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Journal Description

JMIR Serious Games (JSG, ISSN 2291-9279; Impact Factor: 2.226) is a multidisciplinary journal devoted to computer/web/virtual reality/mobile applications that incorporate elements of gaming, gamification or novel hardware platforms such as virtual reality headsets or Microsoft Kinect to solve serious problems such as health behavior change, physical exercise promotion (exergaming), medical rehabilitation, diagnosis and treatment of psychological/psychiatric disorders, medical education, health 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.

The journal is indexed in PubMed, PubMed Central, DOAJ, and SCIE/Web of Science, and JCR (Journal Citation Reports) where it received an official impact factor by Clarivate. In June 2018, JSG received an official inaugural journal impact factor of 2.226 (Journal Citation Reports 2017, Clarivate Analytics), ranking JSG at the top of all gaming related academic journals, ahead of (for example) more established competitor journals such as the Games for Health Journal. 

 

Recent Articles:

  • Source: The Authors / Placeit; Copyright: JMIR Publications; URL: http://games.jmir.org/2018/4/e19/; License: Creative Commons Attribution (CC-BY).

    Potential of an Interactive Drug Prevention Mobile Phone App (Once Upon a High): Questionnaire Study Among Students

    Abstract:

    Background: In recent years, drug prevention networks and drug education programs have started using Web-based or mobile phone apps as novel prevention tools, testing their efficacy compared with face-to-face prevention. Objective: The aim of this study was to assess the potential of an interactive app called Once Upon a High (VoltEgySzer). Methods: The app approaches drug prevention from 6 different aspects, and it addresses youngsters with 6 different modules: (1) interactive comics/cartoons, telling stories of recovery; (2) quiz game; (3) roleplay game; (4) introduction of psychoactive drugs; (5) information on the somatic and psychological effects of psychoactive substances; (6) list of available treatment units, rehabs, and self-support groups in Hungary. Students of 2 vocational schools and 2 high schools filled out a questionnaire at a baseline (T0) and a 2-month follow-up (T1) data collection session. Students of 1 vocational school and 1 high school downloaded the Once Upon a High app (app group), whereas students from the other vocational school and high school did not (nonapp group). The time points of T0 and T1 questionnaires contained demographic variables, items with regard to substance use characteristics for both legal and illegal substances, including novel psychoactive substance, exercise habits, knowledge about psychoactive substances, attitudes toward substance users and validated instruments measuring the severity of tobacco (Fagerström Test for Nicotine Dependence), alcohol (Alcohol Use Disorder Identification Test), cannabis (Cannabis Abuse Screening Test), and synthetic cannabinoid consumption. Beliefs about substance use (Beliefs About Substance Abuse) and perceived self-efficacy (General Perceived Self-Efficacy) were also measured. At T1, members of the app group provided additional evaluation of the app. Results: There were 386 students who participated in the T0 session. After dropout, 246 students took part in T1 data collection procedure. Alcohol was the most frequently consumed psychoactive substance (334/364, 91.8% lifetime use), followed by tobacco (252/386, 65.3%, lifetime use) and cannabis (43/323, 13.3% lifetime use). Decreased self-efficacy (beta=−.29, P=.04) and increased daily physical exercise frequencies (beta=.04, P<.001) predicted higher frequencies of past month energy drink consumption, whereas elevated past month alcohol consumption was mainly predicted by a decrease in negative attitudes toward substance users (beta=−.13, P=.04) in the regression models. Once Upon a High was found to be effective only in reducing energy drink consumption (beta=−1.13, P=.04) after controlling for design effect, whereas perceived utility of the app showed correlation with a decreasing alcohol use (rS(44)=.32, P=.03). The roleplay module of the app was found to be the most preferred aspect of the app by the respondents. Conclusions: The Once Upon a High app can be a useful tool to assist preventive intervention programs by increasing knowledge and self-efficacy; however, its efficacy in reducing or preventing substance use needs to be improved and further studied. Additional potential impacts of the app need further testing.

  • Cigbreak app (montage). Source: The Authors; Copyright: The Authors; URL: http://games.jmir.org/2018/4/e10252/; License: Licensed by JMIR.

    Creating a Theoretically Grounded, Gamified Health App: Lessons From Developing the Cigbreak Smoking Cessation Mobile Phone Game

    Abstract:

    Background: Gaming techniques are increasingly recognized as effective methods for changing behavior and increasing user engagement with mobile phone apps. The rapid uptake of mobile phone games provides an unprecedented opportunity to reach large numbers of people and to influence a wide range of health-related behaviors. However, digital interventions are still nascent in the field of health care, and optimum gamified methods of achieving health behavior change are still being investigated. There is currently a lack of worked methodologies that app developers and health care professionals can follow to facilitate theoretically informed design of gamified health apps. Objective: This study aimed to present a series of steps undertaken during the development of Cigbreak, a gamified smoking cessation health app. Methods: A systematic and iterative approach was adopted by (1) forming an expert multidisciplinary design team, (2) defining the problem and establishing user preferences, (3) incorporating the evidence base, (4) integrating gamification, (5) adding behavior change techniques, (6) forming a logic model, and (7) user testing. A total of 10 focus groups were conducted with 73 smokers. Results: Users found the app an engaging and motivating way to gain smoking cessation advice and a helpful distraction from smoking; 84% (62/73) of smokers said they would play again and recommend it to a friend. Conclusions: A dedicated gamified app to promote smoking cessation has the potential to modify smoking behavior and to deliver effective smoking cessation advice. Iterative, collaborative development using evidence-based behavior change techniques and gamification may help to make the game engaging and potentially effective. Gamified health apps developed in this way may have the potential to provide effective and low-cost health interventions in a wide range of clinical settings.

  • Visual representation of the Emotion-in-Motion task. The images are not those used in the actual task. Source: Image created by the Authors; Copyright: The Authors; URL: http://games.jmir.org/2018/4/e10993/; License: Public Domain (CC0).

    Emotion-in-Motion, a Novel Approach for the Modification of Attentional Bias: An Experimental Proof-of-Concept Study

    Abstract:

    Background: Individuals with heightened anxiety vulnerability tend to preferentially attend to emotionally negative information, with evidence suggesting that this attentional bias makes a causal contribution to anxiety vulnerability. Recent years have seen an increase in the use of attentional bias modification (ABM) procedures to modify patterns of attentional bias; however, often this change in bias is not successfully achieved. Objective: This study presents a novel ABM procedure, Emotion-in-Motion, requiring individuals to engage in patterns of attentional scanning and tracking within a gamified, complex, and dynamic environment. We aimed to examine the capacity of this novel procedure, as compared with the traditional probe-based ABM procedure, to produce a change in attentional bias and result in a change in anxiety vulnerability. Methods: We administered either an attend-positive or attend-negative version of our novel ABM task or the conventional probe-based ABM task to undergraduate students (N=110). Subsequently, participants underwent an anagram stressor task, with state anxiety assessed before and following this stressor. Results: Although the conventional ABM task failed to induce differential patterns of attentional bias or affect anxiety vulnerability, the Emotion-in-Motion training did induce a greater attentional bias to negative faces in the attend-negative training condition than in the attend-positive training condition (P=.003, Cohen d=0.87) and led to a greater increase in stressor-induced state anxiety faces in the attend-negative training condition than in the attend-positive training condition (P=.03, Cohen d=0.60). Conclusions: Our novel, gamified Emotion-in-Motion ABM task appears more effective in modifying patterns of attentional bias and anxiety vulnerability. Candidate mechanisms contributing to these findings are discussed, including the increased stimulus complexity, dynamic nature of the stimulus presentation, and enriched performance feedback.

  • A child playing Heritages (developed by Breathing Games contributors). Source: A New Economy; Copyright: A New Economy; URL: https://www.aneweconomy.ca; License: Licensed by the authors.

    Developing Digital Games to Address Airway Clearance Therapy in Children With Cystic Fibrosis: Participatory Design Process

    Authors List:

    Abstract:

    Background: Children affected with cystic fibrosis do respiratory exercises to release the mucus stuck in their lungs. Objective: The objective of our study was to develop prototypes of digital games that use breath pressure to make this daily physiotherapy more fun. Methods: We used a participatory design approach and organized short events to invite contributors from different disciplines to develop game prototypes. From the 6 prototypes, 3 were tested by 10 children during a prestudy. The source code of the games, of which 2 continue to be developed, has been released on the internet under fair use licenses. Results: We discuss 7 themes of importance in designing games for health, combining our experience with a review a posteriori of literature. Conclusions: This study provides examples of games and their pitfalls as well as recommendations to create games for health in a participatory approach that enables everyone to improve and adapt the work done.

  • Source: The Authors; Copyright: The Authors; URL: http://games.jmir.org/2018/4/e10965/; License: Licensed by JMIR.

    Implementations of Virtual Reality for Anxiety-Related Disorders: Systematic Review

    Abstract:

    Background: Although traditional forms of therapy for anxiety-related disorders (eg, cognitive behavioral therapy, CBT) have been effective, there have been long-standing issues with these therapies that largely center around the costs and risks associated with the components comprising the therapeutic process. To treat certain types of specific phobias, sessions may need to be held in public, therefore risking patient confidentiality and the occurrence of uncontrollable circumstances (eg, weather and bystander behavior) or additional expenses such as travel to reach a destination. To address these issues, past studies have implemented virtual reality (VR) technologies for virtual reality exposure therapy (VRET) to provide an immersive, interactive experience that can be conducted privately and inexpensively. The versatility of VR allows various environments and scenarios to be generated while giving therapists control over variables that would otherwise be impossible in a natural setting. Although the outcomes from these studies have been generally positive despite the limitations of legacy VR systems, it is necessary to review these studies to identify how modern VR systems can and should improve to treat disorders in which anxiety is a key symptom, including specific phobias, posttraumatic stress disorder and acute stress disorder, generalized anxiety disorder, and paranoid ideations. Objective: The aim of this review was to establish the efficacy of VR-based treatment for anxiety-related disorders as well as to outline how modern VR systems need to address the shortcomings of legacy VR systems. Methods: A systematic search was conducted for any VR-related, peer-reviewed articles focused on the treatment or assessment of anxiety-based disorders published before August 31, 2017, within the ProQuest Central, PsycINFO, and PsycARTICLES databases. References from these articles were also evaluated. Results: A total of 49 studies met the inclusion criteria from an initial pool of 2419 studies. These studies were a mix of case studies focused solely on VRET, experimental studies comparing the efficacy of VRET with various forms of CBT (eg, in vivo exposure, imaginal exposure, and exposure group therapy), and studies evaluating the usefulness of VR technology as a diagnostic tool for paranoid ideations. The majority of studies reported positive findings in favor of VRET despite the VR technology’s limitations. Conclusions: Although past studies have demonstrated promising and emerging efficacy for the use of VR as a treatment and diagnostic tool for anxiety-related disorders, it is clear that VR technology as a whole needs to improve to provide a completely immersive and interactive experience that is capable of blurring the lines between the real and virtual world.

  • Source: Image created by the Authors; Copyright: The Authors; URL: http://games.jmir.org/2018/4/e11336/; License: Creative Commons Attribution (CC-BY).

    Patterns Among 754 Gamification Cases: Content Analysis for Gamification Development

    Abstract:

    Background: Gamification is one of the techniques that applies game elements, such as game mechanics and dynamics, to a nongame context (eg, management, education, marketing, and health care). A variety of methodologies have been published for developing gamification. However, some of these are only usable by people with a certain level of gamification knowledge. People who do not have such knowledge face difficulty in using game mechanics and experiencing enjoyment. To ease their difficulties, a gamification methodology should provide directions for using game mechanics. Objective: This study aimed at collecting global gamification cases and determining patterns or differences among the collected cases. Methods: In total, 754 cases were collected based on 4F process elements, such as play type, playful user experience (PLEX)–based fun factors, and game mechanics. In addition, the collected cases were classified into 6 categories. From the data analysis, basic statistics and correlation analyses (Pearson and Kendall) were conducted. Results: According to the analysis results in PLEX-based fun factors, challenge and completion fun factors formed a large proportion among the 6 categories. In the results of the game mechanics analysis, point, leaderboard, and progress accounted for a large proportion among the 6 categories. The results of the correlation analysis showed no difference or specific patterns in game mechanics (Pearson r>.8, Kendall τ>.5, P<.05) and PLEX-based fun factors (Pearson r>.8, Kendall τ>.7, P<.05). Conclusions: On the basis of the statistical findings, this study suggests an appropriate number of PLEX-based fun factors and game mechanics. In addition, the results of this study should be used for people who do not have gamification knowledge and face difficulty using game mechanics and PLEX-based fun factors.

  • In-game welcome screen from OU Brainwave app (montage). Source: The Authors; Copyright: The Authors; URL: http://games.jmir.org/2018/4/e10519/; License: Licensed by JMIR.

    A Mobile App Delivering a Gamified Battery of Cognitive Tests Designed for Repeated Play (OU Brainwave): App Design and Cohort Study

    Abstract:

    Background: Mobile phone and tablet apps are an increasingly common platform for collecting data. A key challenge for researchers has been participant “buy-in” and attrition for designs requiring repeated testing. Objective: The objective of this study was to develop and assess the utility of 1-2 minute versions of both classic and novel cognitive tasks using a user-focused and user-driven mobile phone and tablet app designed to encourage repeated play. Methods: A large sample of app users (N=13,979 at first data collection) participated in multiple, self-paced sessions of classic working memory (N-back), spatial cognition (mental rotation), sustained attentional focus (persistent vigilance task), and split attention (multiple object tracking) tasks, along with the implementation of a comparatively novel action-learning task. The “OU Brainwave” app was designed to measure time-of-day variation in cognitive performance and did not offer any training program or promise any cognitive enhancement. To record participants’ chronotype, a full Morningness-Eveningness questionnaire was also included, which measures whether a person's circadian rhythm produces peak alertness in the morning, in the evening, or in between. Data were collected during an 18-month period. While the app prompted re-engagement at set intervals, participants were free to complete each task as many times as they wished. Results: We found a significant relationship between morningness and age (r=.298, n=12,755, P<.001), with no effect of gender (t13,539=−1.036, P=.30). We report good task adherence, with ~4000 participants repeatedly playing each game >4 times each—our minimum engagement level for analysis. Repeated plays of these games allowed us to replicate commonly reported gender effects in gamified spatial cognition (F1,4216=154.861, P<.001, η2ρ=.035), split attention (F1,4185=11.047, P=.001, η2ρ=.003), and sustained attentional focus (F1,4238=15.993, P<.001, η2ρ=.004) tasks. We also report evidence of a small gender effect in an action-learning task (F1,3988=90.59, P<.001, η2ρ=.022). Finally, we found a strong negative effect of self-reported age on performance, when controlling for number of plays, in sustained attentional focus (n=1596, F6,1595=30.23, P<.001, η2=.102), working memory (n=1627, F6,1626=19.78, P<.001, η2=.068), spatial cognition (n=1640, F6,1639=23.74, P<.001, η2=.080), and split attention tasks (n=1616, F6,1615=2.48, P=.02, η2=.009). Conclusions: Using extremely short testing periods and permitting participants to decide their level of engagement—both in terms of which gamified task they played and how many sessions they completed—we were able to collect a substantial and valid dataset. We suggest that the success of OU Brainwave should inform future research oriented apps—particularly in issues of balancing participant engagement with data fidelity.

  • The Delirium Experience serious game (montage). Source: The Authors / Placeit; Copyright: JMIR Publications; URL: http://games.jmir.org/2018/4/e17/; License: Creative Commons Attribution (CC-BY).

    A Web-Based Serious Game on Delirium as an Educational Intervention for Medical Students: Randomized Controlled Trial

    Abstract:

    Background: Adequate delirium recognition and management are important to reduce the incidence and severity of delirium. To improve delirium recognition and management, training of medical staff and students is needed. Objective: In this study, we aimed to gain insight into whether the serious game, Delirium Experience, is suited as an educational intervention. Methods: We conducted a three-arm randomized controlled trial. We enrolled 156 students in the third year of their Bachelor of Medical Sciences degree at the University Medical Centre Groningen. The Game group of this study played Delirium Experience. The Control D group watched a video with explanations on delirium and a patient’s experience of delirious episodes. The Control A group watched a video on healthy aging. To investigate students’ skills, we used a video of a delirious patient for which students had to give care recommendations and complete the Delirium Observations Screening Scale and Delirium Rating Scale R-98. Furthermore, students completed the Delirium Attitude Scale, the Learning Motivation and Engagement Questionnaire, and self-reported knowledge on delirium. Results: In total, 156 students participated in this study (Game group, n=51; Control D group, n=51; Control A group, n=55). The Game group scored higher with a median (interquartile range) of 6 (4-8) for given recommendations and learning motivation and engagement compared with the Control D (1, 1-4) and A (0, 0-3) groups (P<.001). Furthermore, the Game group scored higher (7, 6-8) on self-reported knowledge compared with the Control A group (6, 5-6; P<.001). We did not find differences between the groups regarding delirium screening (P=.07) and rating (P=.45) skills or attitude toward delirious patients (P=.55). Conclusions: The serious game, Delirium Experience, is suitable as an educational intervention to teach delirium care to medical students and has added value in addition to a lecture.

  • Virtual reality head-mounted display in use. Source: B Garrett, University of British Columbia; Copyright: B Garrett, University of British Columbia; URL: http://games.jmir.org/2018/4/e10839; License: Licensed by JMIR.

    Virtual Reality Clinical Research: Promises and Challenges

    Abstract:

    Background: Virtual reality (VR) therapy has been explored as a novel therapeutic approach for numerous health applications, in which three-dimensional virtual environments can be explored in real time. Studies have found positive outcomes for patients using VR for clinical conditions such as anxiety disorders, addictions, phobias, posttraumatic stress disorder, eating disorders, stroke rehabilitation, and for pain management. Objective: This work aims to highlight key issues in the implementation of clinical research for VR technologies. Methods: A discussion paper was developed from a narrative review of recent clinical research in the field, and the researchers’ own experiences in conducting VR clinical research with chronic pain patients. Results: Some of the key issues in implementing clinical VR research include theoretical immaturity, a lack of technical standards, the problems of separating effects of media versus medium, practical in vivo issues, and costs. Conclusions: Over the last decade, some significant successes have been claimed for the use of VR. Nevertheless, the implementation of clinical VR research outside of the laboratory presents substantial clinical challenges. It is argued that careful attention to addressing these issues in research design and pilot studies are needed in order to make clinical VR research more rigorous and improve the clinical significance of findings.

  • Source: The Authors; Copyright: The Authors; URL: http://games.jmir.org/2018/4/e10213; License: Licensed by JMIR.

    Digital Gaming to Improve Adherence Among Adolescents and Young Adults Living With HIV: Mixed-Methods Study to Test Feasibility and Acceptability

    Abstract:

    Background: An estimated 50% of adolescents and young adults (AYA) living with HIV are failing to adhere to prescribed antiretroviral treatment (ART). Digital games are effective in chronic disease management; however, research on gaming to improve ART adherence among AYA is limited. Objective: We assessed the feasibility and acceptability of video gaming to improve AYA ART adherence. Methods: Focus group discussions and surveys were administered to health care providers and AYA aged 13 to 24 years living with HIV at a pediatric HIV program in Washington, DC. During focus group discussions, AYA viewed demonstrations of 3 game prototypes linked to portable Wisepill medication dispensers. Content analysis strategies and thematic coding were used to identify adherence themes and gaming acceptance and feasibility. Likert scale and descriptive statistics were used to summarize response frequencies. Results: Providers (n=10) identified common adherence barriers and strategies, including use of gaming analogies to improve AYA ART adherence. Providers supported exploration of digital gaming as an adherence intervention. In 6 focus group discussions, 12 AYA participants identified disclosure of HIV status and irregular daily schedules as major barriers to ART and use of alarms and pillboxes as reminders. Most AYA were very or somewhat likely to use the demonstrated game prototypes to help with ART adherence and desired challenging, individually tailored, user-friendly games with in-game incentives. Game prototypes were modified accordingly. Conclusions: AYA and their providers supported the use of digital games for ART adherence support. Individualization and in-game incentives were preferable and informed the design of an interactive technology-based adherence intervention among AYA living with HIV.

  • Source: Pexels.com; Copyright: Jamie McInall; URL: https://www.pexels.com/photo/man-playing-game-on-personal-computer-929831/; License: Licensed by JMIR.

    The Untapped Potential of the Gaming Community: Narrative Review

    Abstract:

    Background: Video gamers are a population at heightened risk of developing obesity due to the sedentary nature of gaming, increased energy intake, and the disruption caused to their sleep. This increases their risk of developing a number of noncommunicable diseases. To date, research seeking to improve health behaviors has focused on developing novel video games to promote behavior change. Although positive results have emerged from this research, large-scale success has been limited due to the lack of transferability to mainstream games and the focus on children and adolescents. The gaming community has a number of unique aspects, which have received comparatively less attention than the development of new video games. Objective: The purpose of this paper is to highlight under-researched areas that have the potential to encourage positive health behavior among this community. Methods: A narrative review of the lay and academic literature was conducted to provide context and support to our claims that further research could be beneficial in this area. Results: Research has found that advertising can have implicit effects on an individual’s memories, which could influence later decisions. However, the effect of the exponential growth of in-game advertisements and the brand sponsorship of gaming events and professional gamers have not been explored in the gaming community. The possibility of using advertising techniques to encourage positive health behaviors within games or at these events has also not been explored. Research suggests that virtual communities can be effective at disseminating health information, but the efficacy of this needs to be explored using known community influencers within the gaming community. Conclusions: This paper has highlighted a number of potential avenues for the development of interventions within the gaming community. Further research must be conducted alongside game developers to ensure that any in-game developed interventions do not deter gameplay and gamers to ensure that potential approaches are acceptable.

  • Participant playing the video game, Lifeguard (montage). Source: The Authors / Placeit.net; Copyright: JMIR Publications; URL: http://games.jmir.org/2018/3/e16/; License: Creative Commons Attribution (CC-BY).

    Investigating the Relationship Between Eye Movement and Brain Wave Activity Using Video Games: Pilot Study

    Abstract:

    Background: All eye movements are related in one way or another to our mental processes with lateral eye movements being associated with the different hemispheres of the brain. Eye movement techniques form the basis of eye movement desensitization and reprocessing therapy, wherein forced eye movements activate neurological pathways to treat the subject. Objective: The objective of our study was to examine the relationship between players' eye movements and their brain wave activities using a video game. Methods: We used similar eye movement techniques in the form of a video game called Lifeguard that could potentially stimulate different eye movement mode and create a more engaging experience for the user. By designing an experiment, we further explored the differences in electroencephalogram spectral power activity for the alpha, beta, theta, delta, and gamma frequency bands in Lifeguard and Tetris. Results: The game based on eye movement technologies resulted in decreased delta power and increased beta power, but significant difference between 2 games was not found. Conclusions: The applied uses of this research could mean that eye movement desensitization and reprocessing can be conducted in a more fun and engaging way through the use of gaming technology.

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  • e-motion1.0: validation of a virtual serious game to assess theory of mind in Primary school children.

    Date Submitted: Nov 28, 2018

    Open Peer Review Period: Dec 12, 2018 - Feb 6, 2019

    Given the interactive media characteristics and intrinsically motivating appeal, virtual serious games are often praised for their potential in assessment and treatment. The aim of this study is to va...

    Given the interactive media characteristics and intrinsically motivating appeal, virtual serious games are often praised for their potential in assessment and treatment. The aim of this study is to validate a virtual serious game (e-motion1.0) in order to evaluate emotional facial expression recognition and social skills, components of theory of mind. A total of 1.236 children took part in the study. The children were classified by age (8-12 years old), gender (males = 639; females = 597) and educational level (3rd – 6th Primary level). Ten schools from the Basque Country and twenty trained evaluators participated in this study. Differences were found in e-motion1.0 scores between groups of children depending on age (p< 0.01) and gender (p< 0.05). Moreover, there was a moderate significant correlation (p< 0.05) between the emotional recognition scores of e-motion1.0 and those of the Feel facial recognition test (Kessler, 2002; Lázaro et al., 2016). E-motion1.0 shows concurrent validity with instruments that assess emotional recognition. Results support the adequacy of e-motion1.0 in assessing components of theory of mind in children.

  • Piloting the FIT Game to Increase Physical Activity in One Sixth Grade Classroom

    Date Submitted: Dec 6, 2018

    Open Peer Review Period: Dec 10, 2018 - Feb 4, 2019

    Background: The FIT Game is an intervention that successfully increases fruit and vegetable consumption in elementary schools. Using the FIT Game to increase physical activity in school would strength...

    Background: The FIT Game is an intervention that successfully increases fruit and vegetable consumption in elementary schools. Using the FIT Game to increase physical activity in school would strengthen its ability as a healthy behavior change intervention. Objective: Evaluate if the FIT Game can increase physical activity among children. Methods: 29 participants were recruited from one sixth grade classroom in one elementary school. Participants wore an accelerometer while at school throughout the study. In an ABAB reversal design (A = baseline, B = FIT Game phase), during the B phases, if the group met a daily step-count goal, the game progressed by presenting another slideshow episode; if not, the game was paused until the next goal was met. Results: A Friedman’s test showed a significant effect of phase (P< .001). The FIT Game significantly increased physical activity at school by an average of 771 steps per day. Conclusions: The FIT Game increased step-counts taken during school hours; its effects on activity at home are unknown, as students wore accelerometers only at school.

  • Exploring efficacy of a Serious Game (TOBBSTOP) for smoking cessation in pregnant: A Pilot Case-Control Study

    Date Submitted: Nov 15, 2018

    Open Peer Review Period: Dec 3, 2018 - Jan 28, 2019

    Background: Tobacco habit entails, during pregnancy, a serious risk to the mother and harmful effects on the development of the child. Europa has the highest tobacco smoking prevalence (19.3%) as comp...

    Background: Tobacco habit entails, during pregnancy, a serious risk to the mother and harmful effects on the development of the child. Europa has the highest tobacco smoking prevalence (19.3%) as compared to a worldwide mean of 6.8%. Twenty to thirty percent of pregnant women use tobacco during pregnancy worldwide. These data emphasize the urgent need for community education and implementation of prevention strategies focused on risks associated to tobacco use during pregnancy. Objective: This study aims to investigate the possibility to address this problem through a serious game (TOBBSTOP), something that has proven efficient as a tool for learning in many situations. By using a game for smoke cessation during pregnancy, we aim to maintain cessation and interest pregnant smokers in learning about healthcare and effects of tobacco by playing a game that helps them to achieve their challenge. Methods: A pilot case-control study enrols 44 women who were visited in two primary care centres in Spain between March 2015 and November 2016. All participants were pregnant smokers over the age of 18 years attending consultation to a midwife during the first trimester of pregnancy who expressed their desire to stop smoking. We recruited a control and a test group (N = 42) among the attended on the centres and instructed them to install the game on their smartphone or tablet and use it for 3 months. Until the delivery, all participants were assessed about their stage on smoke cessation during their follow-up midwife consultations. The selected test group (n = 21), matched with control group for age, level of tobacco-dependence and number of smoking attempts. We tested the amount of CO at each visit with a carboxymeter during the entire intervention period to assess the abstinence. Results: Pregnants from test group, with 80% (12/21), had significant higher rates of cessation until delivery than control group (X2 8.4; P = .004). Bivariate analyses revealed that game’s use was associated with an increased likelihood to maintain smoking cessation during the intervention period compared with those not using the game (12/15; odds ratio 8.0; 95% confidence interval 1.79–35.74). Additionally, a Mantel-Cox means’ analysis revealed that the use of the game was associated with an increased number of days without smoking in the test group (mean 182.9; SD 10.4; X2 3.98; P <.04). Conclusions: Pregnancy is an ideal opportunity to intervene and control tobacco use among future mothers. On the other hand, serious games is an emerging technology, growing in importance, which is shown as a good tool to assist in maintaining women without smoking and help behaviour change during pregnancy. However, due to study design limitations, these outcomes should be interpreted with caution. More research, using larger samples and longer follow-up periods, is needed to replicate the findings of this study.

  • Augmented reality app in ultrasound training A prospective trial to demonstrate the effect of an augmented reality ultrasound trainer application on the motorical skills needed for a kidney ultrasound.

    Date Submitted: Nov 8, 2018

    Open Peer Review Period: Nov 9, 2018 - Jan 4, 2019

    Background: Medical education is currently evolving from 'learning by doing' to simulation based hands on tutorials. Objective: The aim of this prospective 2-armed study is to evaluate a newly develop...

    Background: Medical education is currently evolving from 'learning by doing' to simulation based hands on tutorials. Objective: The aim of this prospective 2-armed study is to evaluate a newly developed augmented reality ultrasound application and its effect on educational training and diagnostic accuracy. Methods: 66 medical students were recruited and using imaging and measuring a kidney as quality indicator were tested on the time they needed for imaging. Both groups used text books as preparation; in addition, the study group had access to a virtual ultrasound simulation application for mobile devices (APP). Results: There was no significant difference between the study arms regarding age, gender and previous ultrasound experience. The time needed to complete the kidney measurements also did not differ significantly. However, the results of the longitudinal kidney measurements differed significantly between study and control group, with larger more realistic values in the study group (study group: medianright 105.3 mm, range 86.1 mm – 127.1 mm, control group: medianright 92 mm, range 50.4 mm – 112.2 mm; p < .01; study group: medianleft 100.3 mm, range 81.7 mm – 118.6 mm, control group: medianleft 85.3 mm, range 48.3 mm – 113.4 mm; p < .01). Furthermore, whilst all students of the study group obtained valid measurements, students of the control group failed to obtain valid measurements of one or both kidneys in seven cases. Conclusions: To summarize, the newly developed augmented reality ultrasound simulator APP provides a useful add-on for ultrasound education and training. Our results indicate that the use of the APP for training purposes results in improved quality of kidney measurements in medical students. Clinical Trial: The Trial was registered with the local ethics commission

  • EpiduroSIM: Epiduroscopy simulator based on serious game for spatial cognitive training

    Date Submitted: Nov 5, 2018

    Open Peer Review Period: Nov 5, 2018 - Dec 31, 2018

    Background: Performing high-level surgeries with endoscopy are challenging, and hence, an efficient surgical training method or system is required. Serious-game-based simulators can provide a trainee-...

    Background: Performing high-level surgeries with endoscopy are challenging, and hence, an efficient surgical training method or system is required. Serious-game-based simulators can provide a trainee-centered educational environment unlike the traditional teacher-centered education environments because serious game provides a high level of interaction (feedback that induces learning). Objective: We herein propose an epiduroscopy simulator, EpiduroSIM, based on a serious game for spatial cognitive training. Methods: The proposed EpiduroSIM is designed based on a serious game. For spatial cognitive training, the virtual environment of the proposed EpiduroSIM is modeled based on a cognitive map. The proposed EpiduroSIM is developed considering user accessibility, to provide various functions. The experiment for the validation of the proposed EpiduroSIM focused on the psychological fidelity and repetitive training effects. The experiments were conducted by dividing 16 specialists into 2 groups of 8 surgeons. The group was divided into the beginner and the expert, based on their epiduroscopy experience. Results: The psychological fidelity of the proposed EpiduroSIM was confirmed through the training results of the expert group rather than the beginner group. In addition, the repetitive training effect of the proposed EpiduroSIM was confirmed by improving the training results in the beginner group. Conclusions: The proposed EpiduroSIM may be useful for beginner surgeons to train epiduroscopy. Clinical Trial: N/A

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