Jose Miguel

by José Miguel Giménez-Lozano Francisco Manuel Morales-Rodríguez and Juan Pedro Martínez-Ramón

by José Miguel Rocha Flores Selma Flor Guerra Hernández and Faculty of Engineering, Universidad Anahuac México, Av.

by and Carla Vidal-San Martín Instituto de Ciencia y Tecnología de los Alimentos (ICYTAL), Universidad Austral de Chile, Independencia 641, Valdivia 5090000, Chile

by Marina Armas-González Candelaria González-Campo and

by Lara Bravo Quiroga Mariam De La Poza Abad and Hospital Universitario Príncipe de Asturias, Alcalá de Henares, 28805 Madrid, Spain

Single-player role-playing games (RPGs) combine two promises that do not always align: delivering a compelling narrative experience (world, characters, choices, and consequences) while sustaining a demanding ludic trajectory in which players face obstacles, master systems, and progress over time. This Systematic Literature Review (SLR) synthesizes existing evidence on the evolution of narrative and challenge in single-player RPGs from a player-centered perspective, with particular attention paid to immersion, engagement, flow, and perceived agency. A multi-database search strategy was conducted across Google Scholar, Scopus, IEEE Xplore, and the ACM Digital Library using query strings targeting narrative/agency, challenge and dynamic difficulty adjustment (DDA), adaptive difficulty, and the historical evolution of RPG narrative design, following a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-reported selection flow and Rayyan-supported screening. From 423 identified records, duplicates and non-eligible records were removed through staged screening, yielding 43 reports sought for retrieval; because six were not accessible in full text at consolidation, the synthesis was conducted on 37 full-text articles. The findings indicate (i) a predominance of work on narrative and agency, where agency is framed as a design effect rather than merely the presence of explicit branching choices; (ii) a recent rise in challenge/adaptation research, frequently tied to flow, fairness, and differentiated player profiles; and (iii) the emergence of artificial intelligence (AI)-driven approaches, including non-player character (NPC) systems, combat AI, reinforcement learning, and large language model (LLM)-based narrative control, which amplify core design trade-offs between narrative coherence and perceived agency. Beyond synthesizing a dispersed body of literature, the review contributes an integrated player-centered analytical framework that brings together narrative, challenge, and player experience, while also highlighting the need for more consistent measurement practices, stronger comparative designs, and longer-term empirical work in single-player RPG research.

The authors apply deep learning to histological and transcriptomic data from female reproductive organs from over 300 donors aged 20–70 years, reporting distinct and asynchronous aging trajectories, detectable in independent plasma proteomics data, with menopause as an inflection point.

Cognition in older adults may be influenced by environmental factors; however, the pathways linking environmental exposures and cognition remain unclear. The aim of this narrative review is to synthesize evidence on the association between the environment and cognition in older adults, integrating biological, environmental, and behavioral elements. Systematic reviews and original studies addressing this topic were identified in Web of Science, PubMed, and Scopus. The primary neural processes associated with maintaining cognition during aging are neuronal plasticity and compensatory scaffolding. Participation in intellectually stimulating activities, physical exercise, and a healthy diet; mitigation of chronic stress; reduction in the severity of depressive symptoms; and buffering against the adverse effects of air pollution are proposed as plausible pathways that may mediate the relationship between neural processes and the environment. In this context, environmental factors that affect cognition can be classified at three levels: (i) micro-level (family and home): social interaction with family members and indoor pollution; (ii) meso-level (community and services): social interaction, land-use diversity, transportation systems, environmental design, and urban green spaces; and (iii) macro-level (society in general and public policies): social representations of old age and aging (positive aging vs. ageism) and public policies aimed at improving pathways related to cognitive maintenance. Overall, the environment may influence cognition in older adults; however, the available studies show methodological and conceptual heterogeneity, inconsistent findings, and important gaps in knowledge.

Diet and lifestyle significantly influence health, and during periods of economic, social, or health-related instability, individuals are more likely to adopt unhealthy eating behaviours. This study aimed to evaluate changes in dietary patterns among the Spanish population during COVID-19 home lockdown, comparing them with data from the 2017 National Health Survey (NHS) and the 2020 European Health Survey in Spain (EHSS). This study is among the first to compare nationally representative data before, during, and after COVID-19 lockdown, enabling assessment of the persistence or reversibility of diet-related behavioural changes following a major public health crisis. A cross-sectional comparative analysis was conducted using food frequency questionnaire (FFQ) data from all three sources: the 2017 NHS (n = 23,089), a survey conducted during lockdown (n = 1640), and the 2020 EHSS (n = 22,072). Z-tests for independent proportions were used to compare adherence prevalence across the three cross-sectional samples, assuming normality due to the large sample size in all cohorts. The findings showed that adherence to nutritional recommendations decreased significantly during lockdown (p < 0.05), while the proportion of individuals consuming processed and highly palatable foods increased. Notably, during the lockdown, more than 97% of the population failed to meet the recommended daily intake for any of the food groups. The proportion of individuals consuming sweets, snacks, and fast food above recommended levels increased from approximately 30% before lockdown to 88% during lockdown (p < 0.05). Following the lockdown period, dietary habits largely returned to baseline levels; however, adherence to dairy (87.3% vs. 81.1%; p < 0.05) and cereals (96.8% vs. 89.2%; p < 0.05) decreased compared with 2017. In contrast, legume consumption remained high after the restriction period (76.1% vs. 86.2%; p < 0.05). Significant differences were observed between the periods before and during lockdown. Specifically, the consumption of fruits (+ 0.9%: p < 0.05), vegetables (+ 0.8%; p < 0.05), sweetened soft drinks (+ 2.6%; p < 0.05), sweets (+ 3.7%; p < 0.05), snacks (+ 0.6%; p < 0.05), and sausages/cold meats (+ 0.7%; p < 0.05) increased, whereas the intake of dairy products (− 6.2%; p < 0.05), cereals including pasta, rice, potatoes, and bread (− 7.6%; p < 0.05), meat (− 1.0%; p < 0.05), fish (− 2.1%; p < 0.05), eggs (− 2.9%; p < 0.05), and legumes (− 1.7%; p < 0.05) decreased. In line with these findings, the dietary diversity score (DDS) showed a marked reduction during lockdown compared with the pre-lockdown period, followed by a substantial increase after restrictions were lifted. These trends suggest that during crises, dietary quality tends to deteriorate. Although some dietary behaviours recovered after lockdown, the persistent decline in adherence to dairy and cereal recommendations, together with the high consumption of processed foods, highlights the need for public health interventions aimed at reinforcing dietary stability and promoting health during periods of crisis.

People with severe mental disorders (SMD) face higher hepatitis C virus (HCV) infection risks and lower treatment adherence compared to the general population. Traditional care pathways often fail due to fragmented coordination and patient-related barriers. This study evaluates the feasibility and acceptability of an individualized nurse navigation program (NNP) designed to facilitate adherence to medical appointments and pharmacological treatment in this population. A feasibility randomized open parallel trial was conducted. The intervention simplified the clinical pathway through intensive nursing support (phone reminders, in-person meetings, home visits) and appointment accompaniment. Primary outcomes included recruitment, retention, refusal rates, cure rate defined as undetectable HCV RNA at 12 weeks post-treatment, and identification of barriers. From 1,916 assessed individuals, 20 were eligible and 13 finally randomized (65% participation, refusal rate 35%). Overall, 69% (9/13) achieved a cure. Notably, the average cure time was nearly 11 months, indicating that standard 6-month follow-up is insufficient. Key facilitators included institutional residency and competent caregivers, while barriers included symptom-related non-attendance and system-level delays, such as deferred treatment prescription by gastroenterologists. The NNP is feasible and enhances HCV outcomes in SMD populations. Definitive trials require extended follow-up periods of 24 months and larger multicenter samples.