Similarities and differences in dynamic properties of brain networks between internet gaming disorder and tobacco use disorder.

BACKGROUND: Internet gaming disorder (IGD) and tobacco use disorder (TUD) are two major addiction disorders that result in substantial financial loss. Identifying the similarities and differences between these two disorders is important to understand substance addiction and behavioral addiction. The current study was designed to compare these two disorders utilizing dynamic analysis. METHOD: Resting-state data were collected from 35 individuals with IGD, 35 individuals with TUD and 35 healthy controls (HCs). Dynamic coactivation pattern analysis was employed to decipher their dynamic patterns. RESULTS: IGD participants showed decreased coactivation patterns within the default mode network (DMN) and between the DMN and the salience network (SN). The SN showed reduced coactivation patterns with the executive control network (ECN) and DMN, and the ECN showed decreased coactivation patterns with the DMN. In the TUD group, the DMN exhibited decreased coactivation patterns with the SN, the SN exhibited reduced coactivation patterns with the DMN and ECN, and the ECN showed decreased coactivation patterns with the DMN and within the ECN. Furthermore, the triple network model was fitted to the dynamic properties of the two addiction disorders. Decoding analysis results indicated that addiction-related memory and memory retrieval displayed similar dysfunctions in both addictions. CONCLUSION: The dynamic characteristics of IGD and TUD suggest that there are similarities in the dynamic features between the SN and DMN and differences in the dynamic features between the DMN and ECN. Our results revealed that the two addiction disorders have dissociable brain mechanisms, indicating that future studies should consider these two addiction disorders as having two separate mechanisms to achieve precise treatment for their individualized targets.

Serious gaming as potential training tool for recognition of adverse drug reactions: side-effect exposure-medical education (SeeMe).

PURPOSE: The recognition of adverse drug reactions (ADRs) is an important part of daily clinical work. However, medical education in this field is mostly drug-based and does not address adequately the complexity of this field regarding individual risk factors and polypharmacy. This study investigates the potential of the web-based serious game SeeMe (side-effect exposure-medical education) in pharmacological education of medical students to improve the recognition of relevant ADRs. METHODS: One hundred fifty-seven medical students were recruited to evaluate the serious game SeeMe. SeeMe was developed to improve knowledge and recognition of ADRs in clinical practice. Players take on the role of a physician trying to understand fictional patients with ADRs. Before and after an 8-week playing period, an evaluation was carried out through a pre- and post-questionnaire and a pre- and post- knowledge test. RESULTS: The students achieved significantly better results in the knowledge test, as almost twice as many exam-relevant questions were answered correctly (p < 0.001). The serious game had a positive effect on the students' perception of the importance of ADRs. CONCLUSION: This study demonstrates the potential of web- and case-based fictional serious games in medical education. The improved recognition of side effects represents a crucial step for education and training in clinical pharmacology. Future versions of the serious game may take this further and focus on training in the treatment of ADRs and their relevance in various healthcare professions.

Investigating the Use of Serious Games for Cancer Control Among Children and Adolescents: Scoping Review.

BACKGROUND: Effective health care services that meet the diverse needs of children and adolescents with cancer are required to alleviate their physical, psychological, and social challenges and improve their quality of life. Previous studies showed that serious games help promote people's health. However, the potential for serious games to be used for successful cancer control for children and adolescents has received less attention. OBJECTIVE: This scoping review aimed to map the use of serious games in cancer prevention and cancer care for children and adolescents, and provide future directions for serious games' development and implementation within the context of cancer control for children and adolescents. METHODS: This study followed a combination of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and the JBI (Joanna Briggs Institute) framework for the conduct of scoping reviews. PubMed, CINAHL Plus Full Text, Scopus, Web of Science Core Collection, and American Psychological Association (APA) PsycINFO databases were used for the search. RESULTS: From the initial 2750 search results, 63 papers were included in the review, with 28 quantitative, 14 qualitative, and 21 mixed method studies. Most of the studies were cancer care serious game papers (55/63, 87%) and a small number of studies were cancer prevention serious game papers (8/63, 13%). The majority of the included studies were published between 2019 and 2023 (cancer prevention: 5/8, 63%; cancer care: 35/55, 64%). The majority of the studies were conducted in Europe (cancer prevention: 3/8, 38%; cancer care: 24/55, 44%) and North America (cancer prevention: 4/8, 50%; cancer care: 17/55, 31%). Adolescents were the most represented age group in the studies' participants (cancer prevention: 8/8, 100%; cancer care: 46/55, 84%). All (8/8, 100%) cancer prevention serious game papers included healthy people as participants, and 45 out of 55 (82%) cancer care serious game papers included patients with cancer. The majority of cancer prevention serious game papers addressed game preference as a target outcome (4/8, 50%). The majority of cancer care serious game papers addressed symptom management as a target outcome (28/55, 51%). Of the cancer care studies examining serious games for symptom management, the majority of the studies were conducted to treat psychological (13/55, 24%) and physical symptoms (10/55, 18%). CONCLUSIONS: This review shows both the growth of interest in the use of serious games for cancer control among children and adolescents and the potential for bias in the relevant literature. The diverse characteristics of the included papers suggest that serious games can be used in various ways for cancer control among children and adolescents while highlighting the need to develop and implement serious games in underrepresented areas.

A Serious Game (MyDiabetic) to Support Children's Education in Type 1 Diabetes Mellitus: Iterative Participatory Co-Design and Feasibility Study.

BACKGROUND: Serious games, which are gaming applications used for purposes beyond entertainment to educate users on, and address, specific issues, may present a timely approach to promote healthy diabetes management behaviors among children with type 1 diabetes mellitus (T1DM). The lasting benefits associated with these serious games encompass improved patient education; enhanced glycemic control; the reinforcement of bonds within the community of people with diabetes; the facilitation of meaningful dialogues with caregivers, especially within the familial setting; and a significant reduction in the economic burdens associated with subsequent complications. OBJECTIVE: This paper primarily aims to provide a detailed overview of the iterative design process and the associated evaluation methods used in the development of the educational game. Furthermore, this study aims to enhance motivation for sustained and extended engagement with the game over time. The MyDiabetic game design aims to educate children on various aspects, including the connections among food, insulin, and physical activity. Furthermore, it seeks to impart knowledge related to the operation of a glucometer and an insulin pen, as well as more advanced technologies such as administering glucagon, measuring ketoacidosis, and continuous glucose monitoring. METHODS: The co-design methodology was applied, involving interviews, design workshops, and prototype feedback sessions. A combination of several approaches, such as tailoring, observational learning, social and family support, decision-making practice, and reward systems, was used to support children's compliance. Moreover, incorporating the literature, guidelines, and current practices into the design ensured that the game was aligned with established health care pathways and included relevant information and best practices for diabetes management. RESULTS: The game was tested on 32 children in 3 iterations. Positive responses were received from children who tested the game as well as their parents. The game was also presented to 5 schoolmates of children with T1DM who appreciated a better understanding of the disease and the opportunity to support their friends more efficiently in T1DM compensation. The involvement of children and clinicians in participatory co-design contributed to to the game's high acceptance. With regard to the game's impact on education, 1 week of testing revealed an enhancement in educational outcomes. CONCLUSIONS: The game is especially suitable for children newly diagnosed with T1DM because it acquaints them in a fun way with new terminology; for example, they can try to measure glycemia levels in an interactive way. The game also caters to children who still need to develop reading skills by including an audio guide. The guide ensures that children of all literacy levels can benefit from the game's educational content and interactive experiences. The game is available for download on Google Play and the Apple App Store.

An International, Multidisciplinary Consensus Set of Patient-Centered Outcome Measures for Substance-Related and Addictive Disorders.

Background: In 1990, the United States' Institute of Medicine promoted the principles of outcomes monitoring in the alcohol and other drugs treatment field to improve the evidence synthesis and quality of research. While various national outcome measures have been developed and employed, no global consensus on standard measurement has been agreed for addiction. It is thus timely to build an international consensus. Convened by the International Consortium for Health Outcomes Measurement (ICHOM), an international, multi-disciplinary working group reviewed the existing literature and reached consensus for a globally applicable minimum set of outcome measures for people who seek treatment for addiction. Methods: To this end, 26 addiction experts from 11 countries and 5 continents, including people with lived experience (n = 5; 19%), convened over 16 months (December 2018-March 2020) to develop recommendations for a minimum set of outcome measures. A structured, consensus-building, modified Delphi process was employed. Evidence-based proposals for the minimum set of measures were generated and discussed across eight videoconferences and in a subsequent structured online consultation. The resulting set was reviewed by 123 professionals and 34 people with lived experience internationally. Results: The final consensus-based recommendation includes alcohol, substance, and tobacco use disorders, as well as gambling and gaming disorders in people aged 12 years and older. Recommended outcome domains are frequency and quantity of addictive disorders, symptom burden, health-related quality of life, global functioning, psychosocial functioning, and overall physical and mental health and wellbeing. Standard case-mix (moderator) variables and measurement time points are also recommended. Conclusions: Use of consistent and meaningful outcome measurement facilitates carer-patient relations, shared decision-making, service improvement, benchmarking, and evidence synthesis for the evaluation of addiction treatment services and the dissemination of best practices. The consensus set of recommended outcomes is freely available for adoption in healthcare settings globally.

Wanting-liking dissociation and altered dopaminergic functioning: Similarities between internet gaming disorder and tobacco use disorder.

Background: Although internet gaming disorder (IGD) has been included in the DSM-5 for approximately 10 years, debate remains regarding its existence and classification. Methods: The current research incorporated three approaches. First, implicit association tests were used to examine for potential dissociation between wanting and liking in IGD. Second, brain features in wanting and liking circuits were tested and compared with tobacco use disorder (TUD) when performing a cue-craving task to explore the neural features of wanting and liking. Third, dopaminergic systems were investigated in IGD and TUD using neuromelanin-sensitive MRI. Results: The implicit association test results supported a wanting-liking dissociation in IGD participants. Functional MRI data suggested neural correlates underlying wanting-liking dissociation in IGD and TUD participants, with positive correlations suggesting greater dissociation with increasing addiction severity. Neuromelanin results suggest dopaminergic differences in IGD and TUD relative to healthy control participants. Conclusions: A wanting-liking dissociation in IGD participants suggests gaming motivations in IGD relating to incentive sensitization rather than hedonic responses. The neuromelanin-sensitive MRI results suggest dopaminergic involvement in IGD and TUD. The findings suggest similar brain-behaviour mechanisms for IGD and TUD based on an incentive-sensitization model for addiction, having implications for potential therapeutic strategies and policy-based interventions.

Validation of the ACSID-11 for consistent screening of specific Internet-use disorders based on ICD-11 criteria for gaming disorder: A multitrait-multimethod approach.

INTRODUCTION: With the inclusion of gaming disorder in the ICD-11, diagnostic criteria were introduced for this relatively new disorder. These criteria may be applied to other potential specific Internet-use disorders. The 11-item Assessment of Criteria for Specific Internet-use Disorders (ACSID-11) was developed for consistent screening of gaming disorder, online buying-shopping disorder, online pornography-use disorder, social networks-use disorder, and online gambling disorder. This study tested the construct validity of the ACSID-11, including convergent and divergent measures. METHODS: The ACSID-11 measures five behavioral addictions with the same set of items by following the principles of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ACSID-11 was administered to a convenience sample of active Internet users (N = 1597) together with validated and established measures of each specific Internet-use disorder along with screeners for mental health. Included are the Ten-Item Internet Gaming Disorder Test (IGDT-10), the Bergen Shopping Addiction Scale (BSAS), the Problematic Pornography Consumption Scale (PPCS), the Bergen Social Media Addiction Scale (BSMAS) and the Berlin Inventory of Gambling behavior - Screening (BIG-S). The ACSID-11 was compared convergently and divergently through a multitrait-multimethod approach along with contingency tables with the other Internet-use disorder screeners. RESULTS: The multitrait-multimethod results shows that each behavior assessed with the ACSID-11 has moderate to strong correlations (r's from 0.462 to 0.609) with the scores of the corresponding established measures and, furthermore, positive correlations (r's from 0.122 to 0.434) with measures of psychological distress and further shows that the ACSID-11 can be used for a comprehensive assessment of different behaviors. The contingency tables reveal large divergences between the ACSID-11 and other screening instruments concerning the classification of problematic specific Internet use based on the given cut-off values. CONCLUSION: The current work provides additional validation for the ACSID-11. Accordingly, this tool can be considered as reliable and valid for the simultaneous assessment of different Internet-use disorders: gaming disorder, online buying-shopping disorder, online pornography use disorder, social networks use disorder, and online gambling disorder. With a subsequent clinical validation of the scale and the proposed cut-off score, the ACSID-11 will be a thoroughly validated useful screening tool for clinical practice.

Large-scale, mobile and technology-enhanced serious game for interprofessional education: pilot study and lessons learnt.

Recent research suggests that serious gaming is a promising strategy for interprofessional education (IPE). This report describes the design and pilot testing of a large-scale, mobile, technology-enhanced serious game embedded in the IPE curriculum in Geneva, Switzerland. Organized into teams of eight, the students were tasked with finding a young patient who had just escaped from the intensive care unit. Through a series of 10 stations, they explored hospital- and community-based locations of the healthcare system and were engaged in various learning and game activities; they were rewarded with cues to unveil the mystery. A total of 582 undergraduate students from seven disciplines (medicine, midwifery, nursing, nutrition-dietetics, pharmacy, physiotherapy, and technology in medical radiology) took part. Survey results (response rate: 62.8%) suggest that an overall majority of students valued the game, particularly the collaborative experience of actively learning from others in autonomous teams. Qualitative feedback allowed us to identify future areas for improvement: simplifying the adventure storyline and optimizing student flow. Educational institutions across the world facing challenges when creating IPE activities will find in this report ideas and lessons learnt to use mobile technology and serious gaming for large cohorts of students.

The Lived Experiences of Individuals and Coping Strategies in the Context of Internet Gaming Disorder: A Qualitative Study Within Higher Education Setting in Uganda.

Background: Internet Gaming Disorder (IGD), recognized as a mental disorder in both the Diagnostic and Statistical Manual (DSM-5) and International Classification of Diseases (ICD-11), poses significant threats to physical, social, and mental well-being. This study aims to delve into the experiences of individuals grappling with IGD. Methods and Materials: The study employed an interpretive phenomenology, conducting interviews with 10 graduate students at Makerere University. Participants were purposefully sampled until data saturation was achieved during interviews, which took place between May and July 2023. An interview guide facilitated data collection (Supplementary File 1), and thematic analysis was manually applied for data interpretation, utilizing intuition and imaginative approaches. Results: The findings revealed that the majority of participants started gaming during childhood, starting with offline games. Exposure to gadgets and games, idle time, and stress emerged as key triggers for IGD. Participants reported experiencing sleep deficits, deteriorating interpersonal relationships, declining job performance, unhealthy eating habits, academic challenges, and wastage of money and time. The study also identified strategies employed by participants to mitigate their gaming behaviors, such as refraining from purchasing data, seeking support from friends, and uninstalling the game app, although relapses were common. Conclusion: The study highlights a global pattern of early initiation into gaming, emphasizing the need for early intervention and preventive measures. Factors such as easy accessibility and affordability of gaming platforms, idleness, and stress play significant roles in motivating internet gaming, contributing to a higher prevalence among the studied population. The research underscores the adverse effects of IGD on students, affecting academic performance, interpersonal relationships, and job performance. Notably, participants demonstrate agency in addressing IGD through practical coping strategies, including controlling data access, seeking social support, and uninstalling games. These coping mechanisms provide valuable insights into the complex nature of addressing IGD and form a basis for developing targeted interventions and support systems within the higher education setting in Uganda.

Problematic video gaming is negatively associated with bone mineral density in adolescents.

Adolescent bone health may be negatively impacted by problematic video gaming (PVG) due to factors such as prolonged screen time, poor sleep quality, and increased depression. Although sedentary behaviors have been linked to decreased bone mass, there is limited research on how PVG impacts bone health. We aimed to evaluate the association between PVG and bone mineral density (BMD) in adolescents by comparing the BMD z-scores of adolescents with and without PVG and by identifying PVG-related risk factors that may affect low BMD scores. This cross-sectional study took place between May 2019 and August 2021 with 110 adolescents who played video games for at least two hours per day. Data on screen time, game genre, tobacco, alcohol, caffeine consumption, and vigorous physical activity status were recorded. PVG was assessed using the Internet Gaming Disorder-Short Form (IGDS9-SF), with scores ≤ 16 comprising the control group and > 16 the PVG group. Sleep quality was assessed by Pittsburgh Sleep Quality Index, and depression was evaluated by Children's Depression Inventory. Dual-energy X-ray absorptiometry measurements of femoral neck and lumbar spine BMD were compared between the two groups. The mean age of the participants was 14.2 ± 1.8 years, and 86.4% were males. The PVG group exhibited lower femoral neck z-scores (p = 0.013) and a higher proportion of adolescents with low femoral neck BMD risk (27.8% vs 9.7%, p = 0.041). Lumber spine z-scores did not differ (p = 0.271). Despite poorer depressive symptoms and sleep quality in the PVG group, they were not associated with low BMD risk (OR 1.02, 95% CI 0.97-1.08, p = 0.398 and OR 1.00, 95% CI 0.87-1.18, p = 0.972, respectively). Among all PVG-related risk factors, video game time (aOR = 1.22, 95% CI = 1.06-1.41, p = 0.006) and vigorous physical activity amount (aOR = 2.86, 95% CI = 0.93-8.76, p = 0.080) showed the strongest associations with femoral neck z-scores.  Conclusion: The results of this study, showing a negative association between PVG and femoral neck BMD in adolescents, underscore the importance evaluating, monitoring, and supporting lower extremity bone health in adolescents with PVG. What is Known: • Adolescents with problematic video gaming are at risk for depression, impaired sleep; sedentary lifestyle; consumption of tobacco, alcohol, and drugs; and high caffeine intake. • These risk factors might lead to compromised bone health. What is New: • Problematic video gaming is associated with the low femoral neck bone mineral density risk in adolescents. • Extended video game time and reduced physical activity are found to be the primary risk factors.

Higher striatal glutamate in male youth with internet gaming disorder.

Internet gaming disorder (IGD) was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a research diagnosis, but little is known about its pathophysiology. Alterations in frontostriatal circuits appear to play a critical role in the development of addiction. Glutamate is considered an essential excitatory neurotransmitter in addictive disorders. This study's aim was to investigate striatal glutamate in youth with IGD compared to healthy controls (HC). Using a cross-sectional design, 25 adolescent male subjects fulfilling DSM-5 criteria for IGD and 26 HC, matched in age, education, handedness and smoking, were included in the analysis. A structural MPRAGE T1 sequence followed by a single-voxel magnetic resonance spectroscopy MEGA-PRESS sequence (TR = 1500 ms, TE = 68 ms, 208 averages) with a voxel size of 20 mm3 were recorded on 3 T Siemens Magnetom Prisma scanner. The voxel was placed in the left striatum. Group comparison of the relative glutamate and glutamine (Glx) was calculated using regression analysis. IGD subjects met an average of 6.5 of 9 DSM-5 IGD criteria and reported an average of 29 h of weekly gaming. Regression analysis showed a significant group effect for Glx, with higher Glx levels in IGD as compared to HC (coef. = .086, t (50) = 2.17, p = .035). Our study is the first to show higher levels of Glx in the striatum in youth with IGD. The elevation of Glx in the striatum may indicate hyperactivation of the reward system in IGD. Thus, results confirm that neurochemical alterations can be identified in early stages of behavioral addictions.

Adverse childhood experiences on internet gaming disorder mediated through insomnia in Chinese young people.

Background: Adverse childhood experiences (ACEs) have been associated with addictions such as substance use disorders. Few have examined ACEs on internet gaming disorder (IGD) as a newly established behavioral addiction, and the potential mediating role of insomnia remains unclear. We examined the associations between ACE number and types, IGD, and insomnia. Methods: Participants included 1, 231 Chinese university students (54.5% male; 56.9% aged 18-20 years) who had played internet games at least once in the previous month. ACEs were measured using the 10-item ACE questionnaire (yes/no). Symptoms of insomnia and IGD were measured using the Insomnia Severity Index and the 9-item Internet Gaming Disorder Scale-Short-Form, respectively. Multivariable regressions examined the associations, adjusting for sex, age, maternal and paternal educational attainment, monthly household income, smoking, and alcohol drinking. The mediating role of insomnia symptoms was explored. Results: The prevalence of ACEs≥1 was 40.0%. Childhood verbal abuse was the most prevalent (17.4%), followed by exposure to domestic violence (17.1%) and childhood physical abuse (15.5%). More ACE numbers showed an association with IGD symptoms (adjusted OR = 1.11, 95% CI 1.04, 1.17). Specifically, IGD symptoms were observed for childhood physical neglect, emotional neglect, sexual abuse, parental divorce or separation, and household substance abuse. Insomnia symptoms mediated the associations of ACE number and types with IGD symptoms (proportion of total effect mediated range 0.23-0.89). Conclusion: The number and specific types of ACEs showed associations with IGD mediated through insomnia. Screening of ACEs is recommended in future studies on IGD. Longitudinal data are warranted to determine the causality of the observed associations.

Interplay between alexithymia, emotion regulation, and positive and negative affect as predictors of gambling and gaming disorders in adolescents and young adults

Introduction/Objectives: Gambling and gaming disorder are usually comorbid addictive behaviours in which alexithymia and emotional regulation have been proved to be of relevance. The present study aimed to analyse the relationship between those variables and their differences depending on the presence or absence of gambling and gaming behaviours. Method: The sample consisted of 1,219 people between 12 and 20 years of age (M = 15.55, SD = 2.07; 51.8% females). Results: The results showed significant differences between players and non-players in gambling disorder, alexithymia and emotional regulation. The findings also indicated that there were differences in alexithymia, emotional regulation, negative affect, gambling disorder and gaming disorder among the different profiles of video game players. The comparison of participants with gaming disorder, gambling disorder, both, or neither of them, showed differences in alexithymia, emotional regulation, negative affect, gambling disorder and gaming disorder. Furthermore, correlations between gambling disorder and age, gaming disorder, negative affect, alexithymia and emotional regulation were found. Similarly, gaming dis-order was associated with gambling disorder, negative affect, alexithymia, emotional regulation and age. Conclusions: The hierarchical regression analyses demonstrated the predictive role of alexithymia and age in gambling disorder as well as the predictive role of age, sex and negative affect in gaming disorder.

Introducción/Objetivos: Los trastornos de juego y videojuego son conductas adictivas habitualmente comórbidas en las que se ha demostrado la relevancia de la alexitimia y la regulación emocional. Este estudio analiza la relación entre dichas variables y sus diferencias en función de la presencia o ausencia de conductas de juego y videojuego. Método: La muestra estuvo formada por 1219 personas de entre 12 y 20 años (M = 15.55, SD = 2.07; 51.8 % mujeres). Resultados: Los resultados mostraron diferencias significativas entre jugadores y no jugadores en el juego patológico, la alexitimia y la regulación emocional. Los resultados también indicaron que había diferencias en alexitimia, regulación emocional, afecto negativo, trastorno de juego y videojuego entre los distintos perfiles de jugadores de videojuegos. La comparación de los participantes con trastorno de juego y videojuego, con ambos o con ninguno de ellos, mostró diferencias en la alexitimia, la regulación emocional, el afecto negativo, el trastorno de juego y videojuego. Además, se encontraron correlaciones entre el juego patológico y la edad, el trastorno por videojuego, el afecto negativo, la alexitimia y la regulación emocional. Del mismo modo, el trastorno por videojuego se asoció con el juego patológico, el afecto negativo, la alexitimia, la regulación emocional y la edad. Conclusiones: Los análisis de regresión jerárquica demostraron el papel predictivo de la alexitimia y la edad en el trastorno de juego y el papel predictivo de la edad, el sexo y el afecto negativo en el trastorno por videojuego.

Interaction effects between smoking and internet gaming disorder on resting-state functional connectivity of the ventral tegmental area and hippocampus.

Background: Many reports have focused on cigarette smoking and internet gaming disorder (IGD), with widespread alterations of resting-state functional connectivity (rsFC) in the reward and memory circuits, respectively. Epidemiological studies have also shown high comorbidity of cigarette smoking and IGD. However, the underlying mechanisms are still unknown. Therefore, this study investigates the comorbidity and interaction effects between smoking and IGD from the rsFC perspective. Methods: Resting-state functional magnetic imaging data were collected from 60 healthy controls (HC), 46 smokers, 38 IGD individuals, and 34 IGD comorbid with smoking (IGDsm) participants. Voxel-wise rsFC maps were calculated for all subjects with the ventral tegmental area, rostral hippocampus, and caudal hippocampus as regions of interest, respectively. Results: Significant interaction effects between smoking and IGD were mainly involved in the reward and memory circuits; that is, the rsFC between the ventral tegmental area and right nucleus accumbens, between the rostral hippocampus and bilateral nucleus accumbens, sensorimotor areas, and left middle temporal gyrus. Specifically, in these circuits, smokers showed decreased rsFC compared to the HC group, while IGDsm showed increased rsFC compared to smokers and IGD individuals. The IGDsm and HC groups showed no significant difference. The altered rsFC also correlated with clinical measures. Conclusion: These findings indicate that lower rsFC in smokers or IGD individuals increases under the effect of another type of addiction, such as smoking and IGD, but only increases to the normal state, which might explain the comorbidity and interaction between smoking and IGD from the perspective of functional circuits.

Virtual Reality for Pulmonary Rehabilitation: Comprehensive Review.

BACKGROUND: Pulmonary rehabilitation is a vital component of comprehensive care for patients with respiratory conditions, such as lung cancer, chronic obstructive pulmonary disease, and asthma, and those recovering from respiratory diseases like COVID-19. It aims to enhance patients' functional ability and quality of life, and reduce symptoms, such as stress, anxiety, and chronic pain. Virtual reality is a novel technology that offers new opportunities for customized implementation and self-control of pulmonary rehabilitation through patient engagement. OBJECTIVE: This review focused on all types of virtual reality technologies (nonimmersive, semi-immersive, and fully immersive) that witnessed significant development and were released in the field of pulmonary rehabilitation, including breathing exercises, biofeedback systems, virtual environments for exercise, and educational models. METHODS: The review screened 7 electronic libraries from 2010 to 2023. The libraries were ACM Digital Library, Google Scholar, IEEE Xplore, MEDLINE, PubMed, Sage, and ScienceDirect. Thematic analysis was used as an additional methodology to classify our findings based on themes. The themes were virtual reality training, interaction, types of virtual environments, effectiveness, feasibility, design strategies, limitations, and future directions. RESULTS: A total of 2319 articles were identified, and after a detailed screening process, 32 studies were reviewed. Based on the findings of all the studies that were reviewed (29 with a positive label and 3 with a neutral label), virtual reality can be an effective solution for pulmonary rehabilitation in patients with lung cancer, chronic obstructive pulmonary disease, and asthma, and in individuals and children who are dealing with mental health-related disorders, such as anxiety. The outcomes indicated that virtual reality is a reliable and feasible solution for pulmonary rehabilitation. Interventions can provide immersive experiences to patients and offer tailored and engaging rehabilitation that promotes improved functional outcomes of pulmonary rehabilitation, breathing body awareness, and relaxation breathing techniques. CONCLUSIONS: The identified studies on virtual reality in pulmonary rehabilitation showed that virtual reality holds great promise for improving the outcomes and experiences of patients. The immersive and interactive nature of virtual reality interventions offers a new dimension to traditional rehabilitation approaches, providing personalized exercises and addressing psychological well-being. However, additional research is needed to establish standardized protocols, identify the most effective strategies, and evaluate long-term benefits. As virtual reality technology continues to advance, it has the potential to revolutionize pulmonary rehabilitation and significantly improve the lives of patients with chronic lung diseases.

Teaching Palliative Care to Emergency Medicine Residents Using Gamified Deliberate Practice-Based Simulation: Palliative Gaming Simulation Study.

BACKGROUND: Emergency departments (EDs) care for many patients nearing the end of life with advanced serious illnesses. Simulation training offers an opportunity to teach physicians the interpersonal skills required to manage end-of-life care. OBJECTIVE: We hypothesized a gaming simulation of an imminently dying patient using the LIVE. DIE. REPEAT (LDR) format, would be perceived as an effective method to teach end-of-life communication and palliative care management skills. METHODS: This was a gaming simulation replicating the experience of caring for a dying patient with advanced serious illness in the ED. The scenario involved a patient with pancreatic cancer presenting with sepsis and respiratory distress, with a previously established goal of comfort care. The gaming simulation game was divided into 4 stages, and at each level, learners were tasked with completing 1 critical action. The gaming simulation was designed using the LDR serious game scheme in which learners are allowed infinite opportunities to progress through defined stages depicting a single patient scenario. If learners successfully complete the predetermined critical actions of each stage, the game is paused, and there is a debriefing to reinforce knowledge or skills before progressing to the next stage of the gaming simulation. Conversely, if learners do not achieve the critical actions, the game is over, and learners undergo debriefing before repeating the failed stage with an immediate transition into the next. We used the Simulation Effectiveness Tool-Modified survey to evaluate perceived effectiveness in teaching end-of-life management. RESULTS: Eighty percent (16/20) of residents completed the Simulation Effectiveness Tool-Modified survey, and nearly 100% (20/20) either strongly or somewhat agreed that the gaming simulation improved their skills and confidence at the end of life in the following dimensions: (1) better prepared to respond to changes in condition, (2) more confident in assessment skills, (3) teaching patients, (4) reporting to the health care team, (5) empowered to make clinical decisions, and (6) able to prioritize care and interventions. All residents felt the debriefing contributed to learning and provided opportunities to self-reflect. All strongly or somewhat agree that they felt better prepared to respond to changes in the patient's condition, had a better understanding of pathophysiology, were more confident on their assessment skills, and had a better understanding of the medications and therapies after the gaming simulation. A total of 88% (14/16) of them feel more empowered to make clinical decisions. After completing the gaming simulation, 88% (14/16) of residents strongly agreed that they would feel more confident communicating with a patient and prioritizing care interventions in this context. CONCLUSIONS: This palliative gaming simulation using the LDR format was perceived by resident physicians to improve confidence in end-of-life communication and palliative care management.

Robotic arm training in neurorehabilitation enhanced by augmented reality - a usability and feasibility study.

BACKGROUND: Robotic therapy and serious gaming support motor learning in neurorehabilitation. Traditional monitor-based gaming outputs cannot adequately represent the third dimension, whereas virtual reality headsets lack the connection to the real world. The use of Augmented Reality (AR) techniques could potentially overcome these issues. The objective of this study was thus to evaluate the usability, feasibility and functionality of a novel arm rehabilitation device for neurorehabilitation (RobExReha system) based on a robotic arm (LBR iiwa, KUKA AG) and serious gaming using the AR headset HoloLens (Microsoft Inc.). METHODS: The RobExReha system was tested with eleven adult inpatients (mean age: 64.4 ± 11.2 years; diagnoses: 8 stroke, 2 spinal cord injury, 1 Guillain-Barré-Syndrome) who had paretic impairments in their upper limb. Five therapists administered and evaluated the system. Data was compared with a Reference Group (eleven inpatients; mean age: 64.3 ± 9.1 years; diagnoses: 10 stroke, 1 spinal cord injury) who trained with commercially available robotic therapy devices (ArmeoPower or ArmeoSpring, Hocoma AG). Patients used standardized questionnaires for evaluating usability and comfort (Quebec User Evaluation of Satisfaction with assistive technology [QUEST]), workload (Raw Task Load Index [RTLX]) and a questionnaire for rating visual perception of the gaming scenario. Therapists used the QUEST, the System Usability Scale and the short version of the User Experience Questionnaire. RESULTS: Therapy with the RobExReha system was safe and feasible for patients and therapists, with no serious adverse events being reported. Patients and therapists were generally satisfied with usability. The patients' usability ratings were significantly higher in the Reference Group for two items of the QUEST: reliability and ease of use. Workload (RTLX) ratings did not differ significantly between the groups. Nearly all patients using the RobExReha system perceived the gaming scenario in AR as functioning adequately despite eight patients having impairments in stereoscopic vision. The therapists valued the system's approach as interesting and inventive. CONCLUSIONS: We demonstrated the clinical feasibility of combining a novel robotic upper limb robot with an AR-serious game in a neurorehabilitation setting. To ensure high usability in future applications, a reliable and easy-to-use system that can be used for task-oriented training should be implemented. TRIAL REGISTRATION: Ethical approval was obtained and the trial was registered at the German Clinical Trials Register (DRKS00022136).

Just five more minutes, mom: why video games could make you a better endoscopist.

BACKGROUND: Gaming is a growing industry, having met an exponential growth amid the pandemic context. Video games improve the allocation and speed of attention and provide better spatial orientation in visual processing. These same qualities are sought after in GI endoscopists. This study aimed to investigate whether individuals with a gaming history have superior fine motor and visual skills on a virtual reality (VR) endoscopy simulator and if gaming consoles could be added as a proficiency tool in acquiring endoscopic skills. METHODS: Firstly, subjects' baseline psychomotor skills and hand-eye coordination were tested using a VR simulator. Secondly, subjects were assigned to either group C and asked to refrain from any gaming for 14 days, or group T, who were asked to play on a console for 14 days. All subjects were then retested. RESULTS: 81 students were included in the study. Baseline VR simulator testing showed better scores in those with a higher number of previous gaming hours (0 h-1598, 0 to 30 h-1970, 30 to 50 h-2150, 50 to 100 h-2395, > 100 h-2519; p < 0.05), with males outperforming females (p < 0.01). After spending an average of 19 h gaming, all parameters showed noteworthy improvement for those in group T (p < 0.01). No improvement was seen in group C. CONCLUSIONS: Subjects who engage in console gaming have superior psychomotor skills and perform better on VR simulators. Approximately 20 h of console gaming can improve one's simulator skills. With consoles being accessible, entertaining, and cheap, they could be used as an additional training platform for GI endoscopy residents.

Enhanced Pavlovian-to-instrumental transfer in internet gaming disorder.

Background and aims: The Pavlovian-to-instrumental transfer (PIT) effect is a phenomenon that Pavlovian conditioned cues that could influence one's instrumental behavior. In several substance and behavioral addictions, such as tobacco use disorder and gambling disorder, addiction-related cues could promote independently trained instrumental drug-seeking/drug-taking behaviors, indicating a specific PIT effect. However, it is unclear whether Internet gaming disorder (IGD) would show a similar change in PIT effects as other addictions. The study aimed to explore the specific PIT effects in IGD. Methods: We administrated a PIT task to individuals with IGD (n = 40) and matched health controls (HCs, n = 50), and compared the magnitude of specific PIT effects between the two groups. The severity of the IGD symptoms was assessed by the Chinese version 9-item Internet Gaming Disorder Scale (IGDS) and the Internet Addiction Test (IAT). Results: We found that: (1) related to the HCs group, the IGD group showed enhanced specific PITgame effects, where gaming-related cues lead to an increased choice rate of gaming-related responses; (2) in the IGD group, the magnitude of specific PITgame effects were positively correlated with IAT scores (rho = 0.39, p = 0.014). Discussion and Conclusions: Individuals with IGD showed enhanced specific PIT effects related to HCs, which were associated with the severity of addictive symptoms. Our results highlighted the incentive salience of gaming-related cues in IGD.

Prevalence of internet gaming disorder and its psychological correlates / Prevalência do transtorno do jogo pela internet e seus correlatos psicológicos

ABSTRACT Objective To investigate the prevalence of internet gaming disorder (IGD) symptoms in a sample of Brazilian adults, and its association with personality, psychiatric symptoms and psychosocial measures. Methods We evaluated 219 adults online recruited using questionnaires and psychometric scales. We evaluated the behavior and pattern of internet games using the Game Addiction Scale (GAS). We tested the association of the previous measures with the GAS scores by spearman correlations and multiple regression analysis. Results Of our sample, 74% played games online. We found correlations between IGD symptoms and most symptoms of mental disorders, with small or moderate effect sizes, as well as correlations with the personality traits of agreeableness (r = -0.272; p < 0.001), conscientiousness (r = - 0.314; p < 0.001), and neuroticism (r = 0.299; p < 0.001). Additionally, we found a negative association with psychosocial outcomes such as quality of life (r = -0.339; p < 0.001) and life satisfaction (r = - 0.202; p < 0.003). The multivariate model included the personality traits of conscientiousness and agreeableness and symptoms of dissociation and somatization as predictors. The prevalence of IGD was 9% in those who played online games. Conclusion IGD is correlated with different areas of the individual's life, such as personality, quality of life, and several common symptoms of mental disorders. The prevalence can be considered high among players (9%). Conscientiousness, agreeability, somatic symptoms, and dissociative symptoms were associated with the symptoms of IGD.

RESUMO Objetivo Investigar a prevalência de sintomas do transtorno do jogo pela internet (TJI) em uma amostra de adultos brasileiros e sua associação com personalidade, sintomas psiquiátricos e medidas psicossociais. Métodos Avaliamos 219 adultos recrutados on-line por meio de questionários e escalas psicométricas. Avaliamos o comportamento e o padrão dos jogos na internet usando a Game Addiction Scale (GAS). Testamos a associação das medidas anteriores com as pontuações na GAS por meio de correlações de Spearman e análise de regressão múltipla. Resultados De nossa amostra, 74% jogavam jogos on-line. Encontramos correlações entre sintomas do TJI e a maioria dos sintomas de transtornos mentais, com tamanhos de efeito pequenos ou moderados, bem como correlações com os traços de personalidade de amabilidade (r = -0,272; p < 0,001), conscienciosidade (r = - 0,314; p < 0,001) e neuroticismo (r = 0,299; p < 0,001). Além disso, encontramos uma associação negativa com resultados psicossociais, como qualidade de vida (r = -0,339; p < 0,001) e satisfação com a vida (r = - 0,202; p < 0,003). O modelo multivariado incluiu os traços de personalidade de conscienciosidade e amabilidade e sintomas de dissociação e somatização como preditores. A prevalência de TJI foi de 9% entre os que jogavam jogos on-line. Conclusão O TJI está correlacionado com diferentes áreas da vida do indivíduo, como personalidade, qualidade de vida e vários sintomas comuns de transtornos mentais. A prevalência pode ser considerada alta entre os jogadores (9%). Conscienciosidade, amabilidade, sintomas somáticos e sintomas dissociativos estavam associados aos sintomas do TJI.