Effectiveness of a healthy lifestyle program based on a mobile serious game for childhood cancer survivors: A quasi-randomized trial.

PURPOSE: This study aimed to develop and evaluate the effectiveness of a healthy lifestyle program based on a mobile serious game (HLP-MSG) to enhance the lifestyles of childhood cancer survivors (CCSs). METHODS: This program proceeded in two stages: development and evaluation, using a non-synchronized design with a quasi-randomized trial. The participants were CCSs aged 6-13 years whose treatment was terminated at least 12 months prior. Data were collected at baseline, and post-intervention, with a follow-up after four weeks using the Child Healthy Lifestyle Profile (CHLP). The experimental (n = 26) and control groups (n = 25) were compared. Data were analyzed using descriptive statistics, chi-squared tests, t-tests, and repeated-measures ANOVA. RESULTS: The HLP-MSG promoted a healthy lifestyle by solving 26 quests, including seven sub-elements (nutrition, exercise, hygiene, interpersonal relationships, stress management, meaning of life, and health responsibility). This study revealed significant differences in the interaction between measurement time and group assignment in the CHLP (p = .006) and physical activity (p = .013), one of the seven sub-dimensions. CONCLUSIONS: A healthy lifestyle program based on a mobile serious game is a feasible health education modality to enhance the physical, psychological, social, and spiritual health of CCSs. IMPLICATIONS TO PRACTICE: The findings add to scientific evidence on a mobile serious game for health education among CCSs. The HLP-MSG provides an evolutionary educational modality that can be delivered non-face-to-face to promote CCSs' continuous healthy behavior maintenance. Moreover, the HLP-MSG is adolescent-friendly and can be utilized as a healthcare tool for parents and children to cooperate.

Experimental warming studies on tree species and forest ecosystems: a literature review.

Temperature affects a cascade of ecological processes and functions of forests. With future higher global temperatures being inevitable it is critical to understand and predict how forest ecosystems and tree species will respond. This paper reviews experimental warming studies in boreal and temperate forests or tree species beyond the direct effects of higher temperature on plant ecophysiology by scaling up to forest level responses and considering the indirect effects of higher temperature. In direct response to higher temperature (1) leaves emerged earlier and senesced later, resulting in a longer growing season (2) the abundance of herbivorous insects increased and their performance was enhanced and (3) soil nitrogen mineralization and leaf litter decomposition were accelerated. Besides these generalizations across species, plant ecophysiological traits were highly species-specific. Moreover, we showed that the effect of temperature on photosynthesis is strongly dependent on the position of the leaf or plant within the forest (canopy or understory) and the time of the year. Indirect effects of higher temperature included among others higher carbon storage in trees due to increased soil nitrogen availability and changes in insect performance due to alterations in plant ecophysiological traits. Unfortunately only a few studies extrapolated results to forest ecosystem level and considered the indirect effects of higher temperature. Thus more intensive, long-term studies are needed to further confirm the emerging trends shown in this review. Experimental warming studies provide us with a useful tool to examine the cascade of ecological processes in forest ecosystems that will change with future higher temperature.