Impact of Salts Mixtures on the Physicochemical and Sensory Characteristics of Spanish-Style Manzanilla Green Table Olives during Packaging.

Using response surface methodology (RSM), this study investigates the effect of NaCl substitution (50%) with KCl, CaCl2, and MgCl2 in the packaging brines (controlled variables) on the characteristics (responses) of plain green Spanish-style Manzanilla olives, maintaining the salt-mixture level of 5%. The RSM showed that the increment of CaCl2 caused a linear significant (p-value ≤ 0.05) decrease in pH and a linear increase in firmness (instrumental), hardness (panel scores), and crunchiness. The models for bitterness and fibrousness also included quadratic (CaCl2·MgCl2) and cubic (the three salt) interactions, which led to areas of minimum and maximum scores around the central points of the CaCl2-MgCl2 and KCl-MgCl2 axes, respectively. In contrast, the increase in the KCl level linearly decreased bitterness scores. Optimisation resulted in a relatively low desirability (0.57) and the selection of a combination that may necessitate further refinement, such as increasing KCl or reducing CaCl2 levels, especially for markets sensitive to bitterness. Interestingly, the overall score and buying predisposition positively correlate with salty, smell, acid, and appearance and negatively with bitterness. Furthermore, PLS-R analysis found that the pivotal attributes influencing overall appreciation were smell and crunchiness while buying predisposition was promoted by crunchiness. Conversely, bitterness had a detrimental impact on these appreciations. Cluster analysis grouped the experimental runs into four categories, with sensory profiles predominantly diverging in bitterness, salty, and kinesthetic characteristics. Ultimately, this study elucidates four distinct sensory profiles that consumers experience.

The Desalting Process for Table Olives and Its Effect on Their Physicochemical Characteristics and Nutrient Mineral Content.

The desalting process is critical for packaging table olives in brine with reduced NaCl or fortified mineral nutrients. In this study, the effect of desalting on the physicochemical characteristics and mineral content of green Manzanilla Spanish-style (plain and stuffed with pepper paste) and DOP Aloreña de Málaga table olives was investigated for the first time. The surface colour of the fruits turned slightly brownish, and the olives became somewhat softer. The lactic acid, the mineral macronutrients (mainly) and micronutrient contents decreased, while flesh moisture increased. The kinetic parameters of the minerals' losses depended on the presentation, with the estimated values for plain olives being the lowest (slowest desalting). Overall, the desalting process resulted in slight quality damage and a moderated decrease in the mineral concentration in the flesh, leading to some product degradation. This study provides quantitative information on these changes that may affect the commercial value of the final products and offers information for viable designs.

Development of the Anxiety, Depression and Coping (ADAF) screening tool for emotional and coping problems in cancer patients.

OBJECTIVE: Clinical guidelines recommend psychological screening in cancer patients. However, most scales cover many items and hamper detection. In addition, patients are generally referred from routine consultations. The specific objective of the present study was to develop and validate a tool, Anxiety, Depression, Coping (ADAF), to screen for anxiety and depression and assess coping in cancer patients. METHODS: Cross-sectional, multicenter study performed in the medical and radiotherapy-oncology services of five hospitals in Madrid and coordinated by the Medical Oncology Service of Hospital Clínico San Carlos (CEIC nº19/265-E). To determine psychometric properties, the ADAF screening questionnaire ADAF was administered. ADAF includes five items (1 related to anxiety symptoms, 2 related to depressive symptoms, 1 for helplessness coping, and 1 for avoidance coping). Hospital Anxiety and Depression Scale and Mini-Mental Adjustment to Cancer scale were used as the gold standards. Intraclass correlation coefficients were calculated and receiver operating characteristic (ROC) curves constructed. A p value of <0.05 was considered significant. RESULTS: A total of 186 patients completed the evaluation. The correlation coefficients were significant for all dimensions (anxiety, depression, helplessness coping, and avoidance coping) (p < 0.001). The statistical analysis of the ROC curves suggested that the cut-off point for screening was >2 points (3 in the case of depression), with a sensitivity and specificity between 62% and 90%, and an area under the curve above 0.8 for the first 4 items. CONCLUSIONS: ADAF screening has adequate reliability and good sensitivity and specificity. This instrument is useful and can be easily applied to identify emotional and coping problems in cancer patients.

Influence of prognosis factors on the prescription of targeted treatments in rheumatoid arthritis: A Delphi survey.

OBJECTIVES: To explore current evidence on the management of poor prognostic factors in rheumatoid arthritis (RA) and to investigate whether this evidence is taken into account by clinicians when deciding on treatment in daily clinical practice. METHODS: We performed a systematic literature review (SLR) to analyse the effects of currently available biologic disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKi) on the classically accepted poor prognostic factors of RA. All randomized controlled trials reporting subgroup analyses about effects on prognostic factors were identified and synthesized. In a second phase, a two-round Delphi survey was carried out to contrast the SLR results with the grade of agreement of a large group of rheumatologists about the effectiveness of each drug class on each prognostic factor. RESULTS: According to the Delphi results, the only prognostic factor that significantly influenced the selection of treatment was the presence of interstitial lung disease (ILD), being the preferred treatment in this scenario abatacept or rituximab. The rest of the poor prognostic factors (including high disease activity at baseline, disability as measured by the Health Assessment Questionnaire index, seropositivity, elevated acute-phase reactants, and evidence of erosions based on plain radiography or ultrasonography) did not seem to significantly influence rheumatologists when choosing a treatment. The results of the SLR results did not show solid evidence regarding the use of any specific therapy in the management of patients with specific poor factors, except in the case of RA-ILD, although the data in the literature in this regard are not free of bias. CONCLUSIONS: The only prognostic factor that seems to significantly influence the selection of treatment is the presence of RA-ILD.

Pain Standards for Accredited Healthcare Organizations (ACDON Project): A Mixed Methods Study.

Up to 50% of cancer patients and up to 90% of those in terminal stages experience pain associated with disease progression, poor quality of life, and social impact on caregivers. This study aimed to establish standards for the accreditation of oncological pain management in healthcare organizations. A mixed methods approach was used. First, a pragmatic literature review was conducted. Second, consensus between professionals and patients was reached using the Nominal Group and Delphi technique in a step that involved anesthesiologists, oncologists, family physicians, nurses, psychologists, patient representatives, and caregivers. Third, eight hospitals participated in a pilot assessment of the level of fulfillment of each standard. A total of 37 standards were extracted. The Nominal Group produced additional standards, of which 60 were included in Questionnaire 0 that was used in the Delphi Technique. Two Delphi voting rounds were performed to reach a high level of consensus, and involved 64 and 62 participants with response rates of 90% and 87%, respectively. Finally, 39 standards for the management of cancer pain were agreed upon. In the self-evaluation, the average range of compliance was between 56.4% and 100%. The consensus standards of the ACDON Project might improve the monitoring of cancer pain management. These standards satisfied the demands of professionals and patients and could be used for the accreditation of approaches in cancer pain management.

In Vitro Bioaccessibility of Ripe Table Olive Mineral Nutrients.

For the first time, the bioaccessibility of the mineral nutrients in ripe table olives and their contributions to the recommended daily intake (RDI), according to digestion methods (Miller's vs. Crews' protocols), digestion type (standard vs. modified, standard plus a post-digest re-extraction), and mineralisation system (wet vs. ashing) were studied. Overall, when the standard application was used, Miller's protocol resulted in higher bioaccessibilities of Na, K, Ca, Mg, and Fe than the Crews' method. The modified protocols improved most of these values, but the Crews' results only approximated the Miller's levels in the case of Na and K. The bioaccessibility of P was hardly affected by the factors studied, except that the modified Miller's protocol led to higher levels when ashing. No significant effect of the mineralisation system was found. The modified Miller's protocol, regardless of the mineralisation system, led to the overall highest bioaccessibility values in ripe olives, which were: Na (96%), K (95%), Ca (20%), Mg (73%), Fe (45%), and P (60%). Their potential contributions to the RDI, based on these bioaccessibilities and 100 g olive flesh service size, were then 29, 0.5, 4, 3, 33, and 1% respectively. The investigation has led to the development of a method for assessing the bioaccessibility of the mineral nutrients not only in ripe but also in the remaining table olive presentations and opens a new research line of great interest for producing healthier products.

Adherencia al tratamiento con fármacos moduladores de la enfermedad sintéticos en la artritis reumatoide. Resultados del estudio OBSERVAR / Adherence to synthetic disease-modifying antirheumatic drugs in rheumatoid arthritis: results of the OBSERVAR study

INTRODUCCIÓN: La cumplimentación del tratamiento modificador de la enfermedad es esencial para alcanzar los objetivos terapéuticos en la artritis reumatoide (AR). Sin embargo, y a pesar de la necesidad de una buena adherencia, existe evidencia de que muchos pacientes con AR no cumplen adecuadamente con la prescripción del tratamiento indicado con fármacos moduladores de la enfermedad de acción lenta (FAME) sintéticos o convencionales. Conscientes de la importancia de este hecho, el estudio sobre observancia terapéutica en AR (estudio OBSERVAR) tiene como objetivo principal valorar los motivos de la falta de adherencia terapéutica a los FAME sintéticos en estos pacientes. PACIENTES Y MÉTODOS: Mediante un proceso Delphi entre 18 reumatólogos españoles seleccionados aleatoriamente se determinó el grado de acuerdo con 66 causas de incumplimiento seleccionadas de la bibliografía, en relación con los FAME sintéticos en la AR. RESULTADOS: Los motivos de incumplimiento fueron consistentes en el 75,7%, si bien 3 razones (4,5%) destacaron como muy consistentes: 1) desconocer qué hacer cuando se sufre un acontecimiento adverso con el FAME; 2) no llevar a cabo métodos de cribado de la adherencia por el personal sanitario para detectar a los «pacientes incumplidores» de forma temprana y 3) no aplicar intervenciones o estrategias que mejoren la adherencia terapéutica. CONCLUSIÓN: Para mejorar la adherencia al tratamiento de la AR con FAME sintéticos se debe informar al paciente de cada tratamiento nuevo introducido, incorporar el perfil de cumplimiento del paciente en la rutina clínica, y reforzar la motivación del paciente al cumplimiento terapéutico mediante los métodos a nuestro alcance

BACKGROUND: Treatment compliance with disease-modifying antirheumatic drugs (DMARD) is essential to achieve the therapeutic goals in rheumatoid arthritis (RA). However, despite the need for good compliance, there is evidence that patients with RA frequently fail to use DMARD for the control of RA. Thus, the main objective of the OBSERVAR study is to evaluate the reasons for the lack of therapeutic adherence to synthetic DMARD in these patients. PATIENTS AND METHODS: A Delphi process involving 18 randomly selected Spanish rheumatologists determined the level of agreement with 66 causes of noncompliance selected from the literature in relation to synthetic DMARD in RA. RESULTS: The reasons for noncompliance were consistent in 75.7%, although 3 reasons (4.5%) were highly consistent: 1) not knowing what to do in the case of an adverse event with DMARD; 2) not having undergone adherence screening by health personnel for early detection of "noncompliant patients"; and 3) not having undergone interventions or strategies that improve adherence. CONCLUSION: In order to improve adherence to RA treatment with synthetic DMARD, the patient should be adequately informed of each new treatment introduced, the patient's compliance profile should be incorporated into the clinical routine and the patient's motivation for therapeutic compliance be reinforced through the methods available to us

Adherence to synthetic disease-modifying Antirheumatic Drugs in Rheumatoid Arthritis: Results of the OBSERVAR Study. / Adherencia al tratamiento con fármacos moduladores de la enfermedad sintéticos en la artritis reumatoide. Resultados del estudio OBSERVAR.

BACKGROUND: Treatment compliance with disease-modifying antirheumatic drugs (DMARD) is essential to achieve the therapeutic goals in rheumatoid arthritis (RA). However, despite the need for good compliance, there is evidence that patients with RA frequently fail to use DMARD for the control of RA. Thus, the main objective of the OBSERVAR study is to evaluate the reasons for the lack of therapeutic adherence to synthetic DMARD in these patients. PATIENTS AND METHODS: A Delphi process involving 18 randomly selected Spanish rheumatologists determined the level of agreement with 66 causes of noncompliance selected from the literature in relation to synthetic DMARD in RA. RESULTS: The reasons for noncompliance were consistent in 75.7%, although 3 reasons (4.5%) were highly consistent: 1) not knowing what to do in the case of an adverse event with DMARD; 2) not having undergone adherence screening by health personnel for early detection of "noncompliant patients"; and 3) not having undergone interventions or strategies that improve adherence. CONCLUSION: In order to improve adherence to RA treatment with synthetic DMARD, the patient should be adequately informed of each new treatment introduced, the patient's compliance profile should be incorporated into the clinical routine and the patient's motivation for therapeutic compliance be reinforced through the methods available to us.

Use of prognostic factors of rheumatoid arthritis in clinical practice and perception of their predictive capacity before and after exposure to evidence.

The aim of the study is to benchmark the use and attributed importance of well-established prognostic factors in rheumatoid arthritis (RA) in daily clinical practice, and to contrast the use of factors with their ability to predict outcome. Medline was searched (inception-Sep. 2016) for systematic reviews on factors predicting death, disability, structural damage or remission in RA. All factors identified were compiled in a matrix of factors × outcomes, and scoping reviews for each cell were then performed. A survey to 42 rheumatologists randomly selected explored the use of the list of prognostic factors and inquired about the perceived strength of association with poor prognosis. In a second round, participants were exposed to evidence from the matrix and to responses from other participants. Change on perceived strength of association was evaluated. Rheumatologists report using prognostic factors in clinical practice on a daily basis. Very young onset, joint counts at diagnosis, rheumatoid factor, ACPA, and radiographic erosions are used frequently and correctly recognized as strong predictors. Comorbidities and other associated problems, such as obesity, low bone mineral density, cardiovascular disease, or extra-articular manifestations, are perceived as moderately associated to prognosis but, nevertheless, rheumatologists also use them profusely. Genetic and other biomarkers and osteitis by magnetic resonance are less accessible in daily practice and they obtained better results on second round (probably after knowing the strength of association with prognosis). Rheumatologists use widely most prognostic factors with a strong predictive value. However, factors with low evidence of prognostic value are also used and some factors are not used despite good evidence.

Sensory Assessment by Consumers of Traditional and Potentially Probiotic Green Spanish-Style Table Olives.

This work presents the sensory characterization by consumers of traditionally and potentially probiotic green Spanish-style table olives. To this aim, green Manzanilla olives from the same lot were debittered, washed, and brined in the same way; then, one sub-lot was allowed fermenting spontaneously while another one was inoculated with a putative probiotic bacterium (Lactobacillus pentosus TOMC-LAB2). After fermentation, the olives from both sub-lots were packed with fresh brine to reach 5.5 g/100 mL NaCl and 0.6 g lactic acid/100 mL in the equilibrium. The stabilized olives were then subjected to sensory evaluation by 200 consumers, and the results were analyzed by ANOVA and multivariate statistical techniques. In a first approach, consumers perceived the spontaneously fermented olives as similar to the potentially probiotic product. However, a biplot based on Canonical Variate Analysis (CVA) showed differences between them in the Salty and Overall score. When data from the consumer test were assessed by PLS analysis, regardless of the fermentation system, Overall score, and Buying predisposition were significantly driven by Appearance, Odor, Salty (negatively), Hardness, and Crispness.

Data on green Spanish-style Manzanilla table olives fermented in salt mixtures.

This article contains processed data related to the research published in "Fermentation in nutrient salt mixtures affects green Spanish-style Manzanilla table olives" [1]. It displays information on the salt substitution by other nutrient salts (potassium chloride and calcium chloride) during fermentation of green Spanish-style Manzanilla table olives to produce healthier products. Particularly, it studies the relationship between the different colour parameters (L*, a*, b* and C i), firmness, and sensory attributes (saltiness, bitterness, hardness, and fibrousness), and the composition of the initial brine in NaCl, KCl, and CaCl2. The composition of the brines affected the characteristics of the product. In general, the higher was the proportion of CaCl2 in the initial brines the better was the colour. Also, the presence of this salt mitigated the saltiness perception but increment those of bitterness, hardness, fibrousness, and crunchiness. Besides, most of the sensory attribute scores could successfully be predicted as a function of the Na, K, and Ca concentrations in the fermented olive flesh. The work allows the production of table olives with specific characteristics and predetermined mineral nutrient composition.

Fermentation in nutrient salt mixtures affects green Spanish-style Manzanilla table olive characteristics.

This work studies the effects of the substitution of NaCl with KCl and CaCl2 on the physicochemical, mineral and sensory profile of fermented green Spanish-style Manzanilla olives, using an enlarged centroid mixture design. An increasing presence of CaCl2 in the initial brines improved the colour index, L(∗), b(∗) values, and firmness. The Na in the olives decreased (linearly) while the levels of K and Ca increased (quadratic) as a function of the KCl and CaCl2 concentrations in the initial brines. CaCl2 also improved the retention of Zn and P in the flesh. PLS showed a strong relationship between Ca and bitterness, hardness, fibrousness, crunchiness and saltiness (negative) and allowed for the prediction of sensory attributes (except acid) from the mineral contents in the flesh. Most of the treatments could lead to new green Spanish-style Manzanilla olive presentations with reduced Na and healthier characteristics.

Clinical features and survival of 338 multiple myeloma patients treated with hematopoietic stem cell transplantation or conventional chemotherapy.

Therapeutic approaches against multiple myeloma (MM) have largely changed during the past decade. Hematopoietic stem cell transplantation (HSCT) and licensing of immunomodulators and proteasome inhibitors have resulted in better response and increased overall survival rates compared to previous conventional therapies. To assess the impact that these new strategies have had on outcome of patients with symptomatic MM in Spain, we conducted an epidemiological retrospective analysis of 338 newly diagnosed patients with stage II-III MM who started first-line treatment over a 2-yr period (2003-2005) by collecting data from their medical records. Most patients had been diagnosed with secretory MM (94.4%), 41.7% stage II and 58.3% stage III. The presence of bone lesions (72.2%), as well as anemia (79.8%) and elevated beta2-microglobulin levels (62.3%), was a common finding; in contrast, hypercalcemia and elevated serum creatinine were less frequent (25% each). First-line treatment had consisted of either conventional chemotherapy (62%) or induction treatment plus autologous HSCT (38%), as per standard clinical practice. HSCT not only resulted in greater objective response rates (93% vs. 50%), but also contributed to a significant increase in 3-yr survival (85% vs. 49.7%; 95% CI, range 77-91 vs. 41-58; P < 0.001). Overall, 55% of patients presented treatment-related adverse events, mainly hematological. Toxicity rates were higher among patients treated with alkylating-based regimens and in those undergoing transplantation. In conclusion, data analysis shows an adequate balance between increased response rates and safety that supports the use of up-front high-dose HSCT therapy in younger patients. Most importantly, this study provides further confirmation that the introduction of HSCT has significantly prolonged survival of patients with MM.

Mineral content and sensory characteristics of Gordal green table olives fermented in chloride salt mixtures.

UNLABELLED: This work studies the effects of the initial brine concentrations of NaCl, KCl, and CaCl(2) on the mineral content and gustatory and kinaesthetic sensations of fermented green table olives, using a simplex centroid mixture design augmented with interior points. The sodium in the flesh was linearly related to the mixture concentrations while potassium and calcium were linked by quadratic and special cubic models respectively. Acidity, saltiness, hardness, fibrousness, and crunchiness were expressed as linear funtions of the NaCl, KCl, and CaCl(2) initial brine contents but bitterness required quadratic equations. The models can be used to produce table olives with specific mineral contents in the flesh and to predict their corresponding sensory characteristics. PRACTICAL APPLICATION: The study provides the industry with models to estimate the Na, K, and Ca mineral contents in the flesh of fermented Gordal green table olives as well as their sensory characteristics as a function of the NaCl, KCl, and CaCl(2) initial compositions in the brining solution. Therefore, the paper provides tools which are able to support the production of commercial presentations which not only satisfy consumer demand for low Na, but are also K and Ca fortified table olive presentations with specific sensory profiles.