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Background: There is no term for bloating in Spanish and distension is a very technical word. "Inflammation"/"swelling" are the most frequently used expressions for bloating/distension in Mexico, and pictograms are more effective than verbal descriptors (VDs) for bloating/distension in general GI and Rome III-IBS patients. However, their effectiveness in the general population and in subjects with Rome IV-DGBI is unknown. We analyzed the use of pictograms for assessing bloating/distension in the general population in Mexico., Methods: The Rome Foundation Global Epidemiology Study (RFGES) in Mexico (n = 2001) included questions about the presence of VDs "inflammation"/"swelling" and abdominal distension, their comprehension, and pictograms (normal, bloating, distension, both). We compared the pictograms with the Rome IV question about the frequency of experiencing bloating/distension, and with the VDs., Key Results: "Inflammation"/"swelling" was reported by 51.5% and distension by 23.8% of the entire study population; while 1.2% and 25.3% did not comprehend "Inflammation"/"swelling" or distension, respectively. Subjects without (31.8%) or not comprehending "inflammation"/"swelling"/distension (68.4%) reported bloating/distension by pictograms. Bloating and/or distension by the pictograms were much more frequent in those with DGBI: 38.3% (95%CI: 31.7-44.9) vs. without: 14.5% (12.0-17.0); and in subjects with distension by VDs: 29.4% (25.4-33.3) vs. without: 17.2% (14.9-19.5). Among subjects with bowel disorders, those with IBS reported bloating/distension by pictograms the most (93.8%) and those with functional diarrhea the least (71.4%)., Conclusions & Inferences: Pictograms are more effective than VDs for assessing the presence of bloating/distension in Spanish Mexico. Therefore, they should be used to study these symptoms in epidemiological research., (© 2023 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd.)

Laughter and smiling are significant facial expressions used in human to human communication. We present a computational model for the generation of facial expressions associated with laughter and smiling in order to facilitate the synthesis of such facial expressions in virtual characters. In addition, a new method to reproduce these types of laughter is proposed and validated using databases of generic and specific facial smile expressions. In particular, a proprietary database of laugh and smile expressions is also presented. This database lists the different types of classified and generated laughs presented in this work. The generated expressions are validated through a user study with 71 subjects, which concluded that the virtual character expressions built using the presented model are perceptually acceptable in quality and facial expression fidelity. Finally, for generalization purposes, an additional analysis shows that the results are independent of the type of virtual character's appearance., Competing Interests: The authors have declared that no competing interests exist.

Humphrey Bogart's mother (Fig. 1) 1 undoubtedly had a strange sense of humor. How else can one explain Maud Humphrey's bizarre image, on a stock trade card, of a lovely little lass dressed up in her Sunday best lighting the flame under a chafing dish containing two adorable kittens (Figs. 2-5)? Were kitten fondue or kitty feline stew, dishes du jour in Victorian times? Pictured here are three Victorian trade cards, related to dentistry, featuring Maud Humphrey's adorable little kitten chef. Dr. Eli H. Neiman of York, Pennsylvania, and Dr. Charles S. Decker of Binghamton, New York, chose this stock image to advertise their respective dental practices (Figs. 3 & 4), Ramon's Relief pain medication, including toothache relief, and RAMON'S LIVER PILLS AND TONIC PELLETS were available from W.E. JUDAY in West Manchester, Ohio (Figure 4). Note on the reverse of the Dr. Decker card, that for 50 cents "Vitalized Air for Painless Extracting" was offered. "Vitalized Air" was nitrous oxide altered with small amounts of chloroform and alcohol. 2-4 Could it be that Maud had sniffed a bit of Vitalized Air before rendering her shocking kitty-cooking image?, (Copyright 2021 © American Academy of the History of Dentistry.)

While studies have shown the importance of pictorial health warnings (PHW) as a tobacco control strategy, empirical evidence on the efficacy of PHW in prompting smoking behavior remains inconclusive. The study aimed to examine the association between PHW and cognitive reactions, emotional/affective reactions, and smoking behavior. We conducted a mixed-methods study, which included a cross-sectional face-to-face survey of 401 smokers in four cities (Jakarta, Bandung, Semarang, and Yogyakarta) and three focus group discussions among 24 participants in Jakarta. We applied multiple logit regression in STATA for quantitative data analysis and explanatory sequential design for qualitative data analysis. Quantitatively, we found high (63-84% of respondents) understanding about PHW objectives (cognitive reactions), including to remind health risks and encourage smoking cessation. With only 40% PHW, we found relatively low (32%-39%) negative emotional reactions, including feeling scared, annoyed and disgusted and relatively low proportions (33-40%) of respondents that reported quit attempt. Consistent with the quantitative findings, qualitative data provided contexts, including in explaining that the professional worker group was the least affected by PHW, while the student and non-professional groups were the most vulnerable. All this is supportive of governments in Indonesia and other countries to increase the PHW size., .

Objective: We developed and validated a drawing test version of the Pictorial Representation of Illness and Self Measure (PRISM), a visual method to assess the perceived burden of illness and illness perception. Our aim was to test whether the drawing version would allow patients more freedom to deliberately vary both the size and position of circles symbolizing illness and individual coping resources, as well as gain more information about illness representations and available resources. Design and Main Outcome Measures: We applied the PRISM-D test to 500 patients with severe somatic diseases under active hospital treatment. We used Spielberger's State and Trait Anxiety Inventory and Beck's Depression Inventory to assess convergent validity. Results: The PRISM-D test is applicable for inpatients and it can be used to explore their subjective representations. The modifications did not cause any loss in convergent validity as the Self-Illness Separation and the Illness Perception Measure are significantly correlated with levels of depression and anxiety. Conclusion: The drawing test enables more detailed measurement of suffering caused by illness, illness perception and more complex assessment of important factors in a patient's life. The test is adequate for clinical use as well as research among a wide range of somatic inpatients.

This painting memorializes the lives of people who died in the COVID-19 pandemic and people who have died from police brutality., (© 2020 American Medical Association. All Rights Reserved.)

Objective: This case series describes tobacco industry tactics and strategies used to interfere, derail, delay, and weaken the development of effective health warning regulations in Malaysia, Cambodia, the Philippines, and Hong Kong., Methods: A historical review of official reports, news articles, and gray literature was undertaken to identify tobacco industry tactics and strategies to hamper government efforts in implementing stronger pictorial health warning regulations in four Asian jurisdictions (Cambodia, Hong Kong, Malaysia, and the Philippines)., Results: Nineteen countries/jurisdictions in the WHO Western Pacific region currently require pictorial health warnings on cigarette packs, including some of the world's largest, in line with the WHO Framework Convention on Tobacco Control Article 11 Guidelines. In the four jurisdictions examined, tobacco industry interference consisted of lobbying and misinformation of high-level government officers and policy-makers, distributing industry-friendly legislative drafts, taking government to court, challenging government timelines for law implementation, and mobilizing third parties. Strong political leadership and strategic advocacy enabled governments to successfully overcome this industry interference., Conclusion: The tobacco industry uses similar tactics in different jurisdictions to derail, delay, and weaken the implementation of effective health warning policies. Identifying and learning from international experiences can help anticipate and defeat such challenges.

Background: It is only recently that written sources of local knowledge on plants are not being ignored by scholars as not belonging to "traditional" knowledge. Ethnobotanical texts, however, if they at all focus on knowledge from written sources, hardly ever pay any attention to the actual processes of interaction with written texts and illustrations. During our research, we examined people's interactions with texts, illustrations, and herbarium specimens of plants they collect or are familiar with. We focused on a small community of Shiri people in the mountainous village and in the lowland settlements in the Republic of Daghestan, Russia. In the paper, we address the following questions: how do Shiri people interact with illustrations, written text, and herbaria specimens? How is this interaction influenced by the practice of plant collection? What are the methodological implications of the ways people interact with illustrations, texts, and herbaria specimens?, Methods: Our research was based on long-term ethnographic fieldwork: co-designing of a booklet showing edible plants people collect in Shiri, semi-structured interviews, and video-recordings, and observing interactions between people and text/illustrations/voucher specimens., Results: We identified three kinds of interactions between individuals and text/illustrations: "text-wayfaring"-predominantly a bodily interaction between an individual and illustrations and text; "fact/spelling checking"-predominantly discursive and information focused; "between wayfaring and fact-checking"-the mix of the two. Using the idea of textual poaching, as well as the knowledge-making approach, we show that the mode of interaction with text/illustrations influences what is acquired, and how. This process influences readers' LEK. The mere presence of an information in the text available to people does not imply that they will acquire it, make use of it, and change their LEK. Photographs and pressed specimens of locally known plants are often not (or only partly) recognized by the interlocutors. Video-recording is essential for analyzing the above mentioned interactions., Conclusions: In ethnobotanical research, it is important to pay more attention to people's interaction with their sources of knowledge, including text and illustrations. The discursive part of LEK is more easily influenced by written sources. The practice of plant collection is not as easily influenced. Ethnobotanists function in a particular context and are embedded in discourses oriented towards conservation of bio-cultural diversity that value heritage as such, so it is important to be aware of one's positionality. A methodology that relies on showing pressed specimens or photographs to interlocutors may be a very misleading way of collecting ethnobotanical data.

The current study examined the relationships of typically developing (TD) children with siblings with and without intellectual disabilities (ID), as expressed in TD children's drawings and questionnaires answered by TD children and their mothers. It also examined group differences in the sibling relationships, as well as the associations between having a sibling with or without ID and sibling relationships, and TD children's social-emotional adjustment. Participants were mothers and their TD children (8-13 years). Some had ID siblings ID (N=28); others had TD siblings (N=31). Sibling relationships were examined via mothers' and target children's completion of questionnaires, and objective visual indicators (location, size, distance) and observed content-based indicators (support, investment, presence of parents) of children's drawings were assessed following the art-based phenomenological analytic approach. Mothers reported on children's social-emotional adjustment. Findings indicated differences in sibling relationships, including higher levels of positive relationships for children with ID siblings. Children's drawings also showed positive relationship aspects for these children. Sibling relationship qualities were significantly associated with children's adjustment. Children's drawings may be a useful data gathering tool to deepen our understanding of unique aspects of sibling relationships., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: This study aimed to determine the usefulness and effects of a pictogram for alerting patients about drugs that affect driving in order to prevent traffic injury and maintain good adherence. Method: The participants comprised 600 men and 600 women aged 20-79 (49.58 ± 16.21) years, registered with an Internet research company. All were licensed to drive a car and were taking prescribed medication. The outcome measures were: 1) awareness of existing pictogram, 2) perceived driving risk after viewing the pictogram, 3) usefulness of the pictogram, and 4) medication-taking and driving behavior after viewing the pictogram. Results: Few respondents (5.4%) were aware of the Japanese pictogram issued by the Council for Appropriate Drug Use. Participants evaluated their driving risk as moderate-to-high (3.51 ± 0.69) after viewing the pictogram, and risk perception was higher among respondents in their 50 s and 60 s than among those in their 20 s. Across all respondents, the pictogram was rated as follows (on a 5-point Likert scale): effective for warning, 3.79 ± 0.90; informative, 3.75 ± 0.84; understandable meaning (comprehensibility), 3.90 ± 0.96; simplicity, 3.71 ± 0.95; and eye-catching, 3.60 ± 0.98. We defined the following as positive behavior: taking medication according to the instructions of a medical professional (good compliance), stopping driving, and consulting medical professionals. The positive behavior rate was 63.2%. Being shown the pictogram might lead to more positive medication-taking and driving behavior among respondents who are female and have lower driving frequency, higher levels of risk perception, and higher evaluation of the pictogram compared to their counterparts. Conclusion: A pictogram is a potentially useful and effective tool for communicating risk and supporting decision-making by supplying drivers with tailored information. However, we assume that some people who drive frequently must drive for work, go to the hospital, etc. It is essential, in these cases, for medical professionals to be more deeply involved with the patients and to maintain lines of communication by listening to patients' descriptions of their everyday life. By adding these pictograms to the labeling of potentially driver-impairing medications (such as by putting them on the outer packaging, package inserts, and inner medicine containers), it is expected that they can better inform users regarding safe behavior and promote medication adherence.

Spatial biases in graphomotor production tasks such as figure drawing may reflect biological (cerebral lateralization), biomechanical (limb movement), and/or cultural (reading/writing direction) influences. The present study examined sources of bias in the placement in graphic space of a symmetrical drawn figure (a tree). A previous study using a child sample found an overall leftward placement bias, independent of participants' reading/writing direction experience [Picard & Zarhbouch, 2014. Leftward spatial bias in children's drawing placement: Hemispheric activation versus directional hypotheses. Laterality: Asymmetries of Body, Brain and Cognition , 19 (1), 96-112]; moreover, the left-side bias was greater in right handers. Using an adult sample, the present study also found an overall left placement bias. This effect was significantly greater in right-handed than left-handed participants. Importantly, a left placement bias was significantly greater in left-to-right readers (English) than in participants whose first learned language was from right-to-left (Urdu, Arabic or Farsi). The fact that script directionality is associated with figure placement in our study but not in the previous study suggests that a certain threshold of experience in reading/writing in a given direction may be needed for scanning biases to exert a demonstrable effect on representational drawing. These findings suggest that biomechanical and cultural factors offer a more parsimonious account of spatial biases in drawing.

The medical community and broader public have historically focused on heart disease as a concern for men, even though it has been the leading cause of death in women for decades. Through an analysis of medical publications, women's health literature, and mainstream media, this article traces the interactions of gender and age on perceptions of heart disease during the twentieth century. I argue that attention to middle-age mortality rates accentuated men's susceptibility to heart disease over women's, even as these differences diminished at older ages, when the majority of deaths occurred. Age and gender biases combined to frame heart disease as a man's disease on one hand, while the women's health movement marginalized older women's health on the other. It was not until the following decades that older women began to attract clinical concern and greater public attention, which ultimately expanded narrow frameworks of both heart disease and women's health.

Background: Several Asian countries have implemented pictorial health warnings on cigarette packs as suggested by the World Health Organization with various policies based on countries' systems. The study is aimed to analyse multiple research studies on the perceived effectiveness of Pictorial Health Warnings as a deterrent to smoking intention and as a stimulant of smoking behaviour in smokers and non-smokers in Asian countries., Method: Peer-reviewed articles were identified through multiple science databases indexed by Scopus, MEDLINE or PubMed. The review was limited to articles that reported original research findings, were conducted in Asian countries and were available for review by January 2010. A PRISMA Flow diagram was used to identify the articles through the process of data screening and extractions., Result: A total of 14 original articles which met the criteria were included in the review, consisting of 12 quantitative studies and 2 studies with both quantitative and qualitative methods from 17 jurisdictions. The reviewed studies found that pictorial health warnings were associated with a greater perception of salience (reading and noticing the warning), emotional effects, and cognitive increase. Additionally, in the reviewed studies, pictorial health warnings were perceived as more effective in deterring smoking initiation and encouraging smoking cessation than text-only warnings. Several studies also evaluated the effectiveness of a new pictorial warning compared with the old one. However, the relevance of refreshing the pictures of pictorial health warnings and the length of the effective period of the implementation of pictorial health warnings were less frequently studied., Conclusion: Pictorial health warnings perceived as more effective in deterring smoking initiation among non-smokers and as well as in stimulating smoking cessation among smokers. Future studies on pictorial health warnings should study the relevance of changing or refreshing pictorial health warning on cigarette packages in a period of time.

Contemporary semiotic cultural tradition in psychology views human meaning making as unfolding through the negotiation of multiple real and imagined scenarios and storylines. While emphasising this complex and layered nature of meaning making, this research tradition offers little methodological guidance for appreciating and evidencing this multiplicity in data analysis and interpretation. This paper suggests that a methodological approach that combines visual and verbal ways of representing one's personal stories might offer a useful alternative for evidencing the multiple meanings that individuals create about their personal journeys. By presenting two examples of drawn timeline images and corresponding interview extracts, the paper discusses how the chosen methodological approach offered opportunities for participants to 'show and tell' their complex and layered stories, and gave them freedom and agency to shape the research encounter and data production processes. The paper also highlights how the incorporation of visual methods into the methodology enabled the researcher to find alternative ways of interpreting participants' stories. The paper argues for a purposeful integration of visual and verbal methods, where the semiotic tensions and clashes between these modes can reveal novel ways of seeing researchers' and participants' meanings in the making.

Introduction: While many countries have adopted prominent pictorial warning labels (PWLs) for cigarette packs, the USA still requires only small, text-only labels located on one side of the cigarette pack that have little effect on smoking-related outcomes. Tobacco industry litigation blocked implementation of a 2011 Food and Drug Administration's (FDA) rule requiring large PWLs. To inform FDA action on PWLs, this study provides research-based estimates of their public health impacts., Methods: Literature was reviewed to identify the impact of cigarette PWLs on smoking prevalence, cessation and initiation. Based on this analysis, the SimSmoke model was used to estimate the effect of requiring PWLs in the USA on smoking prevalence and, using standard attribution methods, on smoking-attributable deaths (SADs) and key maternal and child health outcomes., Results: Available research consistently shows a direct association between PWLs and increased cessation and reduced smoking initiation and prevalence. The SimSmoke model projects that PWLs would reduce smoking prevalence by 5% (2.5%-9%) relative to the status quo over the short term and by 10% (4%-19%) over the long term. Over the next 50 years, PWLs are projected to avert 652 800 (327 000-1 190 500) SADs, 46 600 (17 500-92 300) low-birth-weight cases, 73 600 (27 800-145 100) preterm births and 1000 (400-2000) cases of sudden infant death syndrome., Conclusions: Requiring PWLs on all US cigarette packs would be appropriate for the protection of the public health, because it would substantially reduce smoking prevalence and thereby reduce SADs and the morbidity and medical costs associated with adverse smoking-attributable birth outcomes., Competing Interests: Competing interests: DH and JFT have served as a paid expert witnesses on behalf of governments in tobacco litigation, including challenges to health warning regulations., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

The purpose of this study is to compare similarities and differences in the attitudes toward aging among college students from Taiwan and the United States; 128 Taiwanese students and 124 U.S. students participated in this study. The findings indicate that the majority of students from both countries viewed aging as consisting primarily of physical changes. The differences are the U.S. students' drawings showing physical decline along with hospitals, nursing homes, or death, whereas Taiwanese students presenting physical decline as getting wrinkles, wearing glasses, or needing aid devices. U.S. students associated aging with grandparents-grandchildren relationships, whereas more Taiwanese students thought aging related to spousal relationships. This study adds to the existing literature that demonstrates the strong influence of different cultures on students' attitudes toward aging. Further, knowledge derived from this study can be used in gerontology courses for both students and professors to lessen or correct ageist stereotypes over time.

Purpose: The purpose of this study was to develop web-based, pictograph-formatted discharge instructions and evaluate the website with intended users to maximize the relevance and clarity of the website., Design: A descriptive study., Methods: Low-literacy text and 45 sets of pictographs were implemented in web-based instructions. The content, design, function, and navigation of the website were reviewed by 15 low-literate older adults following hip replacement surgery., Findings: Participants observed that the simple line drawings with clear background were well suited to web pages and helped to convey the points made. They also suggested changes such as adding an additional alphabetical index menu to enhance easy navigation and removing hypertext links to avoid distraction., Conclusions: Web-based, pictograph-formatted discharge instructions were well received by low-literate older adults, who perceived the website easy to use and understand., Clinical Relevance: A pictograph-formatted approach may provide effective strategies to promote understanding of lengthy, complex action-based discharge instructions in rehabilitation facilities.

We describe an integrated and straightforward new analytical protocol that identifies plant gums from various sample sources including cultural heritage. Our approach is based on the identification of saccharidic fingerprints using mass spectrometry following controlled enzymatic hydrolysis. We developed an enzyme cocktail suitable for plant gums of unknown composition. Distinctive MS profiles of gums such as arabic, cherry and locust-bean gums were successfully identified. A wide range of oligosaccharidic combinations of pentose, hexose, deoxyhexose and hexuronic acid were accurately identified in gum arabic whereas cherry and locust bean gums showed respectively Pent x Hex y and Hex n profiles. Optimized for low sample quantities, the analytical protocol was successfully applied to contemporary and historic samples including 'Colour Box Charles Roberson &Co' dating 1870s and drawings from the American painter Arthur Dove (1880-1946). This is the first time that a gum is accurately identified in a cultural heritage sample using structural information. Furthermore, this methodology is applicable to other domains (food, cosmetic, pharmaceutical, biomedical).

The Autobiographical Memory Test (AMT) is the most commonly used tool to assess the phenomenon of overgeneral memory. The AMT has mainly been used in adult populations, but its use in preschool children is less common. The need to create an appropriate instrument to study the memory specificity in preschool years led us to develop an AMT version adapted for early childhood. The AMT-Preschool (AMT-P) was administered to a sample of preschool children aged between 3 and 6 (N = 364). The results suggest that the AMT-P functions differently in preschoolers depending on age. With children older than 53 months, results suggest that the AMT-P is appropriate for assessing overgenerality. Nevertheless, with younger children age, the task is more difficult. These results concur with previous research suggesting that the ability to recall specific memories is consolidated from the age of 4½., (© The Author(s) 2015.)

Sketching is considered by artists and designers to be a vital tool in the creative process. However, research shows that externalisation during the creative process (i.e., sketching) is not necessary to create effectively. This study examines whether sketching may play a more important role in the subjective experience of creativity by facilitating the deeply focused, optimal state of consciousness termed 'flow' (being 'in the zone'). The study additionally explored whether sketching affects flow by easing cognitive load or by providing a clearer sense of self-feedback. Participants carried out the creative mental synthesis task (combining sets of simple shapes into creative drawings), experimentally simulating the visual creative process. Ideas were generated either mentally before committing to a final drawing, or with external perceptual support through sketching, and cognitive load was varied by using either three- or five-shape sets. The sketching condition resulted in greater experience of flow and lower perceived task difficulty. However, cognitive load did not affect flow and there was no interaction between load and sketching conditions. These findings are the first to empirically demonstrate that sketching increases flow experience, and that this is not dependent on an associated reduction in overall working memory load., (Copyright © 2016 Elsevier Inc. All rights reserved.)