Parenting Practices as a Mediator in the Association Between Family Socio-Economic Status and Screen-Time in Primary Schoolchildren: A Feel4Diabetes Study

The aim of this study was to examine the mediating effects of specific parenting practices on the association between family socio-economic status (SES) and screen-time of 6- to 9-year-old children from families with an increased risk of developing type 2 diabetes. This cross-sectional study, focusing on families with an increased risk of developing type 2 diabetes, used the Belgian baseline data of the Movie Models intervention, integrated within the European Feel4Diabetes intervention, and included 247 parents (57.6% lower SES family; 78.0% mothers) who completed a questionnaire. Mediating effects were tested using MacKinnon's product-of-coefficients test via multilevel linear regression analyses. Being consistent concerning rules about gaming (β = 0.127; standard error = 0.055; 95% CI = 0.020; 0.234) and avoiding negative role modeling concerning TV-time (β = -0.082; standard error = 0.040; 95% CI = -0.161; -0.003) significantly mediated the inverse association between family SES and children's screen-time. Parents from lower SES families were more consistent concerning rules about gaming and watched more TV nearby their child compared to parents from higher SES families, and these parenting practices were related to more screen-time. No other parenting practices were found to mediate this association. Thus, parents from lower SES families with a higher risk for developing type 2 diabetes might limit their own TV-time nearby their child to reduce their child's screen-time. Future research should examine other possible mediating factors to develop effective interventions targeting this important at-risk group.

The imperative of integrating empirical and theoretical considerations when developing policy responses to Internet-gaming disorder

This commentary proposes an integrative approach of theoretical and empirical considerations when developing policy responses to Internet-gaming disorder and when evaluating their efficacy. It complements the overview by Király et al. (2018) about preventive and treatment programs by referring to a lack of inclusion of internal factors, such as individual aspects and cognitions, and missing empirical evidence. This commentary claims the integration of current research addressing individual predisposing and maintaining factors in order to evaluate existing programs and to enhance the exchange between actors including policy. This integrative approach has the potential to develop successful preventive strategies, which could be implemented realistically and socially responsible.

May the passion be with you: The addictive potential of collectible card games, miniatures, and dice of the Star Wars universe

BACKGROUND AND AIMS

In recent years, we have witnessed a growing research interest in behavioral addictions and in pleasurable behaviors that generate a certain discomfort in the people who engage in them. The objective of this study was to assess if users of collectible card games, miniatures, and dice from the Star Wars Universe Games (SWUG) may also present criteria of addiction and if the presence of these criteria is related to demographic variables, game-playing habits, and other variables.

METHODS

SWUG players were contacted through specialized gaming chats, and 218 of them completed the Internet Gaming Disorder Scale - Short Form (IGDS-SF9), a scale that assesses motivation to engage in the game (Massively Multiplayer Online Motivations Scale), the Rosenberg Self-Esteem Questionnaire, the Diener Satisfaction with Life Scale, and a question for the self-assessment of addiction.

RESULTS

Significant predictors of addictive symptoms were the motivation to seek dissociation and (negatively) self-esteem. Users more significantly dedicate indirect hours to the game (thinking about the game, preparing material, etc.) than to actually playing. No participant could be considered pathologically addicted, as no one scored above the tentative cut-off point of the IGDS-SF9.

DISCUSSION AND CONCLUSIONS

Despite the fact that many players considered themselves "addicted" and some presented various economic and family problems related to their activity, it was found that playing these games could not be equated to true addictive behavior, since no player had scores above the cut-off point. This finding contributes to current discussions about the tendency to overestimate excessive pleasurable behaviors.

Does "forced abstinence" from gaming lead to pornography use? Insight from the April 2018 crash of Fortnite's servers

In April 2018, the servers of the popular video game "Fortnite" crashed for 24 hr. During this period, Pornhub (a popular pornographic website) analyzed trends in pornography access, finding that: (a) the percentage of gamers accessing Pornhub increased by 10% and (b) the searches of pornographic videos using the key term "Fortnite" increased by 60%. In this letter, we discuss these observations in the context of ongoing debate regarding the validity of "withdrawal" when applied to problematic involvement in video gaming and the potential use of pornography as a "compensation behavior" during the periods of "forced abstinence" from gaming.

Time to call for a global public health approach in prevention of the onset and progression of problematic gaming

Problematic video gaming is a global problem. Policy and programs responses to the problem vary among countries, partly due to cultural differences in the east and the west, meaning that caution is needed in drawing comparisons. Promoting parental education and positive youth development would be a useful approach to curb problematic behavior among children and adolescents. We suggest using a public health approach, based on our experience in dealing with commodities, which are harmful to health.

Reconceptualizing the Link Between Screen Time When Gaming with Physical Activity and Sedentary Behavior

With public health concerns surrounding rates of sedentary behavior (SB), there is often speculation on the role of screen time (in which "computer gaming" is commonly encompassed) as a key contributor to this epidemic. We argue that these assertions are based upon a number of problematic assumptions. Particularly, the notion that screen time necessitates inactivity or SB can be refuted based on the empirical literature. In addition, digital gaming as one so-called problematic screen-time behavior consists of a failed assumption that all games proffer equivalent physical affordances. We argue that these assumptions should be revisited, in which a reconceptualization of screen-time activities (with specific reference to gaming) and its link with inactivity and/or SB should be a key agenda. Within this, we introduce a conceptual model of how this may be realized, with the intention that this may offer a practical guide for researchers, and indeed for health professionals in this field.

Cue-reactivity in behavioral addictions: A meta-analysis and methodological considerations

Background and aims Recent research has applied cue-reactivity paradigms to behavioral addictions. The aim of the current meta-analysis is to systematically analyze the effects of learning-based cue-reactivity in behavioral addictions. Methods The current meta-analysis includes 18 studies (29 data sets, 510 participants) that have used a cue-reactivity paradigm in persons with gambling (eight studies), gaming (nine studies), or buying (one study) disorders. We compared subjective, peripheral physiological, electroencephal, and neural responses toward addiction-relevant cues in patients versus control participants and toward addiction-relevant cues versus control cues in patients. Results Persons with behavioral addictions showed higher cue-reactivity toward addiction-relevant cues compared with control participants: subjective cue-reactivity (d = 0.84, p = .01) and peripheral physiological and electroencephal measures of cue-reactivity (d = 0.61, p < .01). Increased neural activation was found in the caudate nucleus, inferior frontal gyrus, median cingulate cortex, subgenual cingulate, and precentral gyrus. Persons with gambling, gaming, or buying disorders also showed higher cue-reactivity toward addiction-relevant cues compared with control cues: subjective cue-reactivity (d = 0.39, p = .11) and peripheral physiological and electroencephal measures of cue-reactivity (d = 0.47, p = .05). Increased neural activation was found in the caudate nucleus, inferior frontal gyrus, angular gyrus, inferior network, and precuneus. Discussion and conclusions Cue-reactivity not only exists in substance-use disorders but also in gambling, gaming, and buying disorders. Future research should differentiate between cue-reactivity in addictive behaviors and cue-reactivity in functional excessive behaviors such as passions, hobbies, or professions.

Social Capital Accumulation in Location-Based Mobile Game Playing: A Multiple-Process Approach

In the summer of 2016, the widespread popularization of the game Pokémon Go brought the public's attention to the possible socialization benefits associated with location-based mobile games (LBMGs), yet no studies to date have investigated this issue. LBMGs deserve greater research attention because this type of game provides a unique gaming experience that encourages players to leave their homes and navigate around their neighborhood. This distinctive feature may promote more face-to-face interactions among LBMG players. Grounded in social capital theories, the present study compared the levels of both bridging and bonding social capital between LBMG and non-LBMG players. More important, we formulated a multiple-process model to explain the hypothesized psychological mechanisms underlying social capital accumulation among LBMG players. Participants were 349 U.S. participants (57 percent men; M_age = 32.40, SD_age = 7.92, age range = 19-66). Results supported the proposed model by revealing that face-to-face interaction was crucial to the accrual of both bridging and bonding social capital among LBMG players, through enhancing their levels of communication frequency and self-disclosure. The present findings have implications for the utilization of LBMG as a potential tool to promote face-to-face interactions and accumulate social capital.

Mental health service users' and professionals' relationship with games and gaming

BACKGROUND

Games and elements of gamification can be utilized in mental healthcare to provide customized interventions for the service users. However, very little evidence exists as to what kind of experiences service users and professionals have towards games and gaming, and what their perceptions of the phenomenon are. This sort of information is needed to help professionals put game-based interventions actively into practice in mental health services.

RESEARCH OBJECTIVES

The objective is to describe the experiences and perceptions of digital games and gaming from the perspectives of mental health service users and mental health professionals.

METHODS

In this qualitative study, data consisted of interviews of 23 mental health service users and professionals working in the mental health field. We conducted altogether 39 interviews. Sixteen of the participants were interviewed twice. Main categories and subcategories were identified using qualitative content analysis.

RESULTS

The analysis revealed four distinct orientations towards games and gaming: (a) compulsive gaming; (b) closet gaming; (c) gaming as a hobby; and (d) late bloomers. Each group was characterized by different personal histories, experiences, conceptions and attitudes regarding gaming and digital games.

CONCLUSION

When attempting to implement a game-based intervention in mental health services, it is essential to recognize the different attitudes that both service users and staff exhibit concerning games and gaming. The attitudes of service users and professionals described in this study can be utilized in the implementation of game-based methods as part of care and rehabilitation in mental health services.

A Systematic Review on Effect of Electronic Media on Diet, Exercise, and Sexual Activity among Adolescents

Context

Electronic media has become a part of day-to-day life for all, and particularly more so for children and adolescents. Exposure to electronic media may be beneficial as well as harmful.

Aim

The aim of the study is to systematically synthesize existing published and non-published empirical evidence on the effect of exposure to electronic media on diet, exercise, and sexual activity.

Methodology

Two reviewers independently searched online databases such as MEDLINE, CENTRAL, and EMBASE. We applied no language, date, or publication restrictions.

Selection Criteria

We included randomized control trials that assessed the effect of exposure of electronic media on diet, exercise, and sexual activity in participants between 5 and 19 years.

Study Selection Data Extraction

Two reviewers independently screened studies identified in electronic search and independently extracted data and assessed the risk of bias of included studies.

Data Analysis

We had planned to use the risk ratio or odds ratio for dichotomous data, and mean difference (MD) or standardized MD for continuous data. However, as included studied differed in types of intervention and reporting of outcomes, we did not undertake meta-analysis.

Main Results

All included trials were parallel randomized controlled trials except for one that was a crossover trial. Eight studies reported the effect of electronic media on diet and exercise, two on diet, two on exercise, and one on sexual activity. Quality of evidence was rated as "very low" for all outcomes due to too little information or too few data to be able to reach to any conclusions.

Conclusions

There is a little body of evidence that limits conclusions. We need to comprehend as to how to swap undesirable effects of electronic media and make it more desirable.

Registration of Systematic Review

This systematic review has been registered at PROSPERO International prospective register of systematic reviews (Registration number: PROSPERO 2018 CRD42018086935) available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=86935.

Going Forward with Pokemon Go

Pokemon Go is an augmented reality (AR) game which combines the use of smart mobile technology with physical exploration in the real world. It was a global phenomenon that rocked the world since 2016. Across boundaries and nations, the young and seniors were actively downloading and playing, joining the intrend gaming community. Was it a fleeting fad or a more sustainable activity? This paper discusses the literature currently available on this interesting phenomenon: its effect on physical and mental health as well as some documented hazards and distractions. From the review, Pokemon Go demonstrates that cleverly implemented AR games can reach millions of people and trigger substantial behavioral changes. AR games can help increase physical activities and exercise provided people's interest can be sustained.

Tolerance in Internet gaming disorder: A need for increasing gaming time or something else?

Background and aims The criterion of tolerance in DSM-5 Internet gaming disorder (IGD) refers to a need for increasing time spent gaming. However, this focus on "need for gaming time" may overlook some of the broader motivations, outcomes, or effects of gaming that underlie excessive play. This study aimed to explore regular and problematic gamers' experiences and perceptions of tolerance in IGD. Methods An online survey of 630 adult gamers yielded 1,417 text responses to open-ended questions. A thematic analysis of 23,373 words was conducted to extract dominant themes. Results Participants reported that they increasingly desired game items, status, or story progress as they became more involved or invested in games. As players develop higher standards of play in games, an increasing number of potential reward outcomes may have diminishing mood-modifying effects. None of the participants, including those with self-reported IGD, explicitly referred to a need for increasing time spent gaming. Discussion and conclusions These results suggest that players may be motivated by preferences for specific goals or reinforcers in games rather than wanting an amount of time spent gaming. Thus, problematic gaming may involve a need for completion of increasingly intricate, time-consuming, or difficult goals to achieve satisfaction and/or reduce fears of missing out. Further research is needed to determine whether these cognitive and motivational factors related to gaming stimuli should extend or replace the concept of tolerance in IGD or be considered as separate but related processes in disordered gaming.

Protocol for Co-Design, Development, and Open Trial of a Prototype Game-Based eHealth Intervention to Treat Anxiety in Young People With Long-Term Physical Conditions

BACKGROUND

Approximately 10% to 12% of New Zealand young people (and 21% of Maori young people) have long-term physical conditions and are more likely to develop psychological problems, particularly anxiety and depression. Delayed treatment leads to worse management of physical conditions, school absence, and poorer long-term outcomes. Recently, electronic health (eHealth) interventions have been shown to be as good as face-to-face therapy and biofeedback techniques have been shown to enhance relaxation during the treatment of anxiety. In addition, young people with long-term physical conditions have expressed a preference for more technologically based support, including game-based interventions, to deal with psychological issues, particularly anxiety.

OBJECTIVE

The aim of this study is to develop a prototype game-based eHealth intervention to address anxiety in young people with long-term physical conditions. The game will be based on the principles of cognitive behavior therapy (CBT) and will integrate a module of biofeedback-based relaxation.

METHODS

During the first phase of the study, up to 48 young people with long-term physical conditions aged 13 to 18 years, attending a tertiary pediatric hospital will be invited to participate in a 3-stage series of co-design workshops. Following the design, development, and refinement of a working prototype, during the second phase of the study, a further 20 young people with long-term physical conditions and anxiety will be recruited from the same location to participate in an open pilot trial to evaluate its acceptability, usability, and preliminary efficacy.

RESULTS

Changes in anxiety will be measured using the Generalized Anxiety Disorder 7-item scale (GAD-7) and the Spence Child Anxiety Scales (SCAS) at the end of every module (recommended to be completed weekly), post intervention, and 3 months later. Usability of the intervention will be measured using the System Usability Scale (SUS) and by measuring frequency and quantity of use of the intervention. Acceptability of the intervention will be assessed using brief, open-ended questionnaires and semi-structured interviews, the data from which will be analyzed using a general inductive approach. Recruitment to the study commenced in January 2017 and data collection will be completed by the end of December 2017.

CONCLUSIONS

If acceptable and useful, this game-based eHealth intervention may offer a cost-effective and clinically useful intervention for addressing the psychological needs of over 16,000 young people with long term health conditions in New Zealand.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Network Registry (ANZCTR): ACTRN12616001253493p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371443 (Archived by WebCite at http://www.webcitation.org/6sYB716lf).

The relationship between gaming disorder and addiction requires a behavioral analysis

In their position paper, Aarseth et al. (2016) bring to light several timely issues concerning the categorization of gaming disorder as a form of addiction and as a discrete mental disorder. In our commentary, we welcome their caution toward this move and their discussion of the equivocal scientific data in its support and the potential negative consequences for gamers. We suggest that a more heterogeneous approach is required for understanding any behavioral addiction, as concepts from gambling appear to be more relevant for aspects of mobile gaming than for video games more generally. In addition to a greater need for clinical research, we argue that studying gaming at a different level of analysis than the epidemiological study is required to gain a meaningful understanding of the harm video games may or may not entail.

Educational Gaming for Pharmacy Students - Design and Evaluation of a Diabetes-themed Escape Room

Objective. To design an educational game that will increase third-year professional pharmacy students' knowledge of diabetes mellitus disease management and to evaluate their perceived value of the game. Methods. Faculty members created an innovative educational game, the diabetes escape room. An authentic escape room gaming environment was established through the use of a locked room, an escape time limit, and game rules within which student teams completed complex puzzles focused on diabetes disease management. To evaluate the impact, students completed a pre-test and post-test to measure the knowledge they've gained and a perception survey to identify moderating factors that could help instructors improve the game's effectiveness and utility. Results. Students showed statistically significant increases in knowledge after completion of the game. A one-sample t-test indicated that students' mean perception was statistically significantly higher than the mean value of the evaluation scale. This statically significant result proved that this gaming act offers a potential instructional benefit beyond its novelty. Conclusion. The diabetes escape room proved to be a valuable educational game that increased students' knowledge of diabetes mellitus disease management and showed a positive perceived overall value by student participants.

Introduction of a new instrument to measure motivation for gaming: the electronic gaming motives questionnaire

AIMS

To adapt the four-dimensional Gambling Motives Questionnaire-Revised (GMQ-R) to measure the motivation for engaging in electronic gaming, and to validate the internal structure and investigate the criterion validity of the new Electronic Gaming Motives Questionnaire (EGMQ).

DESIGN AND SETTING

The GMQ-R was adapted to measure motivation for playing video games and the new instrument was tested on a sample of Norwegian conscripts selected randomly from the pool of conscripts who started their military service between 2013 and 2015.

PARTICIPANTS

The questionnaire was administered to all those who had played video games during the last 6 months and consisted of 853 gamers (86.8% men, mean age = 19.4 years).

MEASUREMENTS

All participants completed the EGMQ, as well as other measures of gaming behaviour, gaming problems, boredom, loneliness and depression.

FINDINGS

The confirmatory factor analyses showed that the proposed EGMQ (measuring enhancement, coping, social and self-gratification motives) displayed satisfactory fit and internal consistency. Hierarchical regression analyses showed that gender emerged as a significant predictor (P < 0.001) of all the dependent variables (variety, hours weekly gaming, loss of control and gaming problems) and the first step explained between 1 and 6.1% of the variance in the gaming behaviours. In the second step the four motivational dimensions explained an additional 5.8-38.8% of the variance. Coping and self-gratification predicted gaming problems (P < 0.001) and coping alone predicted loss of control (P < 0.001). The four motivational dimensions were also predicted differentially by indicators of psychosocial wellbeing, indicating divergent validity of the four motives.

CONCLUSIONS

The four-dimensional Electronic Gaming Motives Questionnaire is a valid instrument for measuring motives for gaming.

Reducing concussion symptoms among teenage youth: Evaluation of a mobile health app

OBJECTIVE

To evaluate whether a mobile health application that employs elements of social game design could compliment medical care for unresolved concussion symptoms.

DESIGN

Phase I and Phase II (open-label, non-randomized, ecological momentary assessment methodology).

SETTING

Outpatient concussion clinic.

PARTICIPANTS

Youth, aged 13-18 years, with concussion symptoms 3+ weeks after injury; Phase I: n = 20; Phase II: n = 19.

INTERVENTIONS

Participants received standard of care for concussion. The experimental group also used a mobile health application as a gamified symptoms journal.

OUTCOME MEASURES

Phase I: feasibility and satisfaction with intervention (7-point Likert scale, 1 high). Phase II: change in SCAT-3 concussion symptoms (primary), depression and optimism.

RESULTS

Phase 1: A plurality of participants completed the intervention (14 of 20) with high use (110 +/- 18% play) and satisfaction (median +/- interquartile range (IQR) = 2.0+/- 0.0). Phase II: Groups were equivalent on baseline symptoms, intervention duration, gender distribution, days since injury and medication prescription. Symptoms and optimism improved more for the experimental than for the active control cohort (U = 18.5, p = 0.028, effect size r = 0.50 and U = 18.5, p = 0.028, effect size r = 0.51, respectively).

CONCLUSIONS

Mobile apps incorporating social game mechanics and a heroic narrative may promote health management among teenagers with unresolved concussion symptoms.

Home Health Chains and Practice Patterns: Evidence of 2008 Medicare Reimbursement Revision

Home health agencies (HHAs) are known to exploit the Medicare reimbursement schedule by targeting a specific number of therapy visits. These targeting behaviors cause unnecessary medical spending. The Centers for Medicare & Medicaid Services estimates that during fiscal year 2015, Medicare made more than $10 billion in improper payments to HHAs. Better understanding of heterogeneous gaming behaviors among HHAs can inform policy makers to more effectively oversee the home health care industry. This article aims to study how home health chains adjust and adopt new targeting behaviors as compared to independent agencies under the new reimbursement schedule. The analytic data are constructed from: (1) 5% randomly sampled Medicare home health claim data, and (2) HHA chain information extracted from the Medicare Cost Report. The study period spans from 2007 to 2010, and the sample includes 7800 unique HHAs and 380,118 treatment episodes. A multivariate regression model is used to determine whether chain and independent agencies change their practice patterns and adopt different targeting strategies after the revision of the reimbursement schedule in 2008. This study finds that independent agencies are more likely to target 6 and 14 visits, while chain agencies are more likely to target 20 visits. Such a change of practice patterns is more significant among for-profit HHAs. The authors expect these findings to inform policy makers that organizational structures, especially the combination of for-profit status and chain affiliation, should be taken into the consideration when detecting medical fraud and designing the reimbursement schedule.

Social Networking Sites and Addiction: Ten Lessons Learned

Online social networking sites (SNSs) have gained increasing popularity in the last decade, with individuals engaging in SNSs to connect with others who share similar interests. The perceived need to be online may result in compulsive use of SNSs, which in extreme cases may result in symptoms and consequences traditionally associated with substance-related addictions. In order to present new insights into online social networking and addiction, in this paper, 10 lessons learned concerning online social networking sites and addiction based on the insights derived from recent empirical research will be presented. These are: (i) social networking and social media use are not the same; (ii) social networking is eclectic; (iii) social networking is a way of being; (iv) individuals can become addicted to using social networking sites; (v) Facebook addiction is only one example of SNS addiction; (vi) fear of missing out (FOMO) may be part of SNS addiction; (vii) smartphone addiction may be part of SNS addiction; (viii) nomophobia may be part of SNS addiction; (ix) there are sociodemographic differences in SNS addiction; and (x) there are methodological problems with research to date. These are discussed in turn. Recommendations for research and clinical applications are provided.

Video gaming and gaming addiction in transgender people: An exploratory study

Background There is anecdotal clinical evidence that transgender people use the online world - such as forums and online video gaming - for the purpose of experiencing their gender identity in a safe, non-threatening, non-alienating, non-stigmatizing, and non-critical environment. Aims To describe gaming behavior, degree of problematic gaming behavior and associated factors with problematic gaming in a comparatively large group of transgender people accessing transgender health services. Methods Every individual referred to a national transgender health service in the United Kingdom during a 12-month period was invited to complete a series of questionnaires to measure gaming behavior, interpersonal functioning, severity of autistic features, and anxiety and depressive symptoms. Results A total of 245 people agreed to participate in the study with 154 (62.9%) describing themselves as current gamers. Gaming behavior in the transgender population attending transgender health services was prevalent, but less than 1% of them presented with clinical scores for Internet Gaming Disorder, with no differences according to gender. Problematic gaming behavior was associated with general interpersonal problems, depression, and young age. Discussion and conclusions Transgender people who engage in problematic gaming behavior are younger, and present with high interpersonal problems, and depression, which can affect a successful transition. In view of the high levels of gaming activity in this population games that are designed to address these psychological problems may be well received by transgender people.

Motives for online gaming questionnaire: Its psychometric properties and correlation with Internet gaming disorder symptoms among Chinese people

Background and aims Internet gaming disorder (IGD) imposes a potential public health threat worldwide. Gaming motives are potentially salient factors of IGD, but research on Chinese gaming motives is scarce. This study empirically evaluated the psychometric properties of the Chinese version of the Motives for Online Gaming Questionnaire (C-MOGQ), the first inventory that measures seven different gaming motives applicable to all type of online games. We also investigated the associations between various gaming motives and IGD symptoms among Chinese gamers. Methods Three hundred and eighty-three Chinese adult online gamers (Mean age = 23.7 years) voluntarily completed our online, anonymous survey in December 2015. Results The confirmatory factor analysis results supported a bi-factor model with a general factor subsuming all C-MOGQ items (General Motivation) and seven uncorrelated domain-specific factors (Escape, Coping, Fantasy, Skill Development, Recreation, Competition, and Social). High internal consistencies of the overall scale and subscales were observed. The criterion-related validity of this Chinese version was also supported by the positive correlations of C-MOGQ scale scores with psychological need satisfaction and time spent gaming. Furthermore, we found that high General Motivation (coupled with high Escape motive and low Skill Development motive) was associated with more IGD symptoms reported by our Chinese participants. Discussion and conclusions Our findings demonstrated the utility of C-MOGQ in measuring gaming motives of Chinese online gamers, and we recommend the consideration of both its total score and subscale scores in future studies.

Motives Matter: Motives for Playing Pokémon Go and Implications for Well-Being

Mobile games such as Pokémon Go have become a major form of entertainment, and yet little is known about why people play the games and how their motives associate with well-being. Although literature on motives for playing video and online games is informative, the findings may not reflect the full spectrum of mobile gaming motives due to some unique affordances of mobile games (e.g., mobility). To catch up with the evolving gaming context, a popular mobile game, Pokémon Go, was taken as an example to explore individuals' mobile gaming motives. A Pokémon Go Motive Scale was developed. Seven motives were identified through factor analyses based on survey data from 262 Pokémon Go players (45 percent women; M_age = 30.71, standard deviation = 7.77): Exercise, Fun, Escapism, Nostalgia, Friendship Maintenance, Relationship Initiation, and Achievement. Both Fun and Friendship Maintenance were positive correlates of well-being, whereas Escapism and Nostalgia were negative correlates. Relationship Initiation was associated with both better and poorer well-being. Implications of the findings are discussed.

Game-Based Rehabilitation for Myoelectric Prosthesis Control

Background

A high number of upper extremity myoelectric prosthesis users abandon their devices due to difficulties in prosthesis control and lack of motivation to train in absence of a physiotherapist. Virtual training systems, in the form of video games, provide patients with an entertaining and intuitive method for improved muscle coordination and improved overall control. Complementary to established rehabilitation protocols, it is highly beneficial for this virtual training process to start even before receiving the final prosthesis, and to be continued at home for as long as needed.

Objective

The aim of this study is to evaluate (1) the short-term effects of a commercially available electromyographic (EMG) system on controllability after a simple video game-based rehabilitation protocol, and (2) different input methods, control mechanisms, and games.

Methods

Eleven able-bodied participants with no prior experience in EMG control took part in this study. Participants were asked to perform a surface EMG test evaluating their provisional maximum muscle contraction, fine accuracy and isolation of electrode activation, and endurance control over at least 300 seconds. These assessments were carried out (1) in a Pregaming session before interacting with three EMG-controlled computer games, (2) in a Postgaming session after playing the games, and (3) in a Follow-Up session two days after the gaming protocol to evaluate short-term retention rate. After each game, participants were given a user evaluation survey for the assessment of the games and their input mechanisms. Participants also received a questionnaire regarding their intrinsic motivation (Intrinsic Motivation Inventory) at the end of the last game.

Results

Results showed a significant improvement in fine accuracy electrode activation (P<.01), electrode separation (P=.02), and endurance control (P<.01) from Pregaming EMG assessments to the Follow-Up measurement. The deviation around the EMG goal value diminished and the opposing electrode was activated less frequently. Participants had the most fun playing the games when collecting items and facing challenging game play.

Conclusions

Most upper limb amputees use a 2-channel myoelectric prosthesis control. This study demonstrates that this control can be effectively trained by employing a video game-based rehabilitation protocol.

Elderly people's perceptions of using Wii sports bowling - A qualitative study

The Nintendo Wii is a gaming console with motion-sensitive controls that is making inroads into health care and rehabilitation. However, there is still limited knowledge on how elderly people perceive the use of such a product. The aim of this study was to examine how the use of the Wii Sports Bowling in an activity group was perceived by elderly people. The data consisted of observations and interviews with participants who used Wii Sports Bowling and was analysed with content analysis. The findings are described in three themes; 'The use of the Wii Sports game', 'Engagement in the game' and 'Social interaction around the activity'. Wii Sports Bowling was described as easier to play compared to real-life bowling and was enjoyable and a social activity. The opportunity to meet the group each week was important for the participants. Playing the game resulted in signs of immersion and a flow-like state. The Wii was perceived to be easy to use, to provide a way to socialize with peers and to give opportunities to participate in activities in a new way. More studies regarding elderly people's experiences and apprehensions regarding new technology such as gaming consoles and virtual reality are needed.

The Present and Future of Robotic Technology in Rehabilitation

Robotic technology designed to assist rehabilitation can potentially increase the efficiency of and accessibility to therapy by assisting therapists to provide consistent training for extended periods of time, and collecting data to assess progress. Automatization of therapy may enable many patients to be treated simultaneously and possibly even remotely, in the comfort of their own homes, through telerehabilitation. The data collected can be used to objectively assess performance and document compliance as well as progress. All of these characteristics can make therapists more efficient in treating larger numbers of patients. Most importantly for the patient, it can increase access to therapy which is often in high demand and rationed severely in today's fiscal climate. In recent years, many consumer grade low-cost and off-the-shelf devices have been adopted for use in therapy sessions and methods for increasing motivation and engagement have been integrated with them. This review paper outlines the effort devoted to the development and integration of robotic technology for rehabilitation.