JMIR Publications

JMIR Serious Games

A multidisciplinary journal on gaming and gamification for health education/promotion, teaching and social change.


Journal Description

JMIR Serious Games (JSG, ISSN 2291-9279) is a sister journal of the Journal of Medical Internet Research (JMIR), one of the most cited journals in health informatics (Impact Factor 2015: 4.532). JSG is a multidisciplinary journal devoted to computer/web/mobile applications that incorporate elements of gaming to solve serious problems such as health education/promotion, teaching and education, or social change.
The journal also considers commentary and research in the fields of video games violence and video games addiction.

JMIR Serious Games is indexed in Pubmed, PubMed Central, and also in Thomson Reuters new Emerging Sources Citation Index (ESCI) and has a projected impact factor (2015): 1.8.


Recent Articles:

  • Quit Genius App. Image sourced and copyright owned by authors.

    Game On? Smoking Cessation Through the Gamification of mHealth: A Longitudinal Qualitative Study


    Background: Finding ways to increase and sustain engagement with mHealth interventions has become a challenge during application development. While gamification shows promise and has proven effective in many fields, critical questions remain concerning how to use gamification to modify health behavior. Objective: The objective of this study is to investigate how the gamification of mHealth interventions leads to a change in health behavior, specifically with respect to smoking cessation. Methods: We conducted a qualitative longitudinal study using a sample of 16 smokers divided into 2 cohorts (one used a gamified intervention and the other used a nongamified intervention). Each participant underwent 4 semistructured interviews over a period of 5 weeks. Semistructured interviews were also conducted with 4 experts in gamification, mHealth, and smoking cessation. Interviews were transcribed verbatim and thematic analysis undertaken. Results: Results indicated perceived behavioral control and intrinsic motivation acted as positive drivers to game engagement and consequently positive health behavior. Importantly, external social influences exerted a negative effect. We identified 3 critical factors, whose presence was necessary for game engagement: purpose (explicit purpose known by the user), user alignment (congruency of game and user objectives), and functional utility (a well-designed game). We summarize these findings in a framework to guide the future development of gamified mHealth interventions. Conclusions: Gamification holds the potential for a low-cost, highly effective mHealth solution that may replace or supplement the behavioral support component found in current smoking cessation programs. The framework reported here has been built on evidence specific to smoking cessation, however it can be adapted to health interventions in other disease categories. Future research is required to evaluate the generalizability and effectiveness of the framework, directly against current behavioral support therapy interventions in smoking cessation and beyond.

  • A typical usability testing session involving participant, equipment and gesture-based game. Image taken and copyright owned by authors.

    Usability Evaluation Methods for Gesture-Based Games: A Systematic Review


    Background: Gestural interaction systems are increasingly being used, mainly in games, expanding the idea of entertainment and providing experiences with the purpose of promoting better physical and/or mental health. Therefore, it is necessary to establish mechanisms for evaluating the usability of these interfaces, which make gestures the basis of interaction, to achieve a balance between functionality and ease of use. Objective: This study aims to present the results of a systematic review focused on usability evaluation methods for gesture-based games, considering devices with motion-sensing capability. We considered the usability methods used, the common interface issues, and the strategies adopted to build good gesture-based games. Methods: The research was centered on four electronic databases: IEEE, Association for Computing Machinery (ACM), Springer, and Science Direct from September 4 to 21, 2015. Within 1427 studies evaluated, 10 matched the eligibility criteria. As a requirement, we considered studies about gesture-based games, Kinect and/or Wii as devices, and the use of a usability method to evaluate the user interface. Results: In the 10 studies found, there was no standardization in the methods because they considered diverse analysis variables. Heterogeneously, authors used different instruments to evaluate gesture-based interfaces and no default approach was proposed. Questionnaires were the most used instruments (70%, 7/10), followed by interviews (30%, 3/10), and observation and video recording (20%, 2/10). Moreover, 60% (6/10) of the studies used gesture-based serious games to evaluate the performance of elderly participants in rehabilitation tasks. This highlights the need for creating an evaluation protocol for older adults to provide a user-friendly interface according to the user’s age and limitations. Conclusions: Through this study, we conclude this field is in need of a usability evaluation method for serious games, especially games for older adults, and that the definition of a methodology and a test protocol may offer the user more comfort, welfare, and confidence.

  • A study on the validity of an interactive computer game to assess cognitive processes, reward mechanisms, and time perception in children aged 4-8 years. Image sourced and copyright owned by Peijnenborgh et al.

    A Study on the Validity of a Computer-Based Game to Assess Cognitive Processes, Reward Mechanisms, and Time Perception in Children Aged 4-8 Years


    Background: A computer-based game, named Timo’s Adventure, was developed to assess specific cognitive functions (eg, attention, planning, and working memory), time perception, and reward mechanisms in young school-aged children. The game consists of 6 mini-games embedded in a story line and includes fantasy elements to enhance motivation. Objective: The aim of this study was to investigate the validity of Timo’s Adventure in normally developing children and in children with attention-deficit/hyperactivity disorder (ADHD). Methods: A total of 96 normally developing children aged 4-8 years and 40 children with ADHD were assessed using the game. Clinical validity was investigated by examining the effects of age on performances within the normally developing children, as well as performance differences between the healthy controls and the ADHD group. Results: Our analyses in the normally developing children showed developmental effects; that is, older children made fewer inhibition mistakes (r=−.33, P=.001), had faster (and therefore better) reaction times (r=−.49, P<.001), and were able to produce time intervals more accurately than younger children (ρ=.35, P<.001). Discriminant analysis showed that Timo’s Adventure was accurate in most classifications whether a child belonged to the ADHD group or the normally developing group: 78% (76/97) of the children were correctly classified as having ADHD or as being in the normally developing group. The classification results showed that 72% (41/57) children in the control group were correctly classified, and 88% (35/40) of the children in the ADHD group were correctly classified as having ADHD. Sensitivity (0.89) and specificity (0.69) of Timo’s Adventure were satisfying. Conclusions: Computer-based games seem to be a valid tool to assess specific strengths and weaknesses in young children with ADHD.

  • Participant playing Virtual Dodgeball with HMD. Image sourced and copyright owned by authors Thomas et al.

    Effects of Visual Display on Joint Excursions Used to Play Virtual Dodgeball


    Background: Virtual reality (VR) interventions hold great potential for rehabilitation as commercial systems are becoming more affordable and can be easily applied to both clinical and home settings. Objective: In this study, we sought to determine how differences in the VR display type can influence motor behavior, cognitive load, and participant engagement. Methods: Movement patterns of 17 healthy young adults (8 female, 9 male) were examined during games of Virtual Dodgeball presented on a three-dimensional television (3DTV) and a head-mounted display (HMD). The participant’s avatar was presented from a third-person perspective on a 3DTV and from a first-person perspective on an HMD. Results: Examination of motor behavior revealed significantly greater excursions of the knee (P=.003), hip (P<.001), spine (P<.001), shoulder (P=.001), and elbow (P=.026) during HMD versus 3DTV gameplay, resulting in significant differences in forward (P=.003) and downward (P<.001) displacement of the whole-body center of mass. Analyses of cognitive load and engagement revealed that relative to 3DTV, participants indicated that HMD gameplay resulted in greater satisfaction with overall performance and was less frustrating (P<.001). There were no significant differences noted for mental demand. Conclusions: Differences in visual display type and participant perspective influence how participants perform in Virtual Dodgeball. Because VR use within rehabilitation settings is often designed to help restore movement following orthopedic or neurologic injury, these findings provide an important caveat regarding the need to consider the potential influence of presentation format and perspective on motor behavior.

  • Blood glucose monitor. Image source: License: public domain (CC0).

    Gamifying Self-Management of Chronic Illnesses: A Mixed-Methods Study


    Background: Self-management of chronic illnesses is an ongoing issue in health care research. Gamification is a concept that arose in the field of computer science and has been borrowed by many other disciplines. It is perceived by many that gamification can improve the self-management experience of people with chronic illnesses. This paper discusses the validation of a framework (called The Wheel of Sukr) that was introduced to achieve this goal. Objective: This research aims to (1) discuss a gamification framework targeting the self-management of chronic illnesses and (2) validate the framework by diabetic patients, medical professionals, and game experts. Methods: A mixed-method approach was used to validate the framework. Expert interviews (N=8) were conducted in order to validate the themes of the framework. Additionally, diabetic participants completed a questionnaire (N=42) in order to measure their attitudes toward the themes of the framework. Results: The results provide a validation of the framework. This indicates that gamification might improve the self-management of chronic illnesses, such as diabetes. Namely, the eight themes in the Wheel of Sukr (fun, esteem, socializing, self-management, self-representation, motivation, growth, sustainability) were perceived positively by 71% (30/42) of the participants with P value <.001. Conclusions: In this research, both the interviews and the questionnaire yielded positive results that validate the framework (The Wheel of Sukr). Generally, this study indicates an overall acceptance of the notion of gamification in the self-management of diabetes.

  • Screenshot of the layout and design of Re-Mission. Image sourced by authors and copyright held by Robin Raskob, HopeLab.

    A Video Game Promoting Cancer Risk Perception and Information Seeking Behavior Among Young-Adult College Students: A Randomized Controlled Trial


    Background: Risky behaviors tend to increase drastically during the transition into young adulthood. This increase may ultimately facilitate the initiation of carcinogenic processes at a young age, highlighting a serious public health problem. By promoting information seeking behavior (ISB), young adults may become aware of cancer risks and potentially take preventive measures. Objective: Based on the protection motivation theory, the current study seeks to evaluate the impact of challenge in a fully automated video game called Re-Mission on young adult college students' tendency to perceive the severity of cancer, feel susceptible to cancer, and engage in ISB. Methods: A total of 216 young adults were recruited from a university campus, consented, screened, and randomized in a single-blinded format to 1 of 3 conditions: an intervention group playing Re-Mission at high challenge (HC; n=85), an intervention group playing Re-Mission at low challenge (LC; n=81), and a control group with no challenge (NC; presented with illustrated pictures of Re-Mission; n=50). Measurement was conducted at baseline, immediate posttest, 10-day follow-up, and 20-day follow-up. Repeated-measures mixed-effect models were conducted for data analysis of the main outcomes. Results: A total of 101 young adults continued until 20-day follow-up. Mixed-effect models showed that participants in the HC and LC groups were more likely to increase in perceived susceptibility to cancer (P=.03), perceived severity of cancer (P=.02), and ISB (P=.01) than participants in the NC group. The LC group took until 10-day follow-up to show increase in perceived susceptibility (B=0.47, standard error (SE) 0.16, P=.005). The HC group showed an immediate increase in perceived susceptibility at posttest (B=0.43, SE 0.14, P=.002). The LC group exhibited no changes in perceived severity (B=0.40, SE 0.33, P=.24). On the other hand, the HC group showed a significant increase from baseline to posttest (B=0.39, SE 0.14, P=.005), maintaining this increase until 20-day follow-up (B=−0.007, SE 0.26, P=.98). Further analyses indicated that perceived threat from virtual cancer cells in the game is related to the increase in perceived severity (B=0.1, SE 0.03, P=.001), and perceived susceptibility is related to changes in ISB at 10-day follow-up (B=0.21, SE 0.08, P=.008). Conclusions: The feature of challenge with cancer cells in a virtual environment has the potential to increase cancer risk perception and ISB. The results are promising considering that the Re-Mission intervention was neither designed for cancer risk communication, nor applied among healthy individuals. Further research is needed to understand the theoretical framework underlying the effects of Re-Mission on ISB. The findings call for the development of a Web-based, game-based intervention for cancer risk communication and information seeking among young adults. ClinicalTrial: International Standard Randomized Controlled Trial Number (ISRCTN): 15789289; (Archived by WebCite at

  • Physiomat® including a three-dimensional moveable plate with integrated sensors for displacement measurement. It is connected with a computer and a monitor. Grab rails on each side ensure stability of the patients during training and assessment.

    Validation of a Computerized, Game-based Assessment Strategy to Measure Training Effects on Motor-Cognitive Functions in People With Dementia


    Background: Exergames often used for training purpose can also be applied to create assessments based on quantitative data derived from the game. A number of studies relate to these use functionalities developing specific assessment tasks by using the game software and provided good data on psychometric properties. However, (1) assessments often include tasks other than the original game task used for training and therefore relate to similar but not to identical or integrated performances trained, (2) people with diagnosed dementia have insufficiently been addressed in validation studies, and (3) studies did commonly not present validation data such as sensitivity to change, although this is a paramount objective for validation to evaluate responsiveness in intervention studies. Objective: Specific assessment parameters have been developed using quantitative data directly derived from the data stream during the game task of a training device (Physiomat). The aim of this study was to present data on construct validity, test–retest reliability, sensitivity to change, and feasibility of this internal assessment approach, which allows the quantification of Physiomat training effects on motor-cognitive functions in 105 multimorbid patients with mild-to-moderate dementia (mean age 82.7±5.9). Methods: Physiomat assessment includes various tasks at different complexity levels demanding balance and cognitive abilities. For construct validity, motor-cognitive Physiomat assessment tasks were compared with established motor and cognitive tests using Spearman’s rank correlations (rs). For test–retest reliability, we used intra-class correlations (ICC3,1) and focused on all Physiomat tasks. Sensitivity to change of trained Physiomat tasks was tested using Wilcoxon statistic and standardized response means (SRMs). Completion rate and time were calculated for feasibility. Results: Analyses have mostly shown moderate-to-high correlations between established motor as well as cognitive tests and simple (rs=−.22 to .68, P ≤.001-.03), moderate (rs=−.33 to .71, P ≤.001-.004), and complex motor-cognitive Physiomat tasks (rs=−.22 to .83, P ≤.001-.30) indicating a good construct validity. Moderate-to-high correlations between test and retest assessments were found for simple, moderate, and complex motor-cognitive tasks (ICC=.47-.83, P ≤.001) indicating good test–retest reliability. Sensitivity to change was good to excellent for Physiomat assessment as it reproduced significant improvements (P ≤.001) with mostly moderate-to-large effect sizes (SRM=0.5-2.0) regarding all trained tasks. Completion time averaged 25.8 minutes. Completion rate was high for initial Physiomat measures. No adverse events occurred during assessment. Conclusions: Overall, Physiomat proved to have good psychometric qualities in people with mild-to-moderate dementia representing a reliable, valid, responsive, and feasible assessment strategy for multimorbid older adults with or without cognitive impairment, which relates to identical and integrated performances trained by using the game.

  • Compilation of screenshots of tasks reviewed in the paper, copyright the authors, licensed under cc-by. Screenshots used under fair use/ fair dealings.

    Gamification of Cognitive Assessment and Cognitive Training: A Systematic Review of Applications and Efficacy


    Background: Cognitive tasks are typically viewed as effortful, frustrating, and repetitive, which often leads to participant disengagement. This, in turn, may negatively impact data quality and/or reduce intervention effects. However, gamification may provide a possible solution. If game design features can be incorporated into cognitive tasks without undermining their scientific value, then data quality, intervention effects, and participant engagement may be improved. Objectives: This systematic review aims to explore and evaluate the ways in which gamification has already been used for cognitive training and assessment purposes. We hope to answer 3 questions: (1) Why have researchers opted to use gamification? (2) What domains has gamification been applied in? (3) How successful has gamification been in cognitive research thus far? Methods: We systematically searched several Web-based databases, searching the titles, abstracts, and keywords of database entries using the search strategy (gamif* OR game OR games) AND (cognit* OR engag* OR behavi* OR health* OR attention OR motiv*). Searches included papers published in English between January 2007 and October 2015. Results: Our review identified 33 relevant studies, covering 31 gamified cognitive tasks used across a range of disorders and cognitive domains. We identified 7 reasons for researchers opting to gamify their cognitive training and testing. We found that working memory and general executive functions were common targets for both gamified assessment and training. Gamified tests were typically validated successfully, although mixed-domain measurement was a problem. Gamified training appears to be highly engaging and does boost participant motivation, but mixed effects of gamification on task performance were reported. Conclusions: Heterogeneous study designs and typically small sample sizes highlight the need for further research in both gamified training and testing. Nevertheless, careful application of gamification can provide a way to develop engaging and yet scientifically valid cognitive assessments, and it is likely worthwhile to continue to develop gamified cognitive tasks in the future.

  • NOGO app screenshot. Image owned and permission granted by NeuroCog Solutions Pty Ltd, the developer of the NOGO app.

    A Serious Game to Increase Healthy Food Consumption in Overweight or Obese Adults: Randomized Controlled Trial


    Background: Obesity is a growing global issue that is linked to cognitive and psychological deficits. Objective: This preliminary study investigated the efficacy of training to improve inhibitory control (IC), a process linked to overeating, on consumption and cognitive control factors. Methods: This study utilized a multisession mobile phone–based intervention to train IC in an overweight and obese population using a randomized waitlist-control design. A combination of self-assessment questionnaires and psychophysiological measures was used to assess the efficacy of the intervention in terms of improved general IC and modified food consumption after training. Attitudes toward food were also assessed to determine their mediating role in food choices. A total of 58 participants (47 female) completed 2 assessment sessions 3 weeks apart, with 2 weeks of intervention training for the training group during this time. The groups did not differ in baseline demographics including age, body mass index, and inhibitory control. Results: Inhibitory control ability improved across the training sessions, with increases in P3 amplitude implying increased cognitive control over responses. Inhibitory control training was associated with increased healthy and reduced unhealthy food consumption in a taste test and in the week following training, as measured by the Healthy Eating Quiz and the food consumption test. Cognitive restraint was enhanced after training for the training but not the waitlist condition in the Three-Factor Eating Questionnaire, implying that attempts to avoid unhealthy foods in the future will be easier for the training group participants. Conclusions: Inhibitory control training delivered via a purpose-designed mobile phone app is easy to complete, is convenient, and can increase cognitive restraint and reduce unhealthy food consumption. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000263493; (Archived by WebCite at

  • SpaPlay. Source and copyright: the authors.

    Effects of Playing a Serious Computer Game on Body Mass Index and Nutrition Knowledge in Women


    Background: Obesity and weight gain is a critical public health concern. Serious digital games are gaining popularity in the context of health interventions. They use persuasive and fun design features to engage users in health-related behaviors in a non-game context. As a young field, research about effectiveness and acceptability of such games for weight loss is sparse. Objective: The goal of this study was to evaluate real-world play patterns of SpaPlay and its impact on body mass index (BMI) and nutritional knowledge. SpaPlay is a computer game designed to help women adopt healthier dietary and exercise behaviors, developed based on Self-Determination theory and the Player Experience of Need Satisfaction (PENS) model. Progress in the game is tied to real-life activities (e.g., eating a healthy snack, taking a flight of stairs). Methods: We recruited 47 women to partake in a within-subject 90-day longitudinal study, with assessments taken at baseline, 1-, 2-, and 3- months. Women were on average, 29.8 years old (±7.3), highly educated (80.9% had BA or higher), 39% non-White, baseline BMI 26.98 (±5.6), who reported at least contemplating making changes in their diet and exercise routine based on the Stages of Change Model. We computed 9 indices from game utilization data to evaluate game play. We used general linear models to examine inter-individual differences between levels of play, and multilevel models to assess temporal changes in BMI and nutritional knowledge. Results: Patterns of game play were mixed. Participants who reported being in the preparation or action stages of behavior change exhibited more days of play and more play regularity compared to those who were in the contemplation stage. Additionally, women who reported playing video games 1-2 hours per session demonstrated more sparse game play. Brief activities, such as one-time actions related to physical activity or healthy food, were preferred over activities that require a longer commitment (e.g., taking stairs every day for a week). BMI decreased significantly (P<.001) from baseline to 3-month follow-up, yielding a large effect size of 1.28. Nutritional knowledge increased significantly (P<.001) from first to third month follow-ups, with an effect size of .86. The degree of change in both outcomes was related to game play, baseline readiness to change, and the extent of video game play in general. Conclusions: This work demonstrates initial evidence of success for using a serious game as an intervention for health behavior change in real world settings. Our findings also highlight the need to understand not only game effectiveness but also inter-individual differences. Individualizing content and the intervention medium appears to be necessary for a more personalized and long-lasting impact.

  • Virtual Reality Video Game Play. Image sourced and copyright owned by authors Danielle Levac et al.

    Development and Reliability Evaluation of the Movement Rating Instrument for Virtual Reality Video Game Play


    Background: Virtual reality active video games are increasingly popular physical therapy interventions for children with cerebral palsy. However, physical therapists require educational resources to support decision making about game selection to match individual patient goals. Quantifying the movements elicited during virtual reality active video game play can inform individualized game selection in pediatric rehabilitation. Objective: The objectives of this study were to develop and evaluate the feasibility and reliability of the Movement Rating Instrument for Virtual Reality Game Play (MRI-VRGP). Methods: Item generation occurred through an iterative process of literature review and sample videotape viewing. The MRI-VRGP includes 25 items quantifying upper extremity, lower extremity, and total body movements. A total of 176 videotaped 90-second game play sessions involving 7 typically developing children and 4 children with cerebral palsy were rated by 3 raters trained in MRI-VRGP use. Children played 8 games on 2 virtual reality and active video game systems. Intraclass correlation coefficients (ICCs) determined intra-rater and interrater reliability. Results: Excellent intrarater reliability was evidenced by ICCs of >0.75 for 17 of the 25 items across the 3 raters. Interrater reliability estimates were less precise. Excellent interrater reliability was achieved for far reach upper extremity movements (ICC=0.92 [for right and ICC=0.90 for left) and for squat (ICC=0.80) and jump items (ICC=0.99), with 9 items achieving ICCs of >0.70, 12 items achieving ICCs of between 0.40 and 0.70, and 4 items achieving poor reliability (close-reach upper extremity-ICC=0.14 for right and ICC=0.07 for left) and single-leg stance (ICC=0.55 for right and ICC=0.27 for left). Conclusions: Poor video quality, differing item interpretations between raters, and difficulty quantifying the high-speed movements involved in game play affected reliability. With item definition clarification and further psychometric property evaluation, the MRI-VRGP could inform the content of educational resources for therapists by ranking games according to frequency and type of elicited body movements.

  • Game-based assessment for cognitive screening. Source and copyright: the authors.

    A Serious Game for Clinical Assessment of Cognitive Status: Validation Study


    Background: We propose the use of serious games to screen for abnormal cognitive status in situations where it may be too costly or impractical to use standard cognitive assessments (eg, emergency departments). If validated, serious games in health care could enable broader availability of efficient and engaging cognitive screening. Objective: The objective of this work is to demonstrate the feasibility of a game-based cognitive assessment delivered on tablet technology to a clinical sample and to conduct preliminary validation against standard mental status tools commonly used in elderly populations. Methods: We carried out a feasibility study in a hospital emergency department to evaluate the use of a serious game by elderly adults (N=146; age: mean 80.59, SD 6.00, range 70-94 years). We correlated game performance against a number of standard assessments, including the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Confusion Assessment Method (CAM). Results: After a series of modifications, the game could be used by a wide range of elderly patients in the emergency department demonstrating its feasibility for use with these users. Of 146 patients, 141 (96.6%) consented to participate and played our serious game. Refusals to play the game were typically due to concerns of family members rather than unwillingness of the patient to play the game. Performance on the serious game correlated significantly with the MoCA (r=–.339, P <.001) and MMSE (r=–.558, P <.001), and correlated (point-biserial correlation) with the CAM (r=.565, P <.001) and with other cognitive assessments. Conclusions: This research demonstrates the feasibility of using serious games in a clinical setting. Further research is required to demonstrate the validity and reliability of game-based assessments for clinical decision making.

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  • The Rise Of New Alcoholic Games Among Adolescents: The Consequences At The Emergency Department

    Date Submitted: Aug 30, 2016

    Open Peer Review Period: Sep 9, 2016 - Nov 4, 2016

    Background: This article can be considered as a result of three different works. The first one consists on a questionnaire regarding the behaviors about alcohol consumption among young people; the sec...

    Background: This article can be considered as a result of three different works. The first one consists on a questionnaire regarding the behaviors about alcohol consumption among young people; the second one consists on an analysis of the scientific literature about this topic and finally the third one is the analysis of the shelters at the Emergency Department of acute alcoholic intoxication. The link between all these works is the existence of an abuse of alcohol by young people, the spread documented in the literature and the questionnaire on new practices of alcohol consumption and therefore a prevalence of young people in shelters at Emergency Department for reasons attributable to alcoholic behaviors. In scientific literature, there are many papers on the abuse of alcohol and binge drinking, but those are not describing enough how alcohol consumption happens in adolescence and there are no sufficient data about new drinking modes such as Neknomination or Vodka Eyeballing. 1. Today, analyzing scientific journals in PubMed Embase databases, there are no significant publications referring to the relationship between clinical sequelae for Neknomination and access to the emergency room as a result of the various alcoholic games. There are many projects and protocols relating to the Italian and European generic problem of alcohol consumption in adolescents (1) but despite some methodological differences, which can make it difficult to compare data among surveys, in general there are no discrepancies in the consumption trends among young Italians. 2. It is important to inform and educate parents and clinicians about the spread of new alcohol consumption modalities in adolescents, their risk and impact for Emergency Medicine. 3. The quantification of the cases, the knowledge of the clinical significance of the different modes of abuse chronic or acute intoxication of alcohol among teenagers, represent the central point for the development of a control system being aware not only of the distribution of the most dangerous alcohol consumption, but also of their evolution, focusing on Neknomination and new methods of recruitment (games alcohol, "binge roulette" etc.), and the increase of occasional consumption. The new trends related to consumption patterns found among teenagers are leading to a very high number of episodes of drunkenness. There are many risk factors related to alcohol abuse by young people and often the conclusions found in literature are conflicting: the age at which the first taste of alcohol occurs and the context in which this happens, seem to be related to the influence of the Web and "alcohol socialization" social networks with different methods and rules. Another risk factor in the relationship between adolescents and alcohol is the marketing of alcoholic beverages in the web not only throughout advertising but also by social influence model, which is characterized as "social norm and" life skills ". 4. The phenomenon of Neknomination can be seen as the translation on the web of the association between binge drinking (intake of large amounts of alcohol in a short period of time) and happy hour: video publishing on the web seems to be a way to get in a group or to be socially accepted by schoolmates. The amount of alcohol taken in these events is high and since the "game" lasts a few minutes, the boys get the same effects of binge drinking. (2). Other social consequences caused by alcohol can be road and domestic accidents, legal problems, financial problems and gambling. As for young people, alcohol abuse can lead to develop dangerous behaviors such as multiple consumption, unprotected sex, which can cause diseases and unwanted pregnancies, and driving while intoxicated. 5. The strategic role of Emergency Services is to identify and monitor a problem since its debut, to support the planning and to coordinate the implementation of interventions, ensuring operator training. At this stage, considering the literature data and previous experience in Veneto region and Padua, we have assessed the characteristics and extent of the phenomenon of alcohol consumption in young people and adolescents (risk analysis, definition scenarios), in order to identify the best methods to track trends over time; to define in detail the operations to be performed in the Emergency Department, the organization of interventions in the hospital acceptance phase, the alarm mode, the training of the operators involved, the communication between operators and the population (planning). 6. The communication with the public, with the media, and with schools plays a decisive role in this situation to gain timely and reliable information and to obtain cooperation by limiting the effects of the problem in place. It becomes necessary to invest in developing strategies of specific routes that meet the new styles of consumption of alcohol in adolescents, promoting healthy lifestyles, with specific interventions and coordinated between the different health care specialists enabling differentiated access to care pathways, and developing closer collaboration with general practitioners). The excessive and sometimes pathological use of Internet is currently rising among young people in many industrialized countries in Asia, North America and Europe. Recently, the use of internet has spread so rapidly among adolescents to become a serious public health problem, and many authors have started writing about "Internet addiction." It is estimated that 95% of adolescents connects on-line every day in different places and with different devices: computers, cell phones, smartphones, tablets or e-book readers. The effect of social networks on the health of adolescents and in general the influence of this lifestyle today remains controversial, especially when teens become more independent in their decisions (academic, educational and social / recreational) and are increasingly exposed to the trends of social media. While this may seem apparently harmless, it can actually profoundly affect the behaviors of teenagers and young adults. A study analyzed the profiles of MySpace of 400 adolescents and found that 56% contained references to alcohol and among them 49% spoke explicitly of alcohol use (5). Today's teenagers are increasingly inclined to take and share regularly "selfies" on social networking sites like Twitter, Youtube, Facebook, Instagram, snapchat etc., where each user is represented by its profile. Internet sites such as video-sharing platforms can significantly influence the behavior of adolescents and forms of communication between peers. For example, YouTube, which has become property of Google since 2006, is currently the most popular video sharing site in the world, with over one billion users per month. Some of the most popular videos on YouTube are music videos, each of which generates millions of views and comments. However, YouTube also has self-produced material that can be highly subject to interpretation by the users. While some viewers may be savvy enough to display the various video or advertising with detachment and critical spirit, others may be deeply influenced by the spirit of escape, fun and thrill described in some video. (6) The ease of communication between the various teenagers, that is the true success of social networks, not only affects the school environment, family or friends, but, thanks to the virtual network, it also extends globally, allowing one to share instantly a photo, a video or a simple "state". This attitude of ostentation can unfortunately also lead to pressures from peers and pathological conditioning that could adversely affect the behavior of the boy, pushing him toward a potentially reckless behavior (7). It is fast becoming clear that the widespread use of social networks can lead to a "viral phenomenon", where the emulation of dangerous acts spreads very rapidly throughout the world. The importance of these sources of influence becomes evident when looking at the various psychophysical changes typical of adolescence and it is therefore necessary for them to be taken into consideration by medical professionals, given their significant impact on the health not only of the same teenagers but also on that of society as a whole. Previous studies report that many factors can contribute to substance abuse and its evolution during adolescence, including a greater emphasis on independence, the presence of established habits in the family and peer influence. In a descriptive longitudinal study, D'Amico et al. They analyzed the various habits of adolescents, identifying a strong connection between alcohol abuse and other substances consumption such as tobacco and marijuana, demonstrating also a greater propensity to alcohol abuse in people of Hispanic and African American descendence(8). It was then considered that the general assumption of most descriptive models of peer pressure is based on the perception that adolescents have about the consumption of alcoholic beverages by friends, identified as predictor of long-term substance abuse in adolescents and youth in pre-adolescent(9-10) In relation to sexual maturity as it applies to teenagers, it is worth mentioning that the early use of alcohol is an important risk factor in relation to risky sexual activity among young people, whose health and well-being are so compromised by potential exposure to HIV and other sexually transmitted infectious diseases, as well as other potential negative consequences, including unwanted pregnancies. (12). Objective: This study encourages health care providers to pay attention to these new behavioral trends of substance abuse, especially alcohol, related to the use of internet and future surveys should identify potential markers of a problematic use of social networks, including the identification of groups at risk of abuse and should aim to establish a potential prevention strategy in terms of awareness and education that could help to avoid potentially fatal episodes. Methods: METHODS AND MATERIALS Purpose and design of the study This research is an observational study, retrospective longitudinal type single-center study conducted at the Hospital-University of Padua. The study aims to evaluate the influence of the web and social networks in the daily life of adolescents, who access to the Emergency Department of the main hospital of Padua, by questionnaires about the consumption of alcohol. The processing of the answers to these questionnaires allowed us to better understand the most problematic aspects that interfere in the mode of alcohol intake in young people. Admissions for acute alcohol intoxication of adolescents aged between 15 and 20 years old to the Emergency Department. The data obtained were compared with the meta-analysis, the review and the case studies reported in the literature when present. Organizational chart of the study The survey presented in this work let focus the attention of medical professionals, teachers and parents on a rapidly growing phenomenon among adolescents: the rapid development of Internet and with it the social networks. The survey was conducted according to the procedures listed below and then described in detail. 1. In the first part of the study 70 (Attachments) questionnaires were distributed at the entrance of the hospital while attending the emergency department in the period 2013-2015 to the sample of subjects in this study. Data obtained in this way were added to the questionnaires distributed in secondary schools and in health education classes. 2. The estimate of the impact of social networks on the health and daily lives of adolescents was assessed with 50 questionnaires (Attachments). The tool used to gather information is a questionnaire drawn up by a group of multidisciplinary research with Spanish colleagues, partially supplemented by a few questions about smoking and alcohol, placed on the initiative of the national coordinating corpse. To enable a better sharing of these tools, web pages have been created. If accepted, the guy with the consent of the parents, depending on age, will fill out a questionnaire validated for individual pediatric age groups (PedsQL Measurement Model). The questionnaires were processed by the principal investigator and collaborators in compliance with privacy laws. The anonymous questionnaires The information was gathered by analyzing the behavior described in the questionnaire (Attachment). They were alcohol consumption, considering various types of drinks such as spirits, liqueurs, aperitifs, wine or beer, and the use of cigarettes. The age of first use and its frequency were evaluated for each drug of abuse. In order to understand just how dominant the role of social media is in the daily lives of adolescents, they were asked to express an opinion on the importance of the influence of the web among their peers. To increase the validity of the responses, the questions about the use of substances were laid whereas the boy / girl has consumed the substance previously, for example, "How old were you when you..?" with the option "Never drank ..." and "How many times have you made use of...?" with the option to choose how to answer "one time", "2x", "3 or 5 times", "5 or more times, " and never". The questions refer to the last 30 days and events or places such as parties, clubs, bars where there is an increased risk of drinking alcohol in large quantities. In particular, to investigate the spread of binge drinking, he was asked respondents how many times they had consumed five or more drinks within 2 hours during the last 30 days, offering as an option to answer "Never, Once, 2 times , 3-5 times More than 5 times "and inviting to quantify the number of drinks consumed. To try to identify the best luxuries habits of adolescents surveyed, they were asked if they were aware of similar behavior present in their circle of friends or family members ("No member of the family makes use of alcohol, at least one component / both components make routine use of more than one alcoholic drink during or outside meals "). To assess the consequences of substance abuse from a clinical point of view, it was asked if the subjects were aware of the new games as NekNomination alcohol, Vodka Eyeballing etc., if they had ever attended and whether they had ever repented. Symptoms assessed were the most frequent associated to drunkenness or "tremors and incoordination, Altered behavior, increased talkativeness and sociability, language vague, uncertain gait, Abnormal reflexes, Altered perception of reality, Absence of perceptions, sense of death. " Other symptoms evaluated were: "I had a headache and chills, I threw up, I passed out / I had memory lapses" and eventual access to the emergency department. To correlate the recent tendency to alcohol abuse among adolescents and traffic accidents of persons testing positive blood alcohol, it asked respondents whether conducessero motorized vehicles, if they were aware of the alcohol limit foreseen by the Highway Code in Italy, if they had never taken alcohol for two hours prior to taking the lead and if they had never driven in conditions considered by them to little clarity. In the event that they had traffic accidents related to alcohol consumption, we were assessed the following clinical signs reported: "Bruises and minor trauma, Head injuries, fractures, hemorrhages, Abnormal breathing, loss of consciousness." From the standpoint of psycho-sociological was asked the boys surveyed what were the reasons that pushed them to the consumption of alcoholic beverages (To please myself, to please others, I think that alcohol makes me more fun, To not to feel excluded from the group) and what would change in their daily lives if they stopped drinking alcohol (Nothing, I divertirei less, I would not see the same people, I would try other busts). Finally, it was considered, in the same manner as the consumption of alcohol, smoking habits, invited the parties to express themselves about the age at which they started smoking, the frequency and amount of consumption of cigarettes and the duration of exposure to secondhand smoke daily allowance (Never, Occasionally, less than an hour a day, 1-5 hours a day). Evaluation of the phenomenon in a hospital: the Emergency Department Inclusion criteria of patients, data collection Among the 1,224,768 arrived at the emergency room of the Hospital of Padua since 2006, I have been examined 473,531 accesses in the years 2013-2015, selected retrospectively through the computer system Qlik. Including access to the emergency department, through Qlik, they were selected 3742 patients aged between 15 and 30 years old came to the emergency room of the Hospital of Padua hospitalized for acute alcohol intoxication associated with illness or trauma from 2006 to 2015. They were analyzed folders SDO and the database contains the access mode in the emergency department (only, ambulance, etc.), the diagnosis entry, the characteristics (sex, age, nationality), the circumstances of the fact, and the surveys required by ER doctors and in-hospital monitoring (monitoring PS, OBI, hospitalization, operating room, intensive care) and between tests was particularly considered the value of blood alcohol. It was therefore not possible to record the total complexity of emergencies ULSS 16, since the subjects under the age of 15 years have access to the Pediatric Emergency Department and a proportion of patients> 15 years comes to the emergency room of the nearby St. Anthony Hospital. Of these patients were analyzed folders DEA. Comparing the missing data with the computer program Galileo, DB 41, considering the anamnesis (directly or by friends) and symptoms attributable to alcohol consumption (consistent with the history of alcohol- positive: vomiting, altered reflexes , impaired vision, perception of shapes, colors, sizes, serious impairment of physical or mental condition, marked difficulty in standing or walking, hallucinations, cessation of reflexes, incontinence and coma). Data entered in spreadsheets Office Excel 2007 were analyzed using SAS 9.2 (SAS Institute Inc., Cary, NC, USA) for Windows. For categorical variables (gender, diagnosis closing observation period, days of the week, BAC and age) we have been reported the number of patients per category and the percentage of the variable considered. The variable age was reported in classifying subgroups (15-20 years, 20-25 years and 25-30 years). The variable "blood alcohol" has been divided into classes according to the classification scheme in art. 5 of Decree-Law no. 151/2003, conv. with Law no. 214 of 1 August 2003 (<0.5 g / L, 0.5g / L-0.8g / L, 0.8g / L-1.5g / L,> 1.5g / L). The association between categorical variables was evaluated using the chi-square test or the Fisher exact test. Considering significant p values less than or equal to 0.05. For continuous asymmetric (Duration of hospital stay, weight standard DGR) they were calculated Minimum, Maximum, Median and Quantiles; They were then compared between the sexes with the nonparametric Wilcoxon. Economic evaluation Based on the questionnaires, it was decided to select 225 belonging to the age group 15-20 years, because they were considered the main beneficiaries of the new trends about alcohol consumption. Of the 225 patients aged 15-20 years examined in 2013-2015, using the computer program Galileo, DB 41, were considered treatment programs care of a sample of 38 patients, hospitalized in OBI (Observation short intensive ) of which is considered the type of transport by which have come to the emergency department (118 - Ambulance 118 - other means, ambulatory), the access time (from 20 to 24, 24 to 8, from 8 to 20), recovery time. They were then evaluated clinical care processes of samples of patients: 1. inpatient OBI with its performance laboratoristiche and hospital. 2. Patients traumatized (DRG-486 other surgeries for multiple significant trauma, DRG 487-multiple other injuries relevant) and hospitalized with at least 5 days in hospital who had attended the neknomination or other games under the influence of alcohol content. Folders via SDO and the analysis of the therapy welfare of patients have been completed not only the provision of medical and surgical but also all related activities and diagnostic and laboratory allowing to outline the economic value of some cases more or less complex. The path of hospital inpatients or undergoing observation short, allowed the identification of categories or types of patients similar in intensity of consumption of resources and clinically significant in relation to the extent of the trauma or the type of cause of hospitalization associated to ' acute alcohol intoxication. Results: The extent of the phenomenon "Alcohol abuse and alcohol new games" The results for the 120 questionnaires (70 PS and 50 in schools) administered to young teenagers in the province of Padua (Attachments) show that the average respondent’s age is 17 years, 38% of respondents were male while 62% female. The questionnaires refer mainly to people attending secondary schools, especially high schools and technical institutes. 66 respondents (55%) claim to have been 13-14 years old when consumed (and not only tasted) in full his first alcoholic drink, while 41 (34%) say they have started to 15-16 years.Respondents were asked to indicate what was the type of alcoholic beverage consumed by them most: most drinking beer (42 subjects, 35%), 47 respondents (39%) consume aperitifs and digestives (Spritz Aperol, Campari, Amari ), 16 (13%) wine and 10 (8%) makes use of spirits and liquors (Vodka, Gin, Rum, Scotch, Wisky ..). The teens surveyed were then invited to express themselves about the habitual consumption of alcoholic beverages: 100 (83%) do not disapprove drinking one or two glasses regularly while 20 (17%) do not disapprove getting drunk once a week. Referring to the practices of extreme intoxication described in the questionnaire (in the eyes -vodka eyeballing- vodka, drink upside down, strong sucking from a straw, make a cocktail with mouthwash and hand sanitizer-drink hand sanitizer) 109 subjects (91% ) deny having ever participated and 11 (9%) say they have sucked strong from a straw. Despite the denial, 55 respondents (46%) admit to have seen video of guys getting drunk with extreme ways in social media like Youtube, Facebook and Instagram. As regards the NekNomination, 95 respondents (79%) are aware of this practice. Almost all, 112 (93%), denies having ever taken part, although 52 subjects (43%) know of at least one friend who took part in the past (figure 1). In the period from January 2006 to April 2015 a total of 1,224,768 accesses to the Emergency Department (ED) of the main hospital in Padua (Azienda Ospedaliera di Padova) have been recorded, of which 473,531 from January 2012 to April 2015. Of these recent data triage code was assigned as follow: white, 51%; yellow, 26%; red (critical), 4%; green, 18%. (figure 2)By analyzing these patients we considered 3 ages: 1) from 15 to 20 2) from 20 to 25 3) from 25 to 30. The data were further analyzed on the basis of sex. The categorizations by sex and age group are described in (FIGURE 3) for the period 2006-2012, (FIGURE 4) for 2013-2015. The age group between 15 and 30 years is a demographic group with a high incidence of requests for blood alcohol tests (BAC) at the Emergency Department. This age group is responsible for 37% of the total requests, while it represents only 14% of the resident population. (P <0.001). For comparison the report was for the age group 30 to 45: 29 % of BAC compared with 21 % of the population; for the age group from 45 to 60 years: 23 % of BAC compared with 22 % of the population(FIGURE 5).It was ascertained that the number increases considerably over the weekend and that the percentage difference between the sexes is minimal: on Saturday the admission for acute alcohol are 21% of the full week for both females (60) than for males (113). On Sunday the females are 73 (23%) and 132 Males (24%). Interestingly on Thursday the female patients admitted to the Emergency Department for acute alcohol intoxication are as many those admitted on Saturday, i.e. 56 (19%)(FIGURE 6)Subdividing the same patients by age, we note that: -15-20 Years: patients with acute alcohol intoxication accessing ED mainly on weekends with a peak abundance of 50 (22%) on Saturday, and 65 (29%) on Sunday. A certain proportion also focuses in correspondence of Thursday (29 subjects, 13%). -20-25 Years: the large number of such patients is distributed over the week. Wednesday and Thursday is the large number of 43 (14%) and 60 (19%) respectively. Over the weekend we do not have concentrations as high as for the youngest group, registering peaks of 62 patients (20%) on Saturday and 78 patients (25%) on Sunday. (FIGURE 7).Discharge diagnosis patients 15-20 years Among the 830 patients analyzed in the period from 2013 to 2015, of special interest are the 225 belonging to the age group 15-20 years, because they are believed to be those mainly exposed to new mode of intake of drinks with a high alcohol content. Table I summarises the diagnosis at discharge in this sub-group. In the years 2013-2015 blood alcohol content has been tested for 830 patients aged 15 to 30 years (TABLE II).In all the bands of age considered, the majority of patients had levels of ethyl alcohol in the blood greater than 1.5 g / L: 172 (21%) in the age 15-20, 262 (42%) aged 20- 25 and 232 (4%) in range aged 25-30. As shown in Figure 8, the other classes of blood alcohol levels are poorly represented in the age groups 20-25 and 25-30, while a significant percentage of patients aged 15-20 years (36, 10%) is admitted to Emergency Department for acute intoxication of alcohol, with values of ethyl alcohol of blood comprised between 0.8 g / L and 1.5 g / L. Of the 225 patients (135 males and 90 females) aged between 15 and 20 years, admitted to the Emergency Department of the Hospital of Padua for acute alcohol intoxication in the years 2013 to 2015 were analyzed blood alcohol levels obtained from Central Laboratory of the Hospital of Padua. Of these patients, 70 (31%) admitted that they have participated in new alcohol consumption based games. In particular, 14 (19%) reported having taken part in NekNomination, 53 (76%) to "other alcohol games" (among which beer pong, alcohol enema, flip cup were included) and 4 (5%) to VodkaEyeballing. table III. Of all 225 patients the blood alcohol concentration was analyzed and the data was then examined by individual years and by age. Blood concentration of ethanol (BAC Blood Alcohol Concentration) was grouped following the classification scheme outlined by Italian legislation (art. 5 of Decree no. 151/2003, converted in Law no. 214 of August 1, 2003), as described in Table IV. All values are > 0 g/L.Statistical analysis performed with the Chi Square test (Z2) does not identify significant changes over the years analyzed (p> 0.05). In all years 2013, 2014 and 2015 there is a high prevalence of patients whose values fall into the category of BAC> 1.5 g / L: 61 (75%) in 2013, 78 (76%) in 2014 and 33 (81% ) in 2015. The second value range blood alcohol most represented in the studied years is 0.8-1.5 g / L: 12 (13%) in 2013, 16 (15%) in 2014, and 8 (19%) in 2015. In 2015 (the data refer to the months from January to April), all the examined patients 15-20 years have blood alcohol values> 0.8 g / L. These levels are very dangerous for the life of those subjects. (Figure 9) Admissions for trauma. Of the 30 patients admitted for trauma, 24 were male (80%) and 6 women (20%). The median length of stay (one cannot have statistical average as the variables are asymmetrical) was 11 days, with a minimum of 3 and a maximum of 44 days. Overall, males have a median hospital stay which is double than that of females (12 days and 6 respectively). The average number of surgical operations, especially "Exploratory laparotomy, total Splenectomy and Surgical closure of lacerations of internal organs (liver and kidney), was 2 (Min: 0, Max: 4). Finally, the median value of the average weight of the DRG relative to interventions provided by the Hospital, is the same for both sexes and is equal to 46091 Euros, with a minimum of 17,349 euros and a maximum of 46091 Euro(Table 5). Conclusions: The normalization of the use of alcohol, in the light of cultural changes prompted by millions of Euros of investments in marketing, advertising and sponsorship of alcohol aimed at creating a value system for use of licit psychoactive substance and more available, which aims to encourage more However considerations and individual and collective well-being, pleasure, seduction, of leadership, has led and continues to lead the phenomena that go beyond the binge drinking and now come to decline it in various forms of hazardous and harmful alcohol consumption, boosted by 'use of technology and social media, as virtual stages, facilitate anyone in need to homologate and make an impact through risk taking and the violation of laws on the legal minimum, fitting in circles nomination and chains on which alcoholic there can be no control. It is a phenomenon which changes, culturally, more and more toward how their dependency on illegal substances, often integrating with other addictions. Virtual reality supplants, in other words, the concrete everyday: the popularity obtained the web is mirrored in the everyday, at school or in sports for many teens. This results in a spirit of idolatry if it is popular, a sense of marginalization and challenge to be "cool" if, on the contrary, you do not have an appropriate retinue in Social. And technology companies, well aware of the results of prorpi products on kids, continue to bring to market applications for smartphones, tablets and so on pushing more and more behaviors emulators on the web. The Klout Score, for example, is a tangible proof: it is a social networking service that offers customized statistical analysis on social media. In particular, it estimates the influence of the user through a score (from 0 to 100) obtained the degree of interaction in the user profiles of popular social networking sites, including Twitter, Facebook, Google+, LinkedIn and Foursquare. This influence is obtained from the amplitude of the network user, the generated content, and the feedback level obtained ( The birth of NekNomination, Vodka Eyeballing, Butt Chugging and others is relatively recent. Initially concerned mainly beer but the need to dare and to be more popular soon brought teenagers from around the world to compete in these games with any alcoholic beverage they had available, also according to the culture of the country of alcohol: if in Italy and Western Europe consumes more wine, in the countries of Central alcoholic drink is beer cheaper in Eastern Europe you will also have easier access to hard liquor like vodka, which therefore give more effects serious in terms of health. Belts alcoholic Europe are European regions that are considered to be divided by consumption of beer, wine or liquor. Interestingly belts alcoholic beverages refer to traditional countries rather than in what is commonly drunk by the population; Today, in terms of beer consumption has become the most popular alcoholic beverage in the world. By anonymous questionnaires, it follows that 35% of respondents who habitually consume beer and 39% drink normally aperitifs and digestives (Aperol, Campari etc.). Aperitifs alcohol are consumed in 2012 from 31.5% of the population older than 11 years (M: 41.9%; F: 21.7%) The proportion of men aged over 11 years has remained stable compared the previous survey, but by focusing on older age group there was a significant increase in consumer amounting to 2.9 percentage points.The data collected through the study in question do reflect on the importance of dealing with behavior and health of young people who are tomorrow's adults. It is therefore necessary among adolescents to improve the living environment with an integrated approach and policies to prevent large-scale, combating tobacco consumption, obesity, physical inactivity, alcohol abuse and substance. The new games Alcohol encourage young people to consume large amounts of alcohol in a short period of time, putting them at risk of alcohol poisoning, which can potentially cause accidental injuries, unprotected sex, suicide, sexual violence and traffic accidents. This study showed that the frequency of these events is on the rise thanks to the widespread use and often indiscriminate "social media", and for this reason there may be an increase in the number of acute alcohol intoxication, severe trauma. Using the Internet it can be negatively associated with behavioral and social maladjustment among adolescents, and combining this with the fact that it can be a powerful source of pressure among peers with almost no direct link with the person concerned, may represent a potentially dangerous. It is, therefore, a need for greater awareness in order to prevent future incidents and also a deeper understanding of which population subgroups are most at risk, in order to establish a defensive and preventive education strategy. Emergency Physicians (as well as educators and in general all those who work in health care) that assist in these situations, have a responsibility to help identify and prevent the spread of these patterns of behavior, especially when there is a risk that they become hazardous to the health of an individual or of other persons. The alarming increase in the number of hospitalizations due to intoxication by alcohol unintentional adolescence, for neknomination, vodka eyeballing, butt chugging etc., And consequences of the absence of relevant interventions and adults, in all these cases, register exclusively on subjects defined as "disadvantaged" but more and more often in boys and girls around the world coming to characterize a social failure of education that swept reality increasingly heterogeneous and wide of too many young teens, as evidenced by the use of the services health care for the effects and consequences of drinking and alcohol-related mortality data they see alcohol as a leading cause of premature and avoidable death among young people. The questionnaires described in this work, while not constituting a survey of epidemiological, represented a pause for thought about the cescente impact of technology on adolescents. Future studies, conducted with epidemiological criteria and extended not only to the country but also the European, allow you to analyze and understand the true extent of the problem, developing prevention campaigns and education that is not only healthy regard to persons directly concerned but also the teaching staff and parents. The knowledge of the events described in quesa investigation would, in terms of medical and hospital, a better management of critically ill patients, with optimization of time and resources.

  • Planking: The “Lying Down Game” News In “Accidental Falls”

    Date Submitted: Aug 28, 2016

    Open Peer Review Period: Aug 30, 2016 - Oct 25, 2016

    The monitoring and management of risks regarding children and young people admitted to Emergency as a result of dangerous behaviour “distributed via the internet”, should be based on clinical reas...

    The monitoring and management of risks regarding children and young people admitted to Emergency as a result of dangerous behaviour “distributed via the internet”, should be based on clinical reasoning. Some data now available describe a relatively new game: planking, also known as the "lying-down game". A key element of this research study is to report physicians’ misperceptions concerning planking and, with these cases, used for teaching purposes, to improve knowledge of the clinical and forensic aspects of this emerging problem. Adolescents often choose unusual and sometimes dangerous places to increase the number of their "likes" in social media, often with some new "game" like planking,. The poses of the people photographed while planking are unusual. Analysis of published data shows that traumatic lesions may occur as a result of planking, which has probably had little effect on the number of immediate fatalities, but these results can be projected to other trauma centres and processed to create injury surveillance data. Previous studies have shown how much trauma costs. Reporting these cases may potentially prevent future traumatic events occurring in similar circumstances: the scientific community cannot leave this problem unaddressed.