Search Results (650)

Background: The prevalence of mental disorders, particularly anxiety and depression, has been increasing and is becoming a major public health concern in Portugal. Digital mental health solutions offer scalable and accessible tools for monitoring and managing mental health. ‘P5 Mental Health’ has been created as a platform to assess and monitor symptoms of anxiety and depression in the Portuguese population, and to offer strategies to promote well-being to support users. Objective: This study aims to (1) describe the P5 Mental Health platform, (2) evaluate its feasibility as a digital mental health monitoring tool, and (3) analyze trends in the prevalence and severity of anxiety and depression symptoms over a four-year period, particularly in response to major societal stressors. Methods: Between September 2020 and September 2024, 46,032 responses were collected from platform users. Anxiety and depression symptoms were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales. Longitudinal trends were analyzed across four time periods. Welch’s ANOVA and Games–Howell post hoc tests were conducted to compare symptom severity across time, and ordinal logistic regression was used to examine the impact of time on symptom progression. Results: Anxiety and depression symptoms increased between 2020 and 2022, stabilized thereafter, and showed a slight decline in 2024. The proportion of users reporting moderate to severe anxiety (GAD-7 ≥ 10) rose from 30.87% in September 2020 to 66.30% in June 2022. Similarly, the prevalence of moderate to severe depressive symptoms (PHQ-9 ≥ 10) rose from 3.62% in March 2021 to 51.54% in August 2021. Despite a small decrease in 2024, symptom levels remained significantly higher than baseline levels recorded at the beginning (p < 0.001). A strong positive correlation was found between anxiety and depression symptoms (r = 0.739, p < 0.001), underscoring their high comorbidity. Conclusions: This study demonstrates the feasibility of the P5 Mental Health platform as a real-time mental health monitoring tool, particularly during periods of heightened social and economic stress. The findings highlight the need for sustained digital mental health interventions beyond crisis periods to ensure long-term engagement; however, future improvements should focus on increasing user engagement and adding personalized features to ensure long-term mental health management. Full article

Challenges remain in developing a comprehensive understanding of spatial cognition, including gender and developmental differences, partly due to limitations of well-established spatial measures. Many traditional tasks face accessibility constraints and are not well suited for use across broad age ranges, populations, or ability levels. The present study introduced two game-based tasks, Q-bitz^® and Spot it!^®, designed to assess mental rotation and object location memory, respectively. We examined whether these game-based measures meaningfully complement established spatial tests, the Mental Rotation Test (MRT) and the Object Location Memory (OLM) task, across a wide age range (7–79 years, N = 114). Results indicated that MRT scores were strongly related to Q-bitz performance, whereas OLM scores were strongly related to Spot it! performance, supporting the convergent validity of the game-based tasks. Notably, gender-specific patterns emerged in the relationships among spatial measures, suggesting differences in spatial function. Age was associated with performance on speeded tasks (Q-bitz and Spot it!) but not with accuracy-based MRT or OLM performance. Together, these findings demonstrate that game-based assessments capture meaningful spatial constructs and reveal gender-specific patterns across the lifespan, providing a practical and ecologically valid approach for advancing research on spatial cognition. Full article

Background/Objectives: Periodontitis represents a significant global health burden, yet preventive health literacy remains critically low among emerging adults—a developmental stage where lifelong health behaviors crystallize. This study evaluated the effectiveness of the GUM (an acronym of Gum Understanding Mission) game, an interactive gamified digital tool incorporating AI-informed or manual feedback, for improving periodontitis literacy among tenth-semester Software Engineering students at the University of Guayaquil. Methods: In a controlled pre-test/post-test experiment, 50 participants were randomly assigned to either the GUM game intervention or a traditional lecture. Both groups completed identical knowledge assessments immediately before and after their respective 50-min instructional sessions. The GUM game featured adaptive questioning, immediate elaborated feedback, and comprehensive performance analytics, while the control group received instructor-led didactic instruction with a subsequent question-and-answer session. Results: The GUM group improved from a baseline of 21% to 94% correct responses, while the lecture group increased from 22% to 67% ($p<0.001$). Error reduction was 74% in the GUM group versus 45% in the control group. However, the study’s scope is currently limited to a single, digitally literate cohort, and knowledge retention over time was not assessed. Conclusions: These findings suggest that a self-directed, feedback-driven serious game can substantially outperform traditional methods in fostering periodontitis literacy within this population. Further research is needed across diverse populations with extended follow-up periods to assess knowledge retention and generalizability. Full article

Background: Technology such as telerehabilitation, virtual reality, robotics, and wearable systems are reshaping pediatric physiotherapy. While evidence remains fragmented, there is little guidance on how these approaches can be integrated into coherent, family-centered care pathways. Objective: To develop the Digital Pediatric Physiotherapy Framework (DPPF) based on a systematic review of randomized evidence on digital interventions in pediatric physiotherapy. Methods: Several databases were searched for randomized trials published after 1 January 2020, including PubMed, Web of Science Core Collection, and Google Scholar. The included studies assessed the results of physiotherapist-delivered or physiotherapist-supervised digital interventions in children and adolescents aged 18 and younger. Population, intervention, outcome, implementation, and safety data were extracted. Considering the substantial heterogeneity of the findings, they were synthesized narratively. Cochrane RoB 2 was used to assess risk of bias, and GRADE was used to evaluate certainty of evidence. Results: Twenty-nine trials involving 1196 participants were included. Most studies examined virtual reality and gaming-based interventions, with fewer evaluating telerehabilitation/tele-exercise and robotic or wearable technologies. Digital interventions were most often directed at body-function and activity-level outcomes, while participation outcomes were less frequently studied. The strongest evidence supported short-term benefits in balance, gross motor function, upper-limb activity, pain, and selected fitness outcomes, particularly in children with cerebral palsy. Evidence for telerehabilitation and robotic or wearable approaches was more limited but generally promising. Implementation, equity, cost, and long-term outcomes were rarely reported. No eligible trial directly evaluated electronic patient-reported outcome measures, digital triage, or clinical decision support as stand-alone interventions. Conclusions: Digital interventions have the potential to strengthen pediatric physiotherapy, particularly for short-term motor and functional outcomes. The proposed DPPF provides an implementation-informed structure to guide future research, pathway design, and more purposeful integration of digital health into pediatric rehabilitation practice. Full article

Background: Veterinarians are pivotal to wildlife health surveillance and game-meat safety, yet these topics receive limited emphasis in many veterinary curricula. Understanding students’ perceptions can inform targeted educational improvements. Methods: We conducted a cross-sectional, anonymous online survey among students enrolled in the Integrated Master’s in Veterinary Medicine at ICBAS-UP (Portugal). The questionnaire covered sociodemographic, meat and game-meat consumption, perceived appeal of working with game animals, and multi-select views on hunting, game-meat consumption and the veterinary role. We computed descriptive statistics and tested associations between categorical variables using Pearson’s Chi-square or Fisher’s exact tests (Monte Carlo correction when appropriate). Results: Of the 391 eligible students, 152 responded (39%). The majority (76%) associated hunting with veterinary inspection of game meat and research in epidemiology and emerging diseases, and many (72%) recognized as core roles monitoring the health of game animals and the contribution to public health and environmental sustainability. Significant associations included: prior game-meat consumption with finding game animals appealing/interest in learning more; year of enrolment with recognising hunting as an economic activity and acknowledging veterinary inspection and public health contributions; and perceiving game animals as appealing with associating hunting with population control (all p < 0.05; Cramer’s V indicating weak–moderate effects). Conclusions: Students show awareness of veterinary roles in game-animal health and meat inspection, but interest in working with game animals is low and knowledge gaps persist (e.g., inspection of game meat). Findings support curricular integration of wildlife health, game-meat inspection and One Health. Multicenter studies and evaluation of educational interventions are warranted. Full article

Castrate-resistant prostate cancer (PCa) is a critical situation in which many patients will relapse. Hormonal androgen deprivation therapy (HADT) is the gold standard of care when a patient relapses, following primary surgical or radiation therapy. Usually, the benefits from HADT are poor and recurrent disease after HADT treatment is termed castrate-resistant prostate cancer (CRPC), which is in most cases fatal. The therapeutic regimens for CRPC include chemotherapy with docetaxel, immunotherapy agent sipuleucel-T, the taxane cabazitaxel, the CYP17 inhibitor abiraterone acetate and the androgen receptor (AR) antagonist enzalutamide. Thus, it is imperative to study the inherent property of prostate cancer cells, to resist therapy and reconsider the therapeutic protocols (continuous v’s intermittent). We make use of a hybrid mathematical model which consists of an extension of a very potent ordinary differential equation (ODE) Baez–Kuang model, combined with two Game Theory components: the Minority Game for adaptive behavior and the Axelrod model for heterogeneity behavior. Our study suggests that increasing tumor adaptability, through Minority Game dynamics, improves short-term prostatic-specific antigen (PSA) control and stabilizes therapy cycles. However, this comes at the cost of driving the tumor to a homogeneous, androgen-independent (AI) state, which is therapy-resistant. Conversely, maintaining heterogeneity, via Axelrod dynamics, sustains a mixed population, with androgen-dependent (AD) cells persisting longer and potentially delaying resistance emergence. Full article

Background and Objectives: The relationship between mental health and sports injuries has become increasingly important in youth soccer, due to developmental changes in this population, the high demands of training, and the competitive pressures of sport. This cross-sectional study examined the association between injury history (no injuries, 1–2, >2 injuries), mental health indicators (anxiety, stress, depression), and differences by sex, competitive category, and playing position. Materials and Methods: 146 soccer players (79 males, 67 females; ages 12–30; mean age = 16.65, SD = 2.34 years) from youth and senior categories of a professional club in Spain completed the STAI-T (trait anxiety), DASS-21 (state anxiety, stress, depression), sociodemographic and sports-related variables (gender, sports category, playing position), and self-reported injury history: no injuries (n = 39), 1–2 injuries (n = 80), >2 injuries (n = 27). The statistical analyses performed were one-way ANOVA (ηp²), χ² tests, and Games-Howell post hoc tests. Results: 73.3% of the players reported ≥1 injury (54.8% 1–2 injuries; 18.5% >2), with no differences by gender, position, or category (χ² range: p > 0.05). The ANOVA revealed significant differences for trait anxiety (F(2, 143) = 3.68, p = 0.029, ηp² = 0.049; small-to-moderate), and state anxiety (F(2, 143) = 4.63, p = 0.014, ηp² = 0.061; moderate). No effects were found for stress/depression (p > 0.12). The post hoc test (Games-Howell) indicates that the group with no injuries showed significantly lower trait anxiety (p = 0.038, d = 0.33) vs. 1–2 injuries, and state anxiety (p = 0.012, d = 0.70) vs. >2 injuries. Stress and depression showed a non-significant upward trend. Conclusions: A greater history of injuries is associated with higher levels of anxiety in youth soccer players. The findings suggest routine assessment of anxiety and training in emotional self-regulation for injury prevention and rehabilitation. Longitudinal studies are needed to clarify the bidirectional relationship. Full article

In South Africa, both economic and social entrepreneurship have become a game-changing strategy for tackling enduring socioeconomic issues, including inequality, unemployment, and poverty. In contrast to conventional business models that put profit maximisation first, social entrepreneurship combines entrepreneurial tactics with social goals to develop long-lasting solutions for underserved populations. This study examines how social entrepreneurship can be used to address socioeconomic problems in South Africa, highlighting how it can promote inclusive growth and help achieve both national and international development objectives. The study illustrates how social companies use innovation and community participation models to overcome structural impediments such as youth unemployment, healthcare disparities, and limited access to education. It is based on a thorough evaluation of academic literature. The results show that social entrepreneurship fosters social cohesiveness and resilience in marginalised areas in addition to creating job and income opportunities. However, issues including weak finance, insufficient policy frameworks, and a dearth of capacity-building programmes make it difficult for social enterprises to grow and survive. In order to strengthen the social enterprise sector, the study’s conclusion suggests creating supportive ecosystems through impact investments, policy reforms, and educational initiatives. South Africa can expedite its efforts to reduce inequality and achieve sustained socioeconomic transformation by presenting social entrepreneurship as a strategic development tool. Full article

Randomized response is a widely used survey technique for measuring stigmatized populations, but it may provide limited information in small samples. This paper introduces a method of elicitation through perfectly correlated questions, showing that correlation can substantially improve statistical performance and allow a dominant-strategy mechanism when either the interviewer or respondents hold symmetric beliefs. The framework also allows the interviewer to possess private information about the distribution of questions, further relaxing incentive constraints. Building on an existing survey design game framework, the paper introduces a novel efficiency-normalized comparison that holds statistical performance constant across mechanisms, enabling a direct comparison of incentives. The analysis characterizes incentive properties and estimation under correlated questions and randomized response, and identifies when it is optimal to ask respondents directly, use randomized response, or correlate questions. Full article

To design Product–Service System (PSS) schemes that meet individual customer requirements, the configuration of technology systems is commonly used to select and assemble preferable modules from a predefined product and service library under certain constraints. Service delivery and realization have a significant impact on customer satisfaction in PSSs. However, existing research seldom considers the interactions between PSS configuration and service delivery. This paper focuses on two key stakeholders in PSS configuration: the product manufacturer (PSS provider) and the service providers. A bi-level optimization model based on Stackelberg game theory is proposed to configure the optimal PSS solution. Firstly, the upper-level optimization problem represents the PSS configuration as a leader to maximize customer satisfaction. Secondly, the lower-level optimization problem represents service configuration as a follower to minimize the service supply cost. Thirdly, an improved Dual-Population Co-evolutionary Hybrid Algorithm (DPC-NMHA), combining NSGA-II and MOPSO, is proposed to solve the bi-level optimization model. Finally, the feasibility and effectiveness of the proposed method are demonstrated through a case study of a refrigerator PSS configuration. Full article

The aim was to assess the effect of changes in both the net height and the court size, as well as serve limitations on the manner of execution of the technical-tactical actions in youth volleyball. A total of 29 female under-14 volleyball players from three regional club teams participated in the study. A quasi-experimental design was applied. The independent variables included: (a) Tournament following the standard rules, (b) Experimental Tournament 1 (lowering of the net height from 2.10 m to 2 m, no jump serves, and a two serve per-player and -rotation maximum), and (c) Experimental Tournament 2 (lowering of net height from 2.10 m to 2 m, reduced court size from 9 × 9 m to 8 × 8 m, no jump serves, and a two serve per-player and -rotation maximum). Experimental Tournament 1 involved reductions in ball control, duration of the game phases, the occurrence of actions, and their efficacy. Experimental Tournament 2 involved increases in ball control, the duration of the game phase, the occurrence and variability of actions, and their efficacy. Lowering the net height and reducing the court size while adapting the serve rules (Experimental Tournament 2) resulted in situations that were better adapted to this population. Full article

Background: The impact of screen time is having serious adverse effects on people’s lives. Unfortunately, early childhood is the most vulnerable stage in the lifespan, and most children are using television, computers, parents’ and mothers’ mobile phones, or tablets, for longer than recommended. For this reason, the interest of the education community in proposing programs for reducing screen time has grown, which could be of interest for families and professionals in early childhood development and care for children adhering to a healthy lifestyle. For this reason, the objective of this study is to compile programs including families that have tried to reduce preschool-aged children’s time in front of screens. Method: The search strategy is designed based on the PICOS framework. A review was conducted in three databases (PubMed, Web of Science, and ProQuest Central) on 11 October 2024, following the PRISMA guidelines. The systematic review is registered in PROSPERO. Results: A total of 287 articles were initially found, and 15 met all inclusion criteria. Conclusions: The results reveal that programs based on training parents in addition to performing games with children have positive effects for reducing screen time in children up to six years old, even in a specific population. Full article

Internet gaming disorder (IGD) and nonmedical prescription drug use (NMPDU) are prevalent, co-occurring concerns among young adults. Although prior research links problematic gaming and substance misuse, few studies have examined this relationship in non-college populations or whether student status modifies this association. This study examined the relationship between Gaming Addiction Scale (GAS) score and NMPDU among 1022 Rhode Island young adults aged 18 to 25. In the total sample, 44.6% identified as cisgender heterosexual female, 42.4% as sexual or gender minority (SGM), and 13.0% as cisgender heterosexual male. Multivariable logistic regression estimated the adjusted association between GAS scores and NMPDU, and an interaction term between GAS and student status was tested. Overall, 12.1% reported lifetime NMPDU. Higher GAS scores were associated with increased odds of NMPDU (adjusted odds ratio [AOR] = 1.05; 95% confidence interval [CI]: 1.01–1.09). Student status alone was not significantly associated with NMPDU; however, a significant interaction was observed between GAS and student status (AOR = 1.09, 95% CI: 1.01–1.18, p = 0.031). Higher GAS scores were positively associated with NMPDU, with student status strengthening this association. Findings support screening for problematic gaming, particularly among students, and integrated prevention strategies addressing both behavioral and substance-related risks. Full article

Against the backdrop of China’s dual-carbon goals and the global green transition, low-carbon production in the manufacturing sector is crucial to achieving high-quality development. Based on the dual mechanisms of the free-riding effect and technology spillovers, this paper develops a Moran stochastic evolutionary game model of manufacturing firms’ low-carbon production strategies under government regulation. We analyze the dynamic evolution and stability of low-carbon versus conventional production strategies under strong- and weak-selection conditions. The results show that under strong selection, a low free-riding payoff promotes the diffusion of the low-carbon strategy and the formation of a stable equilibrium; a moderate free-riding payoff makes population size the key factor shaping evolutionary outcomes; and a high free-riding payoff leads the system to degenerate into a steady state dominated by conventional production. Under weak selection, government subsidies and fines increase the fixation probability and stability of the low-carbon strategy, whereas excessive free-riding payoffs undermine the persistence of the transition. Numerical simulations validate the theoretical analysis and indicate that government regulation, technology spillovers, and population structure jointly shape the long-term evolution of low-carbon behavior, providing a theoretical basis and decision-making reference for optimizing policy mechanisms and promoting the low-carbon transition of the manufacturing sector. Full article

There is a growing need for accessible and engaging rehabilitation tools for individuals with neurodevelopmental disorders such as Cerebral palsy (CP), Down syndrome (DS), and Autism spectrum disorder (ASD). Serious games offer a promising approach, yet few are tailor-made to meet the therapeutic demands of these populations. A tailor-made, non-immersive virtual reality (VR) serious games framework featuring a basketball task was developed, with therapist-controlled modules for customization and monitoring. Twenty-eight participants (CP: 14; DS: 7; ASD: 7) completed the game across eight sessions, grouped into three practice phases: an initial session, an early adaptation phase, and a consolidated practice phase. Performance metrics included accuracy, reaction time, and number of victories. All groups improved performance across phases, with accuracy increasing significantly in central (p = 0.005) and total positions (p = 0.007). The number of victories also increased from the initial to the early adaptation phase (p = 0.019) and from the initial to the consolidated practice phase (p = 0.008). Participants with ASD showed significantly higher accuracy than the DS group, while CP and DS participants showed a temporary increase in reaction time during the early adaptation phase, followed by a reduction in the consolidated phase, suggesting task adaptation. These findings support the feasibility and short-term effectiveness of a modular, tailor-made serious games platform for telerehabilitation. Full article