Gaming is a common leisure activity among university students, a life stage marked by late adolescence and emerging adulthood, when digital habits and psychosocial outcomes are still developing. However, gaming behaviors and motivations differ by gender, making it important to understand these variations to identify trends and potential risks linked to excessive use. This study examines whether gender is associated with differences in gaming habits, motivations, and perceived toxicity within a sample of Italian university gamers. A total of 394 participants (M = 22.8 years, SD = 3.6; 58% male) who actively played video games completed an online questionnaire on sociodemographic and gaming variables. Data were analyzed using t-tests and linear discriminant analysis. Results showed gender differences in age of gaming onset, weekly gaming time, perceived toxicity, and motivations such as violent gratification, cognitive challenge, coping, and social interaction. However, discriminant analysis identified weekly gaming hours, violent gratification, and age as key differentiating factors, but the model accounted for a limited proportion of between-group variability. These findings suggest that gender accounts for a limited proportion of variability, indicating a trend toward gender parity in the analyzed gaming variables.
Internet gaming has become a widespread global activity, raising concerns about the prevalence of Internet Gaming Disorder (IGD). However, existing meta-analyses report highly variable prevalence estimates. This umbrella review aims to clarify the prevalence and variability of IGD by synthesizing evidence from meta-analyses to provide a comprehensive overview of IGD prevalence across populations, age groups, and regions. Following PRISMA guidelines, systematic searches were carried out across five published literature databases and two supplementary search sources. Title and abstract screening, followed by full-text eligibility assessment, were conducted independently by three authors. The same three authors then performed data extraction and quality assessment for the nine included meta-analyses. After screening, nine eligible meta-analyses were included. The overall median prevalence of IGD was 6.20%, with an interquartile range of 4.25% to 8.30%. Subgroup analyses indicated a higher prevalence among males compared to females. Evidence for age differences between adolescents and adults was limited and should be interpreted cautiously because age groups were inconsistently defined across meta-analyses. Regional comparisons suggested higher prevalence estimates in Asia than in Europe, and gamer profile comparisons suggested higher prevalence estimates in gamers than in the general population, although evidence for these differences was limited and not consistent across meta-analyses. Overall, the findings indicate that IGD affects a sizeable proportion of the population, but prevalence estimates vary depending on demographic and regional characteristics. Greater consistency in diagnostic criteria, assessment tools, and reporting standards is needed to improve the comparability and interpretability of IGD prevalence research.
The increase in sophisticated electronic gambling products offered by gambling manufacturers facilitates an increase in the accessibility of gambling platforms and modes. This study proposes utilising Artificial Intelligence (AI) to enhance self-awareness and self-control within electronic gaming machines. The study adopts a case study that follows an exploratory research design, as the causal explanation argument suggests that the Electronic Gaming Machine (EGM) device causes problem gambling. Secondary data on gambling were obtained and analysed. The machine-learning pattern recognition and classification model; a learning approach which learns from a trained dataset to make decisions or predictions, was employed. The dataset was trained iteratively using the scaled conjugate gradient backpropagation with the input and output target samples divided into training, validation, and test datasets. Furthermore, the softmax was used for classifying the dataset into three classes: responsible, intermediate, and irresponsible gambling. The confusion matrix was used to analyse the percentages of correct and incorrect classifications. The results obtained indicated that the accuracy of the developed model was 99.20%, while the precision was 85.70%. The recall achieved 85.70%, while the F1-score reached 80.50%. The closeness of these performance indices to 1, coupled with the negligible value of mean square error, indicates that the developed classification model is robust and suitable for classification problems. Thus, this study contributes to knowledge by developing an AI model that can track players and reduce harm in a land-based gambling environment.
Extant cross-sectional evidence consistently points to a close association between fear of missing out (FoMO) and internet gaming addiction (IGA), yet longitudinal investigations into this link and its underlying mechanisms remain scarce. To extend prior research, we implemented a three-wave longitudinal design from October 2022 to October 2023, testing a multiple mediation framework that incorporated loneliness and depression. Because FoMO involves anxiety over unmet social belonging, which may foster both loneliness) and depression, these two mediators were selected to represent distinct yet interrelated emotional pathways. A cohort of 326 Chinese undergraduates completed baseline assessments, with 312 and 303 participants retained at the subsequent two waves. FoMO was measured at Wave 1, loneliness and depression at Wave 2, and IGA at Wave 3, using validated Chinese versions of all scales. Results showed a significant positive longitudinal association between FoMO and IGA (r = 0.15, p < 0.01). Both loneliness and depression mediated this relationship (indirect effect = 0.12), explaining 57.14% of the total effect. Gender did not moderate the direct effect of FoMO on IGA nor the indirect effects via loneliness or depression. The results clarify the temporal processes connecting FoMO to problematic gaming, supporting the theoretical perspective that FoMO heightens vulnerability to IGA by first intensifying negative emotional states (loneliness and depression). These findings underscore the value of targeting negative emotional states in psychological interventions designed to reduce vulnerability to IGA.
The I-PACE model identifies person's core characteristics as key antecedents of Internet Gaming Disorder symptoms (IGDs). However, person-centered research profiling these multidimensional indicators and their underlying mechanisms concerning IGDs remains limited. Using a large-sample cross-sectional design, and based on 13 core indicators across four domains from the I-PACE model, this study employed Latent Profile Analysis (LPA) to profile the person's core characteristics of Chinese college students, examining profile differences in IGDs and the mediating role of aggression. A sample of 11,739 Chinese college students (Mage = 21.36, SD = 2.65, 67.47% female) completed measures of 13 indicators across four domains (biopsychological constitution, psychopathology, personality, and social cognitions), along with IGDs and trait aggression. LPA identified latent profiles, the BCH method compared differences in IGDs and aggression, and relative mediation analysis tested the mediating effect of aggression. Five profiles were identified: the Normative (MIGDs = 1.89), Well-Adapted (MIGDs = 1.40), High Psychopathology (MIGDs = 2.19) and Self-Deficient, High Trauma-Exposed (MIGDs = 2.35), and Severe Trauma-Exposed profiles (MIGDs = 2.80). The comparison results revealed that the Well-Adapted profile exhibited the lowest IGDs. Notably, the two trauma-exposed profiles demonstrated higher IGDs levels than the High Psychopathology and Self-Deficient profile. Furthermore, aggression significantly mediated the associations between these profiles and IGDs. Person's core characteristics form distinct subgroups with varying IGDs risk. Compared to concurrent psychopathology and self-deficiency, adverse early experiences represent a more substantial risk factor for IGDs. Additionally, aggression serves as a crucial mediating mechanism linking these core characteristics to IGDs. These findings highlight the importance of a person-centered approach and emphasize early trauma screening in IGDs assessment and intervention.
Human cooperation depends on shared goals and dynamic role-taking, aligning individual actions with goal-related tasks. However, in everyday social interactions, cooperation is often intertwined with personal goals and motivations. In this study, 48 young, healthy participants played the dyadic Pacman Game that incorporated a personal gamble to reflect these social dynamics. Brain oscillations and event-related potentials differentiated between achieving a shared goal enhanced by personal rewards and reaching a shared goal without a personal reward. Specifically, personal rewards, which had to be inferred from social cues rather than explicit feedback, were linked to increased delta/theta power and sustained positive ERP potentials over fronto-central regions. Furthermore, we replicated findings of alpha/beta power decreases and enhanced P3-like positivities associated with cognitive and semantic processing demands of specific player roles. Our results highlight how neural measures obtained in experimental games shed light on the interplay between shared goals and personal motivations, offering a valuable framework to bridge insights from controlled paradigms to real-world social cooperation.
Esports athletes often engage in prolonged gaming sessions that involve repetitive movements and sustained static postures, placing them at increased risk of work-related musculoskeletal disorders (WMSDs). Given the limited regional evidence, this study is among the first to investigate the prevalence and associated factors of WMSDs among Thai esports athletes. Participants aged 15-35 years were recruited through esports club pages and the Thailand Esports Federation, with eligibility criteria including training with a coach and gaming more than four hours per day. They completed a self-administered questionnaire covering general and risk factors, musculoskeletal pain, vision, and gaming stress levels. The prevalence of WMSDs among Thai esports athletes was 63.1%, with a higher rate among professionals (67.4%) compared to university-level players (61.3%). The most affected regions were the neck (40.7%) and lower back (36.2%). Significant factors associated with WMSDs included age over 21 years (OR = 1.75, p < 0.05), overweight BMI (OR = 1.16), smoking (OR = 1.54), and sleeping less than six hours per night (OR = 2.18). In addition, longer gaming experience exceeding five years (OR = 1.64), daily gameplay over five hours (OR = 1.74), and psychological stress during gaming (OR = 1.80) were identified as key risk factors. These findings highlight that WMSDs are highly prevalent among Thai esports athletes, particularly in the neck and lower back, and suggest that limiting daily playtime to under five hours, ensuring adequate rest, and incorporating pre- and postgaming relaxation routines may help reduce WMSD risk and promote musculoskeletal health.
So called "toxic behaviors" (e.g., hate speech, harassment, doxxing) are pervasive in online gaming communities, with research consistently documenting significant negative consequences for player wellbeing, community health, and industry revenue. While gaming studios and platforms have developed a range of reactive and proactive moderation strategies to address these harms, most existing approaches remain reactive, focusing on punishment after harm has already occurred. Community codes of conduct represent a foundational yet underutilized proactive intervention that has received comparatively little systematic attention. This literature review synthesizes existing research to address two core questions: (1) What is known about the design, implementation, and accessibility of community codes of conduct in gaming environments? and (2) How do codes of conduct influence player behavior? Drawing on a final corpus of 84 articles identified through systematic search of academic databases and supplemented by transparency reports from major gaming studios, the review maps the current landscape of both reactive and proactive moderation approaches before examining the specific role of community governance documents. Findings reveal significant gaps between current industry practice and evidence-based best practice. More than half of popular multiplayer games either lack accessible codes of conduct or bury them within legal documentation, limiting meaningful player engagement. Where codes do reach players, however, the evidence is promising: well-designed codes are associated with measurable reductions in toxic behavior, increased community engagement, and stronger community norms. Design features that enhance effectiveness include prominent placement and readability, values-centered and game-specific content, community-centered participatory development, transparent enforcement mechanisms, and integration of peer and community social influence. Despite these positive indicators, the evidence base remains limited, with most studies examining discrete platforms and short-term outcomes. This review concludes with evidence-based recommendations for industry practice, synthesized into the EFFECT Framework - a practical tool distilling six core evidence-based design principles for developing community codes of conduct that actively shape community culture. Together, these contributions call for greater research investment in how codes of conduct can be optimized as living community tools (rather than static legal documents) to meaningfully reduce toxicity and build resilient gaming communities.
Increasing screen exposure among early adolescents has raised concerns regarding technology addiction and its potential impact on visual health. Within the scope of primary health care, early identification of modifiable behavioural risk factors is essential for preventive intervention. This case-control study examined the association between technology addiction and visual problems among early adolescents and explored implications for primary health care and school health services. The study included 585 students in grades 5-8 from three randomly selected public middle schools. The case group comprised 47 students diagnosed with visual impairment or wearing corrective lenses, while the control group included 538 students without visual problems. Data were collected via face-to-face interviews using a Personal Information Form and the Technology Addiction Scale. Logistic regression analysis was conducted to determine predictors of visual problems. Students with visual problems demonstrated significantly higher total technology addiction scores and higher subdimension scores for social media use, instant messaging, online gaming, and website browsing (p < .001). Longer daily screen time and irregular sleep patterns were associated with increased addiction levels. Gender differences were observed: girls scored higher in instant messaging and website use, whereas boys scored higher in gaming addiction. Online gaming duration and total addiction scores were significant predictors of visual problems. Technology addiction, particularly excessive gaming exposure, appears to be a modifiable risk factor for visual problems in early adolescence. Integrating digital hygiene education, screen-time monitoring, and behavioural risk assessment into primary health care and school nursing practice may contribute to early prevention and health promotion strategies.
As gameplay and esports live streaming increasingly coexist within the digital gaming ecosystem, it remains unclear whether players' movement toward spectatorship represents behavioral substitution, complementary media use, or a broader restructuring of game-related consumption. Drawing on the Transtheoretical Model of behavior change, this study examines Chinese game users' stage-based willingness to adjust their consumption from active gameplay toward esports live-streaming spectatorship. A cross-sectional survey was conducted among Chinese game consumers aged 18-45 years, yielding 675 valid responses. Participants were classified into five TTM stages: precontemplation, contemplation, preparation, action, and maintenance. The study used descriptive statistics, reliability analysis, CFA-based measurement validation, one-way ANOVA, and post-hoc tests to examine differences in gameplay habits, esports live-streaming consumption, consumption attitudes, behavioral willingness, and reasons for consumption adjustment across the five stages. The stage distribution showed that 4.44% of participants were in precontemplation, 21.33% in contemplation, 29.33% in preparation, 25.78% in action, and 19.11% in maintenance. Descriptive results suggested a gradual shift from game-centered consumption to live-streaming-centered consumption from the early stages to the action stage, followed by partial stabilization or decline in the maintenance stage. ANOVA results showed significant stage differences in users' attitudes toward playing games and watching esports live streams, current consumption habits, life-stage-related changes, support for esports live-streaming consumption, and opposition to esports live-streaming consumption. However, several game-related evaluations showed no significant stage differences, suggesting that basic gaming motivations and concerns may be shared across stages. The findings indicate that the player-to-viewer shift should not be understood as a simple or linear replacement of gameplay by live-streaming consumption. Instead, it is better conceptualized as a nonlinear, stage-dependent restructuring of game-related engagement. Users may reduce gameplay, combine playing and watching, or move between the two depending on life stage, available time, personal interests, and content quality. This study extends the TTM framework to digital gaming consumption and provides stage-specific implications for esports platforms, game companies, and live-streaming services.
Age-related cognitive and sensorimotor declines co-occur and reinforce one another, increasing vulnerability to functional dependence and falls. Exergaming offers integrated cognitive-motor training, but most systems lack features that support personalized care for socially vulnerable, community-dwelling older adults. Low-income older adults receiving Public Community Care services bear a disproportionate burden of cognitive and sensorimotor decline, yet remain underrepresented in digital health research. As part of a broader program to develop a digital health monitoring-to-intervention framework, we evaluated a pressure sensor-based exergame designed to deliver targeted cognitive-motor training within the existing Public Community Care infrastructure. This study evaluates the feasibility and preliminary effects of the Brain Step exergaming intervention on cognitive and sensorimotor frailty in low-income older adults living alone who were receiving Public Community Care services through a pilot study (study 1) and a randomized controlled trial (RCT; study 2). Study 1 (n=15) was a 12-week single-arm pilot study. Study 2 was a parallel-group pilot RCT conducted in Seoul, South Korea. Thirty-one low-income older adults living alone who were receiving Public Community Care services (mean age 81.5 years; 26/31, 84%, female) were randomized to the intervention (n=16) or control (n=15) group. The 16-week intervention used custom hardware with integrated safety bars and arcade-style games that progressed from single- to dual-task challenges. Primary outcomes were cognitive function (Korean Mini-Mental State Examination [K-MMSE]), physical function (Berg Balance Scale [BBS] and Timed Up and Go [TUG]), and sarcopenia indicators (appendicular skeletal muscle mass [ASM], Appendicular Skeletal Muscle Mass Index, and grip strength). Secondary outcomes were the Korean Montreal Cognitive Assessment, physical fitness (Figure-8 Walk, 30-second Sit-to-Stand, and 2-Minute Step Test), and fall incidence. Generalized estimating equations with Benjamini-Hochberg false discovery rate (FDR) correction for multiple testing were applied. In the single-arm pilot study (study 1), a pre-post increase in BBS scores and a reduction in TUG time survived FDR correction among the primary outcomes (both FDR-adjusted P=.002), as did all 3 secondary physical fitness outcomes (Figure-8 Walk, FDR-adjusted P=.006; 30-second Sit-to-Stand, FDR-adjusted P=.01; and 2-Minute Step Test, FDR-adjusted P=.02). The K-MMSE Visuospatial subscale showed an uncorrected pre-post improvement (P=.02), with differential risk-stratified patterns for Recall (P=.04) and Attention (P=.006). In the pilot RCT (study 2), a nominally significant group × time interaction was observed for ASM (P=.04, FDR-adjusted P=.11), with the intervention group maintaining muscle mass while the control group declined. The risk-stratified analyses showed an uncorrected significant 3-way interaction for K-MMSE Recall (P=.01). No findings from study 2 survived FDR correction. These sequential studies demonstrate the feasibility of delivering a culturally adapted exergaming intervention through the existing Public Community Care infrastructure. The pilot study (study 1) showed FDR-corrected pre-post improvements in balance and mobility within an uncontrolled single-arm design. In the pilot RCT (study 2), no primary outcomes survived FDR correction. The observed preliminary signals for muscle mass preservation and, in exploratory risk-stratified analyses, cognitive improvement in the high-risk subgroups should be regarded as hypothesis-generating only. Adequately powered trials with risk-enriched samples and active comparators are needed to evaluate efficacy. ClinicalTrials.gov NCT06664229; https://clinicaltrials.gov/study/NCT06664229.
Personality research has traditionally focused on stable trait differences, but increasing attention has been devoted to the internal organization of personality traits within individuals. The present study examined whether intraindividual variability in the Big Five traits, operationalized as the within-person standard deviation across trait scores (iSD_BFI), is associated with problematic digital engagement in young adults. A sample of 316 participants completed the Big Five Inventory and selected subscales of the Behavioral Addiction Questionnaire assessing smartphone use, internet use and video gaming. Pearson correlations, hierarchical regression and independent samples t-tests were conducted to evaluate associations between personality trait-profile dispersion and digital behaviors. Results showed that higher iSD_BFI was weakly but significantly associated with greater problematic smartphone use (r = 0.115, p = 0.044) and internet use (r = 0.141, p = 0.012), whereas no significant association emerged with video gaming (r = 0.029, p = 0.764). Hierarchical regression analyses further indicated that iSD_BFI explained a small but statistically significant additional proportion of variance in smartphone use (ΔR2 = 0.014, p = 0.023) and internet use (ΔR2 = 0.019, p = 0.008) beyond age, sex, and the five Big Five traits, but not in video gaming. Participants in the problematic smartphone use group exhibited significantly higher iSD_BFI than those in the moderate risk group. Rather than representing a direct measure of self-coherence or identity fragmentation, iSD_BFI was considered an exploratory structural indicator of personality profile dispersion. Accordingly, a more heterogeneous personality profile may be associated with a greater approach to digitally mediated environments, possibly because these environments provide predictability, feedback, and reinforcement. Overall, the study highlights the importance of exploring intraindividual personality configuration as a complementary dimension to traditional trait-based approaches.
With the growth of the esports industry, concerns about participants' health risks have drawn public and academic attention. However, existing research remains inconsistent and often fails to distinguish esports from general video gaming. This study evaluates health differences between esports participants and non-participants and explores correlations between participation and health outcomes. A systematic search of seven databases (PubMed, Web of Science, Scopus, SPORTDiscus, MEDLINE, Esports Research Network, and ProQuest) was conducted up to May 13, 2026. Data were synthesized using mean differences (MD) or standardized mean differences (SMD) for group comparisons, and Fisher's Z-transformed correlation coefficients (r) for relationships between esports participation and health outcomes. Subgroup analyses based on professional and non-professional status were also conducted. Of 5090 identified studies, 53 (n = 86,652) were included, with 36 analyzed in meta-analyses. Initial analyses showed no significant differences between esports participants and non-participants across physical activity, body mass index (BMI) sleep duration, anxiety, depression, stress, and grip strength. However, following sensitivity analysis, esports participants exhibited significantly lower depression levels (SMD -0.13, 95% CI -0.17 to -0.10). Conversely, non-professional esports players demonstrated a significantly higher body fat percentage than non-players (MD 4.57, 95% CI 1.73 to 7.41). Additionally, esports participation was significantly correlated with sedentary behavior (r = 0.17, 95% CI 0.12 to 0.23), BMI (r = 0.09, 95% CI 0.04 to 0.13), and gaming disorder (r = 0.10, 95% CI 0.05 to 0.15). Although current evidence suggests that esports participants do not generally display worse overall health than non-participants, the association between esports participation and health is multifaceted and requires a nuanced perspective. Furthermore, given the existing heterogeneity and the cross-sectional design of the included studies, alongside a moderate risk of bias, these findings warrant careful interpretation. Future research must prioritize standardized definitions, consistent reporting, objective measures, and longitudinal designs to further validate these associations and investigate causal relationships. Concurrently, the industry should develop stratified, evidence-based guidelines to safeguard the long-term well-being of different types of players. Registration CRD42024622812 (PROSPERO).
Problematic smartphone use in adolescence has been linked cross-sectionally to poorer academic and emotional functioning, but the longitudinal mechanisms remain unclear. Using three waves of the Panel Study on Korean Children (W14-W16; ages 14-16), this study tested whether problematic smartphone use at age 14 predicts four developmental outcomes at age 16-school adjustment, self-regulated learning, ego resilience, and subjective happiness-through four age-15 mediators: gaming, video-watching, self-study hours, and academic stress. Hierarchical regressions with autoregressive controls, bootstrap a-paths, and 16 indirect effects tested with 20,000-draw Monte Carlo confidence intervals were estimated. Problematic smartphone use predicted three outcomes but not subjective happiness, for which the association was indirect only. Seven indirect effects were significant, and six survived Benjamini-Hochberg false discovery rate correction. The findings indicated two pathways: a time-displacement pathway (gaming and reduced self-study) specific to self-regulated learning and an academic-stress pathway linked to school adjustment, ego resilience, and happiness. Crucially, in baseline-controlled sensitivity analyses, the time-use pathways remained significant, whereas the stress pathway was fully attenuated, indicating a concurrent rather than a prospective association. Results were robust across path-model SEM, full-information maximum likelihood, and inverse-probability weighting, supporting a dual-pathway account of adolescent digital development.
Background: This randomized controlled trial aimed to evaluate the effects of a school physician-led counseling intervention on total cholesterol (TC) levels, adherence to the Mediterranean diet, physical activity, and sedentary behavior in children aged 6-7 years with elevated cholesterol levels in a Mediterranean setting. Methods: A one-year randomized controlled study was conducted among children aged 6-7 years with elevated TC levels, excluding those with familial hypercholesterolemia (FH). Participants were randomly assigned to either a control group (n = 38) or an intervention group (n = 39). All participants received standard care consisting of educational materials and baseline counseling, while the intervention group additionally participated in three structured follow-up counseling sessions conducted by school physicians during the one-year study period. Counseling focused on Mediterranean dietary habits, implementation of basic dietary principles in cases of elevated TC levels, promotion of physical activity, and reduction in sedentary behavior. TC levels were measured at baseline and at the end of the study. Dietary habits, physical activity, and sedentary behavior were assessed using validated questionnaires. For the primary outcome, a descriptive change-from-baseline analysis, unadjusted mean difference, the approximate 95% confidence interval, and Cohen's d effect size were calculated. Results: At baseline, no significant differences in TC levels were observed between groups (p = 0.852). After the intervention, mean TC levels were lower in the intervention group than in the control group (4.977 ± 0.414 mmol/L vs. 5.137 ± 0.410 mmol/L); however, the between-group difference did not reach statistical significance (p = 0.089). The unadjusted mean difference at follow-up was -0.160 mmol/L, with an approximate 95% confidence interval from -0.35 to 0.03 and a small-to-moderate effect size in favor of the intervention group (Cohen's d = -0.39). Descriptive change-from-baseline analysis showed a greater mean reduction in TC in the intervention group than in the control group (-0.364 mmol/L vs. -0.195 mmol/L). A statistically significant improvement in adherence to the Mediterranean diet was observed in the intervention group compared with the control group (p < 0.001). Favorable changes were also observed in several physical activity and sedentary behavior variables, including participation in organized physical activity, walking and running activities, and reduced television viewing and video gaming time. Given the exploratory nature of behavioral analyses and the number of physical activity and sedentary behavior outcomes examined, these findings should be interpreted cautiously. Conclusions: The school physician-led counseling intervention did not result in a statistically significant between-group difference in TC levels after one year, although the direction and magnitude of change favored the intervention group. The intervention was associated with improved adherence to the Mediterranean diet and favorable exploratory lifestyle-related behavioral changes. Nevertheless, the findings should be interpreted cautiously in light of the relatively small sample size, non-significant primary outcome, and exploratory nature of behavioral analyses.
OpenWorld Role-Playing Games (OWRPGs) differ from other video game genres in that they offer players vast digital landscapes and significant freedom: they can fight, use diplomacy, play stealthily, or pursue activities like farming or trading. This player autonomy creates a space rich in unintended consequences, incidental learning being just one. A study of higher education (HE) students explored this phenomenon. While existing research on incidental learning in games focuses mainly on language acquisition, the current study argues that commercial OWRPGs have the same educational power as purpose-built learning games, and that the scope of incidental learning is far broader than previously examined. Using a constructivist grounded theory (CGT) approach, 25 semi-structured interviews were conducted and written gaming journals collected from 11 additional participants. All 36 participants played OWRPGs in their leisure time. The analysis identified 34 distinct forms of incidental learning, with language acquisition being just one. These were grouped into three categories: self-improvement, academic, and employability skills, with considerable overlap between each. This study shows that OWRPGs can act as a setting for incidental learning in skills over and above lexical improvement. As a result, it is suggested that future research analyse in further depth the skills this research has discovered, looks for further skills that may be honed via incidental learning, and examine other video game genres to highlight any forms of incidental learning that occur.
Artificial intelligence (AI) is increasingly embedded in health systems globally and has the potential to improve efficiency, diagnostic accuracy, and decision support. However, its benefits remain unevenly distributed, particularly in low- and middle-income countries (LMICs). Models developed using datasets from specific populations may perform poorly in other settings, reinforcing structural inequities rather than correcting them. This viewpoint proposes a composite framework, the AI in Healthcare Equity Index (AIHEI), to support measurable assessment of equity in health AI systems. The AIHEI is designed to assess equity across five domains: data representation, algorithmic fairness, transparency and explainability, governance and oversight, and community impact and benefit sharing. By generating a standardised score, the index could enable comparisons across technologies, incentivise improvement, and support regulation, procurement, publication, and funding decisions. Pilots across diverse health domains and geographic settings are needed to assess feasibility, refine domain weighting, and evaluate reliability, reproducibility, and validity. Important challenges include contextual definitions of fairness, data sovereignty, post-deployment monitoring, and the risk of metric gaming. Quantifying equity in health AI is essential to ensure that AI does not create, widen, or exacerbate existing disparities by neglecting underserved populations. A common, objective measure of AI-related health equity can help move the field from ethical aspiration toward measurable accountability, monitoring, and enforcement.
The objectives of this study were to (1) describe the pedagogical framework and design of an asynchronous online concussion management course for clinicians and (2) report usability testing results. A multidisciplinary team developed an interactive, evidence-based course in Articulate Rise 360 software. Modern instructional strategies were incorporated, including chunking, quizzes, gaming elements, video demonstrations, and clinical vignettes. Content drew on current guidelines for adult and pediatric concussion and the 6th International Consensus on Concussion in Sport. Usability testing was conducted with a convenience sample of clinicians using an adapted System Usability Scale, Likert ratings for relevance and impact, and open-ended questions. The course was refined based on participant feedback. Eight clinicians (3 physiotherapists, 3 chiropractors, 2 occupational therapists) from 3 Canadian regions completed usability testing. All participants (8/8) felt confident using and navigating the course, with 7/8 (87.5%) agreeing that its functions were well integrated. All participants reported improved confidence in adult concussion assessment and management, and 7/8 (87.5%) in adolescent concussion management. Although 7/8 (87.5%) felt confident assessing persistent symptoms, only 3/8 (37.5%) felt confident managing them. Qualitative feedback emphasized interactivity and convenience as strengths and suggested improvements to navigation and content scope. An asynchronous online concussion management course engaged clinicians and enhanced confidence in concussion assessment and management. Future research should evaluate its long-term impact on clinical practice.
BackgroundThe post-COVID surge in school refusal has prompted a clinical response overwhelmingly focused on anxiety and its treatments. While this orientation is scientifically grounded, it remains partial: it fails to account for a dimension that successive lockdowns massively disrupted without the recent literature fully integrating it, namely the separation-individuation process (SIP) specific to adolescence.AimsThis article proposes a complementary and integrative reading of post-COVID school refusal, organized around three axes.ApproachFirst, lockdowns interrupted the environmental conditions necessary for the SIP to unfold, producing a developmental regression whose extent was revealed upon the return to school. Second, the hyperdigitalization that followed the lockdowns offered adolescents a substitution space enabling pseudo-separation without genuine individuation, durably impeding the process. Third, internal working models of attachment constitute the vulnerability substrate within which these impediments take hold.FindingsA clinical vignette illustrates these articulations through a composite case of an adolescent whose partial school refusal is reread as an attempt to regulate a disrupted SIP rather than as an anxiety symptom to be reduced.ConclusionsThe article argues for a non-pathologizing reading of school refusal and opens research perspectives on the relationship between autonomy, attachment, and digital practices in adolescence. Since the COVID-19 pandemic, many more young people are refusing to attend school. Most explanations focus on anxiety (and anxiety-based treatments such as cognitive-behavioral therapy are indeed helpful for many). But they do not explain everything, and a significant proportion of young people do not respond to these approaches. This article proposes a complementary explanation: for many adolescents, school refusal after COVID-19 is not primarily an anxiety problem (it is a disrupted growing-up process). Adolescence is a time when young people need to gradually separate from their family environment and build their own identity. This process requires access to spaces outside the family (school, peer groups, social activities). Successive lockdowns brutally removed these spaces, forcing adolescents back into the family home at precisely the moment when they needed to move away from it. At the same time, the massive increase in screen use during lockdowns offered adolescents a substitute world (social networks, online gaming, short videos) where they could feel socially present without actually leaving home. This digital withdrawal felt like independence, but it was not: it deferred the real work of growing up without replacing it. When schools reopened, many adolescents found themselves having to resume this growing-up process from an earlier stage, without the inner resources to do so. School refusal, in this reading, is less a symptom to eliminate than a signal that something important is being negotiated (and that this negotiation needs support, not just symptom reduction). The article illustrates this through the case of a 15-year-old boy, and concludes with practical suggestions for school psychologists and clinicians working with adolescents who refuse school.
Animal-Assisted Interventions (AAIs) have demonstrated therapeutic benefits across various clinical populations, yet the underlying neurobiological mechanisms remain poorly understood. Prior research examined peripheral biomarkers but lacked integration with central nervous system processes. This preregistered systematic review aims to describe, evaluate, and synthesize evidence on the neural and physiological mechanisms underlying the effects of AAI. Following PRISMA guidelines, we systematically searched ProQuest, PubMed, PsycINFO, and Scopus through November 2025 using three concept groups: animal interventions, neurological measures, and physiological measures. Inclusion criteria required empirical studies that measured neurological or physiological outcomes from structured AAIs using live animals. Thirty-four studies were obtained after screening (seven neuroimaging and twenty-seven biomarker studies). Neuroimaging findings indicated increased functional connectivity within emotion regulation (prefrontal-amygdala) and reward circuits (caudate, striatum), associated with symptom improvement in ADHD, PTSD, and internet gaming disorder. Salivary cortisol concentrations decreased in 64.3% of studies, and salivary oxytocin concentrations increased in 60%. Autonomic outcomes were inconsistent, likely due to methodological heterogeneity. AAIs modulate fronto-limbic circuitry and HPA-axis activity through enhanced prefrontal-amygdala connectivity, reward circuit activation, cortisol reduction, and an increase in oxytocin. These mechanisms collectively contribute to symptom reduction in mood and stress-related disorders. Future research requires larger RCTs with integrated multimodal assessments to establish causal pathways.