Effect of comorbidity and multimorbidity on adherence to follow-up recommendations among long-term breast cancer survivors.

OBJECTIVES: To study the impact of comorbidities, multimorbidity, and multimorbidity clusters on adherence to recommended follow-up guidelines among long-term breast cancer survivors. STUDY DESIGN: Retrospective cohort study based on 2078 women diagnosed with breast cancer from 2000 to 2006 and followed up from 2012 to 2016. MAIN OUTCOME MEASURES: Adherence to breast cancer follow-up recommendations (annual medical visit and imaging) was determined. Comorbidities were classified as acute/chronic. Multimorbidity was defined as the presence of two or more chronic comorbidities aside from breast cancer. Five multimorbidity clusters were considered. Multivariate logistic regression models were fitted to determine the relationship between adherence to recommendations and the presence of comorbidities and multimorbidity, considering both sociodemographic and clinical characteristics. RESULTS: Overall adherence to recommendations was 79.5 %. Adherence was lower among long-term breast cancer survivors with no comorbidities (75.8 %). Among multimorbidity clusters, adherence was highest in the anxiety and fractures cluster (84.3 %) and was lowest in the musculoskeletal and cardiovascular cluster (76.4 %). In adjusted multivariate models, multimorbidity was associated with higher levels of adherence (OR = 1.52 95 %CI 1.16-1.99), and adherence was highest in the metabolic and degenerative cluster (OR = 2.2 95 %CI 1.4-3.5). CONCLUSION: Adherence to follow-up recommendations was higher among long-term breast cancer survivors with multimorbidity than among those without. Adherence also differed by multimorbidity cluster. These results suggest suboptimal adherence to the current follow-up recommendations in certain groups, suggesting the need to adapt clinical practice guidelines to reflect patients' comorbidities and different characteristics.

Soluble ST2, BCN-Bio-HF calculator and MAGGIC-HF score in long-term risk prediction after an urgent visit for heart failure.

Soluble ST2 (sST2) is the expression of a pathogenic process related to adverse remodeling that ultimately leads to increased mortality in heart failure (HF). Risk score models provide a comprehensive approach for mortality prediction, beyond the use of biomarkers alone. The objective was to determine the additional value of sST2 and two well-validated contemporary risk scores, BCN-Bio-HF and MAGGIC-HF, in predicting mortality and readmission in the acute setting. This prospective study included 129 patients (mean age 75 ± 9 years; 52% males) after an urgent HF visit. Baseline sST2 levels were measured and the two risk scores were calculated. The primary endpoint was all-cause mortality, and the secondary endpoint was HF readmissions. The follow-up period was 3.6 ± 1.9 years. Patients who died (46%) had higher sST2 concentrations (80.5 vs. 42.7 ng/ml; p < 0.001). The BCN-Bio-HF calculator with sST2 demonstrated the best discriminative ability for mortality prediction (area under the ROC curve: 0.792; p < 0.001). In multivariate analysis for each risk score, the MAGGIC-HF score retained its predictive value only in the model without sST2 (3-year risk: HR = 1.036; 95% CI 1.019-1.054; p < 0.001). However, the BCN-Bio-HF score maintained its prognostic value with sST2 (HR = 1.032; 95%CI 1.020-1.044; p < 0.001), as well as without sST2 (HR = 1.035; 95% CI 1.021-1.049; p < 0.001). sST2 was not associated with readmission, and only the BCN-Bio-HF risk of HF hospitalization showed independent predictive value (OR = 1.040; 95% CI 1.005-1.076; p = 0.023). For predicting long-term mortality in HF in the emergency department, the BCN-Bio-HF calculator with sST2 demonstrated superior discrimination and allows estimation of the risk of HF hospitalizations.

Synergistic depolymerisation of alginate and chitosan by high hydrostatic pressure (HHP) and pulsed electric fields (PEF) treatment in the presence of H2O2.

Physically-induced depolymerisation procedures are often preferred for obtaining alginate and chitosan oligosaccharides as they either do not use or make minimal use of additional chemicals; therefore, separation of the final products is facile. In this work, solutions of three types of alginate with different mannuronic and guluronic acid residues ratio (M/G ratio) and molecular weights (Mw) and one type of chitosan were non-thermally processed by applying high hydrostatic pressures (HHP) up to 500 MPa (20 min) or pulsed electric fields (PEF) up to 25 kV cm-1 (4000 µm) in the absence or presence of 3 % hydrogen peroxide (H2O2). The impact on the physicochemical properties of alginate and chitosan was investigated by rheology, GPC, XRD, FTIR, and 1H NMR. In the rheological investigations, the apparent viscosities of all samples decreased with increasing shear rate, indicating a non-Newtonian shear-thinning behaviour. GPC results reported Mw reductions that ranged between 8 and 96 % for all treatments. NMR results revealed that HHP and PEF treatment predominantly reduced the M/G ratio of alginate and the degree of deacetylation (DDA) of chitosan, whilst H2O2 promoted an increase in the M/G ratio in alginate and DDA of chitosan. Overall, the present investigation has demonstrated the feasibility of HHP and PEF for rapidly producing alginate and chitosan oligosaccharides.

A symbolic Neanderthal accumulation of large herbivore crania.

This work examines the possible behaviour of Neanderthal groups at the Cueva Des-Cubierta (central Spain) via the analysis of the latter's archaeological assemblage. Alongside evidence of Mousterian lithic industry, Level 3 of the cave infill was found to contain an assemblage of mammalian bone remains dominated by the crania of large ungulates, some associated with small hearths. The scarcity of post-cranial elements, teeth, mandibles and maxillae, along with evidence of anthropogenic modification of the crania (cut and percussion marks), indicates that the carcasses of the corresponding animals were initially processed outside the cave, and the crania were later brought inside. A second round of processing then took place, possibly related to the removal of the brain. The continued presence of crania throughout Level 3 indicates that this behaviour was recurrent during this level's formation. This behaviour seems to have no subsistence-related purpose but to be more symbolic in its intent.

Arts, place, and sacrifice zones: restoration of damaged relational values in a Chilean sacrifice zone.

This paper aims to unpack the relational dimension of place and placemaking by analysing how creative actions underpin relational values towards socio-spatial restoration in the sacrifice zone affecting the communities of Quintero and Puchuncaví (QPSZ) in Chile. Sacrifice zones are places permanently subject to environmental damage and lack of environmental regulation. For affected populations in environmentally degraded areas, creative actions such as murals, music, and street performances have become a way to re-establish connections both among humans, and between humans and the environment. To date, little has been theorized on this connection. With this in mind, we use network analysis to analyze which and how relational values are mobilized by artistic actions, and to examine ensuing socio-spatial transformations. Drawing insights from 35 interviews with activists, artists, and residents in QPSZ, we observed relational effects of arts, especially in creation processes, and in representations of local elements and life histories. The materiality of artistic practices raised as a force of placemaking, and so did artistic spaces as promoters of networking and social cohesion, essential for socio-spatial restoration. By bringing together insights from aesthetic politics, human geography, and relational values, this paper contributes to the emerging literature on art committed to tackling socio-environmental crises, and to political-ecological theories on the transformation of degraded areas. Supplementary Information: The online version contains supplementary material available at 10.1007/s11625-022-01252-6.

Clinical characteristics of admission for mental illness in a Regional Psychiatric Hospitalization Unit. Descriptive study 2008-2018 / Características clínicas del ingreso por enfermedad mental en una Unidad de Hospitalización Psiquiátrica Comarcal. Estudio descriptivo 2008-2018.

Objective: To describe the admissions of patients diagnosed with severe mental illness (SMI) and anxiety disorder in a regional hospital; to explore factors related to the patient's referrer upon admission and prolonged stay. Materials and methods: Cross-sectional study of episodes of admission to the regional Psychiatric Hospitalization Unit over a period of 11 years with ICD-10 diagnostic codesF20-29, F30-39, F60-69 and F40-48. The data was extracted through the Admissions Unit and the information from the electronic medical record. For the statistical treatment, descriptive or inferential tests were used with a confidence level of 95%. Results: 961 patients were included (2,324 total discharges), aged 40.8±14.0 years. The most frequent reasons for admission were: positive symptoms (agitation, delusions and hallucinations), followed by suicidal ideation and attempt. The main remitting agent of the patients was the family itself. Approximately 1/5 of the cases were referred by the health system itself, and » of those admitted had self-excluded themselves from specialized supervision for more than a year. Conclusions: The problems that caused the admission and its origin, as well as its lack of follow-up, can be considered as a clear opportunity for improvement in the follow-up of patients with severe mental illness. An orientation towards proactivity, acting before the decompensation, would contribute to improving the care and quality of life of patients with severe mental illness and their environment.

Objetivo: Describir los ingresos de pacientes diagnosticados de enfermedad mental grave y trastorno de ansiedad en un hospital comarcal; explorar los factores relacionados con la derivación del paciente al ingreso y con estancia prolongada. Materiales y métodos: Estudio de corte transversal de los episodios de ingreso en la Unidad de Hospitalización Psiquiátrica comarcal en un periodo de 11 años con los códigos diagnósticos CIE-10 F20-29, F30-39, F60-69 y F40-48. Se extrajeron los datos a través de la Unidad de Admisión y la información de la historia clínica electrónica. Para el tratamiento estadístico se usaron pruebas descriptivas o inferenciales con nivel de confianza del 95%. Resultados: Se incluyeron 961 pacientes (2.324 altas totales), con edad de 40,8±14,0 años. Los motivos más frecuentes de ingreso fueron: síntomas positivos (agitación, delirios y alucinaciones), seguidos de ideación e intento de suicidio. El principal agente remisor de los pacientes fue la propia familia. Aproximadamente 1/5 de casos fue derivado por el propio sistema sanitario, y » de los ingresados se había autoexcluido de la supervisión especializada durante más de un año. Conclusiones: Los problemas causantes del ingreso y su procedencia, así como su falta de seguimiento, pueden considerarse como una oportunidad clara de mejora en el seguimiento del paciente con enfermedad mental grave. Una orientación hacia la proactividad, actuando antes de la descompensación, contribuiría a mejorar la asistencia y calidad de vida de los pacientes con enfermedad mental grave y su entorno.

Adherence of long-term breast cancer survivors to follow-up care guidelines: a study based on real-world data from the SURBCAN cohort.

PURPOSE: To identify adherence to follow-up recommendations in long-term breast cancer survivors (LTBCS) of the SURBCAN cohort and to identify its determinants, using real-world data. METHODS: We conducted a retrospective study using electronic health records from 2012 to 2016 of women diagnosed with incident breast cancer in Spain between 2000 and 2006 and surviving at least 5 years. Adherence to basic follow-up recommendations, adherence according to risk of recurrence, and overall adherence were calculated based on attendance at medical appointments and imaging surveillance, by year of survivorship. Logistic regression models were fitted to depict the association between adherence and its determinants. RESULTS: A total of 2079 LTBCS were followed up for a median of 4.97 years. Of them, 23.6% had survived ≥ 10 years at baseline. We estimated that 79.5% of LTBCS were overall adherent to at least one visit and one imaging test. Adherence to recommendations decreased over time and no differences were found according to recurrence risk. Determinants of better overall adherence were diagnosis in middle age (50-69 years old), living in a more-deprived area, having fewer years of survival, receiving primary treatment, and being alive at the end of follow-up. CONCLUSION: We identified women apparently not complying with surveillance visits and tests. Special attention should be paid to the youngest and eldest women at diagnosis and to those with longer survival.

Use of health services among long-term breast cancer survivors in Spain: longitudinal study based on real-world data.

PURPOSE: This study aimed to evaluate health service utilization in Spain among long-term breast cancer survivors and to compare it with that among women with no history of breast cancer. METHODS: Study based on the SURBCAN cohort includes a sample of long-term breast cancer survivors and a sample of women without breast cancer from 5 Spanish regions. Healthcare utilization was assessed through primary care, hospital visits, and tests during the follow-up period (2012 to 2016) by using electronic health records. Annual contact rates to healthcare services were calculated, and crude and multivariate count models were fitted to estimate the adjusted relative risk of healthcare services use. RESULTS: Data were obtained from 19,328 women, including 6512 long-term breast cancer survivors. Healthcare use was higher among breast cancer survivors (20.9 vs 16.6; p < 0.0001) and decreased from >10 years of survival. Breast cancer survivors who underwent a mastectomy were more likely to have a primary care visit (RR = 3.10 95% CI 3.08-3.11). Five to ten years survivors were more likely to have hospital inpatient visits and imaging test compared to women without breast cancer (RRa = 1.35 95% CI 1.30-1.39 and RRa = 1.27 95% CI 1.25-1.29 respectively). CONCLUSION: This study shows higher use of health services in long-term breast cancer survivors than in women without breast cancer regardless of survival time. IMPLICATIONS FOR CANCER SURVIVORS: These results help to estimate the health resources needed for the growing group of breast cancer survivors and to identify risk factors that drive higher use of health services.

Development of Chocolates with Improved Lipid Profile by Replacing Cocoa Butter with an Oleogel.

The reformulation of chocolates seeks to find innovative alternatives to cocoa butter (CB) that are more economical and adhere to nutritional recommendations to replace saturated fats with unsaturated ones. In this research, chocolates were elaborated by substituting CB with an oleogel (OG) formulated with hydroxypropyl methylcellulose (HPMC) as an entrapper of sunflower oil by using the foam-templated approach. Four different CB/OG blends were prepared and characterized as potential CB substitutes (100/0 control), at replacement levels of 30%, 50%, 70% and 100% (70/30, 50/50, 30/70 and 0/100 blends), and subsequently, CB/OG-based chocolates (CB/OG-Ch) were formulated (100/0-Ch, 70/30-Ch, 50/50-Ch, 30/70-Ch and 0/100-Ch). Both the CB/OG blends and the CB/OG-Ch counterparts were characterized by dynamic and stationary rheology, hardness, thermal parameters, microstructure, and oil-binding capacity; in addition, the lipid profile of the chocolates was analyzed, and a sensory analysis was performed. Increasing the OG proportion in the CB/OG blend weakens the rigidity and strength of the fat-crystal network conferred by the CB, and decreases both its viscoelasticity and thermal parameters, but the differences between all the different properties and parameters of the CB/OG-Ch samples diminished in presence of the other ingredients used in the chocolate formulation. Sensory analysis evidenced that it is possible to replace up to 70% of CB with the OG, although from a technological point of view a replacement level of 50% would seem more appropriate. As compared to 100/0-Ch, 50/50-Ch and 30/70-Ch involve saturated fat reductions of 55% and 37%, respectively.

ATR-FTIR Spectroscopy Combined with Multivariate Analysis Successfully Discriminates Raw Doughs and Baked 3D-Printed Snacks Enriched with Edible Insect Powder.

In a preliminary study, commercial insect powders were successfully identified using infrared spectroscopy combined with multivariate analysis. Nonetheless, it is necessary to check if this technology is capable of discriminating, predicting, and quantifying insect species once they are used as an ingredient in food products. The objective of this research was to study the potential of using attenuated total reflection Fourier transform mid-infrared spectroscopy (ATR-FTMIR) combined with multivariate analysis to discriminate doughs and 3D-printed baked snacks, enriched with Alphitobius diaperinus and Locusta migratoria powders. Several doughs were made with a variable amount of insect powder (0-13.9%) replacing the same amount of chickpea flour (46-32%). The spectral data were analyzed using soft independent modeling of class analogy (SIMCA) and partial least squares regression (PLSR) algorithms. SIMCA models successfully discriminated the insect species used to prepare the doughs and snacks. Discrimination was mainly associated with lipids, proteins, and chitin. PLSR models predicted the percentage of insect powder added to the dough and the snacks, with determination coefficients of 0.972, 0.979, and 0.994 and a standard error of prediction of 1.24, 1.08, and 1.90%, respectively. ATR-FTMIR combined with multivariate analysis has a high potential as a new tool in insect product authentication.

Thermorheological Characterization of Healthier Reduced-Fat Cocoa Butter Formulated by Substitution with a Hydroxypropyl Methylcellulose (HPMC)-Based Oleogel.

Cocoa butter (CB) is a main ingredient in pastry due to the unique functional properties of its fat, which is high in saturated fatty acids (SFAs). However, excessive consumption of SFAs is associated with the occurrence of several chronic diseases. This study researched the partial or total replacement of CB by an oleogel (OG) formulated with a healthier lipid profile, for mixed systems that would allow a partial substitution of CB in confectionery products. The "emulsion-templated approach" was used to develop a sunflower oil-HPMC-based OG. Different CB:OG ratios were formulated increasing the percentage replacement of CB by OG from 50 to 100%. Rheological and textural properties were determined and compared with a CB control at 20 and 10 °C. Oil-binding capacity was also analyzed. The systems showed a solid-like behavior, with higher elastic than viscous modulus, which increased with CB concentration. Compared with 20 °C, at 10 °C there was an increase in connectivity, viscoelasticity, and consistency of the systems, in response to a more complete CB crystallization. The replaced systems also presented a better lipid profile than CB. This evidence suggests that formulated CB:OG system at 50:50 ratio could become useful as a CB equivalent in chocolate products.

Effect of HHP, Enzymes and Gelatin on Physicochemical Factors of Gels Made by Using Protein Isolated from Common Cricket (Acheta domesticus).

The effect of high hydrostatic pressure (HHP) combined with enzymatic methods or gelatin incorporation in the gelation process of protein isolated from Acheta domesticus was investigated. The results indicate that transglutaminase (TGasa) or glucose oxidase (GOx) enzymes can induce reversible aggregation in dispersions of insoluble protein fractions and increase viscosity in dispersions of soluble fractions, but does not induce gel formation even after HHP treatment; in consequence, enzymatic treatment on cricket protein can be used to increase viscosity but not to form gels. It is technically feasible to obtain gels by adding 2% porcine gelatin to dispersions of protein fractions and subjecting them to HHP. The firmness and syneresis variation values of those gels during storage depended on the protein extracted fraction (insoluble or soluble protein) and on the concentration of protein used. The highest hardness and lowest syneresis was found with the gels obtained from the insoluble fraction at 11 and 15% (w/w) protein concentration. Color difference (ΔE* > 3) appreciable to the naked eye was observed along the storage period and no noticeable pH variations were found after 28 days of storage. Results indicate that new raw materials of interest can be developed for the food industry based on cricket protein isolates, to make high-protein foods which could be applied in a wide variety of different food applications including 3D printing or fat substitution.

Development of Structured Sunflower Oil Systems for Decreasing Trans and Saturated Fatty Acid Content in Bakery Creams.

In this work, the design of low moisture (10%) oil/water emulsions based on sunflower oil were investigated, as well as their application in a bakery cream as a conventional fat replacer. The emulsions were dehydrated to reach 10% moisture content, achieving highly concentrated vegetable oil gel emulsions of different consistencies and qualities. Physical properties of the dried emulsions were evaluated by texture, microstructure, and oil loss determination. The reformulated bakery creams with the dried emulsions obtained from 47% oil showed better spreadability, viscosity, and viscoelasticity properties. A shortening replacement with the dried emulsion obtained from 70% initial oil caused a negative impact on the creams' consistency, with lower viscosity and lower hysteresis area, revealing a weakness of structure. This research provided new knowledge about the structuration of vegetable oils through concentrated emulsions and their application as a source of healthy fat in creams for bakery applications.

Maximizing the oil content in polysaccharide-based emulsion gels for the development of tissue mimicking phantoms.

Formulations based on agar and κ-carrageenan were investigated for the production of emulsion gels applicable as tissue mimicking phantoms. The effects of the polysaccharide matrix, the oil content and the presence of surfactants on the micro-/nanostructure, rheology, and mechanical and dielectric properties were investigated. Results showed a high capacity of the agar to stabilize oil droplets, producing gels with smaller (10-21 µm) and more uniform oil droplets. The addition of surfactants allowed increasing the oil content and reduced the gel strength and stiffness down to 57 % and 34 %, respectively. The permittivity and conductivity of the gels were reduced by increasing the oil content, especially in the agar gels (18.8 and 0.05 S/m, respectively), producing materials with dielectric properties similar to those of low-water content tissues. These results evidence the suitability of these polysaccharides to design a variety of tissue mimicking phantoms with a broad range of mechanical and dielectric properties.

Optimization of Xanthan and Locust Bean Gum in a Gluten-Free Infant Biscuit Based on Rice-Chickpea Flour Using Response Surface Methodology.

Incorporation of xanthan gum and locust bean gum in rice flour supplemented by chickpea flour was used to obtain a good quality of nutritionally enriched biscuit for celiac children. Response surface methodology (RSM) was applied to optimize the levels of xanthan and locust bean gum added to the composite gluten-free flour. Analysis was based on the rheological (hardness and viscoelastic) characteristics of the dough and specific volume, water activity, and hardness of the biscuit. The results revealed that the regression and variance analysis coefficients related to the rheological and physical properties of dough and biscuit under the influence of independent variables were sufficient for an adequate and well-fitted response surface model. Linear terms of variables significantly affect most of the dough and biscuit parameters, where the xanthan gum effect was found to be more pronounced than locust bean gum. Interaction terms showed a significant positive effect on the specific volume of the biscuits and a negative effect on the water activity. However, the interactive effect of gums did not significantly affect the rheological parameters of the dough. Optimized conditions were developed to maximize the specific volume of biscuit and minimize water activity and biscuit hardness, while keeping hardness and viscoelastic properties of the dough in range. Predicted responses were found satisfactory for both rheological and physical characteristics of dough and biscuit.