Pictograms to assess bloating and distension symptoms in the general population in Mexico: Results of The Rome Foundation Global Epidemiology Study.

BACKGROUND: There is no term for bloating in Spanish and distension is a very technical word. "Inflammation"/"swelling" are the most frequently used expressions for bloating/distension in Mexico, and pictograms are more effective than verbal descriptors (VDs) for bloating/distension in general GI and Rome III-IBS patients. However, their effectiveness in the general population and in subjects with Rome IV-DGBI is unknown. We analyzed the use of pictograms for assessing bloating/distension in the general population in Mexico. METHODS: The Rome Foundation Global Epidemiology Study (RFGES) in Mexico (n = 2001) included questions about the presence of VDs "inflammation"/"swelling" and abdominal distension, their comprehension, and pictograms (normal, bloating, distension, both). We compared the pictograms with the Rome IV question about the frequency of experiencing bloating/distension, and with the VDs. KEY RESULTS: "Inflammation"/"swelling" was reported by 51.5% and distension by 23.8% of the entire study population; while 1.2% and 25.3% did not comprehend "Inflammation"/"swelling" or distension, respectively. Subjects without (31.8%) or not comprehending "inflammation"/"swelling"/distension (68.4%) reported bloating/distension by pictograms. Bloating and/or distension by the pictograms were much more frequent in those with DGBI: 38.3% (95%CI: 31.7-44.9) vs. without: 14.5% (12.0-17.0); and in subjects with distension by VDs: 29.4% (25.4-33.3) vs. without: 17.2% (14.9-19.5). Among subjects with bowel disorders, those with IBS reported bloating/distension by pictograms the most (93.8%) and those with functional diarrhea the least (71.4%). CONCLUSIONS & INFERENCES: Pictograms are more effective than VDs for assessing the presence of bloating/distension in Spanish Mexico. Therefore, they should be used to study these symptoms in epidemiological research.

Victorian Era Kitten Cuisine?

Humphrey Bogart's mother (Fig. 1)1 undoubtedly had a strange sense of humor. How else can one explain Maud Humphrey's bizarre image, on a stock trade card, of a lovely little lass dressed up in her Sunday best lighting the flame under a chafing dish containing two adorable kittens (Figs. 2-5)? Were kitten fondue or kitty feline stew, dishes du jour in Victorian times? Pictured here are three Victorian trade cards, related to dentistry, featuring Maud Humphrey's adorable little kitten chef. Dr. Eli H. Neiman of York, Pennsylvania, and Dr. Charles S. Decker of Binghamton, New York, chose this stock image to advertise their respective dental practices (Figs. 3 & 4), Ramon's Relief pain medication, including toothache relief, and RAMON'S LIVER PILLS AND TONIC PELLETS were available from W.E. JUDAY in West Manchester, Ohio (Figure 4). Note on the reverse of the Dr. Decker card, that for 50 cents "Vitalized Air for Painless Extracting" was offered. "Vitalized Air" was nitrous oxide altered with small amounts of chloroform and alcohol.2-4 Could it be that Maud had sniffed a bit of Vitalized Air before rendering her shocking kitty-cooking image?

Laughter and smiling facial expression modelling for the generation of virtual affective behavior.

Laughter and smiling are significant facial expressions used in human to human communication. We present a computational model for the generation of facial expressions associated with laughter and smiling in order to facilitate the synthesis of such facial expressions in virtual characters. In addition, a new method to reproduce these types of laughter is proposed and validated using databases of generic and specific facial smile expressions. In particular, a proprietary database of laugh and smile expressions is also presented. This database lists the different types of classified and generated laughs presented in this work. The generated expressions are validated through a user study with 71 subjects, which concluded that the virtual character expressions built using the presented model are perceptually acceptable in quality and facial expression fidelity. Finally, for generalization purposes, an additional analysis shows that the results are independent of the type of virtual character's appearance.

Creating clear and informative image-based figures for scientific publications.

Scientists routinely use images to display data. Readers often examine figures first; therefore, it is important that figures are accessible to a broad audience. Many resources discuss fraudulent image manipulation and technical specifications for image acquisition; however, data on the legibility and interpretability of images are scarce. We systematically examined these factors in non-blot images published in the top 15 journals in 3 fields; plant sciences, cell biology, and physiology (n = 580 papers). Common problems included missing scale bars, misplaced or poorly marked insets, images or labels that were not accessible to colorblind readers, and insufficient explanations of colors, labels, annotations, or the species and tissue or object depicted in the image. Papers that met all good practice criteria examined for all image-based figures were uncommon (physiology 16%, cell biology 12%, plant sciences 2%). We present detailed descriptions and visual examples to help scientists avoid common pitfalls when publishing images. Our recommendations address image magnification, scale information, insets, annotation, and color and may encourage discussion about quality standards for bioimage publishing.

Effects of Pictorial Health Warnings on Cognitive, Affective, and Smoking Behavior: A Mixed Methods Study in Four Cities in Indonesia.

While studies have shown the importance of pictorial health warnings (PHW) as a tobacco control strategy, empirical evidence on the efficacy of PHW in prompting smoking behavior remains inconclusive. The study aimed to examine the association between PHW and cognitive reactions, emotional/affective reactions, and smoking behavior. We conducted a mixed-methods study, which included a cross-sectional face-to-face survey of 401 smokers in four cities (Jakarta, Bandung, Semarang, and Yogyakarta) and three focus group discussions among 24 participants in Jakarta. We applied multiple logit regression in STATA for quantitative data analysis and explanatory sequential design for qualitative data analysis. Quantitatively, we found high (63-84% of respondents) understanding about PHW objectives (cognitive reactions), including to remind health risks and encourage smoking cessation. With only 40% PHW, we found relatively low (32%-39%) negative emotional reactions, including feeling scared, annoyed and disgusted and relatively low proportions (33-40%) of respondents that reported quit attempt. Consistent with the quantitative findings, qualitative data provided contexts, including in explaining that the professional worker group was the least affected by PHW, while the student and non-professional groups were the most vulnerable. All this is supportive of governments in Indonesia and other countries to increase the PHW size.
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Breath Is Life.

This painting memorializes the lives of people who died in the COVID-19 pandemic and people who have died from police brutality.

Tobacco Industry Fingerprints on Delaying Implementation of Pictorial Health Warnings in the Western Pacific.

OBJECTIVE: This case series describes tobacco industry tactics and strategies used to interfere, derail, delay, and weaken the development of effective health warning regulations in Malaysia, Cambodia, the Philippines, and Hong Kong. METHODS: A historical review of official reports, news articles, and gray literature was undertaken to identify tobacco industry tactics and strategies to hamper government efforts in implementing stronger pictorial health warning regulations in four Asian jurisdictions (Cambodia, Hong Kong, Malaysia, and the Philippines). RESULTS: Nineteen countries/jurisdictions in the WHO Western Pacific region currently require pictorial health warnings on cigarette packs, including some of the world's largest, in line with the WHO Framework Convention on Tobacco Control Article 11 Guidelines. In the four jurisdictions examined, tobacco industry interference consisted of lobbying and misinformation of high-level government officers and policy-makers, distributing industry-friendly legislative drafts, taking government to court, challenging government timelines for law implementation, and mobilizing third parties. Strong political leadership and strategic advocacy enabled governments to successfully overcome this industry interference. CONCLUSION: The tobacco industry uses similar tactics in different jurisdictions to derail, delay, and weaken the implementation of effective health warning policies. Identifying and learning from international experiences can help anticipate and defeat such challenges.

How practice in plant collection influences interactions with illustrations and written texts on local plants? A case study from Daghestan, North Caucasus.

BACKGROUND: It is only recently that written sources of local knowledge on plants are not being ignored by scholars as not belonging to "traditional" knowledge. Ethnobotanical texts, however, if they at all focus on knowledge from written sources, hardly ever pay any attention to the actual processes of interaction with written texts and illustrations. During our research, we examined people's interactions with texts, illustrations, and herbarium specimens of plants they collect or are familiar with. We focused on a small community of Shiri people in the mountainous village and in the lowland settlements in the Republic of Daghestan, Russia. In the paper, we address the following questions: how do Shiri people interact with illustrations, written text, and herbaria specimens? How is this interaction influenced by the practice of plant collection? What are the methodological implications of the ways people interact with illustrations, texts, and herbaria specimens? METHODS: Our research was based on long-term ethnographic fieldwork: co-designing of a booklet showing edible plants people collect in Shiri, semi-structured interviews, and video-recordings, and observing interactions between people and text/illustrations/voucher specimens. RESULTS: We identified three kinds of interactions between individuals and text/illustrations: "text-wayfaring"-predominantly a bodily interaction between an individual and illustrations and text; "fact/spelling checking"-predominantly discursive and information focused; "between wayfaring and fact-checking"-the mix of the two. Using the idea of textual poaching, as well as the knowledge-making approach, we show that the mode of interaction with text/illustrations influences what is acquired, and how. This process influences readers' LEK. The mere presence of an information in the text available to people does not imply that they will acquire it, make use of it, and change their LEK. Photographs and pressed specimens of locally known plants are often not (or only partly) recognized by the interlocutors. Video-recording is essential for analyzing the above mentioned interactions. CONCLUSIONS: In ethnobotanical research, it is important to pay more attention to people's interaction with their sources of knowledge, including text and illustrations. The discursive part of LEK is more easily influenced by written sources. The practice of plant collection is not as easily influenced. Ethnobotanists function in a particular context and are embedded in discourses oriented towards conservation of bio-cultural diversity that value heritage as such, so it is important to be aware of one's positionality. A methodology that relies on showing pressed specimens or photographs to interlocutors may be a very misleading way of collecting ethnobotanical data.

The Rückenfigur: A Note on an Intriguing Rear-View Pictorial Device.

The Rückenfigur, a rear-view depiction of a person, is an artistic device which dates back several centuries but became particularly prominent in 19th century in Germany. The adoption of the rear-view presents an intriguing challenge, since the viewer must engage with a figure which sees without visible eyes. Considered here are some of the perceptual issues which arise from this unusual pictorial device.

The drawing version of the pictorial representation of illness and self measure.

Objective: We developed and validated a drawing test version of the Pictorial Representation of Illness and Self Measure (PRISM), a visual method to assess the perceived burden of illness and illness perception. Our aim was to test whether the drawing version would allow patients more freedom to deliberately vary both the size and position of circles symbolizing illness and individual coping resources, as well as gain more information about illness representations and available resources. Design and Main Outcome Measures: We applied the PRISM-D test to 500 patients with severe somatic diseases under active hospital treatment. We used Spielberger's State and Trait Anxiety Inventory and Beck's Depression Inventory to assess convergent validity. Results: The PRISM-D test is applicable for inpatients and it can be used to explore their subjective representations. The modifications did not cause any loss in convergent validity as the Self-Illness Separation and the Illness Perception Measure are significantly correlated with levels of depression and anxiety. Conclusion: The drawing test enables more detailed measurement of suffering caused by illness, illness perception and more complex assessment of important factors in a patient's life. The test is adequate for clinical use as well as research among a wide range of somatic inpatients.

Co-production of a pictorial recovery tool for people with psycho-social disability informed by a participatory action research approach-a qualitative study set in India.

Mental health problems are recognized as a leading cause of disability and have seen increased allocations of resources and services globally. There is a growing call for solutions supporting global mental health and recovery to be locally relevant and built on the knowledge and skills of people with mental health problems, particularly in low-income countries. Set in Dehradun district, North India, this study aimed to describe first, the process of co-production of a visual tool to support recovery for people affected by psycho-social disability; second, the key outputs developed and third, critical reflection on the process and outputs. The developmental process consisted of participatory action research and qualitative methods conducted by a team of action researchers and an experts by experience (EBE) group of community members. The team generated eight domains for recovery under three meta-domains of normalcy, belonging and contributing and the ensuing recovery tool developed pictures of activities for each domain. Challenges to using a participatory and emancipatory process were addressed by working with a mentor experienced in participatory methods, and by allocating time to concurrent critical reflection on power relationships. Findings underline the important contribution of an EBE group demonstrating their sophisticated and locally valid constructions of recovery and the need for an honest and critically reflective process in all co-productive initiatives. This study generated local conversations around recovery that helped knowledge flow from bottom-to-top and proposes that the grass-root experiences of participants in a disadvantaged environment are needed for meaningful social and health policy responses.

Patients' drawings of their asthma: adding qualitative specificity to a quantitative measure of illness perceptions.

Objective: Patients' perceptions about their asthma can influence behavior, coping and outcomes. Previous studies have also identified that patients' views can differ significantly to that of healthcare professionals. Enhancing current understanding of patients' perceptions can assist in reducing this mismatch. We aimed to utilize the medium of drawings to add qualitative specificity and depth to a quantitative measure of illness perceptions exploring patients' perspectives of their asthma. Methods: Eighteen adults with asthma completed the Brief Illness Perception Questionnaire (BIPQ) and participated in a drawing activity. Analysis was based on the participants' transcribed descriptions of their drawing. A coding approach was used to map the data according to the BIPQ items. Results: The drawings and subsequent discussions specified the "what," the "how," and the "why" of the experience of living with asthma. Prominent emotional and social elements emerged, with evocative images coupled with expressive and profound language. Use of drawing also revealed additional representations which were outside of the BIPQ scope. Conclusions: Using qualitative methods to analyze a novel approach to understanding illness perceptions provided insight into how asthma affects patients' lives personally.

The quality of the relationship between typically developing children and their siblings with and without intellectual disability: Insights from children's drawings.

The current study examined the relationships of typically developing (TD) children with siblings with and without intellectual disabilities (ID), as expressed in TD children's drawings and questionnaires answered by TD children and their mothers. It also examined group differences in the sibling relationships, as well as the associations between having a sibling with or without ID and sibling relationships, and TD children's social-emotional adjustment. Participants were mothers and their TD children (8-13 years). Some had ID siblings ID (N=28); others had TD siblings (N=31). Sibling relationships were examined via mothers' and target children's completion of questionnaires, and objective visual indicators (location, size, distance) and observed content-based indicators (support, investment, presence of parents) of children's drawings were assessed following the art-based phenomenological analytic approach. Mothers reported on children's social-emotional adjustment. Findings indicated differences in sibling relationships, including higher levels of positive relationships for children with ID siblings. Children's drawings also showed positive relationship aspects for these children. Sibling relationship qualities were significantly associated with children's adjustment. Children's drawings may be a useful data gathering tool to deepen our understanding of unique aspects of sibling relationships.

Effect of a Japanese drug alert pictogram on medication-taking/driving behavior.

Objective: This study aimed to determine the usefulness and effects of a pictogram for alerting patients about drugs that affect driving in order to prevent traffic injury and maintain good adherence.Method: The participants comprised 600 men and 600 women aged 20-79 (49.58 ± 16.21) years, registered with an Internet research company. All were licensed to drive a car and were taking prescribed medication. The outcome measures were: 1) awareness of existing pictogram, 2) perceived driving risk after viewing the pictogram, 3) usefulness of the pictogram, and 4) medication-taking and driving behavior after viewing the pictogram.Results: Few respondents (5.4%) were aware of the Japanese pictogram issued by the Council for Appropriate Drug Use. Participants evaluated their driving risk as moderate-to-high (3.51 ± 0.69) after viewing the pictogram, and risk perception was higher among respondents in their 50 s and 60 s than among those in their 20 s. Across all respondents, the pictogram was rated as follows (on a 5-point Likert scale): effective for warning, 3.79 ± 0.90; informative, 3.75 ± 0.84; understandable meaning (comprehensibility), 3.90 ± 0.96; simplicity, 3.71 ± 0.95; and eye-catching, 3.60 ± 0.98. We defined the following as positive behavior: taking medication according to the instructions of a medical professional (good compliance), stopping driving, and consulting medical professionals. The positive behavior rate was 63.2%. Being shown the pictogram might lead to more positive medication-taking and driving behavior among respondents who are female and have lower driving frequency, higher levels of risk perception, and higher evaluation of the pictogram compared to their counterparts.Conclusion: A pictogram is a potentially useful and effective tool for communicating risk and supporting decision-making by supplying drivers with tailored information. However, we assume that some people who drive frequently must drive for work, go to the hospital, etc. It is essential, in these cases, for medical professionals to be more deeply involved with the patients and to maintain lines of communication by listening to patients' descriptions of their everyday life. By adding these pictograms to the labeling of potentially driver-impairing medications (such as by putting them on the outer packaging, package inserts, and inner medicine containers), it is expected that they can better inform users regarding safe behavior and promote medication adherence.

Husbands' Hearts and Women's Health: Gender, Age, and Heart Disease in Twentieth-Century America.

The medical community and broader public have historically focused on heart disease as a concern for men, even though it has been the leading cause of death in women for decades. Through an analysis of medical publications, women's health literature, and mainstream media, this article traces the interactions of gender and age on perceptions of heart disease during the twentieth century. I argue that attention to middle-age mortality rates accentuated men's susceptibility to heart disease over women's, even as these differences diminished at older ages, when the majority of deaths occurred. Age and gender biases combined to frame heart disease as a man's disease on one hand, while the women's health movement marginalized older women's health on the other. It was not until the following decades that older women began to attract clinical concern and greater public attention, which ultimately expanded narrow frameworks of both heart disease and women's health.

The impact of pictorial health warnings on tobacco products in smokers behaviours and knowledge: the first quasi-experimental field trial after the implementation of the tobacco law in Italy.

BACKGROUND: The aim of the study was to evaluate in the Italian smokers, the effects of implementation of the law about Pictorial Health Warnings (PHWs) on tobacco products. METHODS: A quasi-experimental longitudinal design was conducted between 2016 and 2017. The data were collected before (pre-PHW/Wave 1) and after (post-PHW/Wave 2) the implementation of the law. The adopted questionnaire included impact of advertisement (Label Impact Index, LII), quitting behavior and knowledge of tobacco related diseases. RESULTS: 455 respondents completed both the Waves. 7.7% of smokers declared to have stopped smoking in Wave 2 and 29% of these declared the PHWs as one of the reasons to quit. The knowledge of tobacco related diseases was significantly (p <0.001) increased from Wave 1 to Wave 2 (58% versus 72%), similarly the LII (mean = 26.9, SD = 16.7 and mean = 40.4, SD = 16.2). CONCLUSION: Tobacco addiction is a problem that needs to be addressed from different angles. PHWs confirm their complementary role as a support for smokers along with other strategies such as text warnings and the tobacco quit line of the Istituto Superiore di Sanità (Italian National Institute of Health) reported on the packages. Nonetheless, over the years these measures have been not enough and policy makers should consider more strategies synergistically acting in the fight against tabagism.

El arte como herramienta docente en medicina / Art as a resource for teaching medical students

El presente artículo forma parte de un proyecto que pretende formar a estudiantes en la observación de la enfermedad utilizando para ello obras de arte. Los objetivos son desarrollar el interés científico de los participantes, promover y desarrollar la afición por el arte en estudiantes con formación básicamente científica. La peste negra, aunque fue una de las mayores catástrofes del mundo pre-modernista, produjo un obligado avance en la medicina. En este contexto histórico, a través de la representación de san Roque se vislumbra el impacto social de la pandemia gracias a la herencia artística del gótico, del renacimiento y del barroco (siglos XIV a xvii). MATERIAL Y MÉTODOS: Se han analizado algunas obras pictóricas sobre san Roque y, aprovechando la visión artística e histórica de su figura, se ha recopilado información de la labor y relación de san Roque con la peste bubónica. RESULTADOS Y DISCUSIÓN: A través de contenidos artísticos de la figura san Roque se observa una correlación bastante fidedigna entre la clínica representada en los cuadros de san Roque y los signos descritos en la medicina interna e infecciosa actual. Los signos y síntomas comunes de la peste aparecen fielmente representados en las obras analizadas dado que algunos de los pintores que dedicaron trabajos a su figura convivieron con la enfermedad e incluso la padecieron

INTRODUCTION: This article forms part of a project intended to teach students about observation through artwork. The objectives were to promote and develop art appreciation in science students, as well to continue developing their scientific interest. Although bubonic plague was one of the greatest catastrophes in the pre-modern world, it was also partly responsible for major advances in medicine. In this historic context, and using the figure of Saint Roch, a Catholic saint and confessor especially invoked against the plague, the social impact of the pandemic is assessed using the artistic heritage of gothic, renaissance and baroque periods (fourteen to seventeenth centuries). MATERIAL AND METHODS: Some paintings of Saint Roch have been analysed by looking at the historical and artistic viewpoints in order to gather information about his work and the relationship of the Saint with the bubonic plague. RESULTS AND DISCUSSION: Through the artistic representations of Saint Roch, and after a bibliographic review, a good correlation can be established between the clinical signs shown in the paintings and those described by in current internal medicine and knowledge of infections. There is ample evidence showing the fidelity of the representations regarding the common signs and symptoms of Black Death, particularly as some of the painters who painted the Saint lived at the time of the epidemics and even suffered the disease themselves

Spatial bias in figure placement in representational drawing: Associations with handedness and script directionality.

Spatial biases in graphomotor production tasks such as figure drawing may reflect biological (cerebral lateralization), biomechanical (limb movement), and/or cultural (reading/writing direction) influences. The present study examined sources of bias in the placement in graphic space of a symmetrical drawn figure (a tree). A previous study using a child sample found an overall leftward placement bias, independent of participants' reading/writing direction experience [Picard & Zarhbouch, 2014. Leftward spatial bias in children's drawing placement: Hemispheric activation versus directional hypotheses. Laterality: Asymmetries of Body, Brain and Cognition, 19(1), 96-112]; moreover, the left-side bias was greater in right handers. Using an adult sample, the present study also found an overall left placement bias. This effect was significantly greater in right-handed than left-handed participants. Importantly, a left placement bias was significantly greater in left-to-right readers (English) than in participants whose first learned language was from right-to-left (Urdu, Arabic or Farsi). The fact that script directionality is associated with figure placement in our study but not in the previous study suggests that a certain threshold of experience in reading/writing in a given direction may be needed for scanning biases to exert a demonstrable effect on representational drawing. These findings suggest that biomechanical and cultural factors offer a more parsimonious account of spatial biases in drawing.