuries during motion gaming. In our previous work, we invented UKI, a middleware that allows its users to play any existing game by using body motions. The goal of this paper is to add an intelligent module to the UKI for promoting healthy motion gameplay. According to the literature in sports science and medicine, several exercise injuries are caused by the unbalanced use of body segments and repetitive movement. To prevent such injuries, we present a module that monitors and promotes two health metrics of the player: balancedness in use of body segments and variability in body movement. The proposed module recommends motions that will improve the two health metrics during gameplay. We evaluate effectiveness of the module on 45 participants with normal health condition. Two methods for motion recommendation were compared: recommendation according to the health fitness functions (HFF) and recommendation by the random motion selection. Our results indicate significant improvement in the two health metrics when HFF is used.

Abstract Background Current World Health Organization recommendations for the management of malaria include the need for a parasitological confirmation prior to triggering appropriate treatment. The use of rapid diagnostic tests (RDTs) for malaria has contributed to a better infection recognition and a more targeted treatment. Nevertheless, low-density infections and parasites that fail to produce HRP2 can cause false-negative RDT results. Microscopy has traditionally been the methodology most commonly used to quantify malaria and characterize the infecting species, but the wider use of this technique remains challenging, as it requires trained personnel and processing capacity. Objective In this study, the feasibility of an on-line system for remote malaria species identification and differentiation has been investigated by crowdsourcing the analysis of digitalized infected thin blood smears by non-expert observers using a mobile app. Methods An on-line videogame in which players learned how to differentiate the young trophozoite stage of the five Plasmodium species has been designed. Images were digitalized with a smartphone camera adapted to the ocular of a conventional light microscope. Images from infected red blood cells were cropped and puzzled into an on-line game. During the game, players had to decide the malaria species (Plasmodium falciparum, Plasmodium malariae, Plasmodium vivax, Plasmodium ovale, Plasmodium knowlesi) of the infected cells that were shown in the screen. After 2 months, each player’s decisions were analysed individually and collectively. Results On-line volunteers playing the game made more than 500,000 assessments for species differentiation. Statistically, when the choice of several players was combined (n > 25), they were able to significantly discriminate Plasmodium species, reaching a level of accuracy of 99% for all species combinations, except for P. knowlesi (80%). Non-expert decisions on which Plasmodium species was shown in the screen were made in less than 3 s. Conclusion These findings show that it is possible to train malaria-naïve non-experts to identify and differentiate malaria species in digitalized thin blood samples. Although the accuracy of a single player is not perfect, the combination of the responses of multiple casual gamers can achieve an accuracy that is within the range of the diagnostic accuracy made by a trained microscopist.

Background: Children with cancer have difficulty identifying and describing the multiple symptoms they experience during hospitalization and between clinical encounters. Mobile health resources, including apps, are potential solutions to support child-centric symptom reporting. This study evaluated the feasibility and acceptability of a newly developed game-based symptom-reporting app for school-age children with cancer. Procedure: Nineteen school-age children (6–12 years of age) receiving treatment for cancer at a COG institution in the Intermountain West of the United States used a game-based symptom-reporting app between clinical visits. Feasibility was evaluated through a summary of actual days of app use and interaction with each of the app's features. Children and their parents participated in interviews regarding the app's acceptability. Results: Children used the app a median of 4 days (range 1–12) and interacted most frequently with the symptom reporting and the drawing features. Children enjoyed aspects of the app that supported their creativity and provided choices. Parents endorsed the interactive nature of the app and the value of the child providing his/her own report. Both children and parents identified additional opportunities to enhance the child's user experience. Conclusion: Study results support the preliminary feasibility and acceptability of the app. Children's and parents' responses supported the developmental relevance of the app and its role in enhancing the child's autonomy and serving as an outlet for creativity. Future directions include optimizing the child user's experience and investigating the app's role as a resource to enhance shared decision-making for symptom management. [ABSTRACT FROM AUTHOR]

This paper investigates the effect of reinforcement schedules on biofeedback games for stress self-regulation. In particular, it examines whether partial reinforcement can improve resistance to extinction of relaxation behaviors, i.e., once biofeedback is removed. Namely, we compare two types of reinforcement schedules (partial and continuous) in a mobile biofeedback game that encourages players to slow their breathing during gameplay. The game uses a negative-reinforcement instrumental conditioning paradigm, removing an aversive stimulus (random actions in the game) if players slows down their breathing. We conducted an experimental trial with 24 participants to compare the two reinforcement schedules against a control condition. Our results indicate that partial reinforcement improves resistance to extinction, as measured by breathing rate and skin conductance post-treatment. In addition, based on linear regression and correlation analysis we found that participants in the partial reinforcement learned to slow their breathing at the same pace as those under continuous reinforcement. The article discusses the implications of these results and directions for future work. [ABSTRACT FROM AUTHOR]

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