Search

Nondigital board games are being used to engage players and impact outcomes in health and medicine across diverse populations and contexts. This systematic review and meta-analysis describes and summarizes their impact based on randomized and nonrandomized controlled trials. An electronic search resulted in a review of n = 21 eligible studies. Sample sizes ranged from n = 17 to n = 3110 (n = 6554 total participants). A majority of the board game interventions focused on education to increase health-related knowledge and behaviors (76%, n = 16). Outcomes evaluated included self-efficacy, attitudes/beliefs, biological health indicators, social functioning, anxiety, and executive functioning, in addition to knowledge and behaviors. Using the Cochrane Collaboration tool for assessing bias, most studies (52%, n = 11) had an unclear risk of bias (33% [n = 7] had a high risk and 14% [n = 3] had a low risk). Statistical tests of publication bias were not significant. A random-effects meta-analysis showed a large average effect of board games on health-related knowledge (d* = 0.82, 95% confidence interval; CI [0.15-1.48]), a small-to-moderate effect on behaviors (d* = 0.33, 95% CI [0.16-0.51]), and a small-to-moderate effect on biological health indicators (d* = 0.37, 95% CI [0.21-0.52]). The findings contribute to the literature on games and gamified approaches in healthcare. Future research efforts should aim for more consistent high scientific standards in their evaluation protocols and reporting methodologies to provide a stronger evidence base.

BackgroundHealth professions education (HPE) is based on deliberate learning activities and clinical immersion to achieve clinical competence. Simulation is a tool that helps bridge the knowledge-to-action gap through deliberate learning. This paper considers how to optimally engage learners in simulation activities as part of HPE.MethodsThe Simnovate Engaged Learning Domain Group undertook 3 teleconferences to survey the current concepts regarding pervasive learning. Specific attention was paid to engagement in the learning process, with respect to fidelity, realism and emotions, and the use of narratives in HPE simulation.ResultsThis paper found that while many types of simulation exist, the current ways to categorise the types of simulation do not sufficiently describe what a particular simulation will entail. This paper introduces a novel framework to describe simulation by deconstructing a simulation activity into 3 core characteristics (scope, modality and environment). Then, the paper discusses how engagement is at the heart of the learning process, but remained an understudied phenomenon with respect to HPE simulation. Building on the first part, a conceptual framework for engaged learning in HPE simulation was derived, with potential use across all HPE methods.DiscussionThe framework considers how the 3 characteristics of simulation interplay with the dimensions of fidelity (physical, conceptual and emotional), and how these can be conveyed by and articulated through beauty (as a proxy for efficiency) as coexisting factors to drive learner engagement. This framework leads to the translation of deliberately taught knowledge, skills and attitudes into clinical competence and subsequent performance.

PURPOSE The aim of this systematic review was to identify health or health belief factors associated with mammography attendance or with self-initiated medical help-seeking for breast cancer symptoms among women in Europe. METHODS Five databases were searched for articles published between 2005 and 2018. Meta-analyses were conducted for 13 factors related to screening attendance and two factors associated with help-seeking behaviour. Where there were too few studies to include in the meta-analysis, a narrative synthesis was undertaken. RESULTS Sixty-five studies were included. Never having had cervical screening (d = -.72, p

OBJECTIVE: The aim of the current study was to identify which subgroups of children with Attention Deficit Hyperactivity Disorder (ADHD) benefitted the most from playing a Serious Game (SG) intervention shown in a randomized trial to improve behavioral outcomes. METHOD: Pre-intervention characteristics [i.e., gender, age, intellectual level of functioning, medication use, computer experience, ADHD subtype, severity of inattention problems, severity of hyperactivity/impulsivity problems, comorbid Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) symptoms] were explored as potential moderators in a Virtual Twins (VT) analysis to identify subgroups for whom the SG intervention was most effective. Primary outcome measures were parent-reported time management, planning/organizing and cooperation skills. RESULTS: Two subgroups were identified. Girls (n = 26) were identified as the subgroup that was most likely to show greater improvements in planning/organizing skills as compared to the estimated treatment effect of the total group of participants. Furthermore, among the boys, those (n = 47) with lower baseline levels of hyperactivity and higher levels of CD symptoms showed more improvements in their planning/organizing skills when they played the SG intervention as compared to the estimated treatment effect of the total group of participants. CONCLUSION: Using a VT analysis two subgroups of children with ADHD, girls, and boys with both higher levels of CD and lower levels of hyperactivity, were identified. These subgroups mostly benefit from playing the SG intervention developed to improve ADHD related behavioral problems. Our results imply that these subgroups have a higher chance of treatment success. ispartof: PLoS One vol:13 issue:3 pages:1-18 ispartof: location:United States status: published

Self monitoring, personal goal-setting and coaching, education and social support are strategies to help patients with chronic conditions in their daily care. Various tools have been developed, e.g., mobile digital coaching systems connected with wearable sensors, serious games and patient web portals to personal health records, that aim to support patients with chronic conditions and their caregivers in realizing the ideal of self-management. We describe a platform that integrates these tools to support young patients in diabetes self-management through educational game playing, monitoring and motivational feedback. We describe the design of the platform referring to principles from healthcare, persuasive system design and serious game design. The virtual coach is a game guide that can also provide personalized feedback about the user’s daily care related activities which have value for making progress in the game world. User evaluations with patients under pediatric supervision revealed that the use of mobile technology in combination with web-based elements is feasible but some assumptions made about how users would connect to the platform were not satisfied in reality, resulting in less than optimal user experiences. We discuss challenges with suggestions for further development of integrated pervasive coaching and gamification platforms in medical practice.

In this paper we describe a platform that integrates gaming and coaching for adolescent patients with type 1 diabetes and results from user evaluations of the platform. The purpose of the platform is to support patients in diabetes self-management through educational game playing, monitoring and motivational feedback, and to support patients' care givers. We describe the design of the platform referring to principles from health care, persuasive system design and game design. The virtual coach is a game guide that can also provide personalized feedback about the user's daily care related activities which have value for making progress in the game world. We report about user evaluations in the wild which revealed that some assumptions made about how users are connected to the platform were not satisfied in reality, resulting in less optimal user experiences. We discuss challenges with suggestions for further development of integrated pervasive coaching and gamification platforms.

Training in patient safety is imperative for front-line healthcare staff. Simulation is recommended1 but is faculty-intensive, reaches a limited number of candidates per session and delivery remains fragmented. ’Serious games,' defined as ’a mental contest played with a computer in accordance with specific rules, that uses entertainment to further training, education, health, public policy, and strategic communication objectives’,2 may have a niche role as a training resource. Despite high development costs they are potentially cost-effective in the longer term; no faculty requirement and potential to reach many learners at minimal additional cost. The immediacy of feedback promotes achievement of learning outcomes and mitigates against knowledge decay.3 The literature reports few serious games for safety training of healthcare professionals. We performed a feasibility pilot of the serious game ‘Air Medic Sky-1’ (AMS-1) in a cohort of UK medical students. AMS-1 has previously been reviewed in comparison with an e-learning patient safety module,4 where it was found to be comparable with regard to knowledge acquisition and more engaging. We aim to determine the acceptability of training with such a game. AMS-1 (Patient Safety Centre, University Medical centre, Utrecht, Netherlands), is a PC-based interactive serious game incorporating a biofeedback (BF) device (Wild Divine, San Diego, California, USA) that attaches to users' fingers to detect heart rate variability and skin conductance. The game comprises three domains …

As web-based open data sources become increasingly accessible and rich, translating and repurposing this data towards an educational goal is a topic of interest. Significant challenges exist in taking this data and translating it to a form meaningful, relevant, and engaging to the learner, addressing the gap between information, knowledge, and understanding. Games provide a key medium through which this may be achieved, though limited evidence exists as regards the best techniques, both pedagogical and technological, by which data can be translated to engaging and educational material. In this paper, we describe the approach adopted by a serious game supporting the development of healthy lifestyles amongst adolescents. The game itself places the player as a survivor in a post-apocalyptic scenario, tasked with survival and exploration. Utilising the United States Department of Agriculture's open data on nutritional information, four different mini-games are implemented in the form of two quiz-based approaches, a puzzle, and a system directly connected to wider game mechanics as a “crafting” system. We discuss the design rationale behind these games and their differences, and present the outcomes of usability testing showing some insight into the various techniques. Our discussion contributes to the theory of how common game mechanics might best be applied to open data to provide effective and engaging educational experiences.

Although a great deal of media attention has been given to the negative effects of playing video games, relatively less attention has been paid to the positive effects of engaging in this activity. Video games in health care provide ample examples of innovative ways to use existing commercial games for health improvement or surgical training. Tailor-made games help patients be more adherent to treatment regimens and train doctors how to manage patients in different clinical situations. In this review, examples in the scientific literature of commercially available and tailor-made games used for education and training with patients and medical students and doctors are summarized. There is a history of using video games with patients from the early days of gaming in the 1980s, and this has evolved into a focus on making tailor-made games for different disease groups, which have been evaluated in scientific trials more recently. Commercial video games have been of interest regarding their impact on surgical skill. More recently, some basic computer games have been developed and evaluated that train doctors in clinical skills. The studies presented in this article represent a body of work outlining positive effects of playing video games in the area of health care.

Purpose Adolescents with chronic illnesses have been shown to have management and treatment issues resulting in poor outcomes. These issues may arise from non-interest in self care and illness knowledge. A video game, “Re-Mission,” was developed to actively involve young people with cancer in their own treatment. Re-Mission provides opportunities to learn about cancer and its treatment. Method The efficacy of Re-Mission was investigated in a multi-site, randomized, controlled study with 375 adolescent and young adult cancer patients. Participants received either a regular commercial game (control) or both the regular game plus Re-Mission (Re-Mission group). Participants were given a mini-PC with the games installed and requested to play for an hour each week for 3 months. A test on cancer-related knowledge was given prior to game play (baseline) and again after 1 and 3 months. At 3 months the Re-Mission group also rated the acceptability and credibility of Re-Mission. Results Analyses of the knowledge test scores showed that whereas scores of both groups improved significantly over the follow-up periods, the scores of the Re-Mission group improved significantly more. The size of this effect was related to usage of Re-Mission. Credibility scores were negatively correlated with level of knowledge but not with change in knowledge level at 1 month or 3 months. Conclusions The results indicate a specific effect of Re-Mission play on cancer knowledge that is not attributable to patients' expectations. It is concluded that video games can be an effective vehicle for health education in adolescents and young adults with chronic illnesses.

The field of games for health is growing rapidly, but many games for health are not validated for their use as a tool to improve outcomes. The few research studies that do exist are often poorly designed, and their conclusions cannot be considered valid evidence to support or refute efficacy. Based on lessons learned from the field of digital game-based learning in education and recent efforts to systematically review games for health in meta-analyses, guidelines are suggested for conducting high-quality efficacy studies on games for health.

Game mechanics have been identified as "methods invoked by agents for interacting with the game world."(1) They are elements of game play that provide a primary source of interactivity and structure how videogames proceed. Many kinds of game mechanics have been generated. Some provide fun or enjoyment, others may provide excitement or even suspense (i.e., emotional aspects of game play), whereas some are guided by principles of behavior change theory. Game mechanics that succeed in off-the-shelf entertainment videogames, however, may not work in serious games, such as games for health (G4H). Although game mechanics are key to a serious videogame's success, maintaining a balance between the serious intent of the game while keeping it fun, there has been little attention to game mechanics in the academic G4H literature. Several eminent games for health developers (academics and nonacademics) were asked to share their experiences in regard to game mechanics in the serious videogames they have developed.

There has been increasing focus on serious games for health; however, there is very little evidence for the effectiveness of these games and the existing research often lacks scientific rigor. The aim of this chapter is to demystify the process of collaborating with researchers and outline how a researcher can contribute to making more effective games and start the process of evaluating it scientifically. Researchers should be engaged BEFORE serious games for health are developed in order to place serious games for health in the best position to have a measurable impact on health outcomes. The chapter covers issues of working with researchers to agree on problems to address, applying behavioral and learning theories to solve them, and finding optimal research designs to validate the serious game. Issues of safety and ethics in health research are also given considerable attention.

Objective To review empirical studies of psychological interventions for pain and adherence outcomes among patients with sickle cell disease. Method We conducted a literature review of studies using psychological interventions targeted at pain and/or adherence behaviors related to sickle cell disease. The American Psychological Association Division 12 Task Force criteria (Chambless criteria) were used to evaluate the empirical support for three categories of interventions (cognitive-behavioral techniques, interventions aimed at behavioral change, and social support interventions). Results A small number of intervention studies met criteria for demonstrating empirical efficacy. As a group, cognitive-behavioral techniques fall into the category of probably efficacious for sickle cell pain. Other intervention types were limited by inadequate research methodologies. Conclusions Future studies will need to more stringently test outcomes related to acute crises (e.g., pain episodes) as well as day-to-day management of sickle cell disease to clarify the most efficacious intervention approaches. Implications and suggestions for future research directions are discussed.

In Part I of this paper, we described a model that was used as a framework for reviewing studies of psychoeducational interventions intended to influence illness- and treatment-related behaviors and attitudes in pediatric cancer patients. In Part II, we distinguish between interventions that attempt to influence patients' behaviors just by providing information and interventions that specifically teach skills related to the behaviors they are trying to change. Many types of psychoeducational interventions appear to be effective and those that are training-based generally appear more effective than those that are information-based. Training-based interventions may face a barrier to wide adoption because they are resource-costly, but the development of digital-based training interventions may potentially overcome this barrier.

We present a systematic review of published research on psychoeducational interventions for children with cancer. The current lack of an organizational model for this literature makes it difficult to form a coherent picture of the scattered literature and draw nomothetic conclusions. A model is described that is based on functional concepts from the literature on learning and instructional design. It is argued that it makes sense conceptually to analyze psychoeducational interventions in terms of psychoeducational principles, especially if the purpose is to illuminate the learning processes involved. Three categories of intervention are distinguished and the first of these, informational interventions to influence patient knowledge, is considered in this paper, and the other two categories will be reviewed in a subsequent paper. This review is organized by categories of information needs, intervention modes, and major types of independent variables. We concluded that the research supports few generalizable conclusions at this time, except that development of health-related knowledge in children is best accomplished by information transfer methods that are highly interactive and individualized. Interactive multimedia formats such as video games are seen as having the best potential, but further research is required.

Our study evaluates the moral reasoning skills of healthy and chronically ill 3 and 4 year olds with respect to illness and treatment, by use of an interview technique that reduces verbal demands on the child. We presented children with pairs of scenarios comparing ill characters with characters acting immorally and characters being punished, as well as with pairs of scenarios comparing treated characters with characters acting immorally and characters being punished. We asked children to point to the character who did something "naughty." With the exception of the chronically ill 3 year olds, the children performed consistently above chance and did not confuse illness and immorality. Older and healthy children performed better than younger and chronically ill ones (differences were the result of differing receptive vocabulary skill levels). This research has implications for evaluating young children's reasoning abilities and suggests that medical professionals should use tools that reduce demands on children's verbal proficiency.

The impact of psychosocial factors on the incidence and progression of cancer has become an area that demands attention. In this article recent evidence of psychosocial effects on cancer incidence and progression is reviewed in the context of past research. Psychosocial factors discussed include personality, depression, emotional expression, social support, and stress. Mechanisms that could mediate the relationship between psychosocial conditions and cancer incidence and progression are also reviewed. These include alterations in diet, exercise, and circadian cycles; variations in medical treatment received; and physiological mechanisms such as psychoendocrinologic and psychoneuroimmunologic effects. We conclude that there is a nonrandom relationship among various psychosocial factors and cancer incidence and progression that can only partially be explained by behavioral, structural, or biological factors. Suggestions for future research are discussed.

This prospective study investigated predictors of repeat pregnancies by 12 months after the delivery of a first child and their outcomes in inner-city adolescent mothers. The sample included four groups: those who had therapeutic abortions, miscarriages, full-term deliveries, and no repeat pregnancy. The therapeutic abortion group had more pregnancies before their first delivery (41%) than did full term (20%) and no repeat (15%), p less than .01. More delayed grade placement was found in therapeutic abortion -1.6 years (1.3) and full term -1.8 years (.9) than in no repeat pregnancy -.6 years (1.1), p less .001. Reading achievement scores were higher in no repeat 86.3 (17.1) than in full term 75.0 (16.5), p less than .05. School attendance was higher in no repeat (65%) than in therapeutic abortion (35%) and full-term (24%) p less than .01 groups. Depressive symptoms at baseline were higher among therapeutic aborters 18.9 (9.9) than among full term 10.2 (8.2) and no repeat pregnancy groups 12.2 (6.2). Logistic regression analyses identified delayed grade placement as the most important predictor of pregnancy outcome.The purpose of this prospective study of 120 black and Puerto Rican adolescent mothers recruited from an urban adolescent health center was 1) to identify multiple predictors of repeat pregnancies and their outcomes, and 2) to assess the relative contribution of these predictors to repeat pregnancies. Variables include demographic factors, frequency of sexual activity, contraceptive method used, occurrence of pregnancies before the first delivery, educational attainment, and levels of depressive symptoms by 3 weeks postpartum. Pregnancy outcomes included mothers who terminated their pregnancy, who delivered a live birth, and who had a miscarriage; data were available 12 months postpartum. The mean age was 17.13 years. 52% were black and 44% were Puerto Rican and of low socioeconomic status. Reliability of self-reports was 95%. 60.3% had no repeat pregnancy and 39.6% became pregnant during the 1-year followup, of which 15.3% had a therapeutic abortion, 6.3% miscarried, and 18.1% carried to term. There were no significant differences in the characteristics of the repeat and nonrepeat pregnancy groups. The procedure involved interviews at 2-4 weeks (time 1), 6-7 months (time 2), and 12-13 months (time 3). Measures for delayed grade placement, reading achievement, career aspirations and socioeconomic status of the family, and school attendance are described. Multivariate analysis, univariate analyses, and Duncan multiple range tests were conducted as well as logistic regression model construction. The significant predictors of pregnancy outcome (repeat pregnancy) were having 2 or more previous pregnancies. The abortion group was twice as likely to have had a pregnancy before the birth of the first child (41%) than the full-term (20%) and the no-repeat groups (15%). There were no differences in frequency of sexual activity or contraceptive method used. In the no-repeat and miscarriage groups, grade placement was less delayed. In the no-repeat group, reading achievement scores were higher than in the full-term group. There were no differences in career aspirations. 65% of the no-repeat group were attending school at time 2 while only 35% of the therapeutic and 24% of the full-term groups were attending school. Depressive scores were significantly higher for the abortion group. Delayed grade placement was the only predictor independently associated with the increased log odds of repeat pregnancy.

With 120 inner-city, Black and Hispanic adolescent mothers, we investigated demographic, academic, and psychosocial predictors (assessed at 3 weeks postpartum) of their delayed grade placement by 12 months postpartum. Mothers were also classified based on school attendance before pregnancy and up to 12 months postpartum, as continuous attenders, returners, before-pregnancy dropouts, and after-pregnancy dropouts. Differences in subgroup profiles were assessed. Continuous attenders were least delayed in grade placement and few had repeat pregnancies (18%). In contrast, before-pregnancy dropouts were on the average 2.4 years behind in their grade placement, reported highest levels of depressive symptoms, and 69% had repeat pregnancies. Returners and after-pregnancy dropouts were more delayed in grade placement, and more had repeat pregnancies than attenders (32% and 63%, respectively), but they reported similar levels of depressive symptoms. Groups did not differ on measures of stressful life events and soci...

OBJECTIVE. Suboptimal adherence to self-administered medications is a common problem. The purpose of this study was to determine the effectiveness of a video-game intervention for improving adherence and other behavioral outcomes for adolescents and young adults with malignancies including acute leukemia, lymphoma, and soft-tissue sarcoma. METHODS. A randomized trial with baseline and 1- and 3-month assessments was conducted from 2004 to 2005 at 34 medical centers in the United States, Canada, and Australia. A total of 375 male and female patients who were 13 to 29 years old, had an initial or relapse diagnosis of a malignancy, and currently undergoing treatment and expected to continue treatment for at least 4 months from baseline assessment were randomly assigned to the intervention or control group. The intervention was a video game that addressed issues of cancer treatment and care for teenagers and young adults. Outcome measures included adherence, self-efficacy, knowledge, control, stress, and quality of life. For patients who were prescribed prophylactic antibiotics, adherence to trimethoprim-sulfamethoxazole was tracked by electronic pill-monitoring devices (n = 200). Adherence to 6-mercaptopurine was assessed through serum metabolite assays (n = 54). RESULTS. Adherence to trimethoprim-sulfamethoxazole and 6-mercaptopurine was greater in the intervention group. Self-efficacy and knowledge also increased in the intervention group compared with the control group. The intervention did not affect self-report measures of adherence, stress, control, or quality of life. CONCLUSIONS. The video-game intervention significantly improved treatment adherence and indicators of cancer-related self-efficacy and knowledge in adolescents and young adults who were undergoing cancer therapy. The findings support current efforts to develop effective video-game interventions for education and training in health care.

The use of ethnicity as a grouping variable in health research is disturbing to scientists. It is poorly defined, is not objectively measured, and cannot be studied in a true experiment. Thus, scientific conclusions about the causal relationship between ethnicity and health are difficult to make. To a large extent, ethnic categories are problematic because they are socioculturally constructed categories. Depending on the culture, definitions and criteria for ethnic categories vary. Even within cultures, such as the United States, criteria for membership differs from one context to another. However, ethnicity as a grouping variable should not be discarded because it is not scientific. It deserves careful study because it is associated with important health outcomes. It is well known that ethnic groups differ dramatically on many measures of health outcomes (e.g., U.S. Department of Health and Human Services, 1985).

As medicine and psychology join forces in the rapidly growing field of health psychology, the opportunity arises for each to benefit from the other. Research in medicine has typically focused on white males in their 30s, while research in psychology has focused on upper-middle-class college sophomores. Both approaches tend to neglect issues of populations that differ from these norms by age, gender, sexual orientation, or ethnicity in the United States. The aim of this book is to bring together the work of physicians, nurses, epidemiologists, sociologists, social workers, and psychologists who specialize in these populations so that we can learn how to approach these issues in research and clinical practice.

The management of pain in children has lagged far behind advances in other areas of medical achievement. In 1968, physicians Swafford and Allen stated, “Pediatric patients seldom need relief of pain after general surgery. They tolerate discomfort well” (p. 133) and reported that during a 4-month period, 96% of the postoperative pediatric patients in their intensive care unit did not receive any analgesics for pain. As recently as the 1980s and 1990s, many infants and children were not receiving any analgesia during and after major surgery (Anand, Brown, Bloom, & Aynsley-Green, 1985). Indeed, postoperative children and those with disease-related pain frequently received no analgesic medication at all (Gauntlet, 1987). When compared with adults undergoing similar surgeries, infants and children received fewer doses and smaller amounts of analgesic medication per kilogram of body weight (Beyer, Ashley, Russell, & DeGood, 1983; Eland & Anderson, 1977; Schechter, Allen, & Hansen, 1986). The undertreatment of children’s pain is still routine and is striking considering pervasive evidence of children’s experience of physiological, behavioral, and emotional effects of pain.

This study explored whether an action video game about cancer would be acceptable to adolescent and young adult cancer patients as a tool for learning about cancer and self-care during treatment. Interviews about a proposed video game were conducted with 43 young cancer patients, who also completed questionnaires measuring personality and adaptive style. Data were analyzed to assess the overall acceptability of the proposed video game and to reveal any factors associated with measures of acceptability. Most participants expressed willingness to play the game and a moderate degree of interest in it. Cancer content in the game was not a deterrent for most participants. Game acceptability was not affected by personality variables or adaptive style. It is concluded that an action video game using cancer themes could be useful to nurses as a tool to improve understanding and self care of adolescent and young adult cancer patients.

This article reports a survey of the current practices of pediatric oncology nurses in advising patients and families about symptom reporting and self-care interventions. A questionnaire was mailed to 1,000 pediatric oncology nurses requesting information about age, years of experience in nursing and pediatric oncology nursing, current work setting, and professional position. Recipients were asked about their practices for advising patients and their families about self-care measures and reporting of adverse symptoms. Analysis of 135 valid responses showed evidence of both consensus and variability in nursing practice, with variability being partly attributable to differences in nurses’ work settings (inpatient vs. outpatient) and differences in experience level. There was good consensus on nurses’ recommending of several self-care interventions for eight common adverse symptoms and for advice that patients should promptly report to health providers certain symptoms or events.

In contrast to the extensive research on the information needs of older patients with cancer, the question of what information is most relevant for adolescents seems to have been addressed in only one published study. The aim of the present study was to update and extend the sole previous survey of oncology professionals’ views about the information needs of adolescent patients. This was achieved by including professionals other than physicians, by structuring the questionnaire to show whether perceived information needs were different for the time of diagnosis versus during treatment, and by differentiating between the 6 cancer diagnoses most commonly affecting adolescents. Fifteen hundred surveys were distributed to pediatric cancer professionals, and 556 valid returns were analyzed. The main finding was that information was considered more important to provide during treatment than at the time of diagnosis. Also, medical information topics were generally considered more essential than psychological topics. The magnitude of this difference was influenced to a small extent by professional discipline, gender, age and experience of respondent, and whether the information was being given at diagnosis or during treatment. It is notable that whereas respondents generally were confident in their ability to communicate information, physicians rated themselves as better communicators at the time of diagnosis than during treatment.

The diagnosis and treatment of pediatric cancer can be associated with profound psychosocial changes in the life of young patients. Although nurses, physicians, and other health care professionals are important sources of support, psychosocial support is also available through parents, schools, and peers. This article presents a review of the literature on how parents, schools, and peers affect the coping and adjustment of young patients with cancer and critically reviews interventions directed at improving functioning in these areas. Special attention is paid to recent interventions that exploit technology such as video games, CD-ROMs, and the Internet to provide creative new forms of support for patients in pediatric oncology. Existing research on both technological and interpersonal forms of intervention and support shows promising results, and suggestions for further study are provided.

This study examines the manifestation of attention-deficit hyperactivity disorder (ADHD) among females of varying ages by testing the utility of particular tests to discriminate older from younger females with ADHD. A retrospective clinical chart review was conducted at a community outpatient mental health center for 75 girls from 4 to 19 years of age with a diagnosis of ADHD or subthreshold symptoms of ADHD. Signal detection methods were used to identify which variables best differentiate older (mean age = 12.06, SD = 2.61) from younger (mean age = 7.11, SD = 1.08) girls with ADHD. Girls with comorbid diagnoses of a depressive disorder and higher verbal IQ scores were more likely to be older. Overall, the findings suggest that approaches to diagnosing ADHD among females may need to be modified to include appropriate age-based criteria.

Several interventions have been implemented to address the adverse psychological and physical consequences associated with bereavement. In this review, we summarize four major theories of bereavement, present a qualitative review of bereavement intervention studies, and assess the overall effectiveness of bereavement intervention studies in a quantitative meta-analysis. Summaries of the theories are drawn from published theoretical works. The qualitative and quantitative reviews were based on searches of Medline, PsychINFO, and Dissertation Abstracts International databases using the keywords "bereaved" and "bereavement." Overall, the interventions were largely methodologically flawed, rarely specified what theory of bereavement they were testing, and slowed surprisingly weak effect sizes. Possible interpretations for the small effect sizes are discussed, and future directions are outlined.

In this study, we examined why and how preschoolers are able to reason about the moral aspects of illness and treatment with a simple interview that was designed to be sensitive to the abilities of this age group. A total of ninety-six 3- and 4-year-olds were asked to make moral judgments about illness and treatment. The results show that most preschoolers do not associate illness or treatment with wrongdoing. In Experiment 1, an overwhelmingly large proportion of participants distinguished between story children who were sick and story children who committed prudential violations (misbehaviors that harmed the self) by correctly identifying the latter characters as having done something "bad." In Experiment 2, a significant proportion of participants stated that story children who were sick or treated were not "bad," although they tended to make more harsh judgments about treated than ill children. The findings are discussed in terms of their theoretical and clinical significance in health care settings.