Spain Research Articles

Storage of chicken breast meat in paper coated with different types of hydrophobic agents

Chicken meat is well known for its high nutritional value. Its shelf life is short, due to the pronounced perishability, even under refrigeration. Paper bags are usually used as packaging materials, due to their biodegradability. The main negative aspect concerning paper is its high porosity and low moisture barrier. In this regard, it has to be coated/modified with efficient moisture barrier materials. The storage of chicken breast meat wrapped in four types of paper‐based materials currently in use in Romania (RO), Italy (IT), Spain (SP) and Slovenia (SLO) is reported. RO and IT are paper coated with polyethylene (PE) film, SP is waxed paper, and SLO is paper modified with hydrophobized starch. The influence of the coating film on the organoleptical, biochemical and microbiological characteristics of the chicken breast meat stored at 4°C was the aim of the study. The mathematical modelling revealed two aspects: (1) the stability period in which the meat safe for consumption is in the range 1.92–2.18 days in the case of all paper types, and (2) cadaverine, the amine generated by protein degradation, is a less sensitive indicator of the meat alteration than microbial growth. The papers coated with PE (RO and IT samples) and with hydrophobized starch (SLO paper) were packaging materials more efficient that the waxed paper (SP sample). The polyethylene film reduced the conversion of putrescine into spermidine in a higher extent than wax.

Abstract 6276: Real-world prevalence of MSI/MMR testing for patients with recurrent or advanced endometrial cancer in Europe

Abstract Introduction: Microsatellite instability (MSI) due to defective DNA mismatch repair (MMR) has emerged as an actionable biomarker in endometrial cancer (EC) with the recent availability of MSI-directed therapies. Currently, there is no data on utilization of MSI/MMR testing for EC in Europe. This study aims to assess the real-world prevalence of MSI/MMR testing and related tumor status in women with recurrent or advanced EC (aEC) in Europe. Methodology: Endometrial Cancer Health Outcomes-Europe (ECHO-EU) is a multicenter retrospective chart review study in United Kingdom (UK), Germany (GE), Italy (IT) and Spain (SP). Physicians extracted de-identified data from medical records of women (≥18 years) diagnosed with aEC, who progressed after prior systemic therapy between July 2016 and July 2019. Patients’ demographics, clinical characteristics, and MSI/MMR testing data were collected. Women were categorized by MSI/MMR status. Results: Interim data from 81 physicians included 349 eligible women (UK=83, GE=64, IT=102, SP=100). More than 85% of physicians were medical oncologists and 91% had a hospital-based practice. At aEC diagnosis, eligible women were on average 68 years, 91% were Stage III/IV, and 56% had endometrioid carcinoma. Overall, 36% of patients were tested by either polymerase chain reaction (PCR) for MSI or immunohistochemistry (IHC) for MMR (UK=33%, GE=31%, IT=25%, SP=55%). Of those with ≥1 test, 54% were tested prior to systemic therapy initiation, with large inter-country differences (16-70%), 20% were MSI-high/deficient MMR (dMMR), 73% were non-MSI-high/proficient MMR (pMMR), and 7% had a mixed result. (Table) Conclusion: Overall MSI/MMR testing rates in Europe are low. Approximately 1 in 5 tested patients had MSI-high/dMMR tumors and three quarters had non-MSI-high/pMMR tumors. Knowledge regarding MSI/MMR testing and related tumor status may be helpful for optimal utilization of targeted therapies for aEC patients in Europe. Table - Patient characteristics and MSI/MMR testing/prevalence in women with aEC in Europe Variable All (N = 349) UK (N = 83) Germany (N = 64) Italy (N = 102) Spain (N = 100) Age at diagnosis of advanced or recurrent EC (years), Mean (SD) 67.5 (9.2) 69.0 (8.4) 68.5 (8.3) 66.1 (9.3) 67.1 (10.1) Stage III-IV at initial diagnosis, N (%) 318 (91.1) 78 (94) 58 (90.6) 96 (94.1) 86 (86) ECOG at recurrent or advanced diagnosis, N (%) 0-1 287 (82.2) 79 (95.2) 34 (53.1) 88 (86.3) 86 (86) Any MSI/MMR testing (IHC or PCR), N (%) Not tested 222 (63.6) 56 (67.5) 44 (68.8) 77 (75.5) 45 (45) Tested 127 (36.4) 27 (32.5) 20 (31.3) 25 (24.5) 55 (55) MSI/MMR status, N (%) MSI-High/dMMR 25 (19.7) 7 (25.9) 3 (15) 3 (12) 12 (21.8) Non-MSI-High/pMMR 93 (73.2) 20 (74.1) 14 (70) 19 (76) 40 (72.7) Mixed 9 (7.1) 0 (0) 3 (15) 3 (12) 3 (5.5) MSI/MMR testing administration, N (%) Before treatment initiation 68 (53.5) 19 (70.4) 10 (50) 4 (16) 35 (63.6) Citation Format: Jingchuan Zhang, Sneha S. Kelkar, Vimalanand S. Prabhu, Shelby Corman, Lucy Qiao, Véronique Grall, Nicola Miles. Real-world prevalence of MSI/MMR testing for patients with recurrent or advanced endometrial cancer in Europe [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6276.

Treatment patterns and outcomes among patients with recurrent or advanced endometrial cancer in Europe: Endometrial Cancer Health Outcomes Europe (ECHO EU) Study.

e17627 Background: Until recently, recurrent or advanced endometrial cancer (aEC) patients in Europe had limited treatment options, with no consensus on standard of care in such settings. Approval of novel targeted therapies in 2021 are changing the treatment landscape. However, there is little real-world evidence among aEC patients in Europe. The objective of our study was to evaluate real-world treatment patterns and clinical outcomes in aEC patients who progressed following prior systemic therapy (FPST) in clinical practice in Europe. Methods: The ECHO-EU is a multicenter, retrospective chart review study in United Kingdom (UK), Germany (GE), Italy (IT) and Spain (SP). Adult women diagnosed with aEC who received at least one prior systemic therapy and progressed between July 1, 2016 – June 30, 2019, were included. De-identified patient data extracted by treating oncologists from patients’ medical records included patient demographics, clinical and treatment characteristics, and clinical outcomes. Kaplan-Meier analyses were performed to estimate real-world overall survival (OS). Results: A total of 379 (UK=101, GE=88, IT=100, SP=90) eligible aEC patients were included in the analysis. At aEC diagnosis, patients’ median age was 69 years, 97% were White/Caucasian and most prevalent histology was endometrioid carcinoma (58%). Molecular characterization of tumors including microsatellite instability/mismatch repair (MSI/MMR) status was performed in only 37% of patients. Metastases were observed in 56% of the patients at diagnosis. Median duration of follow up from aEC diagnosis was 24 months. The majority (95%) of patients initiated 1st line with chemotherapy (most commonly with platinum chemotherapy and paclitaxel). As 2nd line therapy, 81% received mono or combination chemotherapy, and 19% received hormonal therapy. Doxorubicin was the most frequently used agent (45%) in 2nd line, and 16% of patients were re-treated with platinum therapy. At last follow-up, the majority (90%) of patients discontinued 2nd line treatment, mostly due to disease progression (54%). Median duration of 2nd line therapy was 5 months (95% Confidence Interval [CI]: 4-5). Median OS from initiation of 2nd line therapy was 11 months (95% CI: 10-13). Estimated probability of OS from initiation of 2nd line therapy at 6, 12, and 24 months were 70%, 45%, and 30%, respectively. Conclusions: Our study finds thatin Europe prior to mid-2019, available treatment options were sub-optimal for aEC patients FPST, leading to poor prognosis. The utilization of MSI/MMR testing for molecular characterization of tumors was low and needs to increase. There was a significant unmet need for novel therapies that improve clinical outcomes in this patient population. Future studies evaluating treatment patterns and clinical outcomes with more recently approved treatments are warranted.

Incidence and exploratory analysis of cancer development after new on-set atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Inflammation may play an important role in the development of atrial fibrillation (AF). Some studies have suggested that cancer through inflammatory mediators may promote the development of AF (1-2). Our hypothesis was that patients with a first episode of AF might be at increased risk of developing cancer. We set out to study the incidence of cancer in the 2 years following a first episode of AF and to investigate the differences between patients (pts) who develop malignancies and those who do not. Methods Clinical and analytical data were collected from pts presenting with an episode of AF, diagnosed electrocardiographically, to the Emergency Department of our hospital in Spain between 2010-2015 (n=2013). After selecting pts with a first episode and excluding pts with a history of AF or cancer and those with an identified precipitating factor, a sample of 712 pts was obtained (mean age 74.3±14.7; 61.9% female). The minimum follow-up was 2 years, registering cancer occurrence and type, total mortality, emergency department attendance and hospitalization for cardiovascular causes, AF recurrences as well as bleeding and embolic events. We compared data from those who developed cancer during the 2 years after AF debut with those who did not, as well as with the incidence and types of cancer in the general population in Spain (SP) in 2012 (3). Results Of the 712 patients, 35 patients (4.91%) were diagnosed with cancer during the 2-year follow-up (annual incidence: 2.45% (sample) vs 0.46% (SP); p<0.01). The annual incidence in our <65 years old sample was 0.28% vs 0.18% in SP; p<0.05. In the >65 years old group, annual incidence was 2.17% (sample) vs 0.28% (SP); p<0.01. There were also differences between cancer types, with non-solid neoplasms being more frequent in our sample (34.28%), followed by colorectal and breast (14.28% both) (Figure 1). In multivariate analysis comparing patients with and without cancer in our sample, occurrence of cancer was only associated with non-typical symptoms (absence of palpitations) : 33.38% vs 14.28%; p<0.05, and lower creatinine levels in patients developing cancer. Multiple correspondence analysis (MCA) also found no variables associated with cancer development (Figure 2). The mortality rate was higher in the group that developed cancer (54.28% vs 36.02%, p<0.05), with no significant differences in the remaining events. Conclusions There is a relatively high incidence of cancer in patients with a first episode of AF (annual incidence of 2.45% after AF debut is 6.1 times the risk in the general population), in particular in the group of age > 65 years old. No relevant clinical or analytical variable was able to predict the patient who will develop cancer. Further studies and exploration of new variables are needed to better assess the association between AF and cancer occurrence.

MO926: Development and Implementation of an Electronic Patient-Reported Outcome System to Support Health-Related Quality of Life Management in a Large, European Dialysis Network

Abstract BACKGROUND AND AIMS Electronic patient-reported outcome measures (ePROMs) may help personalize healthcare for dialysis patients. ePROMs allow patients to self-report their symptoms and disease burden remotely and make the data available to healthcare professionals (HCP) in real-time. Such information can be used for digital phenotyping, symptoms and disease burden monitoring and to enable personalized healthcare through improved outcomes prediction, as well as Screen and Act, N-of-1 trials and treat-to-target approaches. However, routine use of ePROM in clinical practice presents several challenges, including respondent burden and a lack of clear guidance on medical and psycho-educational intervention in response to patients’ complains. We sought to implement a quality improvement programme based on ePROM management in a large network of dialysis patients. METHOD ePROM were collected as part of a screen and act programme launched for the first time in all centres belonging to the Fresenius Medical Care (FMC) Nephrocare network in France (FR), Italy (IT), Spain (SP), UK and Ireland (IR) starting on 20 September 2021. The screening phase ended on 4 December 2021. The action phase is still ongoing. The programme aims at screening all dialysis patients for undetected quality of life and adjustment problems and allow physicians, at their sole discretion, to provide remediation actions potentially including adjustment of treatment plan based on revision of patients’ clinical charts and administration of health education modules. The questionnaire included KDQOL-36, the 5D-Itch questionnaire and an ad hoc module on intradialytic symptoms, and its content was mapped to SONG-HD initiative endpoints. ePROM were collected at the bedside or at patients’ home with a web application available for tablet and smartphones either as self-report or assisted self-report. All ePROM data were recorded in EuCLiD®, the clinical information systems adopted by FMC Nephrocare clinics, as part of patients’ clinical chart. A dashboard displaying patients’ scores was shown to the attending healthcare professional upon survey completion. Statistics about patients’ engagement, scores and action alerts are presented in clinical reports. In the present analysis, we report a retrospective analysis of data abstracted from the EuCliD® database. RESULTS Overall, 152 centres (93%) joined the campaign. Participation statistics across countries are reported in Fig. 1. Among 11 537 active patients treated in the five participating countries, 1553 were ineligible because belonging to non-participating centres, temporarily transferred to other centres outside the network (i.e. vacation, rehabilitation, etc.), hospitalized, or because they were considered unable to respond to the survey (i.e. language barrier, inability to read and write or cognitive impairment). Around 23% (IT) to 30% (FR) were considered eligible with assisted administration only. Attrition rate ranged from 3% (IT) to 15% (FR). Item missingness was <2% for all items throughout the survey except for the item on sexual activity (>10% in all countries). KDQOL-36 scores are reported in Fig. 2; 22.5% reported moderate to very severe pruritus mostly distributed on the head/scalp, chest, abdomen, back, lower legs and thighs, forearm and upper arm (all >30% prevalence). Between 10% (IT) and 20% (UK) reported any complications during their last dialysis session, and between 6% (SP) and 12% (IR) suspended or interrupted treatment because of their symptoms. Prevalence of recovery time >3 h ranged from 34.8% (FR) to 46.4% (IR). CONCLUSION The ePROM quality improvement campaign attained wide participation and low attrition. We found no evidence of respondent burden given the low missingness rate throughout the survey items. The screening phase allowed to collect and organize a wealth of patient-reported outcomes amenable of medical or psycho-educational interventions.

First-line treatment of stage IIB to stage IV classical Hodgkin lymphoma in Italy, Israel, and Spain: Patient characteristics, treatment patterns, and clinical outcomes.

Classical Hodgkin lymphoma (cHL) is curable in 90% of cases, but advanced stage patients who do not respond well to first‐line (1L) therapy have poorer outcomes. This retrospective study examines patient characteristics, treatment patterns, clinical outcomes, and safety management of 1L cHL therapies in common clinical practice in Italy (IT), Israel (IL), and Spain (SP). The overall sample (n = 256) included patients with stage IIb to IV cHL, of which 86.3% received ABVD as 1L therapy (n = 221). Clinical outcomes were similar for the overall population and ABVD subsample: complete response (CR) in 75% and 76.5%; 30‐month (30‐mo) survival (OS) of 92.5% and 93.6%; and 30‐mo progression‐free survival (PFS) of 70.7% and 72.6%. Thirty‐month PFS was significantly lower for patients ≥ 60 years and/or with high (4–7) IPS. Treatment‐induced pulmonary and cardiac toxicities, and febrile neutropenia occurred, respectively, in 10%, 2.3%, and 6.8% of ABVD‐treated patients. Interim PET or PET‐CT scans were performed after two cycles of 1L therapy (PET2) for 70.3% and 66.6% of the overall and ABVD cohorts, respectively. PET2 positive rates were nearly 30% (49/173), yet PET‐adapted strategy of dose modification only occurred in a small fraction of patients.

Treatment Preferences Among Patients with Diffuse Large B-Cell Lymphoma: A Survey across Western Europe and the United States of America

Introduction: Diffuse large B-cell lymphoma (DLBCL) is an aggressive form of non-Hodgkin's lymphoma (NHL), encompassing 30-58% of all NHL cases and approximately 60,000 cases annually in the United States of America (US) alone (Tilly et al, 2015; Zolkefli, 2017). The treatment (tx) landscape for DLBCL has significantly expanded, with novel targeted therapies, immunotherapies in addition to chemotherapy and chimeric antigen receptor therapy (CAR-T) (Bachanova et al, 2020). The importance of shared decision-making in cancer tx selection is well recognized; yet, we lack data on patient preferences regarding DLBCL tx, and existing research on tx factors in other disease areas, such as regimen intensity, has shown mixed results (Van Hoogdalem et al, 2019; Rummel et al, 2017; Rubin and Peyrot, 1999).Thus, we aimed to examine patient preferences of tx characteristics across the DLBCL landscape.Methods: Data were drawn from the Adelphi DLBCL Disease Specific Programme™, a point-in-time survey of hematologists, hemato-oncologists, oncologists, and their DLBCL patients conducted in France (FR), Germany (DE), Italy (IT), Spain (SP), the United Kingdom and the US between Jan-May 2021. Eligible patients were asked by their consulting physician to voluntarily complete a patient self-completion form (PSC) capturing demographics and preferences encompassing their DLBCL tx options. Patient tx preference questions were presented in a simplified manner to reduce the risk of misinterpretation. Patients' level of acceptance for characteristics of tx options, such as the patients' willingness to “be hospitalized” or “wait longer” for a more effective tx, were rated using a 7-point Likert scale (1=total disagreement; 7=total agreement). A Likert score of 6-7 was considered “agreement”, whilst a Likert score of 1-2 was considered “disagreement”.Results: Data analysis were conducted on 441 DLBCL patients (FR: n=80, DE: n=150, IT: n=54, SP: n=43, UK: n=34, US: n=80) who completed a PSC (Table 1). At data collection, mean (standard deviation) age was 64.6 (12.4) years, 36% of patients were female, 19% working full- or part-time and 81% were on second line or later. 8%, 24%, 28% and 40% were at Ann Arbor disease stage I, II, III and IV respectively at the time of data collection.Overall, 43% of patients agreed that they would be willing to wait longer (up to 4 weeks) for a more effective tx (e.g. CAR-T) than a tx with no delays (not have to wait 4 weeks), whilst 41% of patients agreed that they would be willing to wait longer (up to 4 weeks) for a tx (e.g. CAR-T) if they were less likely to suffer side effects (SEs) than a tx with no delays. 32% and 31% of patients agreed that they would find being hospitalized (for a period of 1-2 weeks) for safety monitoring at the start (first 1-2 months) of their tx acceptable if they did not have to wait longer to start tx (up to 4 weeks) or if they were less likely to suffer SEs respectively. Finally, 37% of patients agreed that they would find being hospitalized (for a period of 1-2 weeks) for safety monitoring acceptable provided the tx was more effective (Table 1).Conversely, 9% of patients disagreed with the statement “I would find taking a continuous tx as an outpatient for my lymphoma acceptable”. 20% of patients disagreed with the statement “I would find being hospitalized for monitoring (for a period of 1-2 weeks) at the start (first 1-2 months) of my tx acceptable if it were more effective”. 17% of patients disagreed with the statement “I would find being hospitalized for monitoring (for a period of 1-2 weeks) at the start of my tx acceptable if it had less SEs”. 9% of patients disagreed with the statement “I would be willing to wait longer (up to 4 weeks) for a tx (e.g. CAR-T) that was more effective than a tx with no delays” and 11% of patients disagreed with the statement “I would be willing to wait longer (up to 4 weeks) for a tx (e.g. CAR-T) if I were less likely to suffer SEs than a tx with no delays”. Finally, 13% of patients disagreed with the statement “I would find being hospitalized (for a period of 1-2 weeks) for monitoring at the start (first 1-2 months) of my tx acceptable if I did not have to wait longer (up to 4 weeks) to start my tx” (Table 1).Conclusion: A substantial proportion of patients reported that the requirement to wait longer and need for hospitalization were of low concern for their tx selection, often reporting in favor of extended hospitalization if better tx efficacy and SE profile could be achieved. [Display omitted] DisclosuresQuek: Regeneron Pharmaceuticals Inc.: Current Employment, Current holder of individual stocks in a privately-held company. Ma: Regeneron Pharmaceuticals Inc.: Current Employment, Current holder of individual stocks in a privately-held company.

Real-World Health-Related Quality of Life in Patients with Diffuse Large B-Cell Lymphoma: Comparisons with Reference Populations and By Line of Therapy

Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common type of aggressive non-Hodgkin's lymphoma (NHL) constituting 30-58% of all NHL (Tilly et al, 2015; Thieblemont et al, 2020). Treatment can include intensive multiagent chemotherapy and other novel therapies which carries risk for toxicities. Despite this, we lack data comprehensively depicting the quality of life of real-world patients with DLBCL, particularly in the modern era with novel therapies. Therefore, we aimed to compare Quality of Life (QoL) to reference populations and assess real-world DLBCL patients across multiple countries and lines of therapy.Methods: Real-world data were drawn from the Adelphi DLBCL Disease Specific Programme™ (DSP), a point-in-time survey of hematologists, hemato-oncologists, oncologists and their patients with DLBCL conducted in France (FR), Germany (DE), Italy (IT), Spain (SP), the United Kingdom (UK) and the United States of America (US) between Jan-May 2021. Patients were asked to voluntarily complete a patient self-completion form (PSC) capturing demographics and QoL data through the use of patient-reported outcome instruments: the European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30), EuroQol 5-dimension 5-level questionnaire (EQ-5D-5L), EQ-5D-5L Visual Analogue Scale and Work Productivity and Activity Impairment questionnaire. Bivariate analysis was conducted to compare all cancer and NHL-specific reference values from the EORTC QLQ-C30 manual (Scott et al, 2008) to DLBCL DSP data, and to review QoL across lines of therapy, defined as first line and second line (1L+2L) and third line and above (3L+). Statistical significance level was set at p<.05. If functional scores were lower, when compared to reference values, within the DSP, this was indicative of a worse QoL in patients with DLBCL. For symptomatic scores the opposite was true; should the DSP value be higher, this was indicative of a worse QoL in patients with DLBCL.Results: Data analysis was conducted on 441 patients with DLBCL who completed a PSC (FR: n=80, DE: n=150, IT: n=54, SP: n=43, UK: n=34, US: n=80); at data collection, mean (standard deviation) age was 64.6 (12.39) years, 36% of patients were female, 19% working full- or part-time and 80% were relapsed/refractory, 29% were 3L+. 8%, 24%, 28% and 40% were at Ann Arbor disease stage I, II, III and IV respectively at the time of data collection.When comparing DLBCL DSP values to EORTC QLQ-C30 all cancer reference values for functional scores (Table 1), global health status, physical functioning, role functioning, emotional functioning, cognitive functioning and social functioning were significantly worse than all cancer reference values.In terms of symptoms, DSP values for fatigue, nausea and vomiting, dyspnea, appetite loss and diarrhea were significantly worse than all cancer reference values (Table 2).Results were mixed when comparing with EORTC QLQ-C30 NHL-specific reference values (Table 1) for functional scores; global health status was significantly worse for the DLBCL DSP population, whilst role functioning, cognitive functioning and social functioning were significantly better than NHL reference values. Significantly worse symptom scores were observed in the DLBCL DSP population (Table 2) for nausea and vomiting, pain, dyspnea and diarrhea when compared with the reference values.Functioning scores were significantly worse in 3L+ patients vs 1L+2L for global health status, physical functioning, role functioning, cognitive functioning and social functioning (Table 3).Fatigue, dyspnea and diarrhea symptomatic scores were significantly worse in 3L+ vs 1L+2L patients. Symptom burden was high across all lines of therapy (Table 4).Conclusion: Real-world patients with DLBCL demonstrated significantly worse QoL when compared with a general cancer reference population with respect to all functional scores, as well as fatigue, nausea and vomiting, dyspnea, appetite loss and diarrhea, underscoring the high symptom burden experienced by patients with DLBCL.Patients with DLBCL on 3L+ had significantly worse QoL than those on earlier lines of therapy with respect to global health status, physical functioning, role functioning, cognitive functioning and social functioning, fatigue, dyspnea and diarrhea indicating an unmet need in novel treatment options to help improve QoL in later lines. [Display omitted] DisclosuresMa: Regeneron Pharmaceuticals Inc.: Current Employment, Current holder of individual stocks in a privately-held company. Quek: Regeneron Pharmaceuticals Inc.: Current Employment, Current holder of individual stocks in a privately-held company.

Infection rate models for COVID-19: Model risk and public health news sentiment exposure adjustments.

During the COVID-19 pandemic, governments globally had to impose severe contact restriction measures and social mobility limitations in order to limit the exposure of the population to COVID-19. These public health policy decisions were informed by statistical models for infection rates in national populations. In this work, we are interested in modelling the temporal evolution of national-level infection counts for the United Kingdom (UK-Wales, England, Scotland), Germany (GM), Italy (IT), Spain (SP), Japan (JP), Australia (AU) and the United States (US). We model the national-level infection counts for the period January 2020 to January 2021, thus covering both the pre- and post-vaccine roll-out periods, in order to better understand the most reliable model structure for the COVID-19 epidemic growth curve. We achieve this by exploring a variety of stochastic population growth models and comparing their calibration, with respect to in-sample fitting and out-of-sample forecasting, both with and without exposure adjustment, to the most widely used and reported growth model, the Gompertz population model, often referred to in the public health policy discourse during the COVID-19 pandemic. Model risk as we explore it in this work manifests in the inability to adequately capture the behaviour of the disease progression growth rate curve. Therefore, our concept of model risk is formed relative to the standard reference Gompertz model used by decision-makers, and then we can characterise model risk mathematically as having two components: the dispersion of the observation distribution, and the structure of the intensity function over time for cumulative counts of new infections daily (i.e. the force of infection) attributed directly to the COVID-19 pandemic. We also explore how to incorporate in these population models the effect that governmental interventions have had on the number of infected cases. This is achieved through the development of an exposure adjustment to the force of infection comprised of a purpose-built sentiment index, which we construct from various authoritative public health news reporting. The news reporting media we employed were the New York Times, the Guardian, the Telegraph, Reuters global blog, as well as national and international health authorities: the European Centre for Disease Prevention and Control, the United Nations Economic Commission for Europe, the United States Centres for Disease Control and Prevention, and the World Health Organisation. We find that exposure adjustments that incorporate sentiment are better able to calibrate to early stages of infection spread in all countries under study.

Morpho-structural and chemical characterization of paper based materials with functionalized surface

The aim of the study was to perform dimensional, morpho-structural, mechanical and chemical characterization of four materials based on paper currently in use in Romania (RO), Italy (IT), Spain (SP) and Slovenia (SLO) designed for the temporarily wrapping of meat. SEM-EDXS, FTIR and DSC showed that RO is laminated on one side with polyethylene, SP is waxed, IT is modified with a multilayered polyethylene film and SLO is coated with hydrophobized starch. RO, IT and SLO comply with the standards of determination of density, roughness, breaking length and bending resistance. The highest content of metals found in the SP explains the highest electrical conductivity and the poor quality of the recycled material used for manufacturing. The highest values of total dissolved solids (TDS) and chemical oxygen demand (COD) resulted for SP sample expressed its water solubility and availability of migration into foodstuff. RO, IT and SLO are suitable for food packaging. In contrast, SP do not meet the requirements for safety and mechanical resistance.

Persistent Moderate-to-Weak Mediterranean Diet Adherence and Low Scoring for Plant-Based Foods across Several Southern European Countries: Are We Overlooking the Mediterranean Diet Recommendations?

The Mediterranean diet (MD) has been sponsored worldwide as a healthy and sustainable diet. Our aim was to update and compare MD adherence and food choices across several Southern European countries: Spain (SP), Portugal (PT), Italy (IT), Greece (GR), and Cyprus (CY) (MED, Mediterranean), and Bulgaria (BG) and the Republic of North Macedonia (NMK) (non-MED, non-Mediterranean). Participants (N = 3145, ≥18 y) completed a survey (MeDiWeB) with sociodemographic, anthropometric, and food questions (14-item Mediterranean Diet Adherence Screener, 14-MEDAS). The MED and non-MED populations showed moderate (7.08 ± 1.96) and weak (5.58 ± 1.82) MD adherence, respectively, with significant yet small differences across countries (SP > PT > GR > IT > CY > BG > NMK, p-value < 0.001). The MED participants scored higher than the non-MED ones for most of the Mediterranean-typical foods, with the greatest differences found for olive oil (OO) and white meat preference. In most countries, ≥70% of the participants reported quantities of red meat, butter, sweet drinks, and desserts below the recommended cutoff points, whereas <50% achieved the targets for plant-based foods, OO, fish, and wine. Being a woman and increasing age were associated with superior adherence (p-value < 0.001), but differences were rather small. Our results suggest that the campaigns carried out to support and reinforce the MD and to promote plant-based foods have limited success across Southern Europe, and that more hard-hitting strategies are needed.

Adherence to a Mediterranean diet, dyslipidemia and inflammation in familial hypercholesterolemia

Background and aimsFamilial Hypercholesterolemia (FH) is characterized by elevated LDL-cholesterol (LDL-C) and high atherosclerosis risk. The impact of different dietary patterns on atherosclerosis biomarkers has been poorly studied in FH.This study verified the association of adherence to a Mediterranean diet with biomarkers of dyslipidemia and low-grade inflammation in molecularly proven FH adults from Brazil (BR) and Spain (SP). Methods and resultsIn this cross-sectional study adherence to the Mediterranean diet was assessed by a validated score and generalized estimating equations were used to evaluate its association with plasma LDL-C, apolipoprotein-B (ApoB) and high sensitivity C-reactive protein (hs-CRP) concentrations. We included 92 (mean age 45 years, 58.7% females) and 98 FH individuals (mean age 46.8 years, 60.2% females) respectively from BR and SP. FH causing variants did not differ between countries. LDL-C, ApoB and hs-CRP concentrations were higher in BR than in SP: 179 (135–250) and 161 (133–193) mg/dL; 141 (109–181) and 103 (88–134) mg/dL; and 1.6 (0.8–4.0) and 0.8 (0.4–1.5) mg/L respectively (all p < 0.001). Most of BR had low adherence (n = 77, 83.7%), while the majority of SP were divided into moderate (n = 35, 35.7%) and strong adherence to the Mediterranean diet (n = 37, 37.8%), p < 0.001. There was a significant inverse association of adherence to the Mediterranean diet score with higher LDL-C, ApoB, and hs-CRP after adjusting for socio economic parameters, caloric and fatty acid intakes as well as pharmacological lipid lowering therapies. ConclusionsHigher adherence to a Mediterranean diet was associated with better dyslipidemia and low-grade inflammation profiles in FH.

Exploring the Validity of the 14-Item Mediterranean Diet Adherence Screener (MEDAS): A Cross-National Study in Seven European Countries around the Mediterranean Region.

This study provides comprehensive validation of the 14-item Mediterranean Diet Adherence Screener (14-MEDAS) in an adult population from Greece (GR), Portugal (PT), Italy (IT), Spain (SP), Cyprus (CY), Republic of North Macedonia (NMK), and Bulgaria (BG). A moderate association between the 14-MEDAS and the reference food diary was estimated for the entire population (Pearson r = 0.573, p-value < 0.001; Intraclass Correlation Coefficient (ICC) = 0.692, p-value < 0.001) with the strongest correlation found in GR, followed by PT, IT, SP, and CY. These results were supported by kappa statistics in GR, PT, IT, and SP with ≥50% of food items exhibiting a fair or better agreement. Bland–Altman analyses showed an overestimation of the 14-MEDAS score in the whole population (0.79 ± 1.81, 95%Confidence Interval (CI) 0.61, 0.96), but this value was variable across countries, with GR, NMK, and BG exhibiting the lowest bias. Taking all analyses together, the validation achieved slightly better results in the Mediterranean countries but a definitive validation ranking order was not evident. Considering growing evidence of the shift from Mediterranean Diet (MD) adherence and of the importance of culture in making food choices it is crucial that we further improve validation protocols with specific applications to measure and compare MD adherence across countries and to relate it to the health status of a specific population.

Quality of main types of hunted red deer meat obtained in Spain compared to farmed venison from New Zealand

Deer venison is increasingly valued as a natural meat. This study examines the three main sources of venison: farmed venison from New Zealand (NZ), the world’s leading producer, and wild deer from Spain (SP), the second largest producer, which mainly supplies venison from traditional autumn–winter driven hunts (monteria), involving packs of dogs, and a smaller proportion culled through summer selective stalking. Meat from NZ contained more protein, lower shear force and lower n-6/n-3 ratio (P < 0.01). Spanish meat had a greater content of total, essential and non-essential amino acids (P < 0.01). Meat from deer culled in winter had lower intramuscular fat and saturated fatty acids (FA) but higher polyunsaturated FA (P < 0.01) and pH (P < 0.001) than meat from summer stalked deer. Therefore, venison presents differences by country of origin for composition, FA and texture that are likely to affect its health characteristics. Anomalies observed in meat between the winter driven hunt and non-stressful summer stalking may be attributed to the level of death stress in the case of variables such as pH. However, the effect on fat and mineral composition seems to be seasonal, depending respectively on wild diet or cyclic osteoporosis in males.

Abnormal pattern of brain glucose metabolism in Parkinson\u2019s disease: replication in three European cohorts

RationaleIn Parkinson’s disease (PD), spatial covariance analysis of 18F-FDG PET data has consistently revealed a characteristic PD-related brain pattern (PDRP). By quantifying PDRP expression on a scan-by-scan basis, this technique allows objective assessment of disease activity in individual subjects. We provide a further validation of the PDRP by applying spatial covariance analysis to PD cohorts from the Netherlands (NL), Italy (IT), and Spain (SP).MethodsThe PDRPNL was previously identified (17 controls, 19 PD) and its expression was determined in 19 healthy controls and 20 PD patients from the Netherlands. The PDRPIT was identified in 20 controls and 20 “de-novo” PD patients from an Italian cohort. A further 24 controls and 18 “de-novo” Italian patients were used for validation. The PDRPSP was identified in 19 controls and 19 PD patients from a Spanish cohort with late-stage PD. Thirty Spanish PD patients were used for validation. Patterns of the three centers were visually compared and then cross-validated. Furthermore, PDRP expression was determined in 8 patients with multiple system atrophy.ResultsA PDRP could be identified in each cohort. Each PDRP was characterized by relative hypermetabolism in the thalamus, putamen/pallidum, pons, cerebellum, and motor cortex. These changes co-varied with variable degrees of hypometabolism in posterior parietal, occipital, and frontal cortices. Frontal hypometabolism was less pronounced in “de-novo” PD subjects (Italian cohort). Occipital hypometabolism was more pronounced in late-stage PD subjects (Spanish cohort). PDRPIT, PDRPNL, and PDRPSP were significantly expressed in PD patients compared with controls in validation cohorts from the same center (P < 0.0001), and maintained significance on cross-validation (P < 0.005). PDRP expression was absent in MSA.ConclusionThe PDRP is a reproducible disease characteristic across PD populations and scanning platforms globally. Further study is needed to identify the topography of specific PD subtypes, and to identify and correct for center-specific effects.

Association of dietary components with dyslipidemia and low-grade inflammation biomarkers in adults with heterozygous familial hypercholesterolemia from different countries.

The association of components of a low saturated fat (SFA) and of a Mediterranean diet was tested with atherosclerosis biomarkers in 190 familial hypercholesterolemia adults (FH) from Brazil (BR) and Spain (SP). Median blood LDL-C, Apolipoprotein B (apoB), and C reactive protein (hs-CRP) concentrations were higher in BR than in SP: 179.0 vs.161 mg/dL; 141 vs. 103 mg/dL; and 1.6 vs. 0.8 mg/L respectively (all p < 0.001). In BR there was lower median total fat (22.3 vs. 38.3%) and SFA (8.1 vs. 12.5%) but higher cholesterol (283.3 mg vs.188.9 mg) and carbohydrate (57.1 vs. 42.5%) consumption (all p < 0.001). Inverse associations were encountered between fibers, mono, and polyunsaturated fats and their ratios to SFA with LDL-C and ApoB (all p < 0.001). There was a direct association respectively of cholesterol with lipid biomarkers and of carbohydrates and trans-fatty acids with hs-CRP while other fats showed inverse relations with the latter (p < 0.001).

659P - Quality of life (QoL) in metastatic colorectal cancer (mCRC) in the real world: Final results of a European survey

BackgroundDigestive Cancers Europe (DiCE), a European digestive cancer patients umbrella organization, planned and executed a cross-sectional survey in 15 European countries on the Unmet Needs of Patients Living with mCRC to examine the challenges and needs and QoL of those living with mCRC. MethodsDiCE partner organisations, together with clinicians and nurses recruited patients for the survey (paper-based and online). The survey included demographics, data on discovery of the disease, diagnosis and treatment and the EORTC QLQ-C30 and CR29. Single data entry from the paper surveys was done by DiCE. Descriptive statistics and regression analyses were run to examine the global QoL score, function (F) - and symptom-specific scores, the item on financial difficulties and CR29 scores and their association with patient and disease characteristics and care setting by country and overall. Results883 surveys from Austria, Belgium, Cyprus (CY), Germany, Hungary (HU), Italy, Netherlands (NL), Norway, Serbia (RS), Poland, Spain (SP), UK, Portugal, Turkey and Ireland were collected. Only 8 countries with samples over 35 were analyzed on their own. Completion rates across QoL items were high (91-94%). Large variation across countries have been observed in mean scores (Table). Eastern vs Western Europe contrasted sharply, with Serbia and Poland reporting lower functional and much higher symptom scores for fatigue, nausea, vomiting, pain and insomnia. Regression analyses indicated that after adjustment for age, gender and care setting country differences remained significant. Patterns in results across dimensions of EORTC QLQ-CR29 were similar.Table659PTableMean (SD)Global QoLPhysical FRole FEmotional FCognitive FSocial FLowest score55.94 (21.10) RS69.06 (23.93) CY62.58 (34.73) CY53.51 (28.35) RS71.31 (24.6) RS54.04 (25.91) RSHighest score69.26 (20.68) HU84.29 (17.87) SP81.76 (25.41) SP80.92 (21.04) NL87.86 (19.13) HU80.91 (24.63) HUOVERALL62.02 (21.75)74.25 (20.85)71.41 (28.76)68.25 (26.41)78.58 (23.39)68.56 (28.99) ConclusionsCountry specific mean QoL scores in all function/symptom dimensions varied greatly across countries. This study indicates that care setting and other country-specific circumstances have important associations to QoL. Real-world mCRC patients’ QoL may be lower than those recruited in clinical trials. Legal entity responsible for the studyEuropaColon / Digestive Cancers Europe. FundingMerck, BMS, Sandoz and Sirtex. DisclosureAll authors have declared no conflicts of interest.

Impact of packaging properties on the physical‐chemical‐microbiological‐sensory characteristics of Ricotta cheese during storage

Ricotta is a highly perishable cheese of which shelf‐life is strongly influenced by the properties of packages in which it is stored. Four plastic packages currently in use in Italy (IT), Romania (RO), Slovenia (SLO), and Spain (SP) are characterized in term of structure, barrier, and antimicrobial properties, and their efficiency in the ricotta storage at 4°C is assessed. Differential scanning calorimetry and Fourier‐transform infrared spectroscopy analysis indicate that the IT and SP packages are made of low‐density polyethylene and the RO and SLO packages consist of polyethylene and polyamide 6. Permeability to the water vapour and oxygen transmission rate vary as follows: IT&gt;SLO &gt; RO &gt; SP and SP &gt; IT&gt;RO &gt; SLO, respectively. The SP package expressed the highest antimicrobial inhibition whilst the IT package the lowest. The maximum amounts of volatile compounds in cheese were reached after 3 days in the IT and SP packages and after 6 days in the SLO and RO packages. The score 2.8 for cheese overall acceptability was exceeded after 7 days in the IT, RO, and SP packages and 6 days in the SLO package. Barrier properties of packages significantly influence the shelf‐life of ricotta. Low barrier properties resulted in high level of oxygen and water vapours inside the headspace of packages ultimately favour the microbial development. The simultaneous compliance of microbiological safety level and overall acceptability score gives ricotta a shelf‐life of 3 days in the IT, RO, and SP packages and 1 day in the SLO package.

Perceived Parenting Styles and Adjustment during Emerging Adulthood: A Cross-National Perspective.

The aim of the present study is to determine whether the influence of parenting style on children’s wellbeing is sustained during emerging adulthood. This is a stage in which young people, despite feeling themselves to be adults, often remain in the family home and continue to be financially dependent on their parents. Moreover, since parents’ beliefs, attitudes and behaviors are constructed and interpreted within their cultural milieu, the study also aims to explore the situation in Spain (SP) and Portugal (PT). Those two Southern Europe countries are representative of what is known as the “family welfare regime”, in which the family acts as the main provider of care and security not only during childhood, but also during emerging adulthood. Thus, the present study examines, from a cross-cultural perspective, the relationship between perceived parenting styles and psychological adjustment among a sample of 1047 emerging adults from Spain and Portugal. The results reveal that the most beneficial styles during this stage are the authoritative and permissive ones, with the authoritarian style being more closely related to psychological distress. The study highlights intercultural similarities and the positive role played by more symmetrical relationships in the adjustment of emerging adults in both countries.

Sound pleasantness of electrically adjustable exterior mirrors in vehicles

Consumers increasingly demand high quality products, forcing manufacturers to a greater effort when designing. During the last years, the noise has become a key factor in valuing a product, so the use of psychoacoustic techniques has been extended considerably.The automotive sector has always taken into consideration the noise when designing vehicles. A large number of tools and analysis methods have been developed in order to determine the sound quality of their products. Although the first efforts focussed on establishing the sound quality of the propulsion system, they rapidly spread to other parts of the vehicle like doors, powered windows, etc.The present work focuses on studying the behaviour of electrically adjustable exterior mirrors in vehicles. In order to analyse the noise produced by this kind of devices, four different samples were measured in a semi-anechoic chamber. To establish the pleasantness descriptor of the samples, sixty-two subjects were exposed to an auditory test using two different methods: paired comparison and ranking procedure. The experiments were carried out in three different laboratories: University of Kyushu in Japan (JP), University of Coimbra in Portugal (PT) and University of Alicante in Spain (SP); leading to a cross-cultural study. The results showed a great similarity between the preferences obtained by the two methods.