With the development of the silver economy, older adults have shown increasing interest in digital technologies, such as electronic fitness games (Exergames). This study explores the impact of commercial exergames on the emotional experience of older adults in order to provide novel ideas and applications for healthy aging. This was a prospective, single-center, unblinded, repeated-measures randomized controlled trial comparing an exergame intervention with traditional indoor exercise. This study included 30 older adults (aged 60-89 years) who were able to move independently. The intervention group performed exergame training using Ring Fit Adventure, whereas the comparison group performed traditional indoor exercise. The intervention lasted four weeks, with two sessions per week (eight sessions). Mood states were assessed using the Brunel Mood Scale, and data were analyzed using a linear mixed-effects model to examine group, time, and interaction effects. Significant group × time interaction effects were observed for confusion, depression, fatigue, tension, and vigor (p < 0.05). No significant interaction effect was found for anger (p = 0.942). This study examined commercial exergames from the perspectives of emotional experience and mental health. Both commercial exergames and traditional indoor exercise were associated with improvements in immediate mood states. The exergame-based training approach was associated with lower levels of confusion, depression, and fatigue, as well as higher vigor scores. The results provide preliminary evidence regarding the role of digital exercise in mood regulation among older adults.
Trust underpins large-scale cooperation, yet it remains fragile among self-interested individuals. Trust games provide a classic framework for studying the evolutionary dynamics of trustworthy and untrustworthy behaviors under asymmetric payoff structures. However, in most existing trust-game models, investment rules are based on equal or linear allocation, failing to incentivize and constrain the behaviors of trustees effectively. To address this gap, we propose a reputation-based investment allocation mechanism in a networked N-player trust game. In this framework, individual behavior shapes reputation, reputation regulates investment allocation through a nonlinear softmax rule, and both payoff and reputation jointly influence strategy evolution, thereby forming a feedback loop. Numerical simulations demonstrate that this mechanism effectively directs resources toward high-reputation trustees, suppresses untrustworthy behavior, and improves both role-based cooperation index and the average payoff. Reputation-based nonlinear allocation is the key component, which converts reputation differences into resource-allocation advantages. A suitable balance between investment sensitivity and reputation preference is required: excessive reputation preference may reduce investor proportions and limit wealth generation. Thus, the optimal reputation preference is one that suppresses untrustworthy behavior while preserving enough investors to sustain capital flow. Tests on regular lattice, small-world, and scale-free networks show that the mechanism is not limited to the lattice, although stationary payoffs remain network-dependent. This study proposes a novel incentive framework in which reputation scoring, nonlinear allocation, payoff generation, and strategy updating are coupled into a feedback loop that sustains trust in networked N-player trust games.
To evaluate whether a doctor-led interdisciplinary intervention integrating immersive virtual reality (VR) panoramic preview and interactive medical games is associated with reduced perioperative fear and anxiety, improved medical compliance, and enhanced parental satisfaction in children aged 5-12 years undergoing elective pediatric urological surgery. A retrospective cohort study was conducted on 120 eligible children treated between January and December 2024. Participants were divided into a control group receiving conventional preoperative education and nursing care (n=60) and a research group receiving additional VR and medical game intervention (n=60). Propensity score matching (PSM) was applied to balance potential baseline confounding factors. Fear was assessed with the Children's Medical Fear Scale (CMFS) (0-4 points per item, 5-level scoring, Cronbach's α=0.852). Anxiety was measured with the Spence Children's Anxiety Scale-Short Version (SCAS-S) (1-4 points per item, 4-level scoring, Cronbach's α=0.83). Medical compliance and parental satisfaction were also evaluated as secondary outcomes. After intervention, the research group demonstrated significantly lower CMFS (18.5±3.2 vs. 25.8±4.5) and SCAS-S (22.3±4.1 vs. 30.7±5.3) scores, higher medical compliance rate (93.3% vs. 75.0%), and greater parental satisfaction compared with the control group (all P<0.05). The doctor-led combined VR and medical game intervention is associated with reduced perioperative fear and anxiety, improved medical compliance, and enhanced family satisfaction, showing promising clinical value for perioperative psychological management in pediatric urological surgery.
Large language models (LLMs) are increasingly considered for deployment in applications requiring strategic judgment under uncertainty. Yet it remains unclear whether their behavior in adversarial environments resembles normative decision-making, human strategic behavior, or something qualitatively distinct from both. This study addresses that question using a controlled attacker-defender signaling game in which an attacker must interpret potentially deceptive defender announcements and decide whether to attack one of two targets or abstain. We develop a three-way comparison framework that evaluates GPT-4o against two benchmarks simultaneously: a normative Bayesian best-response model and empirical human decisions drawn from a matched experimental data set. Critically, we decompose strategic behavior into two components, belief formation and action selection, to identify whether similarities and divergences across agent types arise at the level of probabilistic inference, behavioral choice, or both. The results provide partial support for normative alignment (H1): GPT-4o's modal action matches the normative benchmark in seven out of eight scenarios, yet its decision distributions diverge significantly in all conditions ( p < 0.001 $p < 0.001$ ), driven by a systematic underutilization of the abort option (6.7% vs. the normative recommendation of 25.6%). Human similarity (H2) is not supported, with action frequency distributions differing significantly across all eight conditions ( p < 0.01 $p < 0.01$ ). The core finding is a cognitive-action decoupling: GPT-4o maintains more diffuse posterior beliefs than humans in six out of eight scenarios yet produces more deterministic actions, and explicitly articulates uncertainty in 14%-28% of reasoning traces while systematically overriding that uncertainty in its final decisions. These findings position current LLMs as a strategically distinct class of agent, neither fully rational equilibrium players nor behavioral mimics of human bounded rationality. The observed commission bias and belief-action decoupling have direct implications for the deployment of LLMs in high-stakes adversarial roles, where abstention under uncertainty is often the strategically rational choice.
This study examined physical activity levels, video gaming habits, and interest in using exergames among adolescents with probable developmental coordination disorder (p-DCD). It also explored relationships between physical activity, sedentary video gaming time, and preferences between sedentary video games and exergames. 103 adolescents with p-DCD (17 girls, 86 boys; M = 12.48 years, SD = 1.25) from the Netherlands (n = 61) and Czech Republic (n = 42) completed a questionnaire. 58.3% of participants reported low physical activity. On weekdays, 46.5% sat for 4-8 h; on weekends, 37.3% sat for 8-12 h. Motivations for sedentary video gaming included entertainment and social interaction. On weekdays, 39.8% played sedentary video games for 1-2 h; on weekends, 43.7% played for 3-5 h. While 43.7% believed exergames could increase their activity, 52.9% preferred sedentary video games. No significant relationship was found between physical activity levels and sedentary video gaming time or video game type preferences. Participants reported high sedentary behavior and sedentary video gaming engagement. Although many expressed interest in exergames, sedentary video games were preferred, suggesting the need to enhance exergames' entertainment value. Game choice may be influenced more by appeal and engagement than by physical activity levels.
Sound is a core component of digital games, and its integration is assumed to support learning, motivation, and positive emotions. However, empirical evidence on the role of sound in educational video games remains limited, particularly in narrative-driven educational adventure games such as digital history games. In a laboratory experiment, university students (N = 111) either played an educational history video game without sound or with additional sound features (ambient audio, character voices, and narrated codex entries providing additional historical information). Post-test measures assessed factual knowledge, triggered and maintained situational interest, and academic emotions (enjoyment and boredom). Engagement with optional supplemental historical information provided through in-game codex entries was measured using behavioral log data. We analyzed differences between the two conditions while controlling for relevant pre-test variables. Participants in the add-on sound condition did not score significantly higher on the knowledge test than those in the no-sound condition. Likewise, no statistically significant differences emerged in situational interest, enjoyment, boredom, or codex engagement between conditions. Additional analyses indicated that participants' interactions with codex entries positively predicted knowledge test performance, indicating that voluntary engagement with supplemental content contributed to learning. Our findings suggest that the presence of sound alone may not enhance academic outcomes in a narrative-driven educational video game. Additionally, our findings indicate that learning outcomes depended strongly on learners' engagement with in-game codex entries. Overall, our results on the inclusion of sound highlight the importance of examining specific design features within educational history video games.
Chronic low back pain (CLBP) is a major global health challenge. While non-pharmacological therapies are recommended, patient compliance is often hindered by kinesiophobia. Virtual reality (VR) offers an immersive, distraction-based approach, but the comparative effectiveness of different VR modalities remains unclear. To compare and rank the efficacy of different virtual reality-based training modalities on pain intensity, disability, and kinesiophobia in patients with CLBP. Systematic searches were conducted in PubMed, Web of Science, Scopus, Embase, CINAHL, and the Cochrane Library from inception until June 2025. Randomized controlled trials assessing the effects of virtual reality-based training on individuals with chronic low back pain were selected. Primary outcomes were pain intensity, disability (Oswestry Disability Index), and kinesiophobia (Tampa Scale of Kinesiophobia). The Cochrane Risk of Bias tool (RoB2) was used for quality assessment. Confidence in the Network MetaAnalysis (CINeMA) framework was used to evaluate the credibility of cumulative evidence. A Bayesian Network Meta-Analysis with Standardized Mean Difference (SMD) as Effect Size was performed to synthesize evidence and rank interventions using Surface Under the Cumulative Ranking Curve (SUCRA) values. The GRADE framework was adapted to evaluate the quality of evidence. 25 RCTs with a total of 2,610 participants were included in the analysis. For pain intensity, shooting games (SMD -4.40; 95% CrI -6.80 to -2.20) and VR-based equestrian training (SMD -2.00; 95% CrI -3.70 to -0.57) were significantly superior to all types of controls. SUCRA indicated that shooting games had the highest probability (98%) of being the most effective intervention for pain relief. For disability, no intervention demonstrated statistically significant superiority. For kinesiophobia, shooting games (SMD -3.40; 95% CrI -5.60 to -1.10) significantly outperformed traditional exercise controls. The quality of evidence ranged from very low to moderate across outcomes. This first network meta-analysis to compare and rank distinct VR modalities for CLBP offers several key innovations and contributions to the field. By moving beyond aggregate VR categorizations, we provide a granular, comparative ranking of specific, actionable VR interventions. Unlike previous reviews that treated VR as a homogeneous group or only compared it to sham, our network meta-analysis directly and indirectly compares seven distinct VR modalities, revealing that not all VR is equally effective. Our findings suggest that shooting games have the potential to be the most effective virtual reality therapy for relieving pain intensity and kinesiophobia, though evidence for disability remains limited. Unfortunately, due to heterogeneity and low-quality evidence, there is no evidence demonstrating significant improvement in specific outcomes for patients with chronic low back pain. More RCTs are needed to provide robust clinical evidence. PROSPERO CRD420251131116; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251131116.
Background The optical clarity of clear aligners is essential for esthetics, and routine cleaning protocols may alter their light transmittance. This study evaluated the effect of commonly used cleaning methods on the light transmittance of polyethylene terephthalate glycol (PET-G) clear aligners in vitro. Materials and methods Forty PET-G specimens (10 × 10 mm) were divided into four groups (n = 10): Control, Listerine® rinse (Johnson & Johnson, Neuss, Germany), Corega® effervescent tablets (Stafford-Miller, Dungarvan, Ireland), and toothbrush with Colgate® toothpaste (Colgate-Palmolive, Guangzhou, China). The specimens were subjected to the assigned cleaning protocols once daily for 14 days. Light transmittance was measured using a UV-Vis-NIR (Ultraviolet-Visible-Near Infrared) spectrophotometer. Data were analyzed using the Shapiro-Wilk test, Levene's test, Welch's ANOVA, and Games-Howell post hoc comparisons at α = 0.05. Measurement reproducibility was assessed using repeated measurements and the intraclass correlation coefficient (ICC). Results Measurement reproducibility was excellent, with no significant systematic difference between repeated measurements (P = 0.515) and an ICC of 0.993. The highest mean light transmittance was observed in the Listerine group (87% ± 2%), followed by the control and Corega groups (85% ± 3% each), whereas the toothbrush group showed the lowest value (64% ± 6%). Levene's test indicated unequal variances (P = 0.001), and Welch's ANOVA showed a significant difference among groups (P < 0.001). Games-Howell post hoc analysis revealed that the toothbrush group had significantly lower transmittance than all other groups (P < 0.001), while no significant differences were found between the control, Corega, and Listerine groups. Conclusion Toothbrush-and-toothpaste cleaning markedly reduced the light transmittance of PET-G clear aligners, whereas chemical cleaning methods preserved optical properties. Non-abrasive cleaning approaches may be preferable for maintaining aligner transparency.
Broadening access to biomarker-informed risk stratification in mild cognitive impairment (MCI) has become even more critical to early assessment in Alzheimer disease given recent developments in regulatory approvals of disease-modifying therapies and advancements of blood-based biomarkers. This requires accessible approaches that can be deployed at scale to better differentiate the disease biology from the clinical progression risk prediction. While entorhinal tau positron emission tomography (PET) can refine near-term prognostic assessment, the cost and logistic burden of imaging limit broad clinical use. Evaluate whether a brief informant-reported screen derived from the Functional Activities Questionnaire (FAQ) could better stratify scalable biologically anchored prognostic information for 3-year progression from MCI to Alzheimer disease dementia. The primary study was designed around FAQ-derived screens performance relative to entorhinal tau PET standardized uptake value ratio (SUVR), plasma phosphorylated tau 217 (p-tau217) and Mini-Mental State Examination (MMSE) score. Secondary analyses evaluated the stable FAQ-derived screen selected for clinical risk separation, tau and amyloid PET biological context, additional plasma biomarkers, resource-use scenarios and sensitivity analyses around subgroups, calibration, decision-curve, survival, timing, early-progressor exclusions and endpoint-ascertainment IPW. This retrospective secondary progression risk prediction study analyzed 350 Alzheimer's Disease Neuroimaging Initiative (ADNI) participants with a baseline clinical diagnosis of MCI at the tau PET anchor visit. All studies were conducted in cohorts with 3-year progression status known. The first primary benchmarking included 157 participants (including 32 progressors) for FAQ with entorhinal tau PET SUVR comparisons and 153 participants (including 31 progressors) for FAQ, entorhinal tau PET SUVR and MMSE comparisons. The second primary benchmarking was derived from a smaller UPENN plasma p-tau217 subset of 66 participants (including 13 progressors). The FAQ-derived candidate screens were evaluated by leakage-controlled repeated nested cross-validation. The stable 3-item FAQ-derived screen selected was defined as any informant-reported difficulty in at least one of the three activities comprising finances/checkbook, shopping and games/hobbies ("Locked FAQ Trio"). The Locked FAQ Trio was compared against both biological and cognitive comparators: entorhinal tau PET SUVR, plasma p-tau217 and MMSE score. Amyloid PET status and Centiloid burden as well as plasma biomarkers paired per same-file plasma such as Aβ42/40 ratio, glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL) and a directionally adjusted 4- marker plasma composite were used for biology or exploratory context and not for defining the clinical endpoint. The primary binary endpoint was progression from baseline MCI at the tau PET anchor visit to Alzheimer disease dementia within 3 years. Model performance used the cross-validated area under the receiver operating characteristic curve (AUC), the difference in AUC (ΔAUC) was bootstrap 95% confidence intervals (CI) at the participant level with P values adjusted using the Benjamini-Hochberg (BH) procedure. Other measures included Brier scores, calibration summaries, survival discrimination and operating characteristics such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and screen-positivity prevalence, while decision-curve analyses and resource-use scenarios remained exploratory. A leakage-controlled nested cross-validation selection repeatedly identified a 3-item screen defined as any difficulty in at least one of the three following activities comprising finances/checkbook, shopping and games/hobbies (Locked FAQ Trio). In an independent 3-year progression benchmark analysis of base-covariate models, the Locked FAQ Trio showed higher numerical, directional but not statistically significant, discrimination than entorhinal tau PET among 157 participants including 32 progressors (AUC, 0.787 vs 0.780; ΔAUC, +0.007; 95% CI, -0.099 to 0.113; BH-adjusted P = 0.926) and was statistically significantly higher than MMSE score (AUC, 0.796 vs 0.637; ΔAUC, +0.159; 95% CI, 0.045 to 0.276; BH-adjusted P = 0.029). The Locked FAQ Trio was positive in 37.6% of participants and captured 27 of 32 progressors, showing sensitivity of 84.4%, specificity of 74.4%, PPV of 45.8%, and NPV of 94.9%. Progression within 3 years occurred in 45.8% of screen-positive participants versus 5.1% of screen-negative participants and the corresponding adjusted hazard ratio over full follow-up was 7.46. The screen was also associated with higher entorhinal tau burden and remained consistent across survival, timing-sensitive, amyloid and missingness analyses. A different 3-item FAQ-derived companion screen ("Companion FAQ Trio") was evaluated for sensitivity, it was defined as any impairment in at least one of the three activities comprising forms/papers, shopping and remembering appointments/medications/holidays. The Companion FAQ Trio was positive in 54.1% participants and captured 96.9% of progressors, with 36.5% of screen-positive progressing to dementia versus 1.4% of screen-negative.In a second primary benchmark analysis of a smaller matched plasma subset of 66 participants including 13 progressors, plasma p-tau217 showed the highest discrimination (AUC, 0.890) across all single predictors in a base-covariates model, compared with the Locked FAQ Trio (AUC, 0.749) and entorhinal tau PET SUVR (AUC, 0.798). A stratification study of the Locked FAQ Trio combined with p-tau217 showed separation of observed risk, differentiating lower and higher risk of progression per strata. Notably, none (0 of 31) of the participants in the lower risk cohort progressed and 64.3% (9 of 14) of participants in the higher risk cohort progressed. Nevertheless, 37.5% (3 of 8) of participants in the Locked FAQ Trio-negative/p-tau 217-high cohort progressed. This emphasizes that patients should not be excluded from further biomarker testing when clinical concern remains. A brief 3-item stable FAQ-derived screen was identified as a compelling front-end additional layer to prognostic triage in MCI patients. This Locked FAQ Trio screen demonstrated a higher numerical discrimination than entorhinal tau PET SUVR in 3-year base-covariates prediction risk models. Plasma p-tau217 remained the strongest scalable predictor of progression to dementia in a smaller plasma subset. These findings reinforce that adding a brief functional screen to the staged prognosis assessment triage pathway can help prioritize and contextualize biomarker escalation, offering a scalable, deployable, and low burden solution to expand screening to a broader patient population. Question: Can a low-burden brief informant-reported functional questionnaire support staged prognostic triage, before biomarker escalation, for near-term progression risk from mild cognitive impairment to Alzheimer disease dementia?Findings: In this progression risk prediction study of 350 individuals with mild cognitive impairment, a 3-item Functional Activities Questionnaire (FAQ) was identified as a stable early signal for progression risk using a leakage-controlled repeated nested cross-validation. The screen was defined as any impairment in at least one of the three activities comprising finances/checkbook, shopping and games/hobbies ("Locked FAQ Trio"). In an independent prognosis prediction study, the Locked FAQ Trio was numerically, but not statistically significantly, higher than entorhinal tau positron emission tomography (PET) standardized uptake value ratio (SUVR) and statistically significantly higher than Mini-Mental State Examination (MMSE) score. In a smaller plasma subset of 66 participants, plasma phosphorylated tau 217 (p-tau217) showed the highest discrimination and the Locked FAQ Trio combined with p-tau217 differentiated lower and higher risk of progression.Meaning: An informant-reported brief 3-item functional questionnaire can help to inform and prioritize biomarker testing. A selected Locked FAQ Trio showed a higher numerical discrimination than specialized entorhinal tau PET biomarker and contextualized plasma p-tau217 biomarker. The suggested staged framework starts with Locked FAQ Trio screen triage, then plasma p-tau217 refinement before selective confirmation disease pathology with cerebrospinal fluid biomarkers or amyloid PET and/or tau PET for staging or prognostic prediction.
Physical inactivity and low enjoyment of physical education during childhood represent a significant public health problem. Although schools are a key setting for promoting active lifestyles, physical education instruction continues to focus largely on traditional sports, which may limit student participation and engagement. In this context, alternative sports emerge as an innovative and potentially more inclusive pedagogical strategy. Therefore, the objective of this study is to evaluate the effectiveness of an alternative sports intervention in the school setting, compared to standard physical education, on physical fitness, body composition, motor competence, and enjoyment of physical activity among elementary school students. A cluster-randomized controlled trial will be conducted among 11- to 12-year-old schoolchildren. Schools will be selected at random, and within each school, two classes from the same grade will be assigned to the intervention or control groups. The intervention will consist of an eight-week instructional unit (16 sessions) based on four alternative sports (flag football, ultimate frisbee, korfball, and kin-ball) taught using the Teaching Games for Understanding approach. The control group will continue with the regular physical education curriculum. Physical fitness, motor competence, and enjoyment of physical activity will be assessed as primary outcomes, while physical activity levels and body composition will be considered secondary outcomes. All variables will be assessed before and after the intervention. Primary analyses will follow the intention-to-treat principle using mixed-effects models to account for clustering (students within schools). The effects of the intervention will be estimated using the group × time interaction. Analyses will be performed using SPSS v28 and R v4.3. This protocol addresses significant gaps in the literature on school-based interventions using alternative sports. It is expected that the experimental design, together with a structured intervention that can be replicated by teachers, will generate robust evidence on the physical, motor, and affective-motivational mechanisms associated with this pedagogical approach. The anticipated findings may serve as a basis for future curricular decisions and educational policies aimed at promoting physical activity and health during school-age years. ClinicalTrials.gov, identifier NCT07313267.
Adolescence is a crucial developmental stage characterized by rapid biological, psychological, and social changes, that increase vulnerability to mental health issues. Nearly half of all mental health conditions have their onset during this period and are influenced by individual, family, and environmental factors. Schools play a key role in promoting mental well-being among adolescents due to their accessibility and reach. While school-based mental health prevention interventions have shown positive outcomes in high-income countries, evidence from low- and middle-income countries (LMICs) is limited. This study aimed to assess the feasibility and acceptability of Health Action in Schools for a Thriving Adolescent Generation (HASHTAG), a comprehensive school-based intervention for adolescents aged 13-16 years in Nepal. A feasibility cluster-randomized controlled trial was conducted in four secondary schools in Morang district, Nepal. Adolescents completed surveys at baseline and at a 3-month follow-up to evaluate mental well-being, emotional and behavioral outcomes, social support, school climate, and functioning. The intervention comprised two components: Thriving Environment in Schools (TES), implemented over three months and Thriving Together (TT), delivered through six weekly sessions. Quantitative data were collected electronically and analyzed descriptively. Qualitative data were gathered through focus group discussions and in-depth interviews with adolescents, teachers, and facilitators to explore implementation experiences and were analyzed thematically. Both the TES and TT components were well received, with TT sessions achieving an average attendance rate exceeding 70%, and being delivered as planned by trained facilitators, indicating good acceptability and feasibility. Explanatory analysis suggested a positive trend in anxiety outcomes in the intervention group while, social support showed a modest increase. Other outcomes showed small, non-significant changes. Qualitative findings highlighted perceived benefits such as improvements in school cleanliness, staff-student relationships, bullying and discrimination reduction, and positive social and behavioral changes. Participants found breathing exercises, games, the workbook, and the 'feeling box' particularly helpful. Implementation challenges included limited space, logistical constraints, COVID-19 related disruptions, and session length. HASHTAG demonstrated feasibility and accessibility as a school-based intervention for adolescents in Nepal, with preliminary indications of potential benefits. Addressing identified implementation challenges will be important for optimizing delivery in future studies. A fully powered randomized controlled trial is warranted to evaluate effectiveness.
The age of 10 to 15 is a period of intense psychosocial changes, often accompanied by increased emotional tension. To date, there is a lack of in-depth analyses in which stress responses and coping strategies are compared between physically active children and their peers not engaged in regular sports training. The study was grounded in transactional and sport-specific coping frameworks and aimed to compare students practicing judo with those not involved in any sports discipline in terms of stress sources, symptoms and coping strategies. Understanding how stress perception and coping profiles differ between children engaged in regular sport and their non-training peers may help identify targets for preventive and psychoeducational programmes in early adolescence. A total of 553 students aged 10 to 15 participated in the study, including 276 children who regularly practiced judo and 277 peers not engaged in any sports disciplines. The grouping criterion was a self-reported participation in training at least three times per week or the absence of regular physical activity. Stress coping strategies were assessed using the standardised "How do you cope?" (JSR) questionnaire developed by Juczyński and Ogińska-Bulik, along with an original survey including questions on stress sources, symptoms and responses. Children practicing judo reported significantly lower levels of school-related stress than their non-training peers (pHolm = 0.006), with 43.8% indicating they "never" or "rarely" experience stress (vs. 25.3% in the non-training group). Judo students also felt safer at school ("always": 44.6% vs. 26.7%; pHolm = 0.006). School-related stressors such as grades, teacher criticism, tests, loneliness and other concerns were more frequently reported by the non-training children (all pHolm < 0.038). Psychosomatic symptoms such as lack of concentration (53.8% vs. 32.6%), stomach pain (40.1% vs. 24.3%) and hand tremors were also more common in the non-training group (pHolm = 0.014). Judo practitioners were more likely to cope through physical activity (42.8% vs. 11.3%; pHolm = 0.008), while non-training students more often used social media (46.4% vs. 29.5%) and video games (42.8% vs. 25.0%; pHolm = 0.008 for both). Judo practitioners showed lower emotion-focused coping, whereas evidence for higher situational active coping was weaker and should be interpreted cautiously. The study indicates that judo participation was associated with lower school-related stress and fewer selected psychosomatic symptoms in children, as well as with more frequent use of physical activity as an everyday coping behaviour. Judo practitioners were less likely to use passive stress relief (e.g. social media) and it was more probable for them to engage in physical activity. Findings align with sport-coping taxonomies and suggest applied opportunities for coping-skills training within youth judo. These findings suggest that structured sport participation, such as judo, may be associated with more favourable stress-and-coping profiles in early adolescence, and warrant further investigation in longitudinal designs.
The application of game elements to engage participants and improve data collection for clinical trials is relatively novel, with limited research around the impact of gamification in clinical research. This article explores published literature and surveys from patients and clinical sites. A targeted literature review was completed in November 2025 to identify published articles (≤10 years) on the application of gamification in clinical trials. Synthesized findings informed the design of two surveys of US adults (n = 1,044 from UserTesting.com) and clinical trial sites (n = 311) on their perceptions of gamification and acceptance in clinical trials. Both were ∼5-minute online surveys utilizing five open- and closed-ended questions. Twenty-four articles were focused on the application of gaming design and mechanics to non-gaming activities. Three primary areas identified were education (n = 3), health outcomes measures (n = 7), and patient engagement (n = 14). Eighteen studies reported an advantage of gamification, including positive impacts on health outcomes measures (n = 5) and patient engagement (n = 11). Survey respondents (adults) were most familiar with computer games (62%), stating a preference for participating in trials that included gamified cell phone applications, with the ability to customize application elements as the most important. From a thematic analysis of respondents' comments, potential impacts on human behavior and performance (33%) were the most prevalent concerns. Data (26%; including concerns about privacy, integrity, and security), and software (22%; including adaptability to account for ability and skill variation, satisfaction, user experience, controls, customization, and personalization) were also key areas of concern for patients. Key perceived benefits included improvements in experience (31%) and engagement (24%). Site respondents were most familiar with managing gamified clinical trials with gamified cell phone applications (30%) and would prefer to manage trials that included these elements vs. traditional trials. Notifications, education, and training were the most important gamification elements for site respondents. Potential advantages of gamification include increased engagement, trial education, adherence to protocols, and enjoyment of the clinical trial experience, which may increase retention and data completeness. Further research is required to better understand the potential impact of gamification on scores of how patients feel or function.
Understanding the physical and physiological demands of female youth basketball is essential for optimizing training and performance monitoring. However, evidence describing match demands in elite U-19 female players, particularly in African contexts, remains limited. Existing profiles are largely derived from male or adult cohorts and may not accurately reflect youth competition. This study aimed to examine the physical and physiological demands of elite North African U-19 female basketball players, considering differences by playing position (guards, forwards, centers) and competitive level (national vs. international). Thirty elite Tunisian U-19 female players (age 18.3 ± 0.2 years, height 1.78 ± 0.05 m, mass 82.9 ± 4.8 kg; 15 national-level, 15 international-level) were monitored during eight playoff games. Video-based time-motion analysis quantified activity frequency and duration across nine movement categories (standing, walking, jogging, running, sprinting, jumping, low/moderate/high-intensity shuffling). Physiological responses included heart rate (HR) monitoring (four intensity zones: <75%, 75-85%, 85-95%, >95% HRmax) and capillary [La] sampling. Two-way ANOVA (position × level) examined main and interaction effects. International-level players performed significantly more high-intensity activities than national-level players (224.0 ± 5.1 vs. 214.1 ± 5.4; p < 0.001, d = 1.95) and spent more time in maximal HR zones (16.1 ± 0.3% vs. 12.1 ± 0.3%; p < 0.001, d = 13.33), indicating greater fatigue resistance. Guards executed more high-intensity shuffling actions than forwards and centers (p < 0.001, η 2 = 0.92), whereas centers performed more static high-intensity actions and exhibited higher [La] concentrations (5.22 ± 0.15 vs. 4.93 ± 0.13 and 4.64 ± 0.12 mmol L-1; p < 0.001, η 2 = 0.76). High-intensity activity declined from the first to the fourth quarter in both groups (p < 0.001, η 2 = 0.94), with a greater reduction in national-level players (37.0% decline) than international players (31.9% decline). Intra-observer reliability was excellent across all movement categories (ICC ≥ 0.91; CV ≤ 4.6%). U-19 female basketball imposes distinct position-specific demands (guards: high-intensity lateral movements; centers: static exertions and elevated metabolic load) and competitive-level differences (international players: superior fatigue resistance). These findings provide the first quantitative profile of elite African female youth basketball, establishing reference benchmarks for position-specific conditioning and competitive-level progression assessment.
Older adults are increasingly engaging in digital games, although little is known about older gamers on a large scale. This study seeks to examine the lifestyle, health, and well-being profiles of older computer gamers versus non-gamers, considering the relevance of our findings on older gamer profiles to key stereotype theories. We reported findings from the UK Biobank data with 73,359 participants aged 50 to 70. Participants were classified as non-gamers (N = 60,540; 82.53%), occasional gamers (N = 10,961; 14.94%), and frequent gamers (N = 1,858; 2.53%). Group comparison results suggested mostly negligible differences between older gamers and non-gamers in the domains of demographics, active/passive lifestyle, social engagement, sleep patterns, physical health, and psychological well-being. Small group differences were found in walking, moderate exercise, TV watching, body mass index, body fat percentage, and self-reported health. These findings help unveil the unique profile (or lack thereof) of older gamers versus non-gamers and provide insights for gerontologists and the gaming industry.
Background: Poor adherence and monotony in home-based pelvic floor muscle training (PFMT) often lead to suboptimal rehabilitation outcomes. Serious games using virtual reality (VR) may improve training motivation and precision. This study aimed to explore user demands for a VR pelvic floor rehabilitation training system with game-based features. Methods: A Kano model-based questionnaire was developed and distributed to patients receiving PFMT. The survey assessed 20 demand items spanning five dimensions: system operation, exercise guidance, personalization, device use, and interaction. Traditional Kano categorization and an optimized mixed-method classification were used to identify core demand attributes. Satisfaction and dissatisfaction indices were also calculated. Results: A total of 112 valid questionnaires were analyzed. Using the Kano model, 20 demand items were classified as attractive (n = 7), one-dimensional (n = 5), must-be (n = 6), or indifferent (n = 2). Personalization-related demands were mainly identified as attractive attributes, whereas exercise guidance-related demands were primarily classified as must-be or one-dimensional attributes. Satisfaction Index (SI) values ranged from 0.27 to 0.64, and absolute Dissatisfaction Index (DSI) values ranged from 0.34 to 0.71. Optimized Kano analysis identified nine mixed attributes. The questionnaire demonstrated excellent internal consistency (Cronbach's α = 0.96). Conclusions: Participants demonstrated positive willingness to adopt a game-based VR system for PFMT, with diverse needs identified across functional and motivational dimensions. These findings suggest that integrating immersive, personalized, and gamified design features may hold promise for enhancing user engagement and anticipated training adherence, though direct evaluation of clinical effectiveness awaits future prototype-based studies. The identified demand priorities provide structured, evidence-informed guidance for the user-centered design of serious game-oriented VR pelvic floor rehabilitation systems.
In this study, salmon fish bone waste from the fish processing industry was converted into an inorganic ash filler by calcination and incorporated into an SLA-compatible photopolymer resin at 4, 8, and 12 wt.%. To compensate for filler-induced optical scattering and rheological changes, the printing parameters were systematically optimized, and the optimum conditions were identified as a layer thickness of 30 µm and an exposure time of 12 s. Tensile tests performed in accordance with ASTM D638 Type IV showed that fish bone ash significantly enhanced the tensile strength of the photopolymer matrix, increasing it from 24.8 MPa for the neat resin to 37.95 MPa at 12 wt.% filler loading. In contrast, increasing filler content reduced elongation at break and promoted a more brittle fracture response. Statistical evaluation using Welch ANOVA and Games-Howell post hoc analysis confirmed that filler loading had a statistically significant effect on tensile strength (p < 0.05). FTIR analysis revealed that the filler remained chemically stable within the matrix and that the interfacial interactions were predominantly physical rather than covalent. SEM observations indicated that low and medium filler loadings improved crack deflection and energy dissipation, whereas particle agglomeration at higher loading increased the tendency for brittle fracture. These findings demonstrate that fish bone ash can be used as a sustainable bio-waste-derived reinforcement to improve the mechanical performance of SLA photopolymer composites.
To examine mouthguard usage, hygiene practices, and oral health status of youth ice hockey players in Ontario. Cross-sectional survey study. Ontario, Canada; recruitment conducted online in collaboration with the Ontario Minor Hockey Association. Youth ice hockey players in Ontario who reported mouthguard use. Participants voluntarily completed an anonymous online questionnaire administered using REDCap. Frequency and consistency of mouthguard use, mouthguard cleaning practices, receipt of hygiene instructions, oral hygiene behaviors, and self-reported caries experience and oral health status. Complete responses were obtained from 214 players using mouthguards. Approximately 47% reported wearing mouthguards during both games and practices, with majority (59%) wearing boil-and-bite type. Among custom mouthguard users, 64% reported never receiving care instructions from a dentist, whereas 29% of stock or boil-and-bite users reported no manufacturer guidance. Overall, 52% reported cleaning their mouthguards, and 38% of these did so after every game or practice. Most participants brushed twice daily (71%), whereas fewer flossed daily (28%). Consistent mouthguard use was associated with significantly lower odds of self-reported caries (OR = 0.49; 95% CI: 0.28-0.85). Higher motivation toward oral health was associated with positive self-rated oral health (OR = 3.45; 95% CI: 1.20-9.97). Youth ice hockey players in Ontario demonstrated inconsistent mouthguard use and suboptimal hygiene practices, compounded by limited guidance from dental professionals and manufacturers. Improved education, clinical engagement, and policy initiatives are needed to enhance mouthguard effectiveness and oral health outcomes among youth athletes.
The preschool years are a crucial period for development. Stable environments and responsive caregivers support children's cognitive and motor development, two interrelated and essential domains. Caregiver smartphone use in front of children may reduce attention and responsiveness, which have been negatively associated with young children's health and development. We examined associations between the frequency of caregiver smartphone use in a child's presence and motor skills and executive functions, and whether these associations vary by country income level. We analysed cross-sectional data from 27 countries participating in the SUNRISE International Study. Caregivers reported the frequency of smartphone use in the child's presence across five scenarios: mealtime, playtime, travel, walk and bedtime routines. Children's motor skills were assessed using four established tests. Early Years Toolbox games were used to assess children's visual-spatial working memory and inhibition. Mixed-effects linear regression models were used to assess the associations, including interaction terms to test variation by country income level. Models were adjusted for the child's sex, age, daily screen time, time spent outdoors, sleep duration and the caregiver's highest level of education. The analytical sample included 2232 preschoolers (mean age = 4.2 ± 0.6 years, 50.9% girls). In fully adjusted models, the frequency of caregiver smartphone use in a child's presence was not associated with gross motor skills, fine motor skills, visual-spatial working memory or inhibition (all p > 0.05). Results did not differ by country income level. Findings suggest that the frequency of caregiver smartphone use in a child's presence alone may not be associated with performance on motor skills and executive function. There is a need for more sensitive measures that capture the frequency, duration and context of interruptions and more longitudinal studies that examine motor development and cognition. Future research should also account for socioeconomic and demographic diversity, environmental factors and cultural context when assessing such associations.
Given concerns that screen time may impact dietary habits, this study investigated the association between screen time and dietary intake among adolescents in the United States. We analyzed a prospective cohort (N = 6485, 47.3% female, age: 12 ± 0.7 years) from the Adolescent Brain Cognitive Development (ABCD) Study, using data from Year 2 (2018-2020) and Year 3 (2019-2021). Multinomial logistic regression models estimated the associations between participant-reported screen time (watching television shows and videos, playing video games, socializing, browsing the internet, and total screen time (hours/day)) and parent/participant-reported intake of various food/nutrient categories 1 year later (Year 3). We adjusted for age, sex, race and ethnicity, household income, parent education, average daily kilocalorie intake, respective food or nutrient, and study site (Year 2). Each additional hour of most screen time modalities was prospectively associated with higher odds of consuming fewer fruits, vegetables, whole grains, legumes, fiber, and dairy, and higher glycemic index, and higher odds of consuming more added sugars and a higher polyunsaturated fats ratio 1 year later. These findings highlight the need for parental guidance and clinical interventions to support screen time habits and promote healthy dietary choices among adolescents. This study examines the association between contemporary screen time modalities and dietary intake 1 year later in a demographically diverse U.S. sample of early adolescents. Most screen time modalities, such as total screen time and watching television shows and videos, were prospectively associated with higher odds of consuming fewer fruits, vegetables, whole grains, legumes, and fiber 1 year later. Greater total screen time and time spent socializing were prospectively associated with higher odds of a higher polyunsaturated fats ratio 1 year later.