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Abstract Objectives Dravet syndrome (DS) is a rare form of refractory epilepsy that begins in the first year of life. Approximately 85% of patients have a mutation in the SCN1A gene, which encodes a voltage‐gated sodium channel. The main objective of the present work was to assess the degree of knowledge of DS among Spanish primary care (PC) professionals, the communication flow between them and the pediatric neurologists (PNs), and the services available and resources offered to patients in Spain when searching for a diagnosis and adequate treatment. Methods Two anonymized online surveys on DS diagnosis and patient management in PC were conducted with Spanish PC pediatricians (PCPs) and caregivers of DS patients in Spain. Results Most PCPs are aware of genetic epilepsy but lack full knowledge of DS and patient advocacy groups (PAGs). Access to epilepsy treatments varies among regions, with many referrals to hospitals and pediatric neurologists. Diagnosis is often delayed, with misdiagnoses and frequent emergency room (ER) visits. Treatment involves multiple drugs, and sodium channel blockers are used, which are contraindicated in DS treatment. Improved training, resources, and communication are needed for early diagnosis. Significance To improve the care and treatment of DS patients in Spain, early diagnosis is required and, possibly, specific efforts aimed at identifying patients in adulthood, generating socio‐sanitary structures that integrate social and health services to provide comprehensive care, taking into account the different features and comorbidities of the disease. Plain Language Summary Dravet syndrome (DS) is a form of genetic epilepsy that starts within the first year of life. We present a study showing that, while family doctors are aware of genetic epilepsies, many don't have a complete understanding of DS. Unfortunately, getting the right diagnosis can take a long time, leading to unnecessary visits to the emergency room. Patients often need several medications, and sometimes they're given drugs that aren't recommended for DS. The takeaway is that training for doctors, more resources, and improved communication could help creating better healthcare systems and therefore give easier access to the right therapies.

Schools are ideal settings to promote adolescent physical activity (PA), yet school-based interventions have shown limited long-term impact. This position paper presents key issues surrounding school-based PA interventions. Collaborative conceptual thinking drawing on multi-author expertise and available evidence advanced our understanding and opinion. Key arguments: 1) the adoption of a systems approach, which maximizes partnership action and leverages policy, is crucial for understanding the complexities of implementing whole-school programs; 2) a reorientation to an assets perspective optimizes existing strengths and resources allowing greater emphasis on the full range of physical, cognitive, emotional and social benefits that PA provides, and 3) a move beyond traditional positivist research designs to advance our knowledge of what works better, for whom and in what context is needed for greater progress We provide suggestions, specifically advocating for systems approaches, as a realistic way to improve how we support PA in schools in the future.

The article deals with the burials at the Taldy-1 burial ground (Republic of Kazakhstan). They belong to the early and classical Middle Ages. Despite the low information content of the early medieval burials, they are of interest at the regional, central Kazakhstan level. The burials considered expand the factual base that is currently insufficient. The burial rite is clearly presented in building No 58. Here, the burial of a child was investigated. It was accompanied by the cattle skeleton. The skeleton position bears a resemblance the posture of a horse in the studied burials of the Turkic culture. The burial of the classical Middle Ages is dated to the XIII century by the radiocarbon method. It was a non-inventory burial of a girl aged 12–13 years. The burial was arranged in a pit. A graphic reconstruction of the appearance was carried out on the skull. The peculiarities of the burial rites allow the researchers to raise the issue of identifying syncretic Muslim-pagan assemblages and the spread of Islam in Central Kazakhstan. Analyzing the materials of the region, it is possible to establish the duration of the process of ritual transformation, which lasted for at least two centuries.

Objective: 24-hour movement behaviours can effect sustainable long-term benefits in children, but their implementation and effectiveness have not previously been reviewed in the school setting. Thus, the aim of this scoping review was to provide an overview of school-based interventions targeting physical activity (PA), sedentary behaviour (SB), and sleep in 5-12-year-old children. Design: Scoping review. Methods: A structured bibliographic search of five databases was conducted to retrieve peer-reviewed intervention studies published in English language, between January 2010 and December 2020. Results: Among the 37 studies included with a total sample size of 27,145 primary school-aged children, only one study assessed sleep, PA and SB. The average duration of the intervention studies was between 7 and 10 months. Conclusion: The main gap identified was that current school-based interventions do not include complete 24-hour movement behaviours among children as there is a lack of intervention studies addressing sleep behaviour. In addition, this first international review of 24-hour movement behaviours in a school setting found that the number of intervention studies that incuded follow-up measures is limited, so it is difficult to interpret their sustainability.

BackgroundHealth Promoting Schools (HPS) have emerged as a powerful framework to promote healthy behaviors in many countries. However, HPS still present several challenges, highlighting the excessive workload involved in the accreditation, design, implementation, and evaluation processes. In this sense, a resource to facilitate the implementation processes may have a positive impact on the support of HPS. ObjectiveThe aim of this study was to describe the co-design processes undertaken and resulting learnings to develop the Red Escuelas Promotoras de Salud (network of health promoting schools; REDEPS)-Gestion platform to facilitate the accreditation, design, implementation procedures, and evaluation processes of the Aragon's Health-Promoting School Network. MethodsThe Double Diamond Design Approach was used to co-design this web-platform. The different stakeholders that participated in this co-design, progressed through a 4-stage reflective phase, to discover, define, develop, and deliver the REDEPS-Gestion platform. ResultsParticipants agreed that the functions of the REDEPS-Gestion platform should permit the management of both the educational centers and the administration such as accreditation processes, definition and review intervention projects, and preparation and review of the different progress reports to evaluate the HPS. Despite co-design being a well-established approach to creative practice, especially within the public sector, some challenges emerged during the co-design process, such as engaging and facilitating stakeholders’ participation or the complexity of combining the interests of all stakeholders. This approach allowed us to identify the main barriers for future users and implement platform improvements. ConclusionsWe hope that the REDEPS-Gestion platform will therefore be able to contribute to facilitating the implementation of HPS. The Double Diamond Design Approach used to co-design this web platform was an efficient and feasible methodological design approach. The REDEPS-Gestion platform will facilitate HPS implementation in Aragon as well as all the processes involving HPS. Future work will determine its effectiveness in improving HPS implementation. International Registered Report Identifier (IRRID)DERR1-10.2196/52110

Introduction: The consequences of medical errors extend beyond the affected patient, impacting both the professionals involved and the institutions where they occur. The aim of this study was to analyze incidents related to patient safety involving medical residents, the repercussions on their health as second victims, the support received, and possible associated factors. Method: Cross-sectional study using an online survey distributed in January 2023 to all medical residents at two hospitals in Zaragoza, through their graduate medical education committees. A descriptive and inferential analysis was carried out using parametric and non-parametric tests. Results: All 43 (10.2% response rate) residents who participated had had at least one incident related to patient safety, and 9.3% reported more than one adverse event, being higher in more senior residents (p=0.01). The most frequent symptoms and manifestations as a second victim were anxiety, doubts regarding clinical decisions, hypervigilance, fatigue and guilt. The perceived probability of receiving support after a clinical error was higher in residents in medical specialties than those in surgical specialties (p=0.002), and 20.9% indicated not receiving any support following a clinical error. Conclusions: Clinical errors are a significant concern for medical trainees and require actions at multiple levels. This includes enhanced training in patient safety and error management, as well as establishing peer and specialized support plans for the professionals involved, where occupational health services should play a relevant role.

Objective To evaluate the impact of coadministering statins with direct oral anticoagulants (DOACs) on the risk of major bleeding events in patients with venous thromboembolism (VTE).Design Observational cohort analysis based on a multicentre international registry.Setting Data were extracted from the Registro Informatizado de Enfermedad TromboEmbolica Registry, which involves 205 centres across 27 countries.Participants A total of 73 659 patients diagnosed with VTE were classified based on their anticoagulant therapy (DOACs) versus low-molecular-weight heparin (LMWH) or vitamin K antagonists (VKAs) and concurrent use of statins.Methods Multivariable Cox proportional hazards models adjusted for confounding variables to assess the risk of major bleeding events stratified by the type of anticoagulant use and statin use.Results From October 2013 to February 2023, 73 659 patients were recruited: 2573 were statin users on DOACs, 14 090 were statin users on LMWH or VKA therapy, 10 088 were non-statin users on DOACs and 46 908 were non-statin users on LMWH or VKA therapy. Statin users were 10 years older and more likely to have hypertension, diabetes, renal failure or prior artery disease. During anticoagulation (median, 187 days), 1917 patients (2.6%) suffered major bleeding. Rates of major bleeding per 100 patient-years were 2.33 (95% CI 1.72 to 3.09), 3.75 (95% CI 3.43 to 4.10), 1.39 (95% CI 1.13 to 1.69) and 3.10 (95% CI 2.93 to 3.27), respectively. On multivariable analysis, patients treated with DOACs had a significantly lower risk of major bleeding compared with those on LMWH or VKA therapy (adjusted HR 0.59; 95% CI 0.48 to 0.74). The adjusted HR in statin users versus non-users was 1.03 (95% CI 0.92 to 1.14), while in statin users on DOACs versus the rest of patients, it was 1.18 (95% CI 0.79 to 1.76).Conclusions In patients with VTE receiving statins, long-term anticoagulation with DOACs was associated with a reduced risk of major bleeding, regardless of the statin use. These findings support the safety profile of DOACs over VKAs or LMWH in the management of VTE in patients requiring statins.

This study is focused on the sorption properties and the changes in the structure and state of Ti-25Al-25Nb (at.%) system alloys under thermal cyclic loading. These samples were produced by combining high-energy processing methods through mechanization and spark plasma sintering in the temperature range of 1100–1300 °C, followed by two-stage heat treatment at temperatures of 800 °C and 1250 °C. Thermal cyclic experiments on hydrogen sorption/desorption with samples of the Ti-25Al-25Nb (at.%) system were conducted at the VIKA experimental installation at a saturation temperature of about 500 °C and a degassing temperature of 610 °C. It took about 41 min to reach pressure equilibrium at 500 °C. The hydrogen diffusion coefficient was calculated based on the Barrer formula and was 9.1 × 10−5 cm2/s at 500 °C. The maximum hydrogen content was recorded after the first sorption/desorption cycle and was 1.91 wt%. Due to the multiple thermal cyclic effects in the hydrogen medium, the predominantly two-phase (O + B2) alloy structure underwent transformation to form a new structure (O-AlNbTi2). In the phase composition of the Ti-25Al-25Nb (at.%) alloy, the formation of hydrides in the form of independent phases as a result of thermal cycling was not detected. Hydrogen absorption is most likely to be associated with the formation of an interstitial solution based on existing crystalline phases.

Background/Objectives: The purpose of this study has been to evaluate the effects of a dance-based aerobic training program on frailty, cognitive impairment, executive functions, and verbal fluency in older adults with mild cognitive impairment. Methods: Randomized clinical trial, whose sample was made up of 92 older adults, of which 47 performed rhythmic physical activity for 12 weeks. Data on frailty were collected through FRAIL, cognitive function through the Mini-Mental State Examination (MMSE), cognitive impairment through The Montreal Cognitive Assessment (MoCA), verbal fluency using the Isaac test, and executive functions with the Trail Making Test (TMT). All variables were measured before and after the intervention by an independent researcher blinded to the treatment. Results: Participants in the experimental group showed statistically significant improvements in frailty (Cohen’s d = 0.60), cognitive function (Cohen’s d = 0.98), cognitive impairment (Cohen’s d = 1.22), verbal fluency (Cohen’s d = 0.61) and executive functions (Cohen’s d = 0.64). Conclusions: This study demonstrated that a 12-week dance-based aerobic training program can significantly reduce frailty and improve cognitive abilities in older adults with mild cognitive impairment. These improvements suggest that the intervention is not only effective in terms of physical health, but also in promoting mental health and general well-being.

This paper presents a review of a number of works devoted to the studies of high-entropy alloys (HEAs). As is known, HEAs represent a new class of materials that have attracted the attention of scientists due to their unique properties and prospects of application in hydrogen power engineering. The peculiarity of HEAs is their high entropy of mixing, which provides phase stability and flexibility in developing materials with given characteristics. The main focus of this paper is on the application of HEAs for solid-state hydrogen storage, their physicochemical and mechanical properties, and synthesis technologies. Recent advances in the hydrogen absorption properties of HEAs are analyzed, including their ability to efficiently absorb and desorb hydrogen at moderate temperatures and pressures. Prospects for their use in the development of environmentally safe and efficient hydrogen storage systems are considered. The work also includes a review of synthesis methods aimed at optimizing the properties of HEAs for hydrogen energy applications.

Summary: Background: The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE. Methods: A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued. Findings: Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3–20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval [CI]: 2.5–4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2–4.2). No patient died of recurrent PE (0%, 95% CI: 0–7.6%). Subgroup analyses showed that patients with diagnosis in 2021–2022 (vs. 2020) (Hazard ratio [HR] 2.86; 95% CI 1.45–5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19–4.49) had significantly higher rates of VTE recurrences. Interpretation: In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. Funding: Sanofi and Rovi, Sanofi Spain.

Background: Dravet syndrome (DS) is a rare developmental and epileptic encephalopathy that presents with frequent and prolonged seizures resistant to treatment as well as cognitive problems such as behavioral and developmental delays. However, there is a lack of scientific literature on the impact of this condition on caregivers and the family unit. Objectives: To find out the social and emotional impact of DS on the family unit, to provide a comprehensive understanding of the disease's effects on both the family and caregivers. Materials and methods: A tailored online survey was administered to Spanish DS families, collecting data on the employment, financial, emotional, and social status of patients and caregivers. Results: A total of 112 Spanish caregivers participated in the study. The mean age of the 112 parents was 46.61 years, and 77.68 % of them were mothers. The majority of caregivers had to quit their jobs or reduce their working hours to take care of their child with DS, being the most of them mothers. Most of the caregivers felt that they were not well-informed by healthcare professionals (HCPs) and the Spanish National Health System (NHS). Despite access to resources, families often face financial strain and challenges in obtaining sufficient support, highlighting the need for enhanced social, economic, and psychological backing. In addition, both sentimental and social relationships were negatively impacted in the vast majority of respondents. Conclusions: The study advocates for policy reforms, integrated social services, community programs, and multidisciplinary efforts to improve the quality of life and social integration for those affected by DS.

ObjectivesThe purpose of this study has been to analyze the efficacy of a yoga-based intervention on stress, emotional wellbeing, state anxiety and trait anxiety in university students.MethodsThis study was a randomized controlled trial. The sample consisted of 129 university students, of which 65 underwent a yoga training for 12 weeks and a control group that did not carry out any type of intervention. The primary outcome was stress, which was collected through The Perceived Stress Scale (PSS). The secondary outcomes were emotional wellbeing which was measured through the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), and anxiety through State–Trait Anxiety Inventory (STAI). All variables were measured before and after the intervention.ResultsParticipants in the experimental group showed statistically significant improvements in the primary outcome perceived stress (Cohen’s d = 0.44) and the secondary outcomes emotional wellbeing (Cohen’s d = 0.47), and both state anxiety (Cohen’s d = 0.38) and trait anxiety (Cohen’s d = 0.80) compared to the control group that did not carry out any type of physical training.ConclusionThis study demonstrated that a 12-week yoga intervention can significantly reduce perceived stress and anxiety, and improve emotional wellbeing in university students. Initially, the experimental group (EG) reported higher levels of stress and anxiety than the control group (CG), but after the intervention, the EG experienced significant improvements compared to the CG.

El presente trabajo correlaciona las competencias curriculares N°3, 18 y 19 (Currículo 2022) referentes a calidad de vida (salud y alimentación), gestión del espacio y decisiones económicas, y su correspondiente presentación en los textos (de distribución gratuita estatal), determinando que los mismos presentan una significativa postergación en el tratamiento de las mencionadas competencias Para probar esta afirmación se establecieron 29 indicadores correlacionando su tratamiento en los contenidos de 73 títulos (libros de Ciencias Naturales, Ciencias Sociales, nivel primario y secundario), demostrando que las competencias referidas no son abordadas cabalmente en la bibliografía analizada. Se omite o soslaya información acerca del entorno nacional en el cual más del 16% de la población menor de cinco años sufre desnutrición crónica, 58% de la población total tienen sobrepeso, y que ha internalizado marcadas preferencias por una dieta alimentaria plena de edulcorantes, saborizantes, colorantes, odorantes, conservantes, bebidas carbonatadas. El estudiante, entre otros, no accede a una bibliografía que trate de la nutrición, sinergia alimentaria, feofícea y entomofagia (consumo de algas e insectos), agricultura transgénica, estacionalidad, migraciones, centralismo), déficit de la balanza comercial (por importaciones), oligopolización alimentaria, empleo de insecticidas y otros aspectos establecidos en el currículo..

The importance of introducing a new sustainable development paradigm to safeguard the entire planet is now undisputed. One of the tools aiming to respond to this need consists of the Sustainable Development Goals (SDGs) contained within the 2030 Agenda. Businesses play a crucial role in achieving these objectives and must prove themselves to be active actors in promoting sustainable practices. However, the integration of these objectives within their business models turns out to be a complex operation, which requires numerous skills and resources. This paper consists of a systematic literature review on the topic of research on the SDGs in the areas of business, management and accounting with the aim of identifying the barriers facing communities and tools to support companies in this process, as well as possible areas for improvement. Furthermore, it allows us to identify gaps on which future research should focus. To achieve this aim, papers related to the 2030 Agenda and the SDGs published in journals indexed in the Scopus database between January 2015 and June 2024 were analysed. The results demonstrated a great heterogeneity within the research area and the emergence of some important concepts, such as the circular economy, artificial intelligence and Industry 4.0, and some recurring themes, such as the role of stakeholders in achieving the SDGs and the financial and non-financial benefits of SDG strategies and practices.

(1) Background: The aim was to analyze the reliability and validity of the Spanish version of the Mini Sarcopenia Risk Assessment (MSRA) in older adults. (2) Methods: A total of 136 participants (72.24 ± 5.21 years, 68.38% women) took part in the study. The MSRA includes two questionnaires with seven (MSRA-7) and five items (MSRA-5). First, reliability (inter-rater and test–retest) of the Spanish MSRA was studied, and then the total scores were compared with the presence of sarcopenia according to three different diagnostic criteria and with other parameters related to sarcopenia (clinical validation). (3) Results: The analysis showed excellent inter-rater and test–retest reliability. As for the clinical validation, and regardless of the criteria, both questionnaires had a high sensitivity (81.82–88.89% for the MSRA-5 and 90.91–94.44% for the MSRA-7), while the MSRA-5 showed a better specificity (32.00–33.90%) than the MSRA-7 (20.80–22.88%). Predictive positive values ranged from 9.57–17.02% (MSRA-5) and 9.17–15.54% (MSRA-7), while predictive negative values were high for both the MSRA-5 (95.24%) and the MSRA-7 (96.30–96.43%). The accuracy was better for the MSRA-5 (36.03–41.18%) than the MSRA-7 (26.47–32.35%), as well as the area under the curve (0.67–0.76 vs. 0.65–0.73, respectively). Higher MSRA-5 and MSRA-7 total scores significantly correlated with greater muscle strength, quantity and gait speed. (4) Conclusions: The adaptation of the Spanish MSRA questionnaires was successfully performed, and they are reliable and clinically valid tools for assessing sarcopenia.

(1) Background: Numerous exercise programs that improve physical capacity and the risk of falls in older adults have been proposed with varying degrees of success. A novel approach may be to use a video game system that uses real-time force feedback to train older adults. The aim of this study was to evaluate the effects of a Nintendo™ Wii-based exercise program on physical function and risk of falls in older people. (2) Methods: This 12-week randomized controlled clinical trial involved 73 participants: 36 individuals participating in a control group (CG) and 37 in an experimental group (EG) participating in a combined program. Balance was measured using the Tinetti scale, flexibility was assessed with the back scratch test and the sit-and-reach test, and lower body strength was assessed with the 30 s chair stand-up test. (3) Results: The results of this study show significant improvements in balance, gait, flexibility, and strength of the lower limbs compared to a control group. (4) Conclusions: A Nintendo™ Wii-based exercise program for seniors produces improvements in the physical health of older adults. These improvements highlight the importance of integrating physical exercise through video games as an effective strategy to improve the general health and quality of life of older adults.

Schools are ideal settings to promote adolescent physical activity (PA), yet school-based interventions have shown limited long-term impact. This position paper presents key issues surrounding school-based PA interventions. Collaborative conceptual thinking drawing on multi-author expertise and available evidence advanced our understanding and opinion. Key arguments: 1) the adoption of a systems approach, which maximizes partnership action and leverages policy, is crucial for understanding the complexities of implementing whole-school programs; 2) a reorientation to an assets perspective optimizes existing strengths and resources allowing greater emphasis on the full range of physical, cognitive, emotional and social benefits that PA provides, and 3) a move beyond traditional positivist research designs to advance our knowledge of what works better, for whom and in what context is needed for greater progress We provide suggestions, specifically advocating for systems approaches, as a realistic way to improve how we support PA in schools in the future. [ABSTRACT FROM AUTHOR]

Abstract Objective Wild-type transthyretin (ATTRwt) amyloidosis is caused by the misfolding and deposition of the transthyretin protein (TTR) in the absence of mutations in the TTR gene. Studies regarding the variant form of ATTR amyloidosis (ATTRv) suggest that the presence of single-nucleotide polymorphisms (SNP) in genes other than the TTR, may influence the development of the disease. However, other genetic factors involved in the aetiopathogenesis of ATTRwt are currently unknown. This work investigates the presence of sequence variants in genes selected for their possible impact on ATTRwt amyloidosis. To do so, targeted sequencing of 84 protein-coding genes was performed in a cohort of 27 patients diagnosed with ATTRwt. Results After applying quality and frequency filtering criteria, 72 rare or novel genetic variants were found. Subsequent classification according to the ACMG-AMP criteria resulted in 17 variants classified as of uncertain significance in 14 different genes. To our knowledge, this is the first report associating novel gene variants with ATTRwt amyloidosis. In conclusion, this study provides potential insights into the aetiopathogenesis of ATTRwt amyloidosis by linking novel coding-gene variants with the occurrence of the disease.

ObjectivesThe purpose of this study has been to evaluate the use of gamification in the classroom, in terms of its effects on attention, concentration, creativity, and generic capabilities, for university students enrolled in a Bachelor’s degree program in Physiotherapy.MethodsAn experimental design was implemented, using three groups differentiated by their time of exposure to the game (0 min, 30 min, or 60 min per week). The sample consisted of 73 s-year students from a Bachelor’s degree program in Physiotherapy. The theoretical content for each class was taught during a period of 4 months, reinforced by use of the Kahoot! Online platform. Selective attention and concentration were evaluated using the d2 Test of Attention; creative intelligence using the Creative Intelligence Test (CREA); and generic capabilities using the capabilities subscale of the Student Engagement Questionnaire (SEQ).ResultsThe study’s participants had a mean age of 19.51 ± 0.9 years, and it has demonstrated that use of Kahoot! For longer periods of time, i.e., more than 60 min per day, can improve essential skills in university students, such as attention, creativity, critical thinking, self-managed learning, adaptability, problem solving, and computer literacy. This study’s results show that integrating Kahoot! Into the educational environment, especially with longer sessions that allow for deeper immersion in the game, produces benefits by stimulating various cognitive aspects and enhancing complex skills.ConclusionThis study has demonstrated that use of Kahoot! Improves key skills such as attention, creativity, and critical thinking, especially when longer sessions are used. It is also suggested that its use should be balanced with other educational activities, in order to achieve comprehensive development for the students.