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- Gamification on mathematics engagement and motivation in secondary school and higher education: a systematic review and meta-analysisPublication . Ratinho, Elias; Figueiredo, Mauro; Estêvão, Maria Dulce da Mota Antunes de Oliveira ; Faísca, Luís; Martins, CátiaThis systematic review and meta-analysis examined the effects of gamification on students’ motivation and engagement in mathematics at the secondary and higher education levels. A literature search (April 2025) followed by an updated search (November 2025) across ten databases identified 45 studies for qualitative synthesis and 11 for meta-analysis. The review followed PRISMA 2020 guidelines with a pre-registered protocol, and study quality was appraised with the Mixed Methods Appraisal Tool. Meta-analytic results using a three-level Correlated and Hierarchical Effects model with robust variance estimation showed a significant small-to-moderate positive effect on motivation (g = .383, 95% CI [.11, .66], p = .0218). Motivation was assessed more consistently than engagement that could not be included in the meta-analysis due to the lack of validated measures. The systematic review indicates that gamification supports motivation and engagement, with only four studies reporting negative effects. Most interventions used digital platforms (e.g., Kahoot!; Classcraft) and common game elements such as points, leaderboards and instant feedback. Overall, gamification appears promising for enhancing motivation and engagement in mathematics when designs are aligned with students’ needs, balancing competition with mastery and cooperation. Therefore, educators should limit excessive competition and prioritize personal progress and cooperative tasks that foster social interaction. Future studies should employ validated measures, larger samples, and examine both motivation and engagement to strengthen the evidence base and guide effective implementation in education.
- Development and psychometric validation of an app-integrated questionnaire to assess healthy habits in children (Ages 8–11): implications for pediatric nursing practicePublication . Merino-Godoy, María Ángeles; Yot-Domínguez, Carmen; Conde-Jiménez, Jesús; Costa, Emília IsabelIntroduction: Promoting healthy habits in childhood is fundamental for fostering long-term well-being. This study aimed to develop and psychometrically validate an app-integrated instrument to assess knowledge, habits, and attitudes related to health in children aged 8–11, within the context of the MHealth intervention Healthy Jeart. Methods: A quantitative, cross-sectional design was used. An initial item pool underwent expert content validation before being administered to a sample of 623 children from primary education centers in Andalusia, Spain. Construct validity was examined through exploratory and confirmatory factor analyses. Results: The analyses supported a coherent four-factor structure comprising 21 items: (1) Use of technologies, (2) diet and growth, (3) psychological well-being, and (4) physical activity and well-being. The instrument demonstrated satisfactory model fit and internal consistency, providing a multidimensional assessment of children’s health-related behaviors. The sample was recruited from primary schools in Andalusia (Spain), which may limit the generalizability of the findings to other regions and cultural contexts. Conclusions: The validated instrument offers a reliable and efficient means of evaluating healthy habits in children aged 8–11, particularly when embedded within digital interventions such as Healthy Jeart. It represents a valuable tool for educators and pediatric nursing professionals working in school settings, enabling early identification of gaps in health literacy and supporting targeted interventions that promote holistic child well-being.
- Editorial: tissue crosstalk in obesity and diabetes: a focus on skeletal musclePublication . De Sousa-Coelho, Ana Luísa; Estêvão, Maria Dulce da Mota Antunes de Oliveira ; Patti, Mary Elizabeth; Lerin, CarlesIn the complex biological system of higher organisms, the maintenance of metabolic homeostasis requires intricate crosstalk among different tissues and organs. Such inter-organ communication, including classical hormones, other peptides, and extracellular vesicles (EVs), allows one tissue to affect metabolic pathways in a distant tissue. Dysregulation of this communication contributes to human pathologies, including obesity, diabetes, liver diseases, and certain cancers. This Research Topic aimed to shed light onto the complex tissue crosstalk underlying metabolic diseases, specifically obesity and type 2 diabetes (T2D). It highlights the latest scientific evidence exploring such interactions among different tissues, with a specific focus on the role of skeletal muscle and its secretion of myokines and EVs that contribute to the regulation of metabolism in liver, adipose tissue, and other organs.
- Drug repurposing for targeting cancer stem-like cells in glioblastomaPublication . De Sousa-Coelho, Ana Luísa; Solaković, Brigita; Bento, Alexandra Diogo; Teotónio Fernandes, Mónica AlexandraGlioblastoma (GBM) is one of the deadliest types of cancer, characterized by a short life expectancy after diagnosis, mostly related to therapy resistance and recurrence. GBM stem-like cells (GSCs) reside within the tumor and contribute to these features; therefore, finding drugs that specifically target such cells holds promise to halt GBM progression. The primary objective of this work is to comprehensively review and discuss the potential of hard drug repurposing to target GSCs. Several studies evaluating drugs showing anti-GSC activity, originally approved for non-cancer indications, were identified. These mainly included antidiabetics (e.g., Metformin, Phenformin, and Sitagliptin), antihypertensives (e.g., Nicardipine, Doxazosin, and Prazosin), antimicrobials (e.g., Pyrvinium pamoate, Flubendazole, and Clofazimine), and central nervous system-acting drugs (e.g., Chlorpromazine, Fluvoxamine, and Disulfiram). Relevant candidates include those that disrupt GSC metabolism, namely impairing mitochondrial function, such as Metformin, Chlorpromazine, and Pyrvinium pamoate. Multiple signaling pathways may be involved, namely the Wnt, PI3K/AKT, and STAT3 pathways, among others. Also significant were those drugs tested in combination, resulting in increased sensitivity to Temozolomide (TMZ), the standard pharmacological treatment available for GBM. Some repurposed agents, such as Disulfiram and Metformin, have already reached clinical testing, although none have yet been incorporated into clinical practice. Importantly, major translational barriers remain, like limited blood–brain barrier penetration and the lack of robust clinical trials. In conclusion, drug repurposing is an affordable and suitable strategy to target GSCs, impairing cell viability, reducing stemness, and enhancing their sensitivity to TMZ, which has potential that should be further explored to improve patients’ clinical outcomes.
- Polypharmacy and the use of potentially inappropriate medications in elderly people in nursing homes: a cross-sectional studyPublication . Fest, Giulia; Costa, Lara; Pinto, Ezequiel; Leitao, Helena; Nascimento, TâniaPolypharmacy and the use of potentially inappropriate medications (PIM) are prevalent issues among institutionalized older adults, contributing to adverse drug events and decreased quality of life. This study aimed to describe the sociodemographic and clinical characteristics associated with polypharmacy and the use of PIM in elderly people in nursing homes. A cross-sectional descriptive study was conducted among 151 residents aged ≥ 65 years. Data was extracted from institutional records. The mean age of participants was 86.48 ± 8.00 years; 71.5% were female. Excessive polypharmacy was observed in 49.7% of residents. The mean number of medications was 9.66 ± 4.18, with nervous system drugs being the most prescribed (3.73 ± 2.31). PDDIs were detected in 94% of the sample and PIMs were present in 82.8% of residents. The most common PIMs were proton pump inhibitors (ATC A) and anxiolytics (ATC N). Binary logistic regression identified two independent predictors for PIMs: the total number of medications (AOR = 1.259) and the use of ATC A (Alimentary tract and metabolism) medications (AOR = 2.315). Conversely, age and sex were not significant predictors. The study reveals a critical prevalence of excessive polypharmacy, PIM use, and PDDIs among institutionalized elderly in the Algarve. These findings underscore the urgent need for systematic, multidisciplinary medication reviews in Portuguese nursing homes to promote safer and more rational prescribing practices.
- Polypharmacy and the Use of Potentially Inappropriate Medications in Elderly People in Nursing Homes: A Cross-Sectional StudyPublication . Fest, Giulia; Costa, Lara; Pinto, Ezequiel; Leitao, Helena; Nascimento, TâniaPolypharmacy and the use of potentially inappropriate medications (PIM) are prevalent issues among institutionalized older adults, contributing to adverse drug events and decreased quality of life. This study aimed to describe the sociodemographic and clinical characteristics associated with polypharmacy and the use of PIM in elderly people in nursing homes. A cross-sectional descriptive study was conducted among 151 residents aged ≥ 65 years. Data was extracted from institutional records. The mean age of participants was 86.48 ± 8.00 years; 71.5% were female. Excessive polypharmacy was observed in 49.7% of residents. The mean number of medications was 9.66 ± 4.18, with nervous system drugs being the most prescribed (3.73 ± 2.31). PDDIs were detected in 94% of the sample and PIMs were present in 82.8% of residents. The most common PIMs were proton pump inhibitors (ATC A) and anxiolytics (ATC N). Binary logistic regression identified two independent predictors for PIMs: the total number of medications (AOR = 1.259) and the use of ATC A (Alimentary tract and metabolism) medications (AOR = 2.315). Conversely, age and sex were not significant predictors. The study reveals a critical prevalence of excessive polypharmacy, PIM use, and PDDIs among institutionalized elderly in the Algarve. These findings underscore the urgent need for systematic, multidisciplinary medication reviews in Portuguese nursing homes to promote safer and more rational prescribing practices.
- Fate of microbial contamination in a South European Coastal Lagoon (Ria Formosa) under the influence of treated effluents dispersalPublication . Caetano, Sandra; Correia, Cátia; Torres, Ana Flor; Matos, André Filipe; Ferreira, Cristina; Cravo, AlexandraAim: Assessment of the fate of microbial contamination driven from treated wastewater disposal at a highly productive zone on a South European coastal lagoon (Ria Formosa). Methods and results: Microbial indicators of contamination (Total coliforms, Escherichia coli and Enterococci) were evaluated monthly during September 2018-September 2020, at three study areas (Faro, Olhão, Tavira) under different wastewater discharge flows and hydrodynamic conditions. Additional data on E. coli monitoring in bivalves, available from the national institution responsible for their surveillance was also considered. The maximum microbial contamination was found at Faro, the highest-load and less-flushed study area, contrasting the lowest contamination at Olhão, a lower-load and strongly flushed area. The wastewater impact decreased along the spatial dispersal gradients and during high water, particularly at Faro and Tavira study areas, due to a considerable dilution effect. Microbial contamination at Olhão increased during the summer while at the other study areas seasonal evidence was not clear. Data also indicate that E. coli in bivalves from BPZ next to the three study areas reflected the differentiated impact of the wastewater treatment plants effluents on the water quality of those areas. Conclusions: Effluent loads together with local hydrodynamics, water temperature, solar radiation, precipitation and land runoff as well as seabirds populations and environmentally adapted faecal or renaturelized bacterial communities, contributed to microbial contamination of the study areas.
- + Equilíbrio 65 - risco de queda em idosos na comunidade da região do algarvePublication . Tome, Ana Maria; Rosa, Marlene Cristina Neves; Pais, Sandra Cristina Cozinheiro Fidalgo Rafael Gamboa; Tomás, Maria Teresa Barreiros Caetano; de Almeida Fontes, Ana PaulaIntrodução - As quedas constituem uma das principais causas de morbilidade na população sénior. A identificação e caracterização dos fatores causais é basilar na intervenção. Objetivo - Caracterizar a população de indivíduos com 65 anos ou mais de idade, da comunidade, inscritos em universidades sénior, do ponto de vista sociodemográfico e dos fatores de risco e risco de queda. Metodologia –Estudo transversal observacional. Incluídos indivíduos com 65 ou mais anos de idade. Dados recolhidos por questionário de autopreenchimento e avaliação de risco de queda e capacidade funcional e cognitiva com instrumentos específicos: FES-I TUG-C, FRT e FAB. Resultados – Avaliados 128 participantes dos 65-92 anos de idade (74.95±6.13), 74.2% mulheres. 31,3% tem história de queda no último ano; 75% toma mais de um medicamento por dia; 97,7% refere comorbilidades crónicas; 14.8% e 13.3% apresentam TUG-C e FRT, respetivamente, compatíveis com risco muito elevado de queda. 74,2% tem medo de cair moderado ou elevado e 49,2% tem disfunção marcada das funções executivas Discussão – A elevada percentagem de fatores de risco, a prevalência de quedas anteriores, polimedicação, comorbilidades crónicas e baixo nível de atividade física, risco psicossocial e baixos níveis de escolaridade são sinais de risco. O elevado medo de cair, desempenho reduzido nos testes de equilíbrio estático e dinâmico e o declínio cognitivo evidenciam a importância de uma avaliação multidimensional do risco de queda. Conclusão – Este estudo permitiu um olhar mais consistente sobre a problemática do equilíbrio e risco de queda e possibilitou sinalizar e analisar os principais fatores de risco de queda, em idosos na comunidade numa região do Algarve.
- Physiotherapy management following surgical neurolysis for a peroneal nerve injury: A case reportPublication . Almeida, Pedro Sérgio Costa da Silva; Tome, Ana Maria; Felicio, João Carlos Martins; de Almeida Fontes, Ana PaulaThe peroneal nerve becomes superficial near the head of the fibula, increasing its exposure to injury mechanisms. There is a need to improve knowledge on the influence of physiotherapy on peripheral nerve injury rehabilitation. The case involves a woman with 47 years who suffered a cut in the region of distal third of right common peroneal nerve. This injury resulted in the loss of sensitivity, strength, foot drop, and neuropathic pain after suturing. These symptoms persisted for six weeks, and she had to undergo surgery six weeks after the accident. Physiotherapy was initiated 1 month after the surgical intervention, incorporating manual therapy, electrical stimulation, functional and aerobic exercise, and patient education. The patient experienced sensory alterations, pain was eliminated, and functional recovery of gait and running was achieved. However, there were residual weaknesses in hallux extensor and dorsiflexors. This case study contributes to the development of peroneal nerve rehabilitation interventions.
- Point-of-care ultrasound for the early detection of intrahepatic biliary tract dilatation: a local study in a basic emergency servicePublication . Miravent, Sérgio; Vaz, Bruna; Lobo, Manuel Duarte; Jimenez, Cármen; Pablo, Pedro; Figueiredo, Teresa; Barbancho, Narciso; Ventura, Miguel; Almeida, RuiBackground/Objectives: Ultrasonography is a diagnostic modality characterized by high sensitivity in detecting hepato-biliary pathology, particularly intrahepatic biliary duct dilation. This study compares the sonographic findings obtained by a radiographer/sonographer in a Basic Emergency Service (BES) using Point-of-Care Ultrasonography (POCUS) in Portugal with the sonographic findings from the same patients acquired by radiologists at a referral hospital (RH) for suspected intrahepatic biliary dilatation. Methods: Nineteen patients presenting with right upper quadrant (RUQ) pain and suspected abdominal pathology underwent sonographic screening using POCUS in the BES. Subsequently, the same patients were referred to the RH, where a radiologist performed a comprehensive ultrasound. Both examinations were compared to determine whether the findings obtained in the BES were confirmed by radiologists in the RH. Results: Cholestasis, cholangitis, lithiasis, pancreatitis, peri-ampullary lithiasis, and neoplasms were observed in association with intrahepatic biliary dilation in this study sample. All six variables showed a strong association between the BES and RH findings (Cramer’s V > 0.6; p < 0.006). A strong kappa measure of agreement between the radiographer and radiologist findings was obtained in “cholelithiasis/sludge/gallbladder acute sonographic changes” (k = 0.802; p = 0.000). A moderate kappa value was obtained for the variable “abdominal free fluid”, (k = 0.706; p = 0.001). Conclusions: In this study, all patients referred from the BES to the RH required hospitalization for treatment and additional imaging exams. Although prehospital screening ultrasound is not intended for definitive diagnoses, the early detection of intrahepatic biliary tract dilatation through screening sonography played a significant role in the clinical referral of patients, with a sensitivity of 94% and specificity of 75%.