Design and development of a new pictorial tool to facilitate communication around advance care planning.

BACKGROUND: Advance care planning (ACP) aims to ensure that people with chronic or advanced disease receive medical care that is consistent with their values and preferences. However, professionals may find it challenging to engage these patients in conversations about the end of life. We sought to develop a pictorial tool to facilitate communication around ACP. METHODS: This was a three-phase study. In phase 1, we used the nominal group and Delphi techniques to achieve expert consensus regarding the conceptual content of the tool. In phase 2, a professional cartoonist was commissioned to create a series of cartoons representing each of the content areas resulting from the Delphi process. The pictorial tool was then administered (phase 3) with a sample of individuals with advanced/chronic disease to explore whether the cartoons were easy to understand and conveyed the intended message. RESULTS: Following a three-round Delphi process, consensus was reached regarding a set of 12 key content areas that should be considered in the context of an ACP interview. The cartoons created to represent each of the 12 areas were then reviewed and ordered so as to reflect the typical stages of an end-of-life care interview. After administering the pictorial tool with 24 frail older adults with advanced/chronic disease, changes were made to 9 of the 12 cartoons. CONCLUSIONS: The new pictorial tool comprises a set of 12 cartoons that can guide professionals as they seek to engage frail older adults with advanced/chronic disease in conversations about the end of life and ACP.

Impaired inhibitory control when processing real but not cartoon emotional faces in autistic children: Evidence from an event-related potential study.

Impaired socioemotional functioning characterizes autistic children, but does weak inhibition control underlie their socioemotional difficulty? This study addressed this question by examining whether and, if so, how inhibition control is affected by face realism and emotional valence in school-age autistic and neurotypical children. Fifty-two autistic and 52 age-matched neurotypical controls aged 10-12 years completed real and cartoon emotional face Go/Nogo tasks while event-related potentials (ERPs) were recorded. The analyses of inhibition-emotion components (i.e., N2, P3, and LPP) and a face-specific N170 revealed that autistic children elicited greater N2 while inhibiting Nogo trials and greater P3/LPP and late LPP for real but not cartoon emotional faces. Moreover, autistic children exhibited a reduced N170 to real face emotions only. Furthermore, correlation results showed that better behavioral inhibition and emotion recognition in autistic children were associated with a reduced N170. These findings suggest that neural mechanisms of inhibitory control in autistic children are less efficient and more disrupted during real face processing, which may affect their age-appropriate socio-emotional development.

Valoración de la formación de niños en reanimación cardiopulmonar mediante cuentos y dibujos animados / Impact of training schoolchildren how to perform cardiopulmonary resuscitation using stories and animated cartoons

Fundamento. El objetivo de este estudioes compararlos resulta-dos obtenidos en escolares formados en RCP por progenitores en el ambiente familiar y por profesores en el ambiente educativo. Método. Estudio aleatorizado del aprendizaje de RCP en escolares de Educación Primaria (1º y 2º curso) de la Región de Murcia. Los progenitores (grupo familia, GF) y profesores (grupo maestros, GM) han participado como formadores a través de un material di-dáctico adaptado para escolares (un cuento y un vídeo de dibujos animados) de la serie educativa Jacinto y sus Amigos©. Se evaluaron ocho conocimientos y cinco habilidades prácticas.Resultados. Se seleccionaron 160 escolares y terminaron el estudio 116; el GF presentó 51,3% de pérdidas. Los escolares formados por el GM obtuvieron puntuaciones medianas significativamente ma-yores tanto en conocimiento teórico (6,7; RIC=1,8 vs 4,7; RIC=3,1; p<0,001) como en todas las habilidades prácticas a excepción de reconocer un situación de emergencia. En el GF, la enseñanza sobre RCP con un cuento y un vídeo de dibujos animados logró puntua-ciones significativamente mejores en cinco conocimientos y en cuatro habilidades que con solo un cuento.Conclusiones. La implementación de recursos educativos no tec-nológicos, cómo cuentos y dibujos animados, en la enseñanza de la RCP en escolares de primaria aumenta los conocimientos y habili-dades. Los escolares formados por los maestros en el ámbito edu-cativo han aprendido significativamente más que los formados por la familia y, dentro del ámbito familiar, la enseñanza sobre RCP fue más eficaz mediante un cuento y un vídeo de dibujos animados que cuando simplemente disponen del cuento (AU)

Background. We compared the outcome of training schoolchil-dren how to perform CPR by parents/legal guardians in the family environment versus by teachers at school.Methods. Randomized study of CPR learning in primary school children (1st and 2nd grades) in the Region of Murcia. Parents/legal guardians (family group) and teachers (teacher group) trained the children using didactic material adapted for that age population (one story and one cartoon video) from the educational series Jacinto y sus Amigos©. We evaluated eight theoretical knowledge questions and five practical skills.Results. One hundred and sixty schoolchildren were selected and 116 completed the study; in the family group, 51.3% did not fin-ish the study. Children trained by teachers obtained significantly higher median scores in comparison with the family group both in theoretical knowledge (6.7; IQR=1.8 vs 4.7; IQR=3.1, respective-ly; p < 0.001) and in all practical skills except for “recognizing an emergency situation”. Children in the family group, learning CPR with one story and one cartoon video achieved significantly better scores in five theoretical knowledge questions and four skills than with only the story.Conclusions. Using non-technological educational resources, e.g., stories and animated cartoons for teaching CPR to primary school students, increases their knowledge and skills. Schoolchildren trained in the educational environment acquired more knowledge and skills than those trained by parents. Within the family environ-ment, CPR teaching was more effective through one story and one cartoon video than when only the story was used (AU)

Effects of a Free Electronic Book on Systemic Anatomy with Schematics on Student Learning / Efectos de un Libro Electrónico Gratuito sobre Anatomía Sistémica con Esquemas sobre el Aprendizaje de los Estudiantes

SUMMARY: For students in schools of nursing, health sciences, and premed, a systemic anatomy textbook with minimized contents, schematics, and mnemonics may be helpful for learning an otherwise often unappealing subject. In this study, we assess the educational effect of such a textbook. Schematic drawings, anatomy comics, and easily readable text were generated for the chapters of the book (e.g., skeletal system, articular system). The book was presented without charge via a webpage (anatomy.co.kr). Nursing students who were exposed to the book and those who were not exposed were compared; a survey was administered to those who were exposed. The students who read the presented textbook were more knowledgeable than those who used other textbooks. Hours spent reading the presented textbook and scores of fill-in-the-blank questions were positively correlated. In general, the students replied that the presented textbook was helpful for learning systemic anatomy. The systemic anatomy textbook accompanies preexisting textbooks in regional anatomy, neuroanatomy, and the histology, all of which are written by the same authors. We suggest anatomy instructors generate their own books with unique style to enrich the student learning process.

Para los estudiantes de las escuelas de enfermería, ciencias de la salud y premedicina, un libro de texto de anatomía sistémica con contenidos, esquemas y mnemónicos minimizados puede ser útil para aprender un tema que de otro modo sería poco atractivo. En este estudio, evaluamos el efecto educativo de dicho libro de texto. Se generaron dibujos esquemáticos, cómics de anatomía y texto de fácil lectura para los capítulos del libro (por ejemplo, sistema esquelético, sistema articular). El libro se presentó sin costo a través de una página web (anatomy.co.kr). Se compararon los estudiantes de enfermería que estuvieron expuestos al libro y los que no estuvieron expuestos. Se administró una encuesta a quienes estuvieron expuestos. Los estudiantes que leyeron el libro de texto presentado tenían más conocimientos que aquellos que usaron otros libros de texto. Las horas dedicadas a leer el libro de texto presentado y las decenas de preguntas para completar espacios en blanco se correlacionaron positivamente. En general, los estudiantes respondieron que el libro de texto presentado fue útil para aprender anatomía sistémica. El libro de texto de anatomía sistémica acompaña a los libros de texto preexistentes de anatomía regional, neuroanatomía e histología, todos escritos por los mismos autores. Sugerimos que los instructores de anatomía generen sus propios libros con un estilo único para enriquecer el proceso de aprendizaje de los estudiantes.

Schoolchildren's motivation for viewing Chinese opera animation according to opera genre.

The emergence of Chinese opera animation allows a wider audience, especially a younger audience, to access and embrace the art of opera heritage. This study used a two-way mixed-design ANOVA to explore the effect of Chinese opera animation on schoolchildren's viewing motivation; the independent variables were the children's grade level and the opera genre of the animation. Grade level was divided into three groups: lower, middle, and upper (grades 2, 4, and 6, respectively). Opera genre consisted of Peking, Yue, and Henan opera. The dependent variable, viewing motivation, comprised six dimensions: entertainment and relaxation, learning knowledge, escapist pastime, aesthetic appreciation, empathic identification, and socializing and sharing. After statistically analyzing the evaluations of 457 participants, the results showed the following: (1) Peking and Yue opera animation had a better entertainment and relaxation effect on the lower and middle groups. Henan opera had a better escapist pastime effect on the upper group but less effect on the lower group. (2) In terms of learning knowledge, empathic identification, aesthetic appreciation, and overall performance, Yue and Henan opera animations were more effective for enhancing viewing motivation compared with Peking opera animation. (3) The middle and lower groups showed higher viewing motivation than the upper group in the learning knowledge, empathic identification, and socializing and sharing dimensions. Overall, grades 2 and 4 were appropriate stages for schoolchildren to engage with opera animation. Our findings can provide a reference for promoting cultural heritage sustainability and support follow-up research on integrating opera animation into children's education.

What's Up With Everyone? A qualitative study on young people's perceptions of cocreated online animations to promote mental health literacy.

INTRODUCTION: Adolescence and young adulthood are especially critical times to learn about mental health, given that 75% of mental health issues are developed by the age of 24. Animations have great potential to effectively deliver mental health information to young people. A series of five short animated films to promote mental health literacy were created with and for young people in partnership with the multi-award-winning independent animation studio, Aardman Animations. The aim of this study was to explore young people's perceptions of the cocreated animated films. METHODS: Seven Youth Juries were conducted to capture young people's opinions and recommendations about the content related to mental health literacy and presentation style of the cocreated animated films. Thematic analysis was used to analyse the audio transcripts. RESULTS: Many participants reported a view that the animated films had the potential to promote mental health literacy, especially for understanding mental health and reducing stigma. Some recommendations were provided to improve the films, such as including subtitles and having a better transition to the companion website. CONCLUSION: Cocreated animations have great potential to promote the mental health literacy of young people. We hope that the findings from the present study will inform future media development to make them as effective as possible. PATIENT OR PUBLIC CONTRIBUTION: Young people were actively involved in the development, production, implementation and evaluation (up to the time before data analysis) of the animated films.

Infants' brain activity to cartoon face using functional near-infrared spectroscopy.

In this study, to investigate whether infants showed face-specific brain activity to a cartoon human face, we conducted a functional near-infrared spectroscopy (fNIRS) experiment and a behavioral experiment. In the fNIRS experiment, we measured the hemodynamic responses of 5- and 6-month-old infants to cartoon female and cartoon character faces using fNIRS. The results showed that the concentration of oxy-Hb increased for cartoon female faces but not for cartoon character faces. This indicates that face-specific brain activity occurred for cartoon female faces but not cartoon character faces, despite the fact that both are faces. In the behavioral experiment, we examined whether the 5- and 6-month-old infants preferred cartoon female faces to cartoon character faces in the upright and inverted conditions. The results showed a preference for cartoon female faces in the upright but not in the inverted condition. This indicates that 5- and 6-month-old infants can perceive cartoon female faces, but not cartoon character faces, as faces. The results of the two experiments indicated that face-specific brain activity occurred for cartoon female faces. This indicates that infants can perceive cartoon female faces as faces.

The use of comics to promote health awareness: A template using nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) constitutes a major threat to public health systems worldwide on account of its widespread prevalence and increasing incidence. More effective tools to raise awareness and increase health communication are therefore needed. Comics may constitute an effective language for this purpose, given the permanence, adaptability and ability of this form of communication to convey complex information, using both visual components and the creation of narrative involvement, thus promoting both awareness and health-conscious behaviours. Importantly, this process requires careful preparation in terms of selecting both the key biomedical concepts to be conveyed, as well as a graphical style and appropriate characters and a narrative arc with which a target audience can identify with. Here we provide a brief introduction to the use of comics in health communication and propose a possible roadmap for the development of comic-based tools for diverse conditions, using the context of NAFLD.

[Development and Evaluation of Prenatal Education for Environmental Health Behavior Using Cartoon Comics].

PURPOSE: This study aimed to develop and examine the effects of a prenatal program on environmental health behavior using cartoon comics among Korean pregnant women. METHODS: This study used a non-equivalent control group pre-test/post-test design. The program used cartoon comics to explore environmental health behaviors during pregnancy. The program consisted of the following four components: environmental toxicants during pregnancy, avoiding particulate matter during pregnancy, environmental toxicants during baby care, and making a healthy environment for children. In total, 35 pregnant women participated in the study: 18 in the experimental group and 17 in the control group. Data collection and program adaptation were conducted between November 3, 2020 and January 19, 2021. The effect of the prenatal education program was evaluated by t-test and repeated measures ANOVA. RESULTS: Learning experience (t = - 2.35, p = .025), feasibility (t = - 2.46, p = .019), satisfaction (t = - 2.23, p = .032) were higher in the experimental group than in the control group in the first post-test. Feasibility (t = - 2.40, p = .022) was higher in the experimental group than in the control group in the second post-test. Repeated-measures ANOVA showed significant interactions between time and group in environmental susceptibility (F = 9.31, p < .001), self-efficacy (F = 3.60, p = .033), and community behavior (F = 5.41, p = .007). CONCLUSION: This study demonstrates the need for a prenatal education program to promote environmental health perceptions and behavior during pregnancy. We suggest a prenatal class adopting the creative cartoon comics to promote the maternal environmental health behaviors.

[Perineal pain in Tintin adventures]. / Les algies périnéo-glutéales traumatiques dans les aventures de Tintin. Ou Tintin au pays des algies périnéales.

AIMS: To analyze the determinants and severity of perineal pain in the adventures of Tintin and Snowy. MATERIAL AND METHODS: All 23 adventures of Tintin and Snowy (Hergé, Moulinsart Ed.) were reviewed in order to determine the presence, causes and severity of perineal pain (PP) observed in the various heroes of this comic book. Several parameters were studied: the cause which could be either accidental or voluntary; the type of patient (good guys-bad guys); the hero concerned (Tintin, Captain Haddock, Thompson and Thomson, Snowy, Professor Calculus …); the duration of the pain (by the number of boxes where the subject was represented suffering from such pains); finally, the severity of these pains, by the number of stars or signs designating the region and stereotyping the importance of the pain. The Student and Chi2 tests were used to analyze these different qualitative and quantitative variables. RESULTS: Five hundred and one traumas were found in the adventures of Tintin and Snowy, including 47 PP, 9.4% of cases compared to 299 head traumas (60% of cases). Six albums out of the 23 did not report any PP. PPs are usually traumatic either by a fall (68%) or by direct trauma (kick to the back 6%, spanking 4%) much more exceptionally by a bite (2 cases), a burn (2 cases), needles or arrows inserted in the bottom (5 cases) and a bullet wound (1 case). Tintin is the most concerned (19%) with Captain Haddock (23%), followed by Snowy (15%). The bad guys and the good guys don't share equally the perineal pain since the good guys are forgivably more exposed (79% vs. 21%). There is no correlation between head trauma and PP (r2=0.117). The severity index for PP is 5.21 with a mean duration of 3.01 vs. 6.88 for severity and 3.2 for duration for head trauma, a highly significant difference in the Student test (P=0.00259). The total number of traumas per album progressively decreases over the albums (r2=0.3111) with, for example, 38 for the first album (Tintin and the Soviets) and 4 for the last one (Tintin and the Picaros). This decrease in trauma is clearer for cephalic trauma (r2=0.1436) than for PP (r2=0.2189). CONCLUSION: The frequency of traumatic PP in Tintin's adventures is important and is second only to head injuries. This frequency of PP traumas is undoubtedly linked to the hectic and adventurous life of Tintin and his acolytes exposed in all circumstances to all kinds of direct or indirect injuries. Future studies will have to specify the risk of after-effects and the psychological impact of PPs on the heroes concerned. LEVEL OF PROOF: 4.

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.

Using a cartoon questionnaire to improve consent process in children: a randomized controlled survey.

OBJECTIVE: The aim of the study was to evaluate the effectiveness of an audio and animated cartoon questionnaire (AACQ) at improving consent process in child for biospecimen donation. METHODS: A multi-center randomized and controlled survey was performed at two pediatric hospitals in China from 2019 to 2020. Children aged from 7 to 18 years in the pediatric surgery wards were invited to investigate the participants' willingness and attitudes for donating biospecimens. A total of 264 children, including 119 in the AACQ group and 145 in the TQ group, and 67 parents of children were analyzed. A separate knowledge test was acquired in the questionnaires. RESULTS: Our findings showed that the response rate of the AACQ group (89.85%) was significantly higher than that of the TQ group (68.44%; p < 0.001). AACQ can improve the child's understanding, increase children's engagement in biospecimen donation, reduced the differences in selected characteristics affecting children understanding, and enhanced their risk awareness of donating biospecimens. We also found that increasing pain and privacy disclosure were the most popular concern among children for the refusal to donate biospecimens. CONCLUSIONS: AACQ is an effective and standardized tool of content delivery to children from the surgical wards. Children who fully understood of biospecimen donation are suggested to participate in the consent signing. IMPACT: Using audio and animated cartoon questionnaire is a more effective and standardized tool of content delivery to children. This study expanded the use of an animated cartoon to a children's survey. Audio and animated cartoon questionnaire (AACQ) can improve the child's understanding, increase children's engagement in biospecimen donation compared to text questionnaire (TQ) group, and enhanced their risk awareness of donating biospecimens. More AACQ should be used with children in the future to effectively deliver content to children and improve children's participation in the survey.

Uso de cómics para la formación médica en contenidos de migraciones internacionales y salud / Use of comics in medical education in international migration and health

INTRODUCCIÓN: El estudio de las migraciones internacionales y sus relaciones con salud-enfermedad-atención en Chile es un foco relevante en la actualidad. El objetivo que se planteó fue analizar cómics efectuados por estudiantes de medicina para conocer los mensajes en ellos sobre salud y migraciones, además de la percepción respecto a su uso educativo. Sujetos y métodos: Estudio cualitativo que considera la descripción y la interpretación de cómics realizados por estudian-tes de medicina de la Universidad de Valparaíso para aprobar un curso de interculturalidad y salud siguiendo los principios de análisis fotográfico. Se evalúa la percepción de su uso para el aprendizaje en la asignatura, obtenido de grupos foca-les, y se realiza posteriormente análisis de contenido. La participación fue anónima y voluntaria. RESULTADOS: Los cómics dan cuenta de una realidad migratoria personificada en población haitiana. La barrera idiomática, el hacinamiento en que viven y las dificultades para encontrar trabajo o atención frente a una enfermedad dentro del sistema de salud son algunas de las características expresadas por los estudiantes. El uso de esta herramienta para la evaluación del curso fue novedoso, aunque encontró resistencia en un inicio. Favorece el trabajo en equipo y la humanización de la medicina. Da cuenta además del aprendizaje de contenidos. CONCLUSIÓN: El uso de cómics en estudiantes de medicina contribuye al aprendizaje de migraciones internacionales y de salud y a la humanización de la medicina

INTRODUCTION: Research on international migration and their relationship with health-disease-care in Chile is currently relevant. This study was aimed to analyze comics made by medical students, in order to know the messages about health and migrations and the perception with respect to their use in education. Subjects and methods: Qualitative study that analyzed comics made by medical students from the University of Valparaíso, as a requisite to pass a course about intercultural health. The principles of photographic analysis were employed to describe and interpret the comics. Focus groups and content analysis were used to identify the perceptions with respect to the use of comics as a learning tool in the course. Participation was voluntary and anonymous. RESULTS: Comics expressed a migrant reality personified in Haitian people. Language barriers, overcrowding, limited access to job and difficulties to obtain health care are characteristics expressed by the students. Although innovative, the use of comics as an assessment tool was initially resisted. It was perceived as promoting teamwork and humanization of medicine. It was also considered that comics could reflect the contents learned. CONCLUSION: The use of comics in medical students contributes to education in international migrations and health and to the humanization of medicine