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.
Serious games (SGs) have emerged as a promising tool in nursing education, providing interactive learning environments for clinical simulation, skill development, and feedback. These games enhance knowledge, clinical reasoning, and psychomotor skills. However, evidence on their effectiveness is dispersed across various platforms and outcome measures, making it difficult to derive clear guidelines for their integration into nursing curricula. This scoping review aimed to systematically identify and map existing evidence on the use of SGs in nursing education, analyze game characteristics, and identify critical gaps to inform future research and practice development. This scoping review followed the JBI framework and the PRISMA-ScR checklist. Nine databases (PubMed, Web of Science, Embase, CINAHL, the Cochrane Library, CBM, Wanfang Data, CNKI, and VIP) were searched from inception to January 15, 2026. Eligible studies were those reporting on original research on SGs in nursing education. Two reviewers screened titles, abstracts, and full texts. Risk of bias was assessed using a standardized checklist. The extracted data encompassed study characteristics, study design, participant information, sample sizes, application context, teaching content, and SG characteristics. Data were extracted and synthesized with descriptive statistics and content analysis. An evidence gap map was created to show the study distribution across course categories and outcome domains. We screened 6078 records and included 24 studies. Publications were from 2021 to 2025 (n=13, 54%), with the majority conducted in Europe (n=13, 54%). Quasi-experimental designs (n=10, 42%) and randomized controlled trials (n=8, 33%) were predominant. SGs were mainly used in fundamental or skills training and adult nursing courses. Scenario-based decision points (n=20, 83%) and points, badges, or leaderboards (n=20, 83%) were the most common game mechanics, while progression or unlocking and collaborative elements were less frequent. Outcomes most often assessed were knowledge (n=16, 67%), skills (n=10, 42%), and engagement or usability (n=13, 54%). Objective use metrics were rarely reported (n=1, 4%), indicating limited data on in-platform learning behaviors. Most SGs were delivered as digital non-virtual reality applications or computer-based simulation games. Follow-up assessment beyond immediate postintervention outcomes was infrequent. An evidence gap map showed studies concentrated in skills-based training and adult nursing, with fewer studies in maternity or neonatal nursing, critical care, and foundational sciences. This review extends earlier work on SGs in nursing education by mapping evidence across curricular areas, intervention reporting, and outcome assessment, rather than focusing mainly on effectiveness or specific formats. It shows where evidence is concentrated and where important gaps remain, particularly in underrepresented course areas, intervention descriptions, follow-up assessments, and objective use data. These findings provide a clearer picture of the evidence base and can inform curriculum planning; the use of SGs in skills-based and clinical training; and future decisions about their design, implementation, and evaluation.
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.
Globally, with the increasing emphasis on cognitive health, exergames gains significant academic attention due to their unique potential for enhancing cognitive function. This study used CiteSpace 6.3R2 to conduct a systematic bibliometric analysis to elucidate research progress and emerging trends in this interdisciplinary field. A comprehensive literature search in the Web of Science Core Collection focused on exergaming and cognitive function. After screening, 545 relevant publications were imported into CiteSpace6.3R2 for bibliometric analysis, generating visual maps of keywords, authors, institutions, and other key indicators. Publications on exergames and cognitive function show a steady upward trend, indicating growing academic interest in this interdisciplinary field. The Games for Health Journal produced the highest number of publications, underscoring its central role. The United States leads in collaborative output, followed by China and Switzerland, with ETH Zürich as the most collaborative institution. Among researchers, de Bruin, is the most prolific. PLOS ONE is the most frequently co-cited journal, while Anderson-Hanley (2013) is the most highly cited reference. High-frequency keywords include physical activity, exergames and physical exercise, with emerging terms such as "exergame intervention," "balance training," and "mild neurocognitive disorder." Research on exergames and cognitive function has emerged as a key interdisciplinary hotspot, encompassing exercise science, neuroscience, and digital health. A bibliometric analysis indicates that related studies are primarily published in a range of specialized journals. Within the collaboration network, developed countries dominate, whereas at the author level, collaboration patterns remain mostly within institutions, suggesting that cross-institutional cooperation needs to be strengthened. Future research could focus on the design and mechanisms of exergame intervention programs and personalized interventions tailored to specific populations.
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.
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.
In VR video games, users can explore virtual worlds by physically walking in the real world or by using alternative locomotion techniques such as teleportation or steering. However, these techniques often pose challenges, including disorientation or sickness. This study presents TransPortal, a novel portal-based locomotion technique for VR video games. The proposed technique allows users to manipulate a marker object to specify a destination and to move there through a portal that can be freely activated or deactivated. To evaluate the proposed method, we conducted a within-subjects experiment with 30 participants, comparing it with traditional teleportation and steering. The results show that TransPortal induces lower VR sickness in a complex scenario without reducing immersion or entertainment quality.
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.
We assessed the association between child-directed marketing on product packages and the nutrition quality of children's foods offered by companies in the US Children's Food and Beverage Advertising Initiative (CFBAI) industry self-regulatory program. Cross-sectional content analysis of children's sweet snacks (n = 118), cereals (n = 109), and yogurts (n = 37) found in 2 US supermarkets in Connecticut, May through August 2021. We determined the number of child-directed promotions and other marketing features per package, as well as the nutrition quality of products according to the CFBAI program nutrition criteria and independent nutrition profile index score. Products with unhealthy Nutrition Profiling Index scores had significantly more child-directed features (e.g., cartoon images, brand characters, cause-related promotions, games) (mean = 4.0; 95% confidence interval, 3.6-4.3) than healthy products (2.9; 95% confidence interval, 2.3-3.6). Products not meeting CFBAI nutrition criteria for products that may be advertised to children averaged 3.4 child-directed features. Child-directed marketing features were prevalent on product packaging, including among products that do not meet companies' own nutrition criteria for healthier choices for children. These findings support strengthening CFBAI guidelines and/or considering government regulations to limit child-directed marketing of less healthy products on packaging.
Previously managed by the Cerebral Palsy International Sport and Recreation Association, Cerebral Palsy (CP)-Football is a para-sport for individuals with neurological impairments such as cerebral palsy, stroke, traumatic brain injury or similar neurological impairments. The sport is currently governed by the International Federation of Cerebral Palsy Football (IFCPF), a non-profit sport organization based in the Netherlands. Since the first Paralympic event CP football took part in, the 1984 New York Paralympic Games, which had 6 countries (Belgium, Canada, Great Britain, Ireland, Portugal, and United States) competing for gold, CP-Football has significantly grown with 70 countries from African, Americas, Asian, European, and Oceania regions registered as members of IFCPF. As the world-governing body of CP-Football, IFCPF has been organizing international level events (i.e., World Cup, World Championships, Regional Championships, and U-19 Championships) to allow member organizations to experience high-quality football in world class venues all around the world. In addition, the International Paralympic Committee, coupled with the various National Paralympic Committees have also been supportive of national level tournaments for the development of the sport. Even with its long history and the support from many sport organizations toward growth, several member organizations of the IFCPC are struggling to grow the sport in their countries, and at the same time, compete in international tournaments. The IFCPF are also seeking to continue to develop their women's game which is needed for gender equality and growing participation around the world. Thus, the purpose of this study is to identify the barriers to and facilitators of growing the sport of CP-Football in IFCPF member organization countries that are in their developmental stages of establishing the sport. In addition, this study seeks to determine the barriers to and facilitators of their participation in international CP-Football events. This study is framed based on an emerging conceptual model within the non-profit and voluntary organization literature, and the organizational capacity framework of Hall et al., used to examine the current issues faced by the IFCPC member organizations around the world.
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.
Preterm birth is a common neurodevelopmental condition that can have lasting impacts on cognition, including attention and working memory. Interventions that strengthen these skills in early childhood could support school readiness. Dino Island is a tablet-based intervention that combines process-specific practice of attention and working memory skills with a compensatory component that teaches metacognitive skills to scaffold learning. In this pilot study, we evaluated the feasibility of parent-delivered Dino Island in young children born preterm (N = 10), alongside a control group who played educational games (N = 12). Both groups were instructed to play 2-3 times per week for approximately 20 minutes over a 12-week period. Attention and working memory on untrained tasks were assessed before and after completing the intervention. Parents provided fidelity data through tracking sheets and participated in exit interviews to offer feedback and identify barriers and facilitators. We found that the Dino Island program was successfully delivered by parents with high fidelity. Attrition was higher in the Dino Island group, likely reflecting the challenges of delivering cognitive remediation in home settings. Comparison of attention and working memory scores on untrained tasks pre- and post- showed practice effects but no specific benefit of Dino Island. However, parent reports suggested behavioral improvements specific to the Dino Island group, noting far-transfer effects where children applied metacognitive strategies in other contexts. Overall, this work shows feasibility and tolerability of Dino Island in young children born preterm. Future research should examine its potential impact on school readiness and longer-term academic outcomes in this population.
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.
In recent years, there has been growing interest in the hybridization of different pedagogical models (PMs), such as Sport Education (SE) and Teaching Games for Understanding (TGfU), to address underexplored learning outcomes and promote the holistic education of pupils. This study aimed to examine interventions applying a hybrid SE-TGfU model in physical education (PE) to enhance positive learning outcomes in the physical, social, affective, and cognitive domains, and to compare its effects across these domains with those of the Traditional Skill Approach (TSA), isolated SE, and isolated TGfU. A systematic search of major scientific databases was conducted. Studies were included if they: (1) implemented the hybrid SE-TGfU model as the instructional intervention, (2) compared it with TSA, isolated SE, or isolated TGfU, and (3) reported quantitative learning outcome(s). After applying the eligibility criteria, a total of nine studies, including 22 effect sizes, were included in the analysis. The hybrid SE-TGfU model was associated with larger pooled effect sizes than TSA (g = 1.29 [0.99; 1.59]) and isolated TGfU (g = 0.71 [0.39; 1.04]). No statistically significant difference was observed compared with isolated SE (g = 0.97 [-2.05; 3.98]); however, this comparison was based on comparatively limited evidence. Larger pooled effect sizes were observed in three domains, with a distinct ordering from highest to lowest: physical (g = 1.75 [0.94; 2.57]), social (g = 1.05 [0.57; 1.54]), and affective (g = 0.82 [0.67; 0.98]). The effect in the cognitive domain was not statistically significant (g = 0.62 [-0.32; 1.57]). The findings suggest that the SE-TGfU hybrid model is associated with larger pooled effect sizes across several learning domains in PE, particularly in the physical, social, and affective domains. However, evidence for the cognitive domain remains inconclusive. These findings should be interpreted cautiously given the substantial heterogeneity and limited evidence base. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251171229.
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.
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.