European Regions Research Articles

Assessing the quality of chest compressions with a DIY low-cost manikin (LoCoMan) versus a standard manikin: a quasi-experimental study in primary education.

Extending the access to cardiopulmonary resuscitation (CPR) training to a wider public is an important step in increasing survivability of out-of-hospital cardiac arrest. However, often price and maintenance of CPR manikins are barriers that prevent training at schools. This study aims to evaluate the learning of hands-only (HO) CPR by practicing with a low-cost manikin (LoCoMan) with visual qualitative feedback and to compare the results with the skills acquired by practice on a conventional manikin. A quasi-experimental study with 193 schoolchildren (10 to 12years old) who were allocated to two groups: the LoCoMan group was taught via an integrative approach (science combined with physical education (PE)) and practiced on a handmade manikin, and a control group practiced in a traditional setting with a commercial manikin (Resusci Junior, Laerdal, Norway). All participants practiced for 1 hands-on skill session before performing a post-test on an instrumented CPR manikin. The outcomes including HO-CPR performance variables were compared between groups. The LoCoMan and control groups both achieved acceptable percentage of HO-CPR quality (57% and 71%, p = 0.004). Among 6th-graders, there were no significant differences in HO-CPR quality between LoCoMan 68% and control 71%, p = 0.66. The control group achieved better chest compression depth while the LoCoMan group showed more compressions with adequate chest recoil. Conclusion: Schoolchildren are able to build and use a low-cost manikin with visual feedback. The integrative learning approach used in this study may be a feasible alternative methodology for training and learning HO-CPR in schools when commercial manikins are not available. What is Known: • Access to CPR training should be universal and independent of age, location, financial means, or access to qualified instructors. • Scientific societies promote the implementation of CPR in schools, so that teachers and schoolchildren can play a multiplier role in their environment, but the gap in CPR learning is related to cultural, economic factors or access to resources and materials. What is New: • LoCoMan may be a useful device for teaching and learning CPR in schoolchildren from the age of 10 and upwards. • LOCOMAN shows that it is feasible and possible to build a low-cost manikin (about €5 in the European Region) and to integrate it into an integrative educational project, and outlines how this could be done. this approach can be an incentive for teachers to attempt teaching CPR, but also for education outside the formal environment.

Alzheimer’s diseases in America, Europe, and Asian regions: a global genetic variation

Background Alzheimer’s disease (AD) is one of the multifaceted neurodegenerative diseases influenced by many genetic and epigenetic factors. Genetic factors are merely not responsible for developing AD in the whole population. The studies of genetic variants can provide significant insights into the molecular basis of Alzheimer’s disease. Our research aimed to show how genetic variants interact with environmental influences in different parts of the world. Methodology We searched PubMed and Google Scholar for articles exploring the relationship between genetic variations and global regions such as America, Europe, and Asia. We aimed to identify common genetic variations susceptible to AD and have no significant heterogeneity. To achieve this, we analyzed 35 single-nucleotide polymorphisms (SNPs) from 17 genes (ABCA7, APOE, BIN1, CD2AP, CD33, CLU, CR1, EPHA1, TOMM40, MS4A6A, ARID5B, SORL1, APOC1, MTHFD1L, BDNF, TFAM, and PICALM) from different regions based on previous genomic studies of AD. It has been reported that rs3865444, CD33, is the most common polymorphism in the American and European populations. From TOMM40 and APOE rs2075650, rs429358, and rs6656401, CR1 is the common investigational polymorphism in the Asian population. Conclusion The results of all the research conducted on AD have consistently shown a correlation between genetic variations and the incidence of AD in the populations of each region. This review is expected to be of immense value in future genetic research and precision medicine on AD, as it provides a comprehensive understanding of the genetic factors contributing to the development of this debilitating disease.

Assessing the conservation and restoration potential of biotopes in a central European region

AbstractChanging environmental conditions and land use are threatening biodiversity on a large scale, making successful conservation and restoration essential for maintaining biodiversity. Planning of such efforts profits from information about where conditions are suitable for biotopes, to evaluate how likely successful conservation or restoration is at these sites. This study uses the distribution model Maxent to identify varying levels of conservation and restoration potential for 29 different biotopes in the central European region of Bavaria, Germany, by comparing the environmentally suitable areas identified by models with the current distribution of each biotope. We identified a conservation potential when a biotope occurred under suitable environmental conditions and a restoration potential when suitable environmental conditions were present at a site where the biotope was not observed. We found that 69.57% of biotope observations occurred under suitable environmental conditions representing a large conservation potential. Also, 22 biotopes showed more restoration potential than their current distribution and both conservation and restoration potential showed a similar geographical distribution. The approach used in this study can provide valuable insights for conservation and restoration decision-making by suggesting priority areas for the conservation and restoration of multiple biotopes. Further, it could be applied in other regions globally and by incorporating future climate projections it could identify particularly resilient locations for biotope conservation or restoration.

CONTEMPORARY STATE OF DIAGNOSIS AND TREATMENT OF BRONCHIAL ASTHMA AMONG CHILDREN

This paper provides a brief overview of the current state of diagnosis and treatment of bronchial asthma among the pediatric population, given the increasing incidence worldwide. Materials and methods: Wiley, PubMed, Web of Science, Scopus databases and health compilations of the Republic of Kazakhstan over a five-year period (2018-2023) were used for this review. Currently, the WHO European Region is facing a significant threat from the growing incidence of preventable noncommunicable diseases (NCDs), among which chronic respiratory diseases are highlighted. These diseases not only reduce the quality of life of individuals but also cause substantial economic damage to families, communities, and countries as a whole, which underscores the relevance of our chosen topic. According to expert estimates, there are more than 350 million people worldwide with bronchial asthma, with about 5-10% of cases being among the pediatric population. In Kazakhstan, there is a steady trend of increasing incidence worldwide.

Contrast between Brazil and other countries in nutraceutical components of Camelina sativa grains

Camelina sativa, also known as false flax, is a species can be cultivated in a variety of climates, seasons and soil types, due to its short development cycle and tolerance to drought and low temperatures. In the composition of its grains, it presents a high amount of oil and rich in unsaturated fatty acids. In view of this, the objective of this work was to compare the composition of the nutraceutical components of Camelina sativa L. grains cultivated in Brazil and countries in Europe, Asia and North America. About 20 kg of grains were collected and then a homogeneous sample of 1kg of grains was cleaned to perform the centesimal composition of the grains. Afterwards, a search for information was carried out on the cultivation of Camelina sativa L. in other countries and the collection of information on the centesimal composition of the grains of this oleaginous plant. The collection of information was based on obtaining published scientific articles on the nutraceutical composition of Camelina sativa in regions of Europe, Asia and North America. Brazil presents a promising environment for the cultivation of Camelina sativa, with superior performance for the content of stearic acid, linoleic acid, linolenic acid and palmitic acid. The fatty acids profile decreased with the reduction of the minimum air temperature. The mineral material, palmitic acid and linolenic acid are positively correlated.

Commonsense sovereignty: a practice theory of Flanders’ paradiplomacy to the European Union

ABSTRACT European regions implement up to 70% of EU legislation, yet they are generally considered ‘objects’ rather than ‘subjects’ of European governance. This article proposes an original conceptual framework derived from practice theory in IR for the analysis of regional paradiplomacy in multilateral institutions. Through a case study of the Delegation of Flanders to the EU based on interviews with Flemish and Federal members of the Belgian Permanent Representation, this research contributes to the literature on paradiplomacy by critically examining the commonsense acceptance that sovereign authority can be delegated to substate actors while the unity of sovereign political representation must remain unchallenged. The analysis therefore shows that regional strategies of engagement with the EU are not only determined by formal institutions but are also shaped by taken for granted understandings of sovereignty which set the standards of competent diplomatic practice and inclusion for substate representatives.

Conducting Drug Treatment Trials in Children: Opportunities and Challenges.

Children were often referred to as "therapeutic orphans" in the past due to different reasons such as ethical, regulatory, economic, scientific, etc., ones. They were exposed to avoidable risks while missing out on therapeutic advances. Pediatric patients have suffered from a lack of scientific and regulatory standards (e.g., proper drug testing, authorization of medicines for their use, etc.), although the pharmaceutical legislative framework, which ensures the high standards of safety, quality, and efficacy of medicinal products for use in adults, was developed primarily in response to past "drug disasters," mainly involving children. The adoption of pediatric regulatory initiatives first in the USA and then in Europe and other countries and regions has significantly changed the worldwide frameworks and permanently changed pediatric drug research and development. This article tries to give various perspectives with historical context, a review of the different challenges and opportunities as well as important stakeholders in pediatric drug development. The pediatric trial networks are probably the most important stakeholder that enables efficient patient recruitment, access to better resource utilization, and global collaboration of different stakeholders necessary for performing quality and well-designed clinical trials.

Inter‐comparison and validation of high‐resolution surface air temperature reanalysis fields over Italy

AbstractSurface air temperature (t2m) data are essential for understanding climate dynamics and assessing the impacts of climate change. Reanalysis products, which combine observations with retrospective short‐range weather forecasts, can provide consistent and comprehensive datasets. ERA5 represents the state‐of‐the‐art in global reanalyses and supplies initial and boundary conditions for higher‐resolution regional reanalyses designed to capture finer‐scale atmospheric processes. However, these products require validation, especially in complex terrains like Italy. This study analyses the capability of different reanalysis products to reproduce t2m fields over Italy during the 1991–2020 period. The analyses encompass ERA5, ERA5‐Land, the MEteorological Reanalysis Italian DAtaset (MERIDA), the Copernicus European Regional ReAnalysis (CERRA), and the Very High‐Resolution dynamical downscaling of ERA5 REAnalysis over ITaly (VHR‐REA_IT). The validation we conduct pertains to both the spatial distribution of 30‐year seasonal and annual normal values and the daily anomaly records. Each reanalysis is compared with observations projected onto its respective grid positions and elevations, overcoming any model bias resulting from an inaccurate representation of the real topography. Key findings reveal that normal values in reanalyses closely match observational values, with deviations typically below 1°C. However, in the Alps, winter cold biases sometimes exceed 3°C and show a relation with the elevation. Similar deviations occur in the Apennines, Sicily, and Sardinia. Conversely, VHR‐REA_IT shows a warm bias in the Po Valley up to 3°C in summer. Daily anomalies generally exhibit lower errors, with MERIDA showing the highest accuracy and correlation with observational fields. Moreover, when aggregating daily anomalies to annual time scales, the errors in the anomaly records rapidly decrease to <0.5°C. The results of this study empower reanalysis users across multiple sectors to gain a more profound insight into the capabilities and constraints of different reanalysis products. The knowledge and the characterization of the reanalyses t2m bias against observations can indeed be crucial when incorporating these products into their research and practical applications.

„Našlaičiams vaikams reikalinga pagalba“: pamestinukų žindyvės Vilniuje XVIII amžiaus antrojoje pusėje

The article focuses on the wet-nurses for foundlings in Vilnius in the second half of the eighteenth century when the number of children abandoned by their parents grew significantly. Wet-nurses who nursed foundlings have already received some attention in previous historiography, however, there have been no attempts to more thoroughly explore who were the women employed by hospitals and other charitable institutions as wet-nurses, what were the conditions of their employment, and how important could the income earned from this work have been in supporting their households. The research, based primarily on two distinct lists of foundlings and wet-nurses from 1789 and 1790 (see apendices), reveals that the wet-nurses were married Catholic women who had given birth several months earlier. The sources show that, throughout the second half of the eighteenth century, their monthly payment of 8 złotys remained unchanged despite inflation or other economic processes as well as the the increase in demand of women able and willing to work as wet-nurses for foundlings when the numbers of abandoned children grew significantly. Nevertheless, such employment provided women with, albeit low, but permanent and–if the nursling did not perish early–lasting income. The research demonstrates that at least some of the wet-nurses were married to artisans and merchants, and resided in Vilnius and its suburbs, not, as was usual in other European regions, the countryside, although there are indications in later sources that foundlings were actually placed with nurses of the surrounding countryside. The registers of baptisms and marriages reveal that at least some of these women were married, baptized their own children at the parish church of St John, and acted as godmothers to the children of other parishioners. However, the data on the social status of women employed as wet-nurses for foundlings is insufficient to confirm that–just like in other European cities–they were destitute and came from the lowest strata of society.

Annual winter crop distribution from MODIS NDVI timeseries to improve yield forecasts for Europe

Crop yield forecasts allow policy makers to anticipate market behaviour and regulate prices. Annual updates on which crops are grown where can improve crop yield forecast accuracy. Existing efforts to map crops across the European Union resulted in late-season map availability or short time series that do not meet forecasting requirements. We propose a new approach to retrieve annual winter crop maps and improve forecasting efforts by identifying pixels with dominant winter crop signals using moderate resolution imagery. These pixels are distinguished from summer crop signals based on their senescence date. When this date precedes the theoretical maturity date of a winter crop, expressed in GDD, the pixel is labelled as having a dominant winter crop signal. Our 2018 map accurately identified 77% and 83% of dominantly winter-crop area, when compared to farmers’ declaration data and a high-resolution crop map for Europe, respectively. While the resulting annual winter crop maps underestimated winter crop area, derived region-specific annual NDVI profiles better described winter crop phenology as compared to the use of static maps. Regression analysis between these regional NDVI profiles and statistical wheat yield data indicates that our annual maps help explain more yield variability than static maps, with an RMSE reduction of 3% for the EU27 as whole. The proposed approach is applicable to long historical timeseries and provides maps before the end of the agricultural season. Those maps positively impact crop yield description, notably in eastern, northern, and northeastern European regions.

Where have Ukrainian refugees gone? Identifying potential settlement areas across European regions integrating digital and traditional geographic data

AbstractThe escalation of conflict in Ukraine has triggered the largest refugee crisis in Europe since WWII. As of early April 2024, over 5.9 million people have fled Ukraine. Large‐scale efforts have been made to identify the major receiving countries. However, less is known about the subnational areas within host countries where refugees have migrated. Identifying these areas is key for the appropriate allocation of humanitarian aid. By combining digital Facebook API data and traditional data from Eurostat, this paper aims to identify and characterise potential settlement areas of Ukrainians across the main destination countries in Europe. We identify high concentrations of Ukrainians in urban areas with a preexisting diaspora and tight labour market conditions across southern, northern‐west and central Poland and the city of Prague in the Czech Republic. We also find potential settlements in key urban agglomerations with a moderate diaspora and high levels of unemployment in Spain. Only in Romania, refugees seem to have settled in rural areas which show a moderate diaspora but low levels of unemployment. Potential settlement areas in Germany, Italy and the United Kingdom are spread across the country. Surprisingly, we do not identify potential settlement areas in bordering regions with Ukraine within neighbouring countries, suggesting that refugees may have used them as transit points. Our findings point out that different packages of humanitarian assistance may be needed according to the number of refugees and the characteristics of settlement areas.

User factors affecting the use of digital services in five European regions and countries

Digitalisation has great potential to reduce costs, improve access and enhance user experience. However, it could also increase inequality, with some people struggling to access and use digital services. It is important to understand who is likely to be excluded in this way and why. This can help to identify groups at particular risk of digital exclusion, inform efforts to overcome the barriers, and develop more inclusive digital services. This paper introduces a set of five linked datasets examining a range of user factors affecting the use of digital services. The datasets focus on the use of digital mobility services, but the data is useful in understanding the use of other digital services as well. The user factors considered include technology access, use and competence and attitudes towards digital technology. The datasets were the results of surveys in five European regions and countries (Germany, Italy, Barcelona Metropolitan Area, Flanders and the Netherlands). Samples were taken of the adult (age 16+) population with a total of 3,454 participants.

SUBSTANTIATION OF THE CERTIFICATE PROGRAM «GLOBAL HEALTH» AS A COMPONENT OF THE TRAINING OF PUBLIC HEALTH SPECIALISTS

The aim: to develop a modern certification program "Global Health" for the continuous professional development of public health professionals. Materials and methods. The study employed bibliosemantic, informational-analytical, medical-statistical, sociological methods, and content analysis method. The research program included an analysis of the main competencies of public health professionals, as defined by the Association of Schools of Public Health in the European Region (ASPHER) and the higher education standard for specialty 229 "Public Health" for the second (master's) level of higher education; analysis of existing certification programs on global health; conducting sociological surveys of public health professionals regarding priority topics and preferred learning methods. The research was based on normative documents, electronic resources, and the results of sociological research. Statistical processing and mathematical analysis of materials were conducted using statistical analysis methods. Results. It was established that global health issues are significant in shaping the professional competencies of public health professionals, considering the requirements of the higher education standard for specialty 229 "Public Health" for the second (master's) level of higher education and those, defined by the European List of Core Competencies for Public Health Professionals ASPHER. The study of these issues was identified as important for continuous professional development based on sociological surveys of disease control and prevention center employees (38.4 out of 100 respondents). Among various forms of education, webinars (62.2±3.8 out of 100 respondents) and online learning (60.4±3.8) are most in demand. Analysis of the obtained data led to the justification of the "Global Health" certification program. In the developed "Global Health" certification program, 26.7% of the workload corresponds to lectures, 33.3% to practical classes, and 40% to preparatory work. Structurally, it covers 2 modules and 8 topics on current issues of the impact of globalization on health and analysis of global health indicators. Conclusions. The "Global Health" certification program meets the requirements of normative documents, considers contemporary challenges and consequences of globalization on health, highlights global health trends, and its topics are in demand among disease control and prevention center professionals.

Systematic review and best practices for drone remote sensing of invasive plants

Abstract Drones have emerged as a cost‐effective solution to detect and map plant invasions, offering researchers and land managers flexibility in flight design, sensors and data collection schedules. A systematic review of trends in drone‐based image collection, data processing and analytical approaches is needed to advance the science of invasive species monitoring and management and improve scalability and replicability. We systematically reviewed studies using drones for plant invasion research to identify knowledge gaps, best practices and a path toward advancing the science of invasive plant monitoring and management. We devised a database of 33 standardized reporting parameters, coded each study to those parameters, calculated descriptive statistics and synthesized how these technologies are being implemented and used. Trends show a general increase in studies since 2009 with a bias toward temperate regions in North America and Europe. Most studies have focused on testing the validity of a machine learning or deep learning image classification technique with fewer studies focused on monitoring or modelling spread. Very few studies used drones for assessing ecosystem dynamics and impacts such as determining environmental drivers or tracking re‐emergence after disturbance. Overall, we noted a lack of standardized reporting on field survey design, flight design, drone systems, image processing and analyses, which hinders replicability and scalability of approaches. Based on these findings, we develop a standard framework for drone applications in invasive species monitoring to foster cross‐study comparability and reproducibility. We suggest several areas for advancing the use of drones in invasive plant studies including (1) utilizing standardized reporting frameworks to facilitate scientific research practices, (2) integrating drone data with satellite imagery to scale up relationships over larger areas, (3) using drones as an alternative to in‐person ground surveys and (4) leveraging drones to assess community trait shifts tied to plant fitness and reproduction.

The effect of temperature on the boundary conditions of West Nile virus circulation in Europe.

West Nile virus (WNV) is a vector-borne flavivirus that causes an increasing number of human and equine West Nile fever cases in Europe. While the virus has been present in the Mediterranean basin and the Balkans since the 1960s, recent years have witnessed its northward expansion, with the first human cases reported in Germany in 2018 and the Netherlands in 2020. WNV transmission and amplification within mosquitoes are temperature-dependent. This study applies a mathematical modelling approach to assess the conditions under which WNV circulation occurs based on the proportion of mosquito bites on WNV-competent birds (dilution), vector-host ratios, mosquito season length and the observed daily temperature data. We modelled five distinct European regions where previous WNV circulation has been observed within the Netherlands, Germany, Spain, Italy, and Greece. We observed that the number of days in which the basic reproduction number (R0) is above one, increased over the last 40 years in all five regions. In the Netherlands, the number of days in which the R0 is above one, is 70% lower than in Spain. The temperature in Greece, Spain and Italy allowed for circulation under low vector-host ratios, and at a high dilution. On the other hand in the Netherlands and Germany, given the observed daily temperature, the thresholds for circulation requires a lower dilution and higher vector-host ratios. For the Netherlands, a short window of introductions between late May and mid-June would result in detectable outbreaks. Our findings revealed that the temperate maritime climate of the Netherlands allows WNV circulation primarily during warmer summers, and only under high vector-host ratios. This research contributes valuable insights into the dynamic relationship between temperature, vector properties, and WNV transmission, offering guidance for proactive strategies in addressing this emerging health threat in Europe.

Antimicrobial resistance, virulence potential and genomic epidemiology of global genomes of the rare Salmonella enterica serovar Orion.

Our aim is to characterize through whole-genome sequencing (WGS) the antimicrobial resistance (AMR) and heavy metal tolerance (HMT) genes content, plasmid presence, virulence potential and genomic diversity of the rare non-typhoid Salmonella enterica serovar Orion (S. Orion) from 19 countries of the African, American, Eastern Mediterranean, European, Southeastern Asia and Western Pacific regions. Totally 324 S. Orion genomes were screened for AMR, HMT and virulence genes, plasmids and Salmonella Pathogenicity Islands (SPIs). Genomic diversity was investigated using Multi-Locus Sequence Typing (MLST) and core-genome MLST (cgMLST). Efflux pump encoding genes mdsA and mdsB were present in all genomes analysed, while quinolone chromosomal point mutations and aminoglycoside, beta-lactam, colistin, lincosamide, macrolide, phenicol, sulphonamide, trimethoprim, tetracycline and disinfectant resistance genes were found in 0.3%-5.9%. A total of 17 genomes (5.2%) from Canada, the United Kingdom, the USA and Tanzania showed a potential multi-drug resistance profile. Gold tolerance genes golS and golT were detected in all genomes analysed, while arsenic, copper, mercury, silver and tellurium tolerance genes were found in 0.3%-35.5%. Col(MGD2) was the most frequently detected plasmid, in 15.4% of the genomes. Virulence genes related to adherence, macrophage induction, magnesium uptake, regulation, serum resistance, stress adaptation, type III secretion systems and six SPIs (1, 2, 3, 4, 5, 9, 12, 13, 14 and C63PI) were detected. ST639 was assigned to 89.2% of the S. Orion genomes, while cgMLST showed core-genome STs and clusters of strains specific by countries. The high virulence factor frequencies, the genomic similarity among some non-clinical and clinical strains circulating worldwide and the presence of a strain carrying a resistance gene against a last resource antimicrobial like colistin, highlight the potential risk of S. Orion strains for public health and food safety and reinforce the importance to not underestimate the potential hazard of rare non-typhoid Salmonella serovars.

Enviro‐economic and feasibility analysis of industrial hemp value chain: A systematic literature review

AbstractA recent renaissance of industrial hemp has been driven by a plethora of ecologically amicable products and their profitability. To identify its environment and economic fate across the value chain (VC), this study conducts a systematic review of 98 studies published in ScienceDirect, Web of Science, and Scopus‐indexed journals. The thematic content of the articles is categorized using three deductively derived classification categories: lifecycle analysis (n = 40), VC analysis (n = 30), and feasibility analysis (n = 28). Bibliometric analysis indicates that the majority (>90%) of the studies were conducted in selected regions of Europe or North America, with further findings around regionally prioritized industrial hemp products, such as hempcrete in Southwest Europe, solid biofuel in North European states, and textile fiber and bio‐composites in East Europe and North America. Lifecycle analysis studies highlight nitrogenous fertilizer use during industrial hemp cultivation as a major ecological hotspot, which is taking a toll on the climate change index. However, hemp‐based products are generally climate‐friendly solutions when contrasted against their fossil fuel counterparts, with hempcrete in particular a highly touted carbon‐negative (−4.28 to −36.08 kg CO2 eq/m2) product. The review also identifies key issues within the hemp VC and presents innovative solutions alongside the recognition of value‐adding opportunities. Furthermore, feasibility analysis indicates unprofitability in using hemp for bioenergy production and there is a relative cost worthiness of hemp bio‐composites and hempcrete at the upstream level. Positive returns are observed under co‐production schemes. In contemplating the literature findings, we discussed and identified gap in existing literature for future exploration, including more studies to provide insights from the Global South, and the production of industrial hemp under a biophysically constrained landscape.

The role of tourism in European regions’ economic recovery: A spatial perspective

The study searches for the presence of a tourism-led growth path after a negative shock. Both the presence of a tourism role in the recovery process and the existence of a spatial interdependence across regions are investigated. The purpose of the study is to look at insights, provided in particular by the experience of the 2007–2008 crisis in European regions, that can be useful to build a recovery after any future shocks, as for example the COVID-19 pandemic resulted to be. The findings show the presence of a strong spatial dependence in the recovery process and, furthermore, the positive potential that tourism activities exert on the ability to recover favouring positive spillovers across regions.

Abstract PO1-01-13: Clinical characterization, prognostic and predictive values of HER2-low in early breast cancer in the PALLAS trial

Abstract Background: Low levels of HER2 expression (HER2-low) have recently emerged as a therapeutic target in patients (pts) with breast cancer (BC). The aim of this study was to evaluate clinical and demographic variables associated with HER2 expression, as well as the value of HER2-low as a prognostic and predictive biomarker for palbociclib benefit in pts enrolled in the PALLAS trial. Methods: The phase III PALLAS trial investigated the addition of palbociclib to adjuvant endocrine therapy (ET) in pts with stage II-III hormone receptor-positive BC. The aims of this analysis are (1) to assess the association between the presence of low levels of HER2 expression with demographic and clinicopathological parameters, (2) to test the prognostic value of HER2-low status on invasive disease-free survival (IDFS), distant relapse-free survival (DRFS), and overall survival (OS) and (3) to assess the value of HER2 expression as a predictive biomarker of response to palbociclib. HER2-low was defined as HER2 immunohistochemistry (IHC) 1+ or IHC 2+ with negative in situ hybridization; all pathologic evaluation was performed locally. Pts with HER2-0 and Her2-low BC were included in this analysis; those with HER2-positive BC or missing HER2 status were excluded. Association of HER2 with other baseline covariates were tested with Chi-squared tests. Prognostic and predictive power of HER2 were assessed with Cox Models. Multivariable models included age, T-stage, N-stage, grade and progesterone receptor (PR) expression. Hazard ratios (HR) and 95% Confidence intervals (CI) are reported. Results: From the original PALLAS intention-to-treat population (N = 5,753), 5304 pts (92.2%) were included in this analysis. Among these, 2,254 pts (42.5%) were classified as HER2 IHC 0 (HER2-0) and 3,050 (57.5%) as HER2-low (1,838 with IHC 1+ and 1,212 with IHC 2+). For this analysis, median follow-up was 59.8 months. Compared to HER2-0, pts with HER2-low tumors had statistically higher estrogen receptor expression levels (mean expression 89.2% vs 88.2%, p = 0.019), lower PR expression levels (65.9% vs 68.2%, p = 0.007). Importantly, HER2-low status varied significantly across 21 participating countries (range 16.7% to 75.6%; p< 0.001) and was more frequent in pts enrolled in North America (63.1%) than in Europe (53.4%) and other regions (53.4%) (p < 0.001). No differences in HER2 expression were observed according to anatomic stage, T-stage, N-stage, histological grade, age, menopausal status, primary surgery type, prior radiation, prior chemotherapy, or baseline performance status. There were no statistically significant differences in IDFS, DRFS or OS according to HER2 status in univariate or multivariable Cox models (prognostic value, HR provided in the Table). There was no significant interaction between the HER2 status and the benefit to palbociclib in IDFS, DRFS or OS (Table). Similar results were obtained when HER2-0 was compared to HER2 1+ and HER2 2+ separately. Conclusions: In this large, prospective and international cohort, no differences were observed in clinical parameters, prognosis, or differential benefit from palbociclib (predictive value) between HER2-0 and HER2-low tumors. Significant geographic variability was observed in the prevalence of HER2-low status, suggesting a high degree of variation in pathologic assessment of HER2 expression without impact on outcomes. Support: AFT, Abbvie Pfizer; Clinicaltrials.gov: NCT02513394 https://acknowledgments.alliancefound.org Citation Format: Guilherme Nader-Marta, Christian F. Singer, Dominik Hlauschek, Angela DeMichele, Paolo Tarantino, Georg Pfeiler, Miguel Martín, Justin Balko, Zbigniew Nowecki, Marija Balic, Adam Brufsky, Arlene Chan, Patrick G. Morris, Tufia Haddad, Sibylle Loibl, Yuan Liu, Lidija Sölkner, Christian Fesl, Erica Mayer, Michael Gnant. Clinical characterization, prognostic and predictive values of HER2-low in early breast cancer in the PALLAS trial [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-01-13.

Consumption of ultra-processed foods and relationship with sodium and potassium excretion: a cross-sectional study

Introduction: Higher consumption of ultra-processed foods (UPF) had been associated with higher risk of non-communicable diseases (NCD) and NCD-promoting nutrient profile such as high sodium content and low potassium content. The objective of the study was to evaluate the level of food processing according to the NOVA classification and its relationship with sodium and potassium intake estimated by 24-hour urinary excretion. Methods: This is a cross-sectional study. Data collection included 107 workers from a public university (51.4% female; mean age 47 years) participating in an iMC Salt clinical trial). A 24-hour urinary collection was used to estimate sodium and potassium intake, validated by the creatinine coefficient. The corresponding 24-hour dietary recall was used to assess food intake and foods were categorized using the NOVA classification according to the degree and purpose of processing, into four groups. Nutri-score was also used to categorize UPF and provide more information about the nutritional quality of products. Results: The largest energy contribution came from the group of unprocessed or minimally processed foods (51.6%), followed by UPF (24%), processed foods (21.8%) and processed culinary ingredients (2.6%). Individuals with the lowest caloric contribution of the consumption of UPF had higher average values of potassium (K) intake (1438 vs 1136 mg/1000kcal; p=0.007), as individuals with the highest weight contribution of the consumption of unprocessed or minimally processed foods (1434 vs 1109 mg/1000kcal; p=0.010). For sodium (Na) intake no significant results were found between individuals with the lowest and the highest consumption of each NOVA group. Conclusions: Higher consumption of fresh or minimally processed foods and lower UPF intake were associated with higher K intake values. On the other hand, higher UPF intake was not associated with higher Na intake values. Funding: This work was supported by Fundação para a Ciência e Tecnologia by Grant POCI-01-0145-FEDER-029269) and by the European Regional Development Fund (ERDF) through NORTE 2020 (Northern Regional Operational Program 2014/2020) - NORTE-01-0145-FEDER-072687.