Electronic Media Use and Sleep Quality: Updated Systematic Review and Meta-Analysis.

BACKGROUND: This paper explores the widely discussed relationship between electronic media use and sleep quality, indicating negative effects due to various factors. However, existing meta-analyses on the topic have some limitations. OBJECTIVE: The study aims to analyze and compare the impacts of different digital media types, such as smartphones, online games, and social media, on sleep quality. METHODS: Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the study performed a systematic meta-analysis of literature across multiple databases, including Web of Science, MEDLINE, PsycINFO, PubMed, Science Direct, Scopus, and Google Scholar, from January 2018 to October 2023. Two trained coders coded the study characteristics independently. The effect sizes were calculated using the correlation coefficient as a standardized measure of the relationship between electronic media use and sleep quality across studies. The Comprehensive Meta-Analysis software (version 3.0) was used to perform the meta-analysis. Statistical methods such as funnel plots were used to assess the presence of asymmetry and a p-curve test to test the p-hacking problem, which can indicate publication bias. RESULTS: Following a thorough screening process, the study involved 55 papers (56 items) with 41,716 participants from over 20 countries, classifying electronic media use into "general use" and "problematic use." The meta-analysis revealed that electronic media use was significantly linked with decreased sleep quality and increased sleep problems with varying effect sizes across subgroups. A significant cultural difference was also observed in these effects. General use was associated with a significant decrease in sleep quality (P<.001). The pooled effect size was 0.28 (95% CI 0.21-0.35; k=20). Problematic use was associated with a significant increase in sleep problems (P≤.001). The pooled effect size was 0.33 (95% CI 0.28-0.38; k=36). The subgroup analysis indicated that the effect of general smartphone use and sleep problems was r=0.33 (95% CI 0.27-0.40), which was the highest among the general group. The effect of problematic internet use and sleep problems was r=0.51 (95% CI 0.43-0.59), which was the highest among the problematic groups. There were significant differences among these subgroups (general: Qbetween=14.46, P=.001; problematic: Qbetween=27.37, P<.001). The results of the meta-regression analysis using age, gender, and culture as moderators indicated that only cultural difference in the relationship between Eastern and Western culture was significant (Qbetween=6.69; P=.01). All funnel plots and p-curve analyses showed no evidence of publication and selection bias. CONCLUSIONS: Despite some variability, the study overall confirms the correlation between increased electronic media use and poorer sleep outcomes, which is notably more significant in Eastern cultures.

Women and videogames: What do they play? / Mujeres y videojuegos: ¿A qué juegan las mujeres?

La información sobre el uso de Videojuegos (VJ) en muestras generales refleja fundamentalmente las características de los hombres, por su mayor participación en VJ, dificultando identificar las características de las mujeres y su actividad de juego. Objetivo: Describir el comportamiento lúdico de adolescentes y jóvenes madrileñas y su relación con el desarrollo de problemas de juego. Método: Se aplicó un cuestionario de autoinforme (Gamertest) a una muestra de 1.228 mujeres (12 -22 años) (M = 14.84; DT= 2.469), seleccionadas mediante muestreo aleatorio en centros educativos de la Comunidad de Madrid. Resultados: el 51% de las mujeres admite jugar. El perfil típico es una mujer que juega a VJ de forma esporádica y por cortos periodos de tiempo, preferiblemente juegos de Acción y Aventura o Puzles y Plataformas; principalmente en smartphones, en casa y sola, con el propósito de divertirse. Las principales variables predictivas de problemas de juego, identificadas con el Trastorno del Juego de Internet (TJI) en mujeres son: mayor número de horas de uso, participación en juegos de rol multijugador masivo online (MMORPG) y VJ de estrategia. El factor protector más importante es jugar a VJ acompañado. Se discuten los resultados.(AU)

The information on the use of Videogames (VG) in general samples fundamentally reflects the characteristics of men, because of their greater participation in VG, making it difficult to identify the characteristics of women and their gaming activity. Objective: To describe the gaming behaviour of adolescent and young women in Madrid, and its relation with the development of gaming problems. Method: A self-report questionnaire(Gamertest) was applied to a sample of 1,228 women (12 -22 years old) (M= 14.84; SD= 2.469), selected by randomized sampling in schools in the Community of Madrid. Results: 51% of women admit gaming. The typical profile is a woman who plays VG sporadically and for short periods of time, preferably Action and Adventure games or Puzzlesand Platforms, mainly on smartphones, at home and alone, with the purpose of having fun. The main predictive variables of gaming problems, identified with the Internet Gaming Disorder (IGD) in women are: a greater number of hours of use, playing MassivelyMultiplayer Online Role-Playing Game (MMORPG), and Strategy VG. The most protective factor is playing VG accompanied. The results are discussed.(AU)

Adolescent Internet gaming addiction and personality characteristics by game genre.

With the emergence of a new concept called 'Internet Gaming Disorder' in DSM-5 and ICD-11, related research is underway around the globe. However, not enough literature on Internet gaming addiction has considered the diversity in game genres. Internet gaming addiction may take on a different form according to the particular characteristics of a game being played. To better understand adolescent Internet gaming addiction, this study sought to identify the differences in Internet gaming addiction and personality characteristics based on the game genre played. A total of 3,217 elementary and middle school students across Korea participated in the survey that included the Maladaptive Game Use Scale and the Adolescent Personality Questionnaire. ANOVA analysis revealed that Internet gaming addiction and personality characteristics varied according to the game genre played. In particular, post-hoc tests showed that Real-Time Strategy (RTS) and First-Person Shooter (FPS) game users have higher levels of tolerance, withdrawal, and neglect of everyday life compared to other genres such as Role-Playing Game (RPG), Racing, and Arcade/Shooting. Also, Internet gamers users of particular genres showed significantly lower self-esteem (Arcade/Shooting), conscientiousness (Racing), empathy (RPG), and sense of community (Racing and RTS) scores than comparison group. The implications of the study results were discussed with a special emphasis on Internet gaming addiction interventions.

Evidence that digital game players neglect age classification systems when deciding which games to play.

This article considers players' experiences seeking out new games to play, and their use of the Australian National Classification Scheme in doing so. The global video game industry is booming, with hundreds of games being released each month across numerous platforms. As a result, players have an unprecedented number of games available when choosing what games to purchase. However, a number of confounding issues around the emergent content of games and the subjective nature of game reviewing makes it difficult to relate what kinds of experiences a given game will facilitate. In this study, we surveyed game players in order to find their game platform and acquisition preferences; strategies and experiences when choosing games; and attitudes towards classification systems. Our findings suggest that players find it difficult to choose what games to purchase, and that existing classification systems are mostly only beneficial when choosing games for minors.

Sociodemographic Correlates of Contemporary Screen Time Use among 9- and 10-Year-Old Children.

OBJECTIVE: To determine sociodemographic correlates of contemporary screen time use among a diverse population-based sample of 9- and 10-year-old children. STUDY DESIGN: In 2021, we analyzed cross-sectional baseline (2016-2018) data from the Adolescent Brain Cognitive Development study (n = 10 755). Multiple linear regression analyses were conducted to estimate associations between sociodemographic factors (sex, race/ethnicity, country of birth, household income, parental education) and 6 contemporary forms of screen time (television, videos [eg, YouTube], video games, social networking, texting, and video chat). RESULTS: On average, children reported 3.99 hours of screen time per day across 6 modalities, with the most time spent watching/streaming television shows/movies (1.31 hours), playing video games (1.06 hours), and watching/streaming videos (1.05 hours). On average, Black children reported 1.58 more hours of screen time per day and Asian children reported 0.35 less hours of screen time per day compared with White children (mean 3.46 hours per day), and these trends persisted across most modalities. Boys reported higher overall screen time (0.75 hours more) than girls, which was primarily attributed to video games and videos. Girls reported more time texting, social networking, and video chatting than boys. Higher income was associated with lower screen time usage across all modalities except video chat. However, in high-income households, Latinx children reported 0.65 more hours of screen time per day than White children. CONCLUSIONS: Given the sociodemographic differences in child screen use, guideline implementation strategies can focus on key populations, encourage targeted counseling by pediatricians, and adapt Family Media Use Plans for diverse backgrounds.

Efeito de uma intervenção com jogos digitas e webgames na motivação intrínseca em escolares / Effect of an intervention with digital games and webgames on intrinsic motivation in schools

RESUMO O objetivo deste estudo foi analisar o efeito de uma intervenção com jogos digitais associados aos webgames na motivação intrínseca de crianças de uma escola pública de Florianópolis, Santa Catarina. Participaram deste estudo de desenho de um estudo de intervenção pedagógica não randomizado, 50 estudantes (52% de meninas), com idade média de 6,7 (±0,54) anos. Duas turmas da escola foram transformadas em dois grupos de pesquisa: 1) grupo intervenção (vivência prévia de jogos digitais no computador e webgames durante as aulas de educação física); e 2) grupo controle (apenas vivência de webgame). O Inventário de Motivação Intrínseca foi o instrumento utilizado, e para comparação intra e intergrupos utilizou-se o método de Equações de Estimativas Generalizadas, adotando-se o nível de significância de 5%. Não foi identificado efeito isolado do grupo ou interação grupo vs momento, o que indica que o grupo submetido a intervenção não se diferiu do grupo controle ao longo do tempo em termos de motivação. Conclui-se que o tipo de intervenção pedagógica realizada não foi capaz de aumentar a motivação intrínseca do grupo intervenção, sugerindo a necessidade de adaptações na estrutura e estratégias da intervenção em um próximo estudo.

ABSTRACT The objective of this study was to analyze the effect of an intervention with digital games associated with webgames on the intrinsic motivation of children from a public school in Florianópolis, Santa Catarina (Brazil). 50 students (52% girls) participated in this design study of non-randomized pedagogical intervention study, with a mean age of 6.7 (± 0.54) years. Two classroom groups were transformed into two research groups: 1) intervention group (preview experience of digital games on the computer and webgames during physical education classes); and 2) control group (only experience of webgame). The Intrinsic Motivation Inventory was the instrument used, and for intra and intergroup comparison, the Generalized Estimation Equations method was used, adopting a significance level of 5%. No isolated effect of the group or interaction between group vs moment was identified, which indicates that the group submitted to the intervention did not differ from the control group over time in terms of motivation. It is concluded that the type of pedagogical intervention performed was not able to increase the intrinsic motivation OF GROUP I, suggesting the need for adaptations in the structure and strategies of the intervention for future research.

A data-driven approach for examining the demand for relaxation games on Steam during the COVID-19 pandemic.

The COVID-19 pandemic has been a major source of stress for a majority of people that might have negative long-term effects on mental health and well-being. In recent years, video games and their potential positive effects on stress relief have been researched and "relaxation" has been an important keyword in marketing a certain kind of video game. In a quasi-experimental design, this study investigated the increase of average daily player peak (ADPPs) for the COVID period compared to the pre-COVID period and if this increase was significantly larger for relaxing games in contrast to non-relaxing games. Results showed a medium-sized increase of ADPPs over all types of games but no difference between relaxing games and non-relaxing games. These results are discussed in regards to their potential of presenting gaps between the current theoretical models of the influence of video games on mental health and actual observed player behaviour.

Association patterns of cannabis abuse and dependence with risk of problematic non-substance-related dysregulated and addictive behaviors.

Co-occurrence of drug misuse with other dysregulated behaviors is common. This study was aimed at exploring the associations between the risk of presenting a clinically relevant condition involving non-substance-related addictive or dysregulated behaviors (as measured by the MultiCAGE CAD-4 screening), and cannabis abuse/dependence (CAST/SDS) scores, and the role of gender therein. Participants were recruited using stratified probabilistic sampling at the University of Granada. Mann-Whitney's U tests were used to compare male and female students in SDS and CAST scores. Associations between gender and MultiCAGE scores were estimated using the γ ordinal correlation index, and tested with χ2. For each MultiCAGE dimension, a Poisson-family mixed-effects model was built with either SDS or CAST as the main input variable, while controlling for nicotine and alcohol dependence, and relevant sociodemographic variables. Incidence rate ratios (IRR) were computed for SDS/CAST effects, and the significance threshold was family-wise Bonferroni-corrected. Gender differences were significant for cannabis dependence/abuse and all MultiCAGE scores for non-substance-related conditions, with males showing higher risk scores for excessive gambling, excessive internet use, excessive video gaming, and hypersexuality, and females presenting higher scores in dysregulated eating and compulsive buying. Cannabis dependence and abuse were significantly associated with a higher risk of problematic video gaming. These associations were mostly driven by males. Importantly, although risk of problematic video gaming was specifically associated with cannabis abuse/dependence, there was only a weak non-significant association between problematic video gaming and alcohol use scores. Risk of alcohol use problems, in turn, was strongly associated with all other non-substance-related problems (problematic gambling, excessive Internet use, dysregulated eating, compulsive buying, and hypersexuality). These differential associations can cast light on the etiological similarities and dissimilarities between problematic substance use and putative addictive behaviors not involving drugs.

Electronic media use and symptoms of depression among adolescents in Norway.

BACKGROUND: The purpose of this study was to examine the association between electronic media use, including use of social media and gaming, and symptoms of depression, and whether gender or having friends moderated these associations. METHODS: This study was based on self-reported cross-sectional data from the Ungdata survey, conducted in 2018 by the Norwegian Social Research (NOVA) Institute in cooperation with seven regional drug and alcohol competence centres. The target group comprised 12,353 15-16 years old adolescents. Binominal logistic regression was used to analyse the association between electronic media use and symptoms of depression. RESULTS: The odds of having symptoms of depression were higher for those who used social media more than 3 hours per day (OR: 1.60, 95% CI: 1.43-1.80), compared to those who used social media 3 hours or less per day. Additionally, the odds of having symptoms of depression was higher for those who used more than 3 hours on gaming per day (OR: 1.57, 95% CI: 1.36-1.80), compared to those who used 3 hours and less on gaming per day after adjustment for potential confounders. There were no interaction effects between social media and gaming use with symptoms of depression. Neither were the associations between social media use and gaming with symptoms of depression moderated by gender or having friends. CONCLUSIONS: The odds of having symptoms of depression were significantly higher for adolescents with a more frequent use of electronic media.

The Effect of Video-Based Games on Hand Functions and Cognitive Functions in Cerebral Palsy.

Objective: The purpose of this study is to investigate the effect of Leap Motion Based Exergame Therapy (LMBET) on upper limb gross grip strength (GGS), pinch forces, hand functions, gross motor function, and cognitive functions in patients with cerebral palsy (CP). Materials and Methods: Twenty patients with CP (11 hemiplegia and 9 diplegia) were included in the study. Structured Neurodevelopmental Therapy-based hand rehabilitation (SNDTBHR) (first treatment period) was applied a total of 12 sessions, 2 sessions per week (total 6 weeks), and then LMBET (second treatment period) was applied a total of 12 sessions, 2 sessions per week (total 6 weeks). GGS was evaluated by "dynamometer," pinch strengths were evaluated by "pinch meter," hand skills were evaluated by "Manual Ability Classification System (MACS)" and "Jebsen-Taylor Hand Function Test (JHFT)," the gross motor level was evaluated by "Gross Motor Function Classification System (GMFCS)," and cognitive functions were evaluated by "Wisconsin Card Sorting Test (WCST)." Results: Significant difference was found between LMBET and SNDTBHR on GGF, pinch forces, JHFT, and WCST in favor of LMBET (P < 0.017). There was no significant difference between both MACS and GMFCS measurements (P > 0.05). Conclusion: Positive effects of both SNDTBHR and LMBET have been found. However, measurements after LMBET are statistically more significant. Future research should take into account higher patient allocation. Including additional leap motion training to conventional physiotherapy is feasible and might be promising to train cognitive function in children with CP.

Videogame and Computer Intervention Effects on Older Adults' Mental Rotation Performance.

Objective: This article examined older adults' performance on two components of a mental rotation task (reaction time and rotation rate) in a home-based intervention study of videogame (Crazy Taxi [CT]) and computerized cognitive training (PositScience InSight). Materials and Methods: Participants were randomized to one of three groups: one group played an off-the-shelf videogame (i.e., CT), the second group engaged in a computerized training program focused on fast perceptual comparisons, visuospatial working memory, rapid scanning of a visual array and pattern recognition, visual discrimination, and selective and divided attention and processing speed (i.e., InSight), and the third (control) group received no training. Training in the two intervention conditions consisted of 60 training sessions of 1 hour each, which were completed in 3 months (5 hours a week). As part of a larger study, participants received mental rotation testing, which was administered immediately before (baseline), after (post-test), and 3 months after (follow-up) training. Results: Although the InSight group showed greater improvements in rotation rate at the immediate post-test, by the 3-month follow-up, the combined treatment groups (CT and InSight) had improved more than controls. Conclusion: The improvements in mental rotation performance found at 3-month follow-up add additional support to previous research, showing visuospatial benefits of both videogame play and cognitive training in older adults. Common elements of both interventions may include expansion of the attentional field of view and faster visual comparison efficiency.

EEG in game user analysis: A framework for expertise classification during gameplay.

Video games have become a ubiquitous part of demographically diverse cultures. Numerous studies have focused on analyzing the cognitive aspects involved in game playing that could help in providing an optimal gaming experience by improving video game design. To this end, we present a framework for classifying the game player's expertise level using wearable electroencephalography (EEG) headset. We hypothesize that expert and novice players' brain activity is different, which can be classified using frequency domain features extracted from EEG signals of the game player. A systematic channel reduction approach is presented using a correlation-based attribute evaluation method. This approach lead us in identifying two significant EEG channels, i.e., AF3 and P7, among fourteen channels available in Emotiv EPOC headset. In particular, features extracted from these two EEG channels contributed the most to the video game player's expertise level classification. This finding is validated by performing statistical analysis (t-test) over the extracted features. Moreover, among multiple classifiers used, K-nearest neighbor is the best classifier in classifying game player's expertise level with a classification accuracy of up to 98.04% (without data balancing) and 98.33% (with data balancing).

The Use of Gamification in Patients Undergoing Hip Arthroplasty: Scoping Review.

Objective: The use of gamification can promote health-related behavior. This article is the first attempt to provide a historical overview of the use of games in patients undergoing hip arthroplasty. Materials and Methods: We conducted a scoping review to map and characterize the games used for the person undergoing hip arthroplasty. To perform this review, the respective descriptors were identified using search syntax appropriate to each of the databases: MEDLINE_ (Medical Literature Analysis and Retrieval System Online), CINAHL_ (Cumulative Index to Nursing and Allied Health Literature), SPORTDiscus, in the Psychology and Behavioral Sciences Collection, SCOPUS, SciELO (Scientific Electronic Library Online), and PEDRo (Physiotherapy Evidence Database). Results: An initial 968 articles were identified, of which 7 articles were included. The domains of the games under analysis essentially focus on aspects of rehabilitation (n = 5), or related (n = 2), and mostly exergames (n = 6). However, the instruments, characteristics, and procedures used to evaluate the games in the included studies have little depth and large variability. Conclusion: Few games exist that support people who have undergone hip arthroplasty. Most of the games under review were exergames to support rehabilitation. Consequently, we recommend developing another type of game with a focus on monitoring, counseling, and/or social support for selfmanagement training in persons undergoing hip arthroplasty.

Communication of pain by school-age children with cancer using a game-based symptom assessment app: A secondary analysis.

PURPOSE: To evaluate the self-reported pain experiences of school-age children with cancer participating in a feasibility trial of a game-based symptom assessment app. METHOD: Nineteen children (median: 8 years, range 6-12 years old) receiving cancer treatment were recruited to complete five days of symptom tracking between clinical visits using a symptom assessment app. Children could report pain as a general symptom with the ability to further localize pain on an avatar. Children could also describe symptoms in response to the app's free-text questions or the app's diary. Descriptive statistics characterized reports of pain frequency, severity, bother, and location. Free-text responses were examined for pain-related statements and analyzed using content analysis. RESULTS: All 19 children documented pain on at least one day of app reporting between clinical visits. Pain was most frequently recorded as of mild severity and mild bother. Participants localized pain most frequently to the head, followed by the stomach, chest, extremities, and mouth. Eleven children documented 32 qualitative statements which included rich descriptions of pain-related topics (i.e., "my port hurts a little") and location (i.e., "my vision aching"). CONCLUSIONS: These results demonstrate that school-age children with cancer are willing to describe their ambulatory pain experiences on a game-based mobile app through quantitative reports and by using narrative descriptions. Additionally, these findings can potentially guide clinicians in using multiple approaches to elicit a clinically meaningful evaluation of pain in this population.

Effects of Nintendo Ring Fit Adventure Exergame on Pain and Psychological Factors in Patients with Chronic Low Back Pain.

Objective: In recent years, there has been an increase in research on the therapeutic effects of exergaming, but there have been few studies on these types of interventions for chronic low back pain. In this study, we hypothesized that the Nintendo Ring Fit Adventure (RFA) exergame would be effective for patients with chronic low back pain, and we conducted a randomized prospective longitudinal study. Materials and Methods: Patients with chronic low back pain were included in this study. Twenty randomly selected patients (9 males and 11 females, mean age 49.3 years) were included in the RFA group, and RFA exergaming was performed once a week for 40 minutes for 8 weeks. Twenty patients (12 males and 8 females, mean age 55.60 years) served as the control group and received oral treatment for 8 weeks. Pain and psychological scores (pain self-efficacy, pain catastrophizing, and kinesiophobia) were measured and analyzed before and after 8 weeks of treatment in both groups. Results: In the RFA group, low back pain, buttock pain, and pain self-efficacy were significantly improved after 8 weeks of RFA exergaming, but there was no significant improvement in lower limb numbness, pain catastrophizing, or kinesiophobia. In the control group, no significant improvement was observed after 8 weeks of oral treatment. Conclusion: RFA exergaming increased pain self-efficacy and reduced pain in patients with chronic low back pain. Future treatment protocols should be developed to improve pain self-efficacy. Approval code: 2894, School of Medicine, Chiba University.

El uso de videojuegos en adolescentes. Un problema de Salud Pública / The use of video games in adolescents. A Public Health problema

INTRODUCCIÓN: El uso excesivo de videojuegos ha aumentado de manera vertiginosa y, especialmente, entre los varones con edades comprendidas entre los 10 y los 19 años. Muchos adolescentes pierden el control sobre el videojuego, lo que puede tener consecuencias negativas como el juego patológico, problemático o la adicción al videojuego. OBJETIVOS: Conocer la producción científica existente sobre el uso problemático de videojuegos y la adicción al videojuego en los adolescentes. METODOLOGÍA: Se han analizado los documentos encontrados tras una búsqueda bibliográfica en las bases de datos COCHRANE, MEDLINE, LILACS, CINAHL y CUIDEN. RESULTADOS: Se han definido los factores predictores, la prevalencia, las características, los cuestionarios validados, la relación con otras adicciones, la relación con el TEA (Trastorno del Espectro Autista) y con el TDAH (Trastorno por Déficit de Atención e Hiperactividad) y la prevención del uso problemático y la adicción al videojuego. CONCLUSIONES: Hay inconsistencias en los resultados debido al diseño transversal de la mayoría de los estudios, a las muestras pequeñas, a la ausencia de muestras clínicas o aleatorizadas, a la extracción de datos con cuestionarios de autorreporte, a la realización de estos en colegios, sin tener en cuenta a los adolescentes ingresados en centros de salud mental u hospitales, a la falta de estudios en el género femenino y a la falta de estandarización de los criterios diagnósticos. El tema menos estudiado es el tratamiento y la prevención, el más importante para nuestra profesión, por lo que la principal futura línea de investigación sería en este ámbito

INTRODUCTION: The excessive use of videogames has increased dramatically, especially among 10-to-19-year-old males. Many teenagers lose control over video games, which may have negative consequences such as pathological, problematic, or addictive gaming. OBJECTIVES: Knowing the existing scientific production about the problematic use of video games and video games addiction in teenagers. METHODOLOGY: Documents found after a bibliographic search in the databases COCHRANE, MEDLINE, LILACS, CINAHL and CUIDEN have been analyzed. RESULTS: It has been defined the predictive factors, the prevalence, the characteristics, the validated questionnaires, the associations with other addictions, the relations with ASD (Autism Spectrum Disorder) and ADHD (Attention-Deficit/Hyperactivity Disorder), and prevention of problematic use and addiction to video games. CONCLUSIONS: There are inconsistencies in the results due to the transversal design of most of the studies, such as small samples, the absence of clinical or randomized samples, data extraction with self-reporting questionnaires conducted in schools, without taking into account adolescents hospitalized into mental health centers or hospitals, the gender bias in research and the lack of standardization of diagnostic criteria. The least studied subject is the treatment and prevention, the most important for nursing profession, so the future main line of research would be in this area

Examining homicides and suicides cross-nationally: Economic factors, guns and video games.

Understanding why different nations have different homicide and suicide rates has been of interest to scholars, policy makers and the general public for years. Multiple theories have been offered, related to the economy, presence of guns and even exposure to violence in video games. In the current study, several factors were considered in combination across a sample of 92 countries. These included income inequality (Gini index), Human Capital Index (education and employment), per capita gun ownership and per capita expenditure on video games. Results suggest that economic factors primarily were related to homicide and suicide cross-nationally. Video game consumption was not a major indicative factor (other than a small negative relationship with homicides). More surprisingly, per capita gun ownership was not an indicator factor cross-nationally. The results suggest that a focus on economic factors and income inequality are most likely to bear fruit regarding reduction of violence and suicide.

A novel "video-game" simulator for training fetoscopic laser coagulation of anastomoses in twin-to-twin transfusion syndrome.

 : We have developed a high-fidelity interactive "video-game" simulator in order to teach fetoscopic laser ablation of placental anastomoses for twin-twin transfusion syndrome This simulator may be used by teachers in order to provide metrics-based simulator education to multiple trainees, in both hands-on and distanced learning settings WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: The use of simulation improves training of the fetoscopic laser techniques utilized in the treatment of twin-twin transfusion syndrome A number of mannequins have been developed to aid this education WHAT DOES THIS STUDY ADD?: Two new simulators are described for twin-twin transfusion syndrome training-silicone and digital The digital simulator is a novel digital video game virtual format This new format has enhanced interactivity and has the potential to enable distance learning.

Reality and Virtual: Hemodynamic Variables and Rating of Perceived Exertion Between Dance Sessions and Active Videogame Just Dance in Women.

Objective: To analyze the hemodynamic variables and the rating of perceived exertion (RPE) between an active videogame (AVG) session and a dance session. Materials and Methods: The sample consisted of 30 university women between 18 and 30 years of age, physically active and having some kind of experience with dancing. The volunteers participated in the two sessions held on different days, the first with an active dance videogame and the other with a dance instructor, both lasting 50 minutes, with a sequence of songs and moderate intensity. For the evaluation of the two sessions, heart rate (HR), blood pressure (BP), and RPE measurements were taken before and every 10 minutes, until the time for each modality (AVG or dance) was completed. The Shapiro-Wilk and Levene test were used for normal data. For the comparison of two sessions, the two-way ANOVA test was used for repeated measures, and were considered to have a significance level of P < 0.05. Results: There were significant differences in HR [F(6, 96) = 2.606, P = 0.02, η2 P = 0.140], from 10 to 50 minutes (P < 0.01), and diastolic BP [F(6, 84) = 1.858, P = 0.10, η2 P = 0.117], as well as, in the 20th minute (P = 0.02) between Just Dance 2016® and a dance session. All the variables analyzed showed an effect size as large in the classification of the degree of magnitude. Conclusion: There are similarities between the virtual and real dance sessions regarding hemodynamic variables and RPE. Thus, AVGs, especially Just Dance®, may be a favorable option for individuals who wish to exercise at home.

[Family habits related to the excessive use of recreational screens (television and video games) in childhood.] / Hábitos familiares relacionados con el uso excesivo de pantallas recreativas (televisión y videojuegos) en la infancia.

OBJECTIVE: An increase in screen time has been observed among children despite the impact on health. This study was aimed to analyze if the child population complies with health recommendations for adequate use of recreational screens (television and video games) and to evaluate associated variables. METHODS: Cross-sectional study with 521 children between 6 months and 14 years old who attended Primary Care. A self-administered survey was used to collect sociodemographic variables, child's recreational screens time, the parent's television (TV) time, and related environmental and sociocultural variables. RESULTS: 521 surveys were carried out (55.2% boys and 44.8% girls). Recreational screen time in children under 2 years of age averaged 71 minutes/day and increased to 160 minutes/day in those over 10 years old. Boys had 30% more video game time than girls. A total of 80% of the sample started using TV before 2 years of age. The modifiable variables that showed an independent association with excess of time spent on recreational screens were the parental TV time (OR 4.34; 95% CI: 2.48-7.72), maintaining the "background TV on often" (OR 1.70; 95% CI: 1.07-2.72) and watching TV usually alone (OR 2.08; 95%: 1.30-3.32). CONCLUSIONS: Most of the child population does not comply with the main recommendations of health organizations regarding the adequate use of recreational screens. Our results indicated that environmental and cultural variables influence screen time. Our findings can contribute to design strategies to improve the use of recreational screens in childhood.

OBJETIVO: El abuso de pantallas recreativas se ha relacionado con repercusiones negativas para la salud. El objetivo del estudio fue determinar si la población infantil cumple las recomendaciones sanitarias de uso adecuado de pantallas recreativas (televisión y videojuegos) y evaluar las variables asociadas a un uso inadecuado. METODOS: Estudio transversal con 521 niños de entre 6 meses y 14 años que acudieron a consultas de Atención Primaria. Se utilizó una encuesta auto administrada para recoger variables sociodemográficas, tiempo de uso de pantallas recreativas del niño/a, tiempo de televisión (TV) del progenitor y variables ambientales y socioculturales relacionadas con el uso de pantallas. Se ajustó un modelo de regresión logística binaria para evaluar la asociación entre variables sociodemográficas, ambientales y socioculturales y el abuso de pantallas recreativas en los niños (tiempo superior a 2 horas/día). RESULTADOS: Se realizaron 521 encuestas (55,2% niños y 44,8% niñas). El tiempo medio de pantallas recreativas en los menores de 2 años fue de 71 minutos/día y aumentó hasta 160 minutos/día en los mayores de 10 años. Los niños presentaron un 30% más de tiempo de videojuegos que las niñas. El 80% de la muestra inició el uso de TV antes de los 2 años. Las variables modificables que mostraron asociación independiente con exceso de tiempo de pantallas recreativas fueron el tiempo de TV de progenitores (OR 4,34; IC95%: 2,48-7,72), mantener la "TV de fondo" (OR 1,70; IC 95%: 1,07-2,71) y ver TV habitualmente solo (OR 2,08; IC95%: 1,30 3,31). CONCLUSIONES: La mayoría de la población infantil no cumple las recomendaciones de las organizaciones sanitarias respecto las pantallas recreativas. Nuestros resultados indican que existen variables ambientales y culturales que influyen en el abuso de pantallas. Estos hallazgos pueden orientar el diseño de estrategias que mejoren el uso de las pantallas recreativas en la población infantil.