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El Dipòsit Digital de la Universitat de Barcelona es el repositorio institucional que contiene en formato digital los materiales derivados de la actividad docente, investigadora e institucional de la comunidad universitaria.

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Association of a healthy beverage score with total mortality in the adult population of Spain: A nationwide cohort study
(Public Library of Science (PLoS), 2024-01-23) Rodríguez-Ayala, M.; Donat Vargas, Carolina; Moreno Franco, Belén; Mérida, Diana María; Ramón Banegas, José; Rodríguez-Artalejo, Fernando; Guallar Castillón, Pilar
Background: Despite the substantial evidence of the relationship between diet and mortality, the role of beverage consumption patterns is not well known. The aim of this study was to assess the association of the adherence to a Healthy Beverage Score (HBS) and all-cause mortality in a representative sample of the Spanish adult population. Methods and findings: We conducted an observational cohort study using data from the Study on Nutrition and Cardiovascular Risk in Spain (ENRICA), which included 12,161 community-dwelling individuals aged ≥18 years recruited in 2008 to 2010 and followed until January 2022. At baseline, food consumption was collected using a validated diet history. The HBS consists of 7 items, each of which is scored from 1 to 4 (highest adherence). The HBS ranges from 7 to 28 points with a higher score representing a healthier pattern. Adherence was assigned as a higher consumption of low-fat milk, and coffee and tea, a lower consumption of whole-fat milk, no consumption of fruit juice, artificially sweetened beverages, or sugar-sweetened beverages, and no or moderate consumption of alcohol. Total mortality was ascertained by linkage to the Spanish National Death Index. Statistical analyses were performed with Cox models and adjusted for the main confounders, including sociodemographic, lifestyle, dietary variables, and morbidity. After a mean follow-up of 12.5 years (SD: 1.7; range: 0.5 to 12.9), a total of 967 deaths occurred. For all-cause mortality, the fully adjusted hazard ratio (HR) for the highest versus lowest sex-specific quartiles of HBS was 0.72 (95% confidence interval [0.57, 0.91], p linear-trend = 0.015), corresponding to an 8.3% reduction in the absolute risk of death. A linear relationship between the risk of death and the adherence to the HBS was observed using restricted cubic splines. The results were robust to sensitivity analyses. The main limitation was that repeated measurements on beverage consumption were not available and beverage consumption could have changed during follow-up. Conclusions: In this study, we observed that higher adherence to the HBS was associated with lower total mortality. Adherence to a healthy beverage pattern could play a role in the prevention of premature mortality.
Factors predictius d'afectació axil·lar postneoadjuvància en les pacients de càncer de mama amb biòpsia positiva de gangli sentinella
(Universitat de Barcelona, 2026-02-02) Cebrecos Lerena, Isaac; Vidal Losada, María Jesús; Mension Coll, Eduard; Universitat de Barcelona. Facultat de Medicina i Ciències de la Salut
[cat] Antecedents del tema: El factor pronòstic més rellevant en el càncer de mama és la valoració de l’estatus ganglionar. Durant moltes dècades, la limfadenectomia axil·lar (LDAx) ha estat part essencial del tractament quirúrgic, complint la doble finalitat de procurar un bon control locorregional de la malaltia i facilitar la seva estadificació per guiar els tractaments adjuvants. Tot i això, aquesta cirurgia comporta riscos importants, com el limfedema i la pèrdua de funcionalitat del braç, fet que ha impulsat la recerca d’alternatives menys invasives. En context de cirurgia primària, la biòpsia selectiva del gangli sentinella (BSGS) ha anat substituint progressivament la LDAx com a eina d’estadificació, sense impactar negativament en la supervivència global ni en la supervivència lliure de malaltia. Diversos assajos clínics han demostrat que, fins i tot en presència de fins a dues macrometàstasis al gangli sentinella, es pot evitar la LDAx de manera segura. Aquestes evidències han estat incorporades a les guies clíniques i permeten limitar la cirurgia axil·lar en pacients seleccionades. Tanmateix, en el marc neoadjuvant, els criteris per evitar la LDAx no són extrapolables. La malaltia residual al GS suposa un grau de resistència al tractament primari i les taxes d’afectació ganglionar addicional poden arribar al 60%. Tot i els avenços procurats per la Targetted Axillary Dissection (TAD) en la desescalada quirúrgica de pacients cN1 i les millores en les pautes i desenvolupament de nous tractaments sistèmics, la manca d’estudis amb seguiment a llarg termini en pacients amb gangli sentinella positiu limita la desescalada quirúrgica en aquest escenari. Amb tot, encara hi ha moltes pacients que en aquestes circumstàncies no manifesten afectació ganglionar més enllà del gangli sentinella positiu, representant un grup de sobretractament innecessari per la realització de LDAx blanques. A l’espera dels resultats dels estudis prospectius actualment en curs, que avaluaran la seguretat oncològica d’ometre aquestes cirurgies, aquesta tesi té com a objectiu aportar dades i eines clíniques que permetin optimitzar la selecció dels tractaments quirúrgics axil·lars en pacients amb càncer de mama, amb la finalitat última de millorar-ne la qualitat de vida. Hipòtesi: Existeixen característiques clíniques i patològiques que permeten seleccionar millor les pacients amb càncer de mama que podrien evitar una limfadenectomia axil·lar en el context neoadjuvant quan presentin positivitat del gangli sentinella. Es podria evitar un tractament quirúrgic en aquelles pacients amb menys probabilitats de presentar afectació metastàtica axil·lar. Objectius: 1. Identificar les característiques clínico-patològiques associades a la presència de malaltia axil·lar addicional en pacients amb càncer de mama inicial (cN0) i biòpsia selectiva de gangli sentinella positiva després del tractament sistèmic primari. 2. Desenvolupar un model predictiu d’afectació axil·lar per identificar pacients amb càncer de mama inicial (cN0) que presenten afectació del gangli sentinella després del tractament sistèmic primari. 3. Avaluar l'eficàcia d’una nova variable clínica (Sentinel Lymph Node-Ratio), definida com la relació de ganglis sentinelles positius entre el total de ganglis sentinelles obtinguts, com a predictor de malaltia axil·lar residual en les pacients amb càncer de mama després de quimioteràpia neoadjuvant. 4. Avaluar la correlació entre variables epidemiològiques i clíniques i la presència de malaltia residual a la linfadenectomia axil·lar de pacients amb càncer de mama amb estadificació axil·lar positiva després del tractament amb quimioteràpia neoadjuvant. Metodologia: Es van dur a terme dos estudis en un únic centre, observacional de dades històriques recollides prospectivament i transversal, per analitzar pacients amb càncer de mama sotmeses a limfadenectomia axil·lar després de tractament sistèmic primari amb resultat positiu del gangli sentinella. El primer estudi incloïa pacients cN0 tractades amb quimioteràpia o hormoteràpia, mentre que el segon incloïa pacients cN0 i cN+ tractades amb quimioteràpia. L’estadificació es va fer amb biòpsia del gangli sentinella o Targetted Axillary Dissection segons l’estat clínic inicial, cN0 i cN+ respectivament, i sempre amb ecografia prèvia. Es va analitzar la relació entre els factors clínico-patològics i l’afectació axil·lar addicional i es van desenvolupar models predictius per seleccionar pacients candidates a evitar cirurgies axil·lars radicals. Principals resultats: La presència de ganglis metastàtics addicionals a la linfadenectomia axil·lar es va detectar en el 22,2% i el 33% dels casos de les dues poblacions analitzades. Entre els factors clínico-patològics analitzats, es va observar que els nivells de receptors de progesterona, la presència de macrometàstasis, un major número de ganglis sentinelles afectats i l’estatus ganglionar incial cN+ estaven associats de manera independent amb afectació ganglionar addicional quan es completava la cirurgia. Per al grup de pacients cN0, l’anàlisi de regressió LASSO va identificar els nivells de receptors de progesterona, Ki67, les macrometàstasis i el número de ganglis sentinella positius com les covariables més eficients per construir l’índex predictiu de malaltia axil·lar addicional (ALND-predict). Aquest índex identificava amb precisió les pacients candidates a evitar una LDAx, mostrant una àrea sota la corba de 0,83 i un punt de tall òptim de 63, amb un valor predictiu negatiu de 0,925. Per al grup de pacients cN0/cN+ que realitzaven quimioteràpia neoadjuvant, es va realitzar una anàlisi de regressió logística univariada de la variable SLN-R per avaluar el seu valor predictiu, obtenint una ràtio d'odds (OR) de 7,79 (CI 1,92–29,5, p = 0,003). Es va identificar un punt de tall de SLN-R de <0,35 mitjançant l'anàlisi de la corba ROC, amb una taxa de fals negatiu del 10,2%, com a predictor de no presència de metàstasi addicional en cas de completar la cirurgia. Conclusions: Una proporció rellevant de pacients amb càncer de mama i gangli sentinella positiu després del tractament neoadjuvant no presenten afectació axil·lar addicional, fet que suggereix un possible sobretractament amb la limfadenectomia axil·lar. Factors com la presència de macrometàstasis, múltiples ganglis afectats, baixos nivells de receptors hormonals i un Ki67 elevat s’associen a més risc d’afectació. Eines com ALND-predict i la variable Sentinel Lymph Node-Ratio mostren una alta capacitat per identificar pacients amb baix risc, i podrien contribuir a personalitzar l’abordatge quirúrgic, reduint la morbiditat i millorant la qualitat de vida.
Perceived Healthcare Interventions and Clinical Strategies Against Dating Violence: A Qualitative Exploration of Expert and Nursing Perspectives
(MDPI, 2026-09-04) Puig Llobet, Montserrat; Sánchez Balcells, Sara; Agüera, Zaida; Sanchez-Ortega, M. Aurelia; Ventosa Ruiz, Ana; El Abidi, Khadija; Vergés Bosch, Núria; Rodríguez-Martín, Dolors; Rodríguez Ávila, Núria; Juárez Sánchez, Alba; Maestre, Elena; Perau Campos, Mireia; Luque-Tintó, Alba; Martínez Bueno, Cristina; Aragón Castro, Liliana; Esteban Sanz, Cristina; Nebot Echeverria, Marina; Rigol Cuadra, Assumpta; Prats Arimon, Marta
Introduction: Dating violence is an early form of intimate partner violence characterized by controlling behaviors, psychological and sexual abuse, and digital coercion. Despite its high prevalence among adolescents and young adults, it remains underrecognized and insufficiently addressed in healthcare settings. Nurses are strategically positioned to identify and respond to dating violence due to their close contact with patients and holistic approach to care. However, important gaps remain between existing protocols and their implementation in clinical practice. Methods: An exploratory qualitative study was conducted within a constructivist paradigm as part of a multicenter research project on dating violence among health sciences university students. Twelve experts, including nurses, healthcare professionals, and representatives of survivor-led organizations, participated in focus groups and reflective journals between September and December 2025 at the University of Barcelona. Data were analyzed using an interpretative phenomenological approach, with inductive thematic analysis guiding coding and theme development. Methodological rigor was ensured following the Consolidated Criteria for Reporting Qualitative Research (COREQ). Ethical approval was obtained. Results: Four themes emerged: (1) barriers to identification, including the normalization of controlling behaviors, myths of romantic love, and limited recognition of psychological and digital violence; (2) challenges in nursing responses, such as insufficient training, clinical uncertainty, organizational barriers, and lack of screening tools; (3) identification strategies, including systematic screening, relationship-centered interviewing, emotional education, and recognition of subtle warning signs; and (4) actions following identification, focused on validation, confidentiality, risk assessment, interdisciplinary referral, and ongoing support. Conclusions: Findings highlight the need to update protocols to explicitly address digital violence and strengthen nursing-led interventions. Participants emphasized the need for enhanced professional training, context-appropriate screening tools, and intersectoral collaboration as potential strategies to improve the identification and response to dating violence.
Consumer Responses to Generative AI in Marketing: A Systematic Literature Review and Causal-Chain Framework
(2026) Román Yseki, Jorge Hiroshi; Forgas Coll, Santiago
Generative artificial intelligence (GenAI) is increasingly embedded in consumer-facing marketing activities, yet research on consumer responses remains fragmented across theoretical perspectives, marketing contexts, and constructs. This study systematically reviews and synthesizes the emerging literature to develop an integrative causal-chain framework of consumer responses to GenAI in marketing. Following a structured search and screening process using Scopus and Web of Science, 143 core studies were retained for analysis. The review maps their theoretical foundations, methodological characteristics, marketing contexts, and constructs, organizing the latter according to their roles as antecedents, mediators, moderators, and outcomes. The findings reveal substantial theoretical diversity but also recurring patterns across the literature. Consumer responses originate from characteristics of GenAI sources and production, content and messages, AI agents and systems, consumers, and marketing contexts, and operate through cognitive-functional, affective-experiential, social-relational, legitimacyrelated, and attitudinal mechanisms. Trust, authenticity, and credibility emerge as particularly prominent legitimacy-related mechanisms across the reviewed literature. The evidence further indicates that GenAI effects are highly contingent on factors including disclosure, human involvement, content and product characteristics, modality, and consumer differences. Finally, the literature remains substantially more developed in explaining consumer evaluations, relationships, and behavioral intentions than actual and sustained marketplace behavior. By integrating these fragmented relationships into a common causal architecture, the study provides a structured foundation for cumulative research and more context-sensitive managerial decision-making regarding GenAI in marketing.
CD6 and CD5 as mediators of lymphocyte response and tumor progression
(Universitat de Barcelona, 2026-02-13) Carrillo i Serradell, Laura; Lozano Soto, Francisco; Velasco de Andrés, María; Universitat de Barcelona. Facultat de Medicina i Ciències de la Salut
[eng] CD5 and CD6 are scavenger lymphocytic receptors mainly expressed in all T cells and the small B1a cell subset. They exert a dual function, as they can sense the presence of microbial associated molecular patterns (MAMPs), but they can also modulate activation or death signals derived from the antigen-specific clonotypic receptors of T and B cells. This duality is what confers CD5 and CD6 a special relevance in infectious, autoimmune and cancer immune responses, where antigenic signalling strength is a critical element for lymphocyte activation, survival and differentiation. Based on previous work from our group, the present thesis aimed at exploring the interplay between gut microbiota and the anti-tumor effects of soluble forms of human CD5 (shCD5) and CD6 (shCD6), as well as the assessment of CD6 role in the biology and clinical behavior of normal and malignant B cells. Regarding the former objective we analysed the antitumor responses of mice that were firstly treated with an antibiotic cocktail to deplete the basal microbiota, then administered with shCD5 and shCD6 along microbiota reconstitution, and challenged afterwards with mouse melanoma B16F10 cells. No significant differences were detected between the shCD5- and shCD6-treated mice and the control groups regarding gut microbiota composition, as deduced from sequential whole genome sequencing (WGS) and 16S rRNA sequencing from faecal samples. However, it was observed that the antitumor effects derived specifically from shCD6 administration were enhanced by the antibiotic cocktail preconditioning, and that this enhancement was associated with a diminished production of IL-10 by B cells. Similar anti-tumor effects were observed following gut microbiota reconstitution simultaneous to shCD6 administration in Eμ-Myc mice, which spontaneously develop B-cell lymphomas. Whereas the inhibitory role of CD5 in both TCR and BCR signalling is widely accepted, CD6’s involvement is yet to be fully unravelled. Recent signalosome studies provide evidence on CD6 engagement of both stimulatory and inhibitory intracellular effectors following TCR triggering. However, there is little evidence on its involvement in BCR signal transduction and B cell physiology. To this end, we worked with neoplastic B (Daudi and CLL) cells as a source of CD6 positive and negative B cells. Our studies with Daudi cells lentivirally transduced and selected for stable expression of CD6 or a control green fluorescent protein (GFP) demonstrated that CD6 expression induces i) relevant changes at both phenotypic and transcriptomic levels, involving down-regulation of genes positively related to cancer progression (e.g., MYC-regulated, genes associated to the G2M checkpoint...), and ii) lower cell metabolic activity as deduced XTT assays, demonstrating a distinct and relevant role for CD6, comparable to that previously attributed to CD5. Further studies with chronic lymphocytic leukemia (CLL) cells, all of them CD5-positive, demonstrated that patient showing higher CD6 mRNA levels displayed a longer time to first treatment (TTFT) – an independent predictor of overall survival- and increased mutational state of IGHV genes, both being parameters associated with a favourable prognosis in CLL. In conclusion, the results of the present thesis show that soluble forms of CD5 and CD6 do not modulate gut microbiota composition and that re-setting gut microbiota potentiate the anti-tumor effects of shCD6 in experimental models of melanoma. Furthermore our work with neoplastic B cells shows that CD6 regulates gene expression and potentially attenuates tonics signalling and tumor progression. Altogether, it supports the interplay between gut microbiota and shCD6 therapy, as well as the deep involvement of CD6 expression in B cell biology.