Examining the Acceptability of Helminth Education Packages "Magic Glasses Lower Mekong" and "Magic Glasses Opisthorchiasis" and Their Impact on Knowledge, Attitudes, and Practices Among Schoolchildren in the Lower Mekong Basin: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: Helminths are a major global health issue, impacting health, educational, and socioeconomic outcomes. Infections, often starting in childhood, are linked to anemia, malnutrition, cognitive deficit, and in chronic cases of Opisthorchis viverrini (OV), cholangiocarcinoma. The main control strategy for helminth infection is mass drug administration; however, this does not prevent reinfection. As such, prevention strategies are needed. The "Magic Glasses" is a school-based cartoon health education package that has demonstrated success in improving knowledge, attitudes, and practices (KAP) surrounding soil-transmitted helminths (STH) in China and the Philippines. This study is designed to assess the acceptability and impact of the 2 new versions of the Magic Glasses targeting STH and OV designed for the Lower Mekong audience in Cambodia, Lao People's Democratic Republic (PDR), and Thailand. OBJECTIVE: The objective of this study is to evaluate the acceptability of the "Magic Glasses Lower Mekong" and "Magic Glasses Opisthorchiasis" education packages among schoolchildren in the Lower Mekong Basin, and the impact of these education packages on students' KAP surrounding STH and OV, respectively. METHODS: Schoolchildren will be recruited into a cluster randomized controlled trial with intervention and control arms in rural schools in Cambodia, Lao PDR, and Thailand. Schoolchildren's initial acceptability of the intervention will be evaluated using an adapted questionnaire. Sustained acceptability will be assessed at 9-month follow-up through focus group discussions with students and interviews with teachers. Impact will be evaluated by KAP questionnaires on STH and OV. KAP questionnaires will be administered to children at baseline and at follow-up. Indirect impact on parents' KAP of OV and STH will be assessed through focus group discussions at follow-up. RESULTS: The trial is in progress in Lao PDR and Thailand and is expected to commence in Cambodia in January 2024. The results of the study are expected to be available 18 months from the start of recruitment. We hypothesize that participants enrolled in the intervention arm of the study will have higher KAP scores for STH and OV, compared with the participants in the control arm at follow-up. We expect that students will have initial and sustained acceptability of these intervention packages. CONCLUSIONS: This trial will examine the acceptability of the "Magic Glasses Opisthorchiasis" and "Magic Glasses Lower Mekong" interventions and provide evidence on the effectiveness of the "Magic Glasses" on KAP related to OV and STH among schoolchildren in the Lower Mekong Basin. Study results will provide insight on acceptability and impact indicators and inform a scaling up protocol for the "Magic Glasses" education packages in Cambodia, Lao PDR, and Thailand. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12623000271606; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385315&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55290.

The effects of icon design features on user perception and preference: A case study of icons for Covid-19.

The objective of this study is to evaluate users' perceptions and preferences on the design features of the COVID-19 prevention promotion icon from the perspective of users' aesthetic and perceptual needs. In this study, 120 officially published icons from 24 countries and regions were collected from online platforms for ranking tests, and then the top-ranked icons were subjectively rated by the semantic differential method. By evaluating the quality of users' perceptions of multiple semantic dimensions of icons, we extracted the perceptual semantic words that users valued as the main icon design features. Spearmen correlations were applied to derive possible correlations between user rankings and semantic scales, and a Friedman test was also conducted to determine the true differences in user perceptions and preferences for different styles of icons. Factor analysis was conducted to extract six perceptual words that influence the design features of the COVID-19 prevention promotion icon. The methodology adopted in this study facilitated the screening of design features related to icon effectiveness, and the findings show that "Interesting," "Simple," "Familiar, "Recognizable," "Concrete," and "Close(semantic distance)" are the key features that influence users' perception and preference of COVID-19 icon design. The results of this study can be used as the basis for designing and improving publicity icons for preventive measures in COVID-19, and the methods adopted in this study can be applied to evaluate other types of icon design.

Design and development of a new pictorial tool to facilitate communication around advance care planning.

BACKGROUND: Advance care planning (ACP) aims to ensure that people with chronic or advanced disease receive medical care that is consistent with their values and preferences. However, professionals may find it challenging to engage these patients in conversations about the end of life. We sought to develop a pictorial tool to facilitate communication around ACP. METHODS: This was a three-phase study. In phase 1, we used the nominal group and Delphi techniques to achieve expert consensus regarding the conceptual content of the tool. In phase 2, a professional cartoonist was commissioned to create a series of cartoons representing each of the content areas resulting from the Delphi process. The pictorial tool was then administered (phase 3) with a sample of individuals with advanced/chronic disease to explore whether the cartoons were easy to understand and conveyed the intended message. RESULTS: Following a three-round Delphi process, consensus was reached regarding a set of 12 key content areas that should be considered in the context of an ACP interview. The cartoons created to represent each of the 12 areas were then reviewed and ordered so as to reflect the typical stages of an end-of-life care interview. After administering the pictorial tool with 24 frail older adults with advanced/chronic disease, changes were made to 9 of the 12 cartoons. CONCLUSIONS: The new pictorial tool comprises a set of 12 cartoons that can guide professionals as they seek to engage frail older adults with advanced/chronic disease in conversations about the end of life and ACP.

Impaired inhibitory control when processing real but not cartoon emotional faces in autistic children: Evidence from an event-related potential study.

Impaired socioemotional functioning characterizes autistic children, but does weak inhibition control underlie their socioemotional difficulty? This study addressed this question by examining whether and, if so, how inhibition control is affected by face realism and emotional valence in school-age autistic and neurotypical children. Fifty-two autistic and 52 age-matched neurotypical controls aged 10-12 years completed real and cartoon emotional face Go/Nogo tasks while event-related potentials (ERPs) were recorded. The analyses of inhibition-emotion components (i.e., N2, P3, and LPP) and a face-specific N170 revealed that autistic children elicited greater N2 while inhibiting Nogo trials and greater P3/LPP and late LPP for real but not cartoon emotional faces. Moreover, autistic children exhibited a reduced N170 to real face emotions only. Furthermore, correlation results showed that better behavioral inhibition and emotion recognition in autistic children were associated with a reduced N170. These findings suggest that neural mechanisms of inhibitory control in autistic children are less efficient and more disrupted during real face processing, which may affect their age-appropriate socio-emotional development.

Effects of a Free Electronic Book on Systemic Anatomy with Schematics on Student Learning / Efectos de un Libro Electrónico Gratuito sobre Anatomía Sistémica con Esquemas sobre el Aprendizaje de los Estudiantes

SUMMARY: For students in schools of nursing, health sciences, and premed, a systemic anatomy textbook with minimized contents, schematics, and mnemonics may be helpful for learning an otherwise often unappealing subject. In this study, we assess the educational effect of such a textbook. Schematic drawings, anatomy comics, and easily readable text were generated for the chapters of the book (e.g., skeletal system, articular system). The book was presented without charge via a webpage (anatomy.co.kr). Nursing students who were exposed to the book and those who were not exposed were compared; a survey was administered to those who were exposed. The students who read the presented textbook were more knowledgeable than those who used other textbooks. Hours spent reading the presented textbook and scores of fill-in-the-blank questions were positively correlated. In general, the students replied that the presented textbook was helpful for learning systemic anatomy. The systemic anatomy textbook accompanies preexisting textbooks in regional anatomy, neuroanatomy, and the histology, all of which are written by the same authors. We suggest anatomy instructors generate their own books with unique style to enrich the student learning process.

Para los estudiantes de las escuelas de enfermería, ciencias de la salud y premedicina, un libro de texto de anatomía sistémica con contenidos, esquemas y mnemónicos minimizados puede ser útil para aprender un tema que de otro modo sería poco atractivo. En este estudio, evaluamos el efecto educativo de dicho libro de texto. Se generaron dibujos esquemáticos, cómics de anatomía y texto de fácil lectura para los capítulos del libro (por ejemplo, sistema esquelético, sistema articular). El libro se presentó sin costo a través de una página web (anatomy.co.kr). Se compararon los estudiantes de enfermería que estuvieron expuestos al libro y los que no estuvieron expuestos. Se administró una encuesta a quienes estuvieron expuestos. Los estudiantes que leyeron el libro de texto presentado tenían más conocimientos que aquellos que usaron otros libros de texto. Las horas dedicadas a leer el libro de texto presentado y las decenas de preguntas para completar espacios en blanco se correlacionaron positivamente. En general, los estudiantes respondieron que el libro de texto presentado fue útil para aprender anatomía sistémica. El libro de texto de anatomía sistémica acompaña a los libros de texto preexistentes de anatomía regional, neuroanatomía e histología, todos escritos por los mismos autores. Sugerimos que los instructores de anatomía generen sus propios libros con un estilo único para enriquecer el proceso de aprendizaje de los estudiantes.

Schoolchildren's motivation for viewing Chinese opera animation according to opera genre.

The emergence of Chinese opera animation allows a wider audience, especially a younger audience, to access and embrace the art of opera heritage. This study used a two-way mixed-design ANOVA to explore the effect of Chinese opera animation on schoolchildren's viewing motivation; the independent variables were the children's grade level and the opera genre of the animation. Grade level was divided into three groups: lower, middle, and upper (grades 2, 4, and 6, respectively). Opera genre consisted of Peking, Yue, and Henan opera. The dependent variable, viewing motivation, comprised six dimensions: entertainment and relaxation, learning knowledge, escapist pastime, aesthetic appreciation, empathic identification, and socializing and sharing. After statistically analyzing the evaluations of 457 participants, the results showed the following: (1) Peking and Yue opera animation had a better entertainment and relaxation effect on the lower and middle groups. Henan opera had a better escapist pastime effect on the upper group but less effect on the lower group. (2) In terms of learning knowledge, empathic identification, aesthetic appreciation, and overall performance, Yue and Henan opera animations were more effective for enhancing viewing motivation compared with Peking opera animation. (3) The middle and lower groups showed higher viewing motivation than the upper group in the learning knowledge, empathic identification, and socializing and sharing dimensions. Overall, grades 2 and 4 were appropriate stages for schoolchildren to engage with opera animation. Our findings can provide a reference for promoting cultural heritage sustainability and support follow-up research on integrating opera animation into children's education.

What's Up With Everyone? A qualitative study on young people's perceptions of cocreated online animations to promote mental health literacy.

INTRODUCTION: Adolescence and young adulthood are especially critical times to learn about mental health, given that 75% of mental health issues are developed by the age of 24. Animations have great potential to effectively deliver mental health information to young people. A series of five short animated films to promote mental health literacy were created with and for young people in partnership with the multi-award-winning independent animation studio, Aardman Animations. The aim of this study was to explore young people's perceptions of the cocreated animated films. METHODS: Seven Youth Juries were conducted to capture young people's opinions and recommendations about the content related to mental health literacy and presentation style of the cocreated animated films. Thematic analysis was used to analyse the audio transcripts. RESULTS: Many participants reported a view that the animated films had the potential to promote mental health literacy, especially for understanding mental health and reducing stigma. Some recommendations were provided to improve the films, such as including subtitles and having a better transition to the companion website. CONCLUSION: Cocreated animations have great potential to promote the mental health literacy of young people. We hope that the findings from the present study will inform future media development to make them as effective as possible. PATIENT OR PUBLIC CONTRIBUTION: Young people were actively involved in the development, production, implementation and evaluation (up to the time before data analysis) of the animated films.

Infants' brain activity to cartoon face using functional near-infrared spectroscopy.

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

The use of comics to promote health awareness: A template using nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) constitutes a major threat to public health systems worldwide on account of its widespread prevalence and increasing incidence. More effective tools to raise awareness and increase health communication are therefore needed. Comics may constitute an effective language for this purpose, given the permanence, adaptability and ability of this form of communication to convey complex information, using both visual components and the creation of narrative involvement, thus promoting both awareness and health-conscious behaviours. Importantly, this process requires careful preparation in terms of selecting both the key biomedical concepts to be conveyed, as well as a graphical style and appropriate characters and a narrative arc with which a target audience can identify with. Here we provide a brief introduction to the use of comics in health communication and propose a possible roadmap for the development of comic-based tools for diverse conditions, using the context of NAFLD.

[Development and Evaluation of Prenatal Education for Environmental Health Behavior Using Cartoon Comics].

PURPOSE: This study aimed to develop and examine the effects of a prenatal program on environmental health behavior using cartoon comics among Korean pregnant women. METHODS: This study used a non-equivalent control group pre-test/post-test design. The program used cartoon comics to explore environmental health behaviors during pregnancy. The program consisted of the following four components: environmental toxicants during pregnancy, avoiding particulate matter during pregnancy, environmental toxicants during baby care, and making a healthy environment for children. In total, 35 pregnant women participated in the study: 18 in the experimental group and 17 in the control group. Data collection and program adaptation were conducted between November 3, 2020 and January 19, 2021. The effect of the prenatal education program was evaluated by t-test and repeated measures ANOVA. RESULTS: Learning experience (t = - 2.35, p = .025), feasibility (t = - 2.46, p = .019), satisfaction (t = - 2.23, p = .032) were higher in the experimental group than in the control group in the first post-test. Feasibility (t = - 2.40, p = .022) was higher in the experimental group than in the control group in the second post-test. Repeated-measures ANOVA showed significant interactions between time and group in environmental susceptibility (F = 9.31, p < .001), self-efficacy (F = 3.60, p = .033), and community behavior (F = 5.41, p = .007). CONCLUSION: This study demonstrates the need for a prenatal education program to promote environmental health perceptions and behavior during pregnancy. We suggest a prenatal class adopting the creative cartoon comics to promote the maternal environmental health behaviors.

[Perineal pain in Tintin adventures]. / Les algies périnéo-glutéales traumatiques dans les aventures de Tintin. Ou Tintin au pays des algies périnéales.

AIMS: To analyze the determinants and severity of perineal pain in the adventures of Tintin and Snowy. MATERIAL AND METHODS: All 23 adventures of Tintin and Snowy (Hergé, Moulinsart Ed.) were reviewed in order to determine the presence, causes and severity of perineal pain (PP) observed in the various heroes of this comic book. Several parameters were studied: the cause which could be either accidental or voluntary; the type of patient (good guys-bad guys); the hero concerned (Tintin, Captain Haddock, Thompson and Thomson, Snowy, Professor Calculus …); the duration of the pain (by the number of boxes where the subject was represented suffering from such pains); finally, the severity of these pains, by the number of stars or signs designating the region and stereotyping the importance of the pain. The Student and Chi2 tests were used to analyze these different qualitative and quantitative variables. RESULTS: Five hundred and one traumas were found in the adventures of Tintin and Snowy, including 47 PP, 9.4% of cases compared to 299 head traumas (60% of cases). Six albums out of the 23 did not report any PP. PPs are usually traumatic either by a fall (68%) or by direct trauma (kick to the back 6%, spanking 4%) much more exceptionally by a bite (2 cases), a burn (2 cases), needles or arrows inserted in the bottom (5 cases) and a bullet wound (1 case). Tintin is the most concerned (19%) with Captain Haddock (23%), followed by Snowy (15%). The bad guys and the good guys don't share equally the perineal pain since the good guys are forgivably more exposed (79% vs. 21%). There is no correlation between head trauma and PP (r2=0.117). The severity index for PP is 5.21 with a mean duration of 3.01 vs. 6.88 for severity and 3.2 for duration for head trauma, a highly significant difference in the Student test (P=0.00259). The total number of traumas per album progressively decreases over the albums (r2=0.3111) with, for example, 38 for the first album (Tintin and the Soviets) and 4 for the last one (Tintin and the Picaros). This decrease in trauma is clearer for cephalic trauma (r2=0.1436) than for PP (r2=0.2189). CONCLUSION: The frequency of traumatic PP in Tintin's adventures is important and is second only to head injuries. This frequency of PP traumas is undoubtedly linked to the hectic and adventurous life of Tintin and his acolytes exposed in all circumstances to all kinds of direct or indirect injuries. Future studies will have to specify the risk of after-effects and the psychological impact of PPs on the heroes concerned. LEVEL OF PROOF: 4.

Comics in the Time of a Pan(dem)ic: COVID-19, Graphic Medicine, and Metaphors.

Comics have always responded to pandemics/catastrophes, documenting the way we deal with such crises. Recently, graphic medicine, an interdisciplinary field of comics and medicine, has been curating comics, editorial cartoons, autobiographical cartoons, and social media posts under the heading "COVID-19 Comics" on their websites. These collected comics express what we propose to call covidity, a neologism that captures both individual and collective philosophical, material, and wide-ranging emotional responses to the COVID-19 pandemic. Treating such comics as the source material and drawing insights from theorists Ian Williams, Alan Bleakley, Susan Sontag, and others, this article examines graphic medicine's representation of the COVID-19 pandemic. The conceptual metaphors of war, anthropomorphism, and superheroism are used to represent and illustrate the lived experience of the pandemic, and the article investigates metaphor types, their utility, and motivational triggers for such representations. In doing so, the essay situates graphic medicine as a productive site that presents the pandemic's multifarious impact.

Using a cartoon questionnaire to improve consent process in children: a randomized controlled survey.

OBJECTIVE: The aim of the study was to evaluate the effectiveness of an audio and animated cartoon questionnaire (AACQ) at improving consent process in child for biospecimen donation. METHODS: A multi-center randomized and controlled survey was performed at two pediatric hospitals in China from 2019 to 2020. Children aged from 7 to 18 years in the pediatric surgery wards were invited to investigate the participants' willingness and attitudes for donating biospecimens. A total of 264 children, including 119 in the AACQ group and 145 in the TQ group, and 67 parents of children were analyzed. A separate knowledge test was acquired in the questionnaires. RESULTS: Our findings showed that the response rate of the AACQ group (89.85%) was significantly higher than that of the TQ group (68.44%; p < 0.001). AACQ can improve the child's understanding, increase children's engagement in biospecimen donation, reduced the differences in selected characteristics affecting children understanding, and enhanced their risk awareness of donating biospecimens. We also found that increasing pain and privacy disclosure were the most popular concern among children for the refusal to donate biospecimens. CONCLUSIONS: AACQ is an effective and standardized tool of content delivery to children from the surgical wards. Children who fully understood of biospecimen donation are suggested to participate in the consent signing. IMPACT: Using audio and animated cartoon questionnaire is a more effective and standardized tool of content delivery to children. This study expanded the use of an animated cartoon to a children's survey. Audio and animated cartoon questionnaire (AACQ) can improve the child's understanding, increase children's engagement in biospecimen donation compared to text questionnaire (TQ) group, and enhanced their risk awareness of donating biospecimens. More AACQ should be used with children in the future to effectively deliver content to children and improve children's participation in the survey.

Meeting Report: 68th Montagna Symposium on the Biology of Skin "Decoding Complex Skin Diseases: Integrating Genetics, Genomics, and Disease Biology".

The 68th Montagna Symposium on the Biology of the Skin was held from 10 to 14 October 2019 at Salishan Lodge in Gleneden Beach, Oregon. The theme of the meeting was "Decoding Complex Skin Diseases: Integrating Genetics, Genomics, and Disease Biology." The meeting emphasized the integration of multiple themes and disciplines to better understand some of the most common skin diseases, ranging from psoriasis to alopecia areata to vitiligo to lupus erythematosus to atopic dermatitis and food allergy. Promising therapeutic strategies are emerging for all of these diseases, providing clues for ways to connect the bench to the bedside. A common thread was the success of GWASs, which have highlighted the importance of regulatory signals versus coding variation. These diseases also share an environmental component linked to immune system function. Hence, beyond GWASs, this meeting focused on gene regulatory mechanisms, the single-cell revolution, in vivo systems for dissection of disease pathogenesis, and the relationship between genetics and environment in the context of host defense. We concluded with a translational roundtable designed to explore how these interrelated fields can best be directed toward long-term disease control and, ultimately, a cure.