"Inside Out of Mind": Alternative Realities, Dementia and Graphic Medicine

Graphic medicine, an interdisciplinary field situated at the crossroads of comics and healthcare, operates as a medium through which the intricate nature of experiences with illness can be articulated, challenging orthodox medical dogmatism in an engaging and accessible way. Combining the affordances of comics and the narrative power of storytelling, graphic medicine elucidates the socio-cultural stigmatization of dementia influenced by a multitude of discourses. Diverging from existing discourses that depict individuals with Alzheimer's disease (AD) as zombies, brain-dead, or empty shells, graphic memoirs reconstruct these reductive notions and represent them as imaginative, productive, and perceptive. Taking these cues, the present paper close reads some sections of Dana Walrath's (2016) Aliceheimer's: Alzheimer's Through the Looking Glass in order to demonstrate how graphic medicine reconceptualizes the preeminent hallucinatory experiences of her AD-afflicted mother, Alice, as visions. Walrath deploys collage art to epitomize Alice's ordeal with AD. In particular, Walrath deploys thought-provoking fragments from Lewis Caroll's Alice in Wonderland, strategically to proximate Alice's experiences with AD and tackle the problem of dementia and sociality. Additionally, the paper explores how the text fosters interdependence, respect, and trust to recognize and restore Alice's personhood. The paper concludes by discussing how Aliceheimer's operates as an alternative paradigm beyond the confines of biomedical and cultural models of dementia through the use of lexical puissance.

A Healthy Liver Will Always Deliver: Impact Study of a Non-Alcoholic Fatty Liver Disease (NAFLD) Awareness Comic

Based on previous work, we developed the comic "A healthy liver will always deliver!" to raise awareness about Non-Alcoholic Fatty Liver Disease (NAFLD) and promote healthy lifestyles. An online pre-post questionnaire design demonstrated an increase in health-threat beliefs regarding NAFLD among the general public, as well as response efficacy and self-efficacy beliefs, normative and control beliefs regarding the maintenance of preventive strategies involving healthy diets and active lifestyles, after interaction with the comic's narrative. This effect was more evident in women. Furthermore, although we could not perform all the ideal controls during the COVID-19 pandemic, and the online strategy attracted mostly university education-level subjects, the comic seemed relatable and engaging. However, more work will have to be performed to ensure its usefulness in terms of acquired knowledge and behavior changes, especially in at-risk segments of the population.

Best of Graphic Medicine-The 2023 Graphic Medicine International Collective Awards

This Arts and Medicine feature reviews 4 health-related graphic medicine (comic) projects judged as the best of 2022 by the Graphic Medicine International Collective.

Comics in the Time of a Pan(dem)ic: COVID-19, Graphic Medicine, and Metaphors

Comics have always responded to pandemics/catastrophes, documenting the way we deal with such crises. Recently, graphic medicine, an interdisciplinary field of comics and medicine, has been curating comics, editorial cartoons, autobiographical cartoons, and social media posts under the heading "COVID-19 Comics" on their websites. These collected comics express what we propose to call covidity, a neologism that captures both individual and collective philosophical, material, and wide-ranging emotional responses to the COVID-19 pandemic. Treating such comics as the source material and drawing insights from theorists Ian Williams, Alan Bleakley, Susan Sontag, and others, this article examines graphic medicine's representation of the COVID-19 pandemic. The conceptual metaphors of war, anthropomorphism, and superheroism are used to represent and illustrate the lived experience of the pandemic, and the article investigates metaphor types, their utility, and motivational triggers for such representations. In doing so, the essay situates graphic medicine as a productive site that presents the pandemic's multifarious impact.

Informing children citizens efficiently to better engage them in the fight against COVID-19 pandemic

Since the beginning of the year, the world’s attention has rightly been focused on the spread of the Coronavirus Disease 2019 (COVID-19) pandemic and the implementation of drastic mitigation strategies to limit disease transmission. However, public health information campaigns tailored to children are very rare. Now more than ever, at a time when some governments are taking populations out of lockdown and youth are returning to schools, children around the world need to fully grasp the modes of transmission of the disease, the health risks, the scientific notions of the immune system, the value of barrier measures, and the progress of scientific research. In the context of the COVID-19 pandemic, comics can be very useful for communicating quickly and effectively abstract and important information to children who might be under the influence of a large amount of sometimes contradictory information. Conveying precise, reliable, and accessible information to children is key in a world overwhelmingly impacted by the outbreak. This should be the role and the responsibility of world health official leaders and governments in compliance with the United Nations Convention on the Rights of the Child. In partnership with mainstream medias, consortia of scientists, communication experts, and education specialists, it is urgent that world leaders engage children in this worldwide public health fight.

Microbiology can be comic

For microbiologists, the importance of microorganisms in our daily lives and their impact on our well-being is evident. However, microbiology literacy in our society is far from being enough for individuals to make informed choices and to demand actions based on that information. The vaccine hesitation movement and the alarming increase in antimicrobial resistance due to overuse and misuse of antibiotics are just two examples of how much work is needed to make our society literate in topics related to microbiology. Considering the challenges of communicating a discipline surrounded by misconceptions, which studies the role of living organisms that cannot be seen in plain sight, we need to explore different strategies to effectively contribute to microbiology literacy in our society. Here, we will comment on the use of comics for such a task.

Comic book-based educational program on epilepsy for high-school students: Results from a pilot study in the Gran Chaco region, Bolivia

INTRODUCTION

In low- and middle-income countries (LMIC), epilepsy still represents a significant health challenge. In the Bolivian Chaco, we have previously found high levels of stigma towards people with epilepsy (PWE) especially expressed by high school students. In order to increase the knowledge about epilepsy, we have tested a comic book-based intervention on a sample of high school students.

METHODS

The study has been conducted in the Bolivian Chaco region where two urban and two rural classrooms have been randomly selected. Students have been administered a knowledge, attitudes, and practices (KAP) questionnaire, and then they underwent a comic book-based educational program where they were randomly assigned either to an autonomous reading or a character interpretation methodology. The same KAP questionnaire has been administered after the teaching session and at a three months follow-up. Mean KAP scores at the baseline were compared with the after teaching and the three-month assessment.

RESULTS

Eighty-three students with a mean age of 15.5 ± 0.9 years, of whom 38 (45.8%) males, were recruited. After the comic book session, students improved in the global score (p < 0.001) and in the knowledge (p < 0.001), attitudes (p = 0.004), and practices (p < 0.001) subscores. Both the autonomous reading and the character interpretation groups significantly improved in the global score, but only the latter improved in all the subscores. At the three months follow-up, there were no differences in the global, knowledge, and attitudes subscores, compared with scores immediately after the intervention.

CONCLUSION

Using a comic book to teach about epilepsy led to a significant improvement in the knowledge, attitudes, and practices about the disease in high school students of LMIC. This teaching strategy can be easily implemented in LMIC.

Agricultural Safety Comic Book for Latinx Migrant Families: Development and Evaluation

INTRODUCTION

Comic books and graphic novels have been used in health education. The youth of migrant and seasonal agricultural workers are highly vulnerable to the health hazards associated with agricultural work and the migrant workers' itinerant home environment.

METHOD

The purpose of the study was to create a bilingual, culturally specific educational comic book to inform families of safety issues in youth hand-harvesting agricultural work and provide anticipatory guidance safety tips for agricultural work camp residence. In a mixed-methods design, a multistate and multidisciplinary team used focus groups to obtain the voice of potential users regarding the strengths and weaknesses of the comic book prototype and scales on satisfaction, helpfulness, and usability.

RESULTS

Focus group participants contributed constructive criticism to modify the prototype. Quantitative surveys found the comic book to be satisfactory, helpful, and highly usable.

DISCUSSION

This report describes the steps in the creation of the comic book that can be used for health promotion education.

Graphic illustration of impairment: science fiction, Transmetropolitan and the social model of disability

The following paper examines the cyberpunk transhumanist graphic novel Transmetropolitan through the theoretical lens of disability studies to demonstrate how science fiction, and in particular this series, illustrate and can influence how we think about disability, impairment and difference. While Transmetropolitan is most often read as a scathing political and social satire about abuse of power and the danger of political apathy, the comic series also provides readers with representations of impairment and the source of disability as understood by the Social Model of Disability (SMD). Focusing on the setting and fictional world in which Transmetropolitan takes place, as well as key events and illustration styling, this paper demonstrates that the narrative in this work encompasses many of the same theoretical underpinnings and criticisms of society's ignorance of the cause of disability as the SMD does. This paper aims, by demonstrating how Transmetropolitan can be read as an allegory for the disabling potential of society as experienced by individuals with impairments, to prompt readers into thinking more creatively about how narratives, seemingly unconcerned with disability, are informed and can be understood via disability theory.

Modifiable motion graphics for capturing sensations

Objective

The purpose of this study was to assess the relationship between an embodied sensory experience and the ability to translate the perception of this experience visually using modifiable motion graphics.

Methods

A custom-designed software was developed to enable users to modify a motion graphic in real-time. The motion graphics were designed to depict realistic visualizations of pain quality descriptors, such as tingling and burning. Participants (N = 34) received an electrical stimulation protocol known to elicit sensations of tingling. The protocol consisted of eight stimulation intensities ranging from 2—6mA delivered, in a randomized fashion and repeated three times, to the index finger. Immediately after each stimulus, participants drew the area of the evoked sensation on a digital body chart of the hand. Participants then modified the motion graphic of tingling by adjusting two parameters, namely the speed (rate of dots disappearing and re-appearing) and density of these dots in the drawn area. Then, participants rated the perceived intensity and selected the most appropriate pain quality descriptor.

Results

There was an increase in the area, density, and perceived intensity ratings as the electrical stimulation intensity increased (P<0.001). The density of the motion graphic, but not speed, correlated with perceived intensity ratings (0.69, P<0.001) and electrical stimulation intensities (0.63, P<0.01). The descriptor ‘tingling’ was predominantly selected in the range of 3–4.5mA and was often followed by ‘stabbing’ as the electrical intensity increased.

Discussion

The motion graphic tested was perceived to reflect a tingling sensation, the stimulation protocol elicited a tingling sensation, and participants adjusted one of the two motion graphic features systematically. In conclusion, an embodied sensation, such as tingling, maybe visually represented similarly between individuals. These findings create research, clinical, and commercial opportunities that utilize psychophysics to explore, visualize, and quantify changes in embodied sensory experiences in response to known stimuli.

Exploring gendered leadership stereotypes in a shared leadership model in healthcare: a case study

The existing literature on leadership often describes it within fairly rigid gender roles. Entire models of leadership have been ascribed gendered labels. Shared leadership is, in traditional leadership theory, a feminine model. After observing a National Health Service (NHS) department enacting a shared leadership model, and using ethnography, grounded theory and comics-based research, we decided to explore the relationship between shared leadership and gender stereotypes. We realised our hope was to see a subversion of traditional stereotypes. Our data showed shared leadership overall as a feminine model, with its focus on distribution and compassion. Within the group, a range of gender roles were performed, meaning that the group could represent itself to the outside world as either more masculine or more feminine as required. This was beneficial, as conflict with outsiders was minimised and hence anxiety reduced. However, we noted that within the group, traditional gender roles were not subverted and were probably reinforced. Despite our view that shared leadership has not been an opportunity to resist gender stereotyping within this department, the success of this feminine model may represent a challenge to the prevailing masculine model of leadership within the NHS.

(Un)bridgeable Chasms?: Doctor-Patient Interactions in Select Graphic Medical Narratives

Effective doctor patient relationships are predicated on doctors' relational engagement and affective/holistic communication with the patients. On the contrary, the contemporary healthcare and patient-clinician communication are at odds with the desirable professional goals, often resulting in dehumanization and demoralization of patients. Besides denigrating the moral agency of a patient such apathetic interactions and unprofessional approach also affect the treatment and well-being of the sufferer. Foregrounding multifaceted doctor-patient relationships, graphic pathographies are a significant cultural resource which recreate the embodied moment of clinical encounters as they also lay bare qualitative tensions between patient' illness experience with doctor's professional understanding of the same. Taking these cues, the present article drawing theoretical postulates of Rita Charon, Deborah Lupton, and Havi Carel close reads Peter Dunlap-Shohl's My Degeneration: A Journey Through Parkinson's (2015), Brian Fies' Mom's Cancer (2006), and Stan Mack's Janet & Me: An Illustrated Story of Love and Loss (2004) to investigate the nature of doctor-patient relationship vis-à-vis communication and the implications of bad doctoring/communicative practices on patient identity and emotions. Furthermore, the article also examines the aesthetic and functional role of comics in bringing into relief the graphically mediated doctor-patient relationship.

Loop: there's no going back: A Graphic Novel by Adolescent Cancer Patients on the Youth Project in Milan

The present paper describes the story of the development of a graphic novel-a story about superheroes-written by adolescent cancer patients on the Youth Project at the Istituto Nazionale Tumori in Milan (Italy). Nineteen patients from fifteen to twenty-five years old (fifteen receiving treatment for their cancer, four who had recently completed their treatments) participated in a four month creative writing laboratory managed by a professional teacher. The output from the writing laboratory was a written text that was used as the script for a graphic novel drawn by professional cartoonists and working together with the patients. Through their story, adolescent patients succeeded in voicing their dreams and fears. It was the adolescent patients themselves who explained how they had each tried to bring out the superhero inside them. This project describes the amazing powers of adolescents with cancer and opens a precious window on their inner world, enabling us to gain a better understanding of what they are really thinking and feeling through their own words.

Depictions of Tobacco and Alcohol Use in Contemporary Japanese Shōnen Manga: A Content Analysis

Japanese manga, which present dramatic and imaginative stories in comic book form, have a growing readership in Asia, Europe, and North America. We investigated depictions of tobacco and alcohol use in a sample of contemporary shōnen manga, which have a primary readership of males ages 8-18, but also appeal to young females and adults. Large number of characters were shown smoking cigarettes and drinking alcohol, especially males, adults, and those categorized as "good" characters. Compared to the shōnens' early chapters (initiated in 1990-2003, depending on the series), more recently published chapters (2011-2016) portrayed fewer characters overall using a tobacco product and fewer minors using an alcohol product. The later chapters also presented significantly fewer depictions of tobacco-related behavior, consumption of both beer and other/unknown alcoholic beverages, and alcohol-related paraphernalia. Antitobacco and antialcohol behaviors or dialogue were rare. These findings raise legitimate concerns about the influence of these depictions on young readers' beliefs, attitudes, and behavioral choices. Future research should explore whether those concerns are warranted, but in the interim, government agencies and watchdog groups in Japan should consider applying increased public pressure on manga artists and producers to curtail these depictions and to offer positive role models in their place.

When Good Women Decide to Do Nothing

Many health professions students struggle with deciding whether and when to challenge their teachers. This graphic memoir, When Good Women Do Nothing, conveys what happened one day in the life of a paramedic student called to help an incarcerated, handcuffed woman in labor who gave birth on a stretcher. The memoir documents numerous clinical and ethical disagreements and decision points throughout the paramedic team's time with this patient.

A Matter of Words

Word Choices is a mixed-media digital illustration that explores the importance of clinicians' word choices during their encounters with patients. Clinicians often face ethical questions about sharing information with vulnerable patients, dimensions of which are represented by the illustration's content and colors.

Comics as an Educational Tool on a Clinical Clerkship

OBJECTIVES

The authors investigated student satisfaction with the use of comics as an educational tool in clinical medical education.

METHODS

Students on a Psychiatry clinical clerkship reviewed educational comics at the time of orientation. End of clerkship surveys were utilized to assess students' perceptions about the usefulness of comics for their learning during the clerkship. Students' responses were qualitatively and quantitatively analyzed.

RESULTS

Eighty-four percent of students indicated that comics helped improve their understanding of clinical concepts, while approximately 80% felt that reviewing comics prior to each clerkship rotation helped ease transition into their assigned clinical service. Almost three quarters of all responders (74%) indicated that they were more likely to review preparatory material in comic form, as compared to other formats. Students found the comics easy to read, fun, and appreciated the concise presentation of information within them. Students also highlighted the limited amount of information presented as a relative weakness of the program.

CONCLUSIONS

Comics may be utilized as an acceptable educational tool in clinical medical education.

The Banality of Anal: Safer Sexual Erotics in the Gay Men's Health Crisis' Safer Sex Comix and Ex Aequo's Alex et la vie d'après

Analyzing two harm reduction comics campaigns-one early in the AIDS crisis (the Gay Men's Health Crisis' [GMHC] 1980s Safer Sex Comix) and one more recent (Fabrice Neaud and Thierry Robberecht's 2008 Alex et la vie d'après), I explore tensions between queer safer sexual erotics and national discourses of sexual norms/deviation raised by Cindy Patton and William Haver at the height of AIDS discourse theory in 1996, approximately halfway between the comics. Using these theorists' reflections on the history of AIDS activism/representation as a hinge, I explore the manifestation/transformation a decade later of the ethical, educational, and erotic issues they raise. Both foreground the ways that HIV, safer sex, and/or eroticism pose difficulties for systems of linguistic and visual representation. Combining text and image, comics-a common harm reduction medium-epitomize this representational issue. While the GMHC addresses an immediate need for information about safer sex, Alex attempts to tackle the unrepresentability/unthinkability of safer and/or seropositive sex(uality). Safer Sex Comix, while largely prioritizing directness above formal experimentation, employ strategies of transgressing the borders of the comics panel to emphasize a plethora of lower-risk sexual acts. The most visually inventive moments in Alex represent Alex's feelings of unintelligbility post-diagnosis, but the comic restricts its representation of sex only to anal intercourse, and it proves unable to visualize alternative formulations of the erotic, turning to more normative narratives and images as earlier, visually explicit unsafe sexual encounters are replaced with more a/illusive representations post-conversion, literalizing the unrepresentability of seropositive erotic life.

The Influence of Presentation Format of Story on Narrative Production in Chinese Children Learning English-as-a-Second-Language: A Comparison Between Graphic Novel, Illustration Book and Text

Past studies have shown that multimodal presentation of story can improve story-retelling performance in the first language. The purpose of the present study was to investigate whether similar multimedia effects can be observed in second language learning and graphic novel reading. A total of 51 Chinese elementary school children, aged 7-8, who were learning English as a second language were recruited. They were randomly assigned to one of the three experimental conditions that differed in the format of story presentation: English text, English text with pictorial illustrations or graphic novel. After reading the same story, the children retold the story in English. The narratives produced were then rated by two independent raters. The results of group comparison showed that children from the three experimental groups had similar performance, indicating that multimedia presentation may not always facilitate narrative production in English as a second language. Within-subject comparison further showed that the children were relatively strong in language skills and capturing the main ideas of the story, while showing weakness in story structure awareness, elaboration, as well as local and global cohesion. Suggestions for the application of multimodal presentation of narrative texts are discussed.

Comics, Corn, and the Queer Phenomenology of Depression

Grounded in analyses of two graphic memoirs, Ellen Forney's Marbles: Mania, Depression, Michelangelo and Me and Allie Brosh's "Depression (Parts One &amp; Two)," this article draws from Sara Ahmed's 2006 book, Queer Phenomenology: Objects, Orientations, Others, in order to theorize the "queer phenomenology" of what gets called depression within many Western psychiatric, medical, and cultural discourses. Arguing that queer desires orient the subject away from (hetero)normative objects (or "happy objects," as Ahmed calls them, because they promise a life of happiness), Queer Phenomenology suggests that the subsequent turn toward queer objects produces feelings of dis-orientation in the subject. Noting the similarities between Ahmed's idea of queer disorientations and my own disorienting experiences of depression, this essay posits that depression similarly constitutes a turn away from"happy objects" andtoward objects which, through their newfound prominence in the depressed person's life, may appear as strange or even queer.

School-based secondary prevention of overweight and obesity among 8- to 12-year old children: Design and sample characteristics of the SNAPSHOT trial

Rising levels of severe obesity among children, worsening disparities by race and ethnicity and reluctance of primary care clinicians' to provide obesity management to children are compelling reasons to consider alternatives to primary care management of childhood obesity. The Students Nurses and Parents Seeking Healthy Options Together (SNAPSHOT) trial will test the efficacy of an elementary school-based, school nurse-led, healthy weight management program to reduce excess weight gain among children, 8- to 12-years old with a body mass index (BMI) ≥75th percentile, by increasing healthy dietary practices and physical activity and decreasing sedentary behaviors. SNAPSHOT has enrolled and randomized 132 child/parent dyads to either the: (1) 9-month SNAPSHOT intervention that includes four home visits, 14 kid groups held during out-of-school time and five parent groups or (2) a newsletter program consisting of monthly mailings and family-focused healthy lifestyle information. Outcomes are assessed at baseline, 12-months (post intervention) and 24-months (follow-up) post randomization. The primary outcome is child age- and gender-adjusted BMI z-score. Secondary outcomes include child dietary intake assessed with 24-h dietary recall interviews and accelerometer-measured activity levels. The SNAPSHOT intervention is a model of secondary obesity prevention for children that addresses the urgent need for theory-informed, evidence-based and safe weight management programs, delivered by skilled health professionals in accessible settings. This report describes development of the SNAPSHOT trial, including recruitment and randomization procedures, assessments, intervention and implementation plans, and baseline characteristics of the study sample.

Drawing Invisible Wounds: War Comics and the Treatment of Trauma

Since the Vietnam War, graphic novels about war have shifted from simply representing it to portraying avenues for survivors to establish psychological wellness in their lives following traumatic events. While modern diagnostic medicine often looks to science, technology, and medications to treat the psychosomatic damage produced by trauma, my article examines the therapeutic potential of the comics medium with close attention to war comics. Graphic novels draw trauma in a different light: because of the medium's particular combination of words and images in sequence, war comics represent that which is typically unrepresentable, and these books serve as useful tools to promote healing among the psychologically wounded. Graphic narratives, both fictional and non-fictional, illuminate the ways that the unseen wounds of traumatic experience affect public health by compromising the ability of communities, individuals, and survivors to create and maintain meaningful relationships with others.

A didactic approach to presenting verbal and visual information to children participating in research protocols: the comic book informed assent

OBJECTIVE

When children participate in research protocols, consent (by a parent or legal guardian) and assent (by the children) must be given. Understanding research protocols can be challenging for an adult and even more difficult for a child. The aim of this study was to describe the development of a comic book created to facilitate children's understanding of informed assent with clear and simple language.

METHODS

Five researchers with scores above seven according to the Fehring criteria developed the comic book, avoiding the use of technical terminology. Twenty children between 7 and 12 years old, and enrolled in a larger study, responded using a Likert scale and questions about the clarity of texts and illustrations. The final version met National Health System Resolutions (Resoluções do Conselho Nacional da Saúde - CNS n° 196/1996 and 466/2012).

RESULTS

The comic book assent presents a short story containing information about a real study: the invitation to participate, objectives, methods, instruments, procedures, risks, benefits, and the researchers' contact information. Most of the participants answered that they perceived the content of the text to be "Excellent" (40%) and "Very good" (40%), and the illustrations were perceived as "Excellent" (45%) and "Very good" (55%).

CONCLUSION

The construction of a simple and clear model of informed assent is possible, and this model should be used in experiments with children.

Cruel Carousel: The Grim Grind of "Compassionate" Dialysis

In this graphic narrative, a clinician illustrates an experience of caring for an undocumented patient suffering from end-stage renal disease (ESRD). Cruel Carousel tells one of the stories that most profoundly shaped the author's own views on health care for undocumented immigrants. Graphic narrative was chosen to tell this story because words alone couldn't capture the patient's experience or the author's distress about what happened to him.

PoC, LGBTQ, and gender: The intersectionality of America Chavez

The Life and Times of America Chavez was a comic book series eventually published in trade form. Written by Gabby Rivera, queer Latinx young adult literature author, this iteration of Marvel Comic's Miss America (America Chavez) possesses an awareness and authenticity of Latinx culture and lesbian identity that was nothing less than revolutionary. Joe Quinones's artwork, rich in color, spirit, and pride, underscored the need for Latinx voices (both visual and verbal) to tell our stories. In this essay, I provide both a scholarly view of AMERICA as a superhero tale and illuminate the experience of reading her as a Latina lesbian.

Perception about use of comics in medical and nursing education among students in health professions' schools in New Delhi

BACKGROUND

Graphic narratives can give medical and nursing students a broader concept of health and illness. However, graphic texts are not yet integrated into medical education in India. The present study was undertaken to assess the perception of medical and nursing undergraduate students about the use of comics in health professions' education.

METHODS

This study was an institution-based cross-sectional study conducted among 130 medical and 108 nursing students of a medical and nursing college, respectively, in Central Delhi. A pretested self-administered questionnaire containing items to assess knowledge and perception about graphic medicine in medical education was used for data collection. Data were analyzed using SPSS 16.0.

RESULTS

The mean age of students was 20.82 ± 1.51 years. Out of the 238 students, only 21.8% had heard about graphic medicine. However, 76.9% (n = 183) of students agreed that comics should be used in health professions' education. When asked about the subjects in which comic strips can be useful, the majority of medical students wanted them to be used in teaching community medicine (n = 95; 73.1%), while nursing students more often indicated their use in anatomy (n = 59; 54.6%). Overall large proportion of both nursing and medical students opined that comics aid in better understanding (58.8%) and memorization of concepts and content (57.6%). The majority of respondents felt that comic designing requires expertise (67.6%). Students also stated that comic strips on communicable diseases and reproductive and child health could be developed and used in teaching the subject of community medicine/public health.

DISCUSSION

Majority of students felt that comics should be used in medical education in India, preferably for teaching community medicine. Further, maternal and child health are important topics that can be taught using comics in public health. There is a need to explore ways for integrating graphic medicine into health professions' education.

Introduction: "Suffering Sappho!": Lesbian content and queer female characters in comics

Comics have been an important locus of queer female identity, community, and politics for generations. Whether taking the form of newspaper strips, comic books, or graphic novels and memoirs, the medium has a long history of featuring female same-sex attraction, relationships, and identity. This special issue explores the past place, current presence, and possible future status of lesbianism in comics. It features essays about cartoonists such as Jennifer Camper, characters such as Wonder Woman, and titles such as Lumberjanes. This special issue also includes a roundtable that examines underrepresented identities in lesbian comics. These pieces address subjects ranging from the depiction of a Latina lesbian protagonist in AMERICA: The Life and Times of America Chavez and the debut of the first lead Black lesbian female superheroine in Cyberzone to the presentation of queer women in graphic novels from South Asia and the experience of re-reading Hothead Paisan in the age of Trump.

Representations of same-sex relationships between female characters in all-ages comics: Princess Princess Ever After and Lumberjanes

Representations of lesbian, gay, bisexual, transgender, and queer (LGBTQ) characters in comics for an all-ages readership have emerged in the United States in the early twenty-first century. This essay examines the narrative constructions of same-sex relationships between female characters in two all-ages speculative fiction comics, Princess Princess Ever After by Katie O'Neill, and Lumberjanes, created by Shannon Watters, Grace Ellis, Noelle Stevenson, and Brooke Allen.

Situating Cyberzone: Black lesbian identity in comics

Cyberzone is a fitting place to start any discussion around Black lesbian identity in comics, as it is the first comic book that this researcher could find which features a Black lesbian female lead superheroine. Cyberzone was self-published by Jimmie Robinson in 1994 and later re-vamped into a mini-comic series called Amanda and Gunn with Image Comics. First, this article deconstructs Cyberzone through the lens of Cultural Prism Theory (CPT). Second, this article situates Cyberzone within the framework of CPT to address Cyberzone's place within the comic book ecosystem. Finally, this essay offers a close reading of Cyberzone, issues #1-#4, against the backdrop of the intersectional framework Black Queer Identity Matrix. During this process, the researcher demonstrates how Cyberzone is a powerful site of resistant cultural commentary.

"There is no such thing as a straight woman": Queer female representations in South Asian graphic narratives

This essay provides a brief overview of some recent Indian and Bangladeshi comics and graphic novels, whether print-based or online, which feature queer female characters. The essay contextualizes these texts with respect to the anti-LGBTQ+ legal climate in South Asian countries, but also places them within a larger trajectory of literary representations of queer (female) love in the Indian subcontinent. The texts under examination range from print graphic novels and indie comics anthologies in India to comic strips brought out by queer activists working for LGBTQ+education and advocacy in Bangladesh. Taken together, they offer diverse portrayals of female-centric love and desire that challenge hetero-patriarchal representations of desi women.

A regressive formula of perversity: Wertham and the women of comics

This essay serves as a close reading of psychiatrist Fredric Wertham's 1950s descriptions and critiques of female comics characters. I draw on archival sources as well as relevant texts in the study of gender and sexuality. Additionally, I integrate ideas from two of his close associates, folklorist Gershon Legman and psychiatrist Hilde Mosse, whose contributions to Seduction of the Innocent are woven-often invisibly-throughout that text. The character of Wonder Woman serves as a touchstone, but other provocative female figures that Wertham found objectionable in mid-twentieth-century comics accompany her. My goal is to illuminate Wertham's understanding of what he viewed as the "regressive formula of perversity" enacted through women's representations in comics, particularly those female characters who played active roles. Although not all of these concerns are tied to lesbian identity, they do all touch on broader notions of queerness vis-à-vis deviant sexual and gender expression.

Divide and conquer: improving parental understanding of health-related instructions using sequential pictorial instructions

Patient misunderstandings of healthcare-related instructions result in significant health, social and economic consequences. Pushing the boundaries of traditional academic methods may offer strategies that promote new ways to improve communication and understanding between healthcare providers, caregivers and patients. Comics can be an educational tool, offering an innovative strategy to communicate health-related information. Our study objective was to compare parents' understanding of health-related instructions (i.e. prescription labels, medical instructions and emergency situation scenarios) that were presented using two different formats-sequential pictorial instructions (SPIs) versus written text instructions (WRIs).This was a cross-sectional study to compare parents' understanding of health-related instructions for pediatric patients using structured SPIs versus WRIs. Parents (n = 359, 18-82 years old) of pediatric patients were given a card with instructions that were presented as SPIs (n = 195, 54.3%) or WRIs (n = 164, 45.7%), and then they completed a questionnaire. Total (14 questions) and grouped scores (10 questions) for parental comprehension of prescription and medical emergency instructions were significantly higher among participants viewing the SPIs than those viewing the WRIs in both English and Spanish. The mean understanding of instructions significantly increased from 6% to 12.2% when comparing the WRI versus the SPI.Our initial findings indicate that parents and caregivers of pediatric patients had significantly better understanding and recall of instructions delivered using SPIs than using WRIs.

Developing a Motion Comic for HIV/STD Prevention for Young People Ages 15-24, Part 2: Evaluation of a Pilot Intervention

In the United States, young people (ages 15-24 years) are disproportionately affected by human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), due at least in part to inadequate or incorrect HIV/STD-related knowledge, attitudes, beliefs, and behavioral intentions (KABI). Comic book narratives are a proven method of HIV/STD prevention communication to strengthen KABI for HIV/STD prevention. Motion comics, a new type of comic media, are an engaging and low-cost means of narrative storytelling. The objective of this study was to quantitatively evaluate the effectiveness of a pilot six-episode HIV/STD-focused motion comic series to improve HIV/STD-related KABI among young people. We assessed change in HIV/STD knowledge, HIV stigma, condom attitudes, HIV/STD testing attitudes, and behavioral intentions among 138 participants in 15 focus groups immediately before and after viewing the motion comic series. We used paired t-tests and indicators of overall improvement to assess differences between surveys. We found a significant decrease in HIV stigma (p < .001) and increases in both HIV knowledge (p = .002) and behavioral intentions to engage in safe sex (p < .001). In summary, this motion comic intervention improved HIV/STD-related KABI of young adult viewers by reducing HIV stigma and increasing behavioral intentions to engage in safer sex. Our results demonstrate the promise of this novel intervention and support its use to deliver health messages to young people.

Developing a Motion Comic for HIV/STD Prevention for Young People Ages 15-24, Part 1: Listening to Your Target Audience

Young people (15-24 years) in the United States are disproportionately affected by infection with human immunodeficiency virus (HIV) and sexually transmitted diseases (STD). Shortfalls in HIV/STD-related knowledge, attitudes, beliefs, and behavioral intentions (KABI) likely contribute to this discrepancy. In this report we describe our experience developing a novel means of health communication combining entertainment-education theory and recent technological advances to create a HIV/STD-focused "motion comic." We also report the audience satisfaction and acceptance of the intervention. We used the Health Belief Model (HBM), entertainment-education (EE) principles, and the Sabido Method (SM) and conducted three rounds of focus groups to develop a 38-minute HIV/STD focused motion comic for young people between the ages 15 and 24 years. Participants indicated that motion comics were an acceptable method of delivering HIV/STD prevention messages. They also expressed satisfaction with motion comics plot, story settings, the tone of humor, and drama. Our results suggest that motion comics are a viable new method of delivering health communication messages about HIV/STD and other public health issues, and warrant further development and broader evaluation.

How Should We Judge the Ethics of Illustrations in Graphic Medicine Novels?

This essay argues that we should judge the illustrations in a graphic novel (often a memoir) in the context of the entire work. Judging a work on its emotive effects and the values it expresses, we can consider the ways a graphic novel represents the experience of illness, disability, or injury.

How Should a Stigmatized Diagnosis Be Conveyed? How What Went Wrong Is Represented in Swallow Me Whole

This essay considers the ethical problems raised by a scene of diagnosis presentation in Nate Powell's graphic novel Swallow Me Whole, in which the patient is not only not engaged by the physician, but also effectively marginalized from the moment that her condition is named and medicalized. Put in the context of the book as a whole and in relationship to the unique affordances of the comics form, however, we see that though the physician made a correct diagnosis, the case did not end well due to the poor delivery of that diagnosis and the lack of support from members of the patient's extended community.

Not Playing Around: Games in Graphic Illness Narratives

Why do recent graphic narratives about illness play with metaphors of merry-go-rounds, board games, and games of pretend and performance to explain the experience of being ill? Play and game typically associate with nostalgia, with pleasure, and with a sense of freedom, none of which come to mind as viable images to discuss a struggle with difficult physical and mental illnesses. Acclaimed graphic narratives including Miriam Engelberg's Cancer Made Me a Shallower Person (2006), Daryl Cunningham's Psychiatric Tales (2011), Ellen Forney's Marbles (2012), Marisa Acocella Marchetto's Cancer Vixen (2006), and Brian Fies's Mom's Cancer (2006) use the rich narrative ambiguities of game situations to work against the grain, correlating the gap between "player" and "played" with the gap between an active, organically healthy self and a self being unmade by illness.

Losing Thomas & Ella: A Father's Story (A Research Comic)

"Losing Thomas & Ella" presents a research comic about one father's perinatal loss of twins. The comic recounts Paul's experience of the hospital and the babies' deaths, and it details the complex grieving process afterward, including themes of anger, distance, relationship stress, self-blame, religious challenges, and resignation. A methodological appendix explains the process of constructing the comic and provides a rationale for the use of comics-based research for illness, death, and grief among practitioners, policy makers, and the bereaved.

Stories in the Data

To some degree, comics have always been used to convert data into stories, from ancient Egyptian heiroglyphics to crude biology diagrams in grade-school textbooks. By their very nature, comics communicate through a variety of visualization techniques. Benjamin Bach, who along with his coauthors Nathalie Henry Riche, Sheelagh Carpendale, and Hanspeter Pfister created this issue's Art on Graphics special contribution about the emerging genre of data comics, here talks about their attempts to leverage the massive untapped potential for data-driven comics to explain multiple threads of simultaneous data.

The Emerging Genre of Data Comics

As we increasingly rely on data to understand our world, and as problems require global solutions, we need to effectively communicate that data to help people make informed decisions. The special Art on Graphics article explores the potential of data comics and their unique ability to communicate both data and context via compelling visual storytelling.

Lessons from Helen Keller: How to Make the Comics Accessible?

This paper addresses the lack of accessibility of the comics for deaf or hard-of-hearing readers. Comics are a major cultural object, used in many different contexts with, as much as different purposes (leisure, education, advertising, etc.). We report here the results of an experimentation during a communication operation, including a regular exhibition made of panels and a digital mirroring of the contents, with extra materials and information. This digital part, accessible through our institution website, is the basement of this paper.

[Head injuries in Duckburg in 1959 and 2009]

Comic books have been a part of popular culture through generations. Debates concerning their graphic depictions of violence have been ongoing for nearly as long. Our aim was to examine if the violence in "Donald Duck & Co." (a weekly published Danish comic book), illustrated through the number of head injuries, increased in the period from 1959 to 2009. The comic book vintages from the years 1959 and 2009 were read, and the number of head injuries noted. The head injuries were characterized by severity, in part by a modified Glasgow Coma Scale and in part by a newly developed Comic Book Coma Scale. The number of head injuries were equal in the examined years, however, the number of head injuries per page decreased from 1/10 pages to 1/20 pages. Donald Duck sustained a better part of the injuries increasing from 17% in 1959 to 33% in 2009. The study indicates that we, with peace of mind, can read a comic book while the rest of the family takes care of the dishes at Christmas.