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The premier source of information for the management of patients with Dysphagia

Effect of Human Saliva on the Consistency of Thickened Foods for Patients with Dysphagia

Effect of Human Saliva on the Consistency of Thickened Foods for Patients with Dysphagia

Written by: Edward Sliwinski, Simone la Faille, and Lizette Oudhuis

Purpose: To increase the viscosity of foods/drinks for patients with swallowing difficulties (eg dysphagia), starch-based thickeners (ST) are commonly used. These are highly sensitive to α-amylase in saliva, leading to a potential thin and unsafe fluid consistency during consumption. We tested the effect of human saliva on the consistency of newly developed α-amylase-resistant (AR) products in comparison with standard ST.

Methods: AR products: Nutilis Aqua (ARA), Fortimel Fruit (ARF), Nutilis Complete (ARC), all from Nutricia. Control: tap water thickened with standard ST. In vitro: 10 and 50 min after addition of human saliva the amount of decantable thin liquid was determined. Consistency change was determined by measuring the uniaxial compression force in a Texture Analyzer (Microsystems) and the viscosity in a rotational rheometer (RVA).

In vivo: Healthy adults took one spoon of test product and moved the tongue at ~1 rotation/s. After 10 and 20 s the bolus was spat out into an acid solution to stop α-amylase activity. Viscosity was then measured in a rotational rheometer (Paar Physika).

Results: The amount of decantable liquid was significantly (p<0.05) lower for AR products than for the control. Furthermore, the compression force and viscosity for AR products were significantly (p<0.05) higher compared to the control. The adult testing showed the relative viscosity of AR products to be significantly (p<0.05) higher compared to ST.

Conclusions: Once in contact with human saliva, AR products retain their prescribed consistency significantly better than water thickened with ST. Therefore the use of amylase-resistant thickener combinations might support safer swallowing in patients with dysphagia.

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Dysphagia.ie | Gastrointestinal tolerance & ease of use of a new mildly thick ONS with amylase resistance features

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Gastrointestinal tolerance & ease of use of a new mildly thick ONS with amylase resistance features

Gastrointestinal tolerance and ease of use of a new mildly thick oral nutritional supplement with amylase resistance features

Written by: Ralf-Joachim Schulz, T. Dennehy, B. O’Doherty, M. Perry, M. Shaw, P. Harrington, S. Mulholland, F. Veldkamp, M. Klebach, M. van Miltenburg, E.L. Sliwinski

Rational: Dysphagia can impair oral feeding, causing malnutrition, dehydration, and aspiration. A common therapy is diet modification aimed at increasing bolus viscosity. In this randomized controlled open label study the gastro-intestinal (GI) tolerance of a new pre-thickened α-amylase resistant Oral Nutritional Supplement (ONS) (AR) was compared with a standard ONS manually thickened to the same consistency using a standard thickener (C).

Methods: Products used: 1.) Active AR: pre-thickened mildly-thick energy-dense multi-fiber ONS (Nutilis Complete, Nutricia) and 2.) Control C: standard multi fiber ONS (Fortisip Multi-fiber, Nutricia) thickened with a thickener (Nutilis, Nutricia). After 1-day baseline, 50 subjects (of which 48% dysphagic) were randomly allocated to AR (n=27) or C (n=23) for a 28-day intervention period, in which they were prescribed ≥ 1 study product. Stool frequency was recorded on a daily basis. Parameters of GI tolerance (incidence and intensity of seven GI symptoms) were recorded at baseline, day 14 and day 28. Additionally, product appreciation parameters were determined after the study period. Statistics included Fisher’s Exact test between groups.

Results: No significant differences were found in stool frequency and GI symptoms between the groups.  Furthermore, there were no safety issues based on reports of adverse events. The AR product was evaluated significantly better by the carer on appearance (p<0.05), preparation time, ease of preparation, and stability of thickness (P<0.001).

Conclusions: This study shows that this new ready-to-use AR product is well-tolerated. Furthermore it is easier to administer and has a more stable consistency over time. Therefore, this ready-to-use AR product supports a safe and easy use in patients with dysphagia.

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Dysphagia.ie | Effect of human saliva on the consistency of a newly developed mildly thick ONS

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Effect of human saliva on the consistency of a newly developed mildly thick ONS

Effect of human saliva on the consistency of a newly developed mildly thick oral nutritional supplement for patients with dysphagia

Written by: Lizette Oudhuis and Edward Sliwinski

Rational: To increase the viscosity of foods/drinks for patients with swallowing difficulties, starch-based thickeners (ST) are commonly used. These are highly sensitive to α-amylase in saliva, leading to a potential thin and unsafe fluid consistency during consumption. We tested the effect of human saliva on the consistency of a newly developed pre-thickened α-amylase-resistant Oral Nutritional Supplement (ONS) (AR) in comparison with standard ST.

Methods: AR product: pre-thickened mildly thick ONS (Nutilis Complete) from Nutricia.

Control: tap water thickened with standard ST. In vitro test: One ml of human saliva was added to 100g product. After 10 and 50 min the amount of decantable liquid was determined. Consistency change was determined by measuring the uniaxial compression force with a SMS TA-XT2i Texture Analyser.

Human testing: Healthy adults took ~30ml of test product and moved the tongue at ~1 rotation/s. After 10s the bolus was spat out into a canister and viscosity measurement was started directly. Viscosity was determined in a rota-tional viscometer, Rapid Visco Analyser (RVA), at 50 s-1.

Results: After addition of human saliva, no decantable thin liquid was formed for AR. For drinks thickened with ST the amount of thin liquid formed varied between 8 and 21 ml (p<0.05) which corresponds with 2 to 4 boluses. Furthermore, the compression force for the AR product was significantly (p<0.05) higher than for the control. The human testing showed that after treatment in the mouth the relative viscosity of the AR product was 79%. The value was significantly lower for ST (12%; p<0.05).

Conclusion: The newly developed pre-thickened AR ONS retains the consistency significantly better than drinks thickened with ST in presence of saliva. Therefore, the use of AR products supports safer swallowing for patients with dysphagia.

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Dysphagia.ie | About Nutricia

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About Nutricia


Nutricia Medical is the largest specialist medical nutrition company in Europe and specialises in the provision of advanced medical nutrition to assist people recovering from illness. We offer high quality feeds, systems and support services to patients, carers and healthcare professionals. In partnership with doctors, healthcare professionals and caregivers, we aim to make a difference in people’s lives by assisting them to get back on their feet after illness or surgery.

 

Nutricia Medical provides products for individuals who need nutritional support as a result of illness, injury, surgery, or age. We also provide products that assist the day-to-day dietary management of specific conditions, such as cows’ milk allergy, swallowing problems, PKU and epilepsy.

All Nutilis products are made by Nutricia Medical and are specifically designed for the dietary management of patients with dysphagia and swallowing difficulties.

Nutricia Medical is a specialised medical division of the international food company Danone.

For more information about Nutricia Medical please visit our Website.

Nutricia

Dysphagia.ie | Privacy and Cookies

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Privacy and Cookies

Introduction

Danone knows that you care how your personal data is used and we recognize the importance of protecting your privacy.

This Privacy Statement explains how Danone S.A. and all its subsidiaries (“Danone”) collect and manage your personal data. It contains information on what data we collect, how we use it, why we need it and how it can benefit you.

Contact us here if you have any queries and comments, or if you want to make a request regarding any of your data subject rights.

This privacy statement was last updated on May 18, 2018

Basic principles and our privacy commitment

At Danone we are committed to protecting your right to privacy. We aim to protect any personal data we hold, to manage your personal data in a responsible way and to be transparent in our practices. Your trust is important to us. We have therefore committed ourselves to the following basic principles:

 

  • You have no obligation to provide any personal data requested by us. However, if you choose not to, we may not be able to provide you with some services or products;
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  • We only collect and process your data for the purposes set out in this Privacy Statement or for specific purposes that we share with you and/or that you have consented to;
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  • We aim to collect, process and use as little personal data as possible;
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  • When we do collect your personal data, we aim to keep it as accurate and up to date as possible.
  • If the personal data we collect is no longer needed for any purposes and we are not required by law to retain it, we will do what we can to delete, destroy or permanently de-identify it.

    Your personal data will not be shared, sold, rented or disclosed other than as described in this Privacy Statement.

    What personal data do we collect?

    The personal data we collect varies depending upon the purpose of the collection and the product or service we are providing you.

    Generally, we may collect the following types of personal data from you directly:

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    We may also collect personal data about you indirectly when:

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    Where we process your personal data, you are entitled to a number of rights and can exercise these rights at any point. We have provided an overview of these rights below together with what this entails for you. You can exercise your rights via our contact page.

    The right to access your personal data and correction

    You have the right to access, correct or update your personal data at any time. We understand the importance of this and should you want to exercise your rights, please contact us via our contact page.

    The right to data portability

    Your personal data is portable. This means it can be moved, copied or transmitted electronically. However, this right only applies where:

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    The right to deletion of your personal data

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    Your personal data will be shared with the following third parties for the purposes described:

                                                       
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    Automated decision-making and profiling

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    If we intend to make use of such methods, we will of course inform you and we will give you an opportunity to object to these processes in advance. You are also free to contact us for further information on such processing.

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    Please see our cookie statement for more information on this

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    If you have any questions, comments or complaints regarding this Privacy Statement or the processing of your personal data, please contact us via our contact page.

    Cookie Policy

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    There are two broad categories of cookies: persistent cookies and session cookies. Persistent cookies remain on your device until deleted manually or automatically. Session cookies remain on your device until you close your browser and are thereby automatically deleted.

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    Dysphagia.ie | Request a Sample

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    Request a Sample

    Please note that without exception samples can only be requested by Healthcare Professionals resident in the Republic of Ireland or Northern Ireland. We reserve the right to limit the number of samples sent to any individual Healthcare Professional or practice.

    You can also order samples over the phone by calling our Freephone numbers on 1800 923 404 (ROI) and 0800 783 4379 (NI).

    Alternatively you can order online via the Nutricia.ie website.

    Dysphagia.ie | Forum

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    Dysphagia.ie | Thank You

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    Thank You

    Thank you for placing your sample request!

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    Dysphagia.ie | Thickeners for dysphagic patients - In vitro study

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    Thickeners for dysphagic patients - In vitro study

    Thickeners for dysphagic patients: comparison for a new amylase resistant product with four standard starch-based products.

    - IN VITRO STUDY -

    Written by: A.A.C.M. Oudhuis, H.J. Helmens, and M.A. Bos

    Rationale: Patients with dysphagia are commonly prescribed pureed meals or liquids with increased viscosity. Standard starch-based thickeners are sensitive to α-amylase, which may result in a potentially unsafe fluid consistency during consumption. This study reports the effect of human saliva on the consistency of drinks thickened with a new developed α-amylase-resistant thickener and four standard starch-based thickeners.

    Materials and Methods: 100 g artificial tap water, milk and coffee were thickened to custard consistency with an Amylase-Resistant Thickener (ART; Nutilis®, Nutricia) and four standard Starch-based Thickeners (ST: Thick&Easy®, Hormel; Resource® ThickenUp, Novartis; Clinutren®, Nestlé; Magic Mix, Laboratoires DHN). After 10 min, the thickened drinks were inoculated with 1ml of human saliva. After 10 and 50 minutes the amount of decantable formed thin liquid was determined by weight. The change in consistency was determined by measuring the uniaxial compression force with a Stable Micro Systems TA-XT2i Texture Analyser.

    Results: After addition of human saliva, the amount of decantable formed thin liquid for drinks thickened with ART was lower than 2% of the total amount. These values were significantly (p < 0.05) higher for drinks thickened with ST (10–98% of the total amount). The compression force for ART was 0.38N, 0.18N, 0.31-0.56N for water, milk and coffee, respectively. These values were significantly (p < 0.05) lower for drinks thickened with ST (0.18-0.25N, 0.11-0.13N, 0.22-0.27N for water, milk and coffee, respectively).

    Conclusions: After addition of human saliva, drinks thickened with ART retain their consistency significantly better than drinks thickened with ST. It is therefore hypothesized that the use of an α-amylase-resistant thickener supports safer swallowing for patients with dysphagia.

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    Dysphagia.ie | Thickeners for dysphagic patients - In vivo study

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    Thickeners for dysphagic patients - In vivo study

    Thickeners for dysphagic patients: comparison of a new amylase resistant product with a standard starch-based product.

    - IN VIVO STUDY WITH HEALTHY VOLUNTEERS -

    Written by: A.A.C.M. Oudhuis, H.J. Helmens, and C. Kistemaker

    Rationale: Texture-modified diets are commonly prescribed for patients with swallowing disorders like dysphagia. To increase the viscosity of their drinks, mainly starch-based thickeners are being used, which are highly sensitive to α-amylase. This may result in a potential thin unsafe fluid consistency during consumption. This study reports the effect of human saliva produced by healthy volunteers on the consistency of an α-amylase-resistant and starch-based thickener.

    Methods: 35 healthy adult persons participated in this double blind cross-over study. In the test, the person took one spoon of 10 g 10DH water thickened to custard consistency with α-amylase-resistant thickener (ART, Nutilis, Numico) or starch-based thickener (ST, Thick&Easy, Hormel). The persons were instructed to move the tongue approximately 1 rotation per second. After 10 and 20 seconds the bolus was spitted out into a 0.2 M acid solution to stop the α-amylase activity. The viscosity was measured in a rotational rheometer using Coquette-DIN geometry at 50 s-1.

    Results: After 10s the relative viscosity of ART (61%) was significantly (p<0.05) higher compared to ST (27%). After 20s the relative viscosity of ART (45%) was significantly (p<0.05) higher compared to ST (14%). Even the relative viscosity of water (10DH) thickened with ART at 20s was significantly higher compared to that of ST at 10s.

    Conclusions: Saliva produced by females and males (young and old) has a significant effect on the viscosity changes of the products ART and ST. The viscosity reduction during the oral phase of 10DH water thickened with ART is significantly less compared to ST. It is hypothesized that the use of an α-amylase resistant thickener supports safer swallowing in patients with dysphagia.

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    Dysphagia.ie | What is dysphagia?

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    What is dysphagia?

    Dysphagia ia the medical term used to describe swallowing difficulties. With dysphagia, you may experience difficulties in swallowing foods and drinks. Dysphagia is not a medical condition in itself, but results from a common condition in many patient types, such as stroke, dementia, Parkinson’s disease, multiple sclerosis, head & neck resections and tumours.

    Dysphagia.ie | What is Nutilis?

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    What is Nutilis?

    image

    Nutilis

    The Nutilis range offers products to thicken foods and drinks. All Nutilis products have amylase resistant features which means they remain at the prescribed consistency when being swallowed.

    Nutilis Powder

      Thickens any food or drink - hot or cold
      Suitable for freezing, thawing and reheating
      Easy to use
      Available in a 300g tin, 670g catering size tin and 12g sachets (20 per box)
    Dysphagia.ie | Imprint

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    Dublin 18
    Ireland

    www.designid.ie

    Nutricia Advanced Medical Nutrition is a specialised unit of Danone. Copyright: ©DANONE

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    Disclosure

    The personal information collected on the website may be disclosed to other companies within the Danone Group, Danone’s contractors and agencies hired by Danone in accordance with this Privacy Policy.

    Apart from the sale of any relevant part of Danone business including this website, requests from government bodies and law enforcement agencies or performance of services by contractors that support our business (such as our internet service provider), we will not disclose your personal information to any third party without your prior consent.

     

     

    Disclaimer for Third-Party website

    This website offers links to websites of third parties (i.e. non-Danone companies). Those third party websites have their own separate Privacy Policy. Please ensure that you are aware of the Privacy Policy of such websites before you submit any personal information. Danone cannot be held legally responsible for privacy policies, levels of privacy compliance of the websites of third parties.

     

     

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    We are here for you!

    For free product and nutritional advice from our nutrition experts or to request a visit from your local Nutricia representative contact Nutricia Medical.

    You can reach us by filling in the form below or giving us a call on our Free Phone numbers (ROI) 1800 923 404 or (NI) 0800 783 4379 Monday to Friday from 09.00 - 17:00.

    If you would like to contact us about a Data Subject Access request, please click here.

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    Dysphagia.ie | Privacy Policy

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    Privacy Policy

    Introduction

    Danone knows that you care how your personal data is used and we recognize the importance of protecting your privacy.

    This Privacy Statement explains how Danone S.A. and all its subsidiaries (“Danone”) collect and manage your personal data. It contains information on what data we collect, how we use it, why we need it and how it can benefit you.

    Contact us here if you have any queries and comments, or if you want to make a request regarding any of your data subject rights.

    This privacy statement was last updated on May 18, 2018

    Basic principles and our privacy commitment

    At Danone we are committed to protecting your right to privacy. We aim to protect any personal data we hold, to manage your personal data in a responsible way and to be transparent in our practices. Your trust is important to us. We have therefore committed ourselves to the following basic principles:

     

  • You have no obligation to provide any personal data requested by us. However, if you choose not to, we may not be able to provide you with some services or products;
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  • We only collect and process your data for the purposes set out in this Privacy Statement or for specific purposes that we share with you and/or that you have consented to;
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  • We aim to collect, process and use as little personal data as possible;
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  • When we do collect your personal data, we aim to keep it as accurate and up to date as possible.
  • If the personal data we collect is no longer needed for any purposes and we are not required by law to retain it, we will do what we can to delete, destroy or permanently de-identify it.

    Your personal data will not be shared, sold, rented or disclosed other than as described in this Privacy Statement.

    What personal data do we collect?

    The personal data we collect varies depending upon the purpose of the collection and the product or service we are providing you.

    Generally, we may collect the following types of personal data from you directly:

    1. Personal contact data, such as your name, email address, physical address occupation and telephone numbers;
    2. Account login details, such as your user ID, e-mail username and password. This is necessary to create a personal user account on one of our online communities;
    3. Communications with us, which may include details of our conversations via chat, care lines and/or customer service lines;
    4. Demographic information, such as your age and gender and lifestyle preferences. Lifestyle preferences may include your preference for some of the products we offer, and your interests related to those products;
    5. Browser history, such as pages accessed, date of access, location when accessed, and IP address;
    6. If ever you apply for employment with us, we will collect additional personal data, such as your employment history, educational history and employment references.

    We may also collect personal data about you indirectly when:

    1. you share content on social media pages, websites or applications related to our products or in response to our promotional material on social media; or
    2. we read or collect personal data about you by reading information collected by other websites (for instance, we may place an ad on a third party website, and when you click on that ad, we may receive information about you and other website visitors in order to measure the reach and success of that ad).

    Why do we collect and use your personal data?

    We collect your personal data so we can provide you with the best online experience and to provide you with a high quality of customer service. In particular we may collect, hold, use and disclose your personal data for the following purposes:

    1. To process and answer your inquiries or to contact you in order to answer your questions and/or requests;
    2. To develop and improve our products, services, communication methods and the functionality of our websites;
    3. To communicate information to you and to manage your registration and/or subscription to our newsletter or other communications;
    4. To manage our everyday business needs in connection with your participation in our contests, sweepstakes or promotional activities or request;
    5. To authenticate the identity of individuals contacting us by telephone, electronic means or otherwise;
    6. For internal training and quality assurance purposes;
    7. To understand and assess the interests, wants, and changing needs of customers, in order to improving our website, our current products and services, and/or developing new products and services;
    8. To provide personalized products and communications as well as product recommendations to you;

    We may also need your personal data to comply with legal obligations or in the context of a contractual relationship that we have with you.

    When we collect and use your personal data for purposes mentioned above or for other purposes, we will inform you before or at the time of collection. 

    Where appropriate, we will ask for your consent to process the personal data. Where you have given consent for processing activities, you have the right to withdraw your consent at any time.

    Your rights

    Where we process your personal data, you are entitled to a number of rights and can exercise these rights at any point. We have provided an overview of these rights below together with what this entails for you. You can exercise your rights via our contact page.

    The right to access your personal data and correction

    You have the right to access, correct or update your personal data at any time. We understand the importance of this and should you want to exercise your rights, please contact us via our contact page.

    The right to data portability

    Your personal data is portable. This means it can be moved, copied or transmitted electronically. However, this right only applies where:

    1. The processing is based on your consent;
    2. The processing takes place for the performance of a contract;
    3. The processing takes place by automated means;

    If you wish to exercise your right to data portability, please contact us via our contact page.

    The right to deletion of your personal data

    You have right to request that we delete your data if:

    1. your personal data is no longer necessary in relation to the purposes for which we collected it; or
    2. you withdraw the consent that you had previously given us to process your personal data, and there is no other legal ground to process that personal data; or
    3. you object to us processing your personal data for direct marketing purposes; or
    4. you object to us processing your personal data for Danone’s legitimate interests (such as improving overall user experience on websites);
    5. the personal data is not being processed lawfully; or
    6. your personal data needs to be deleted to comply with the law.

    If you wish to delete the personal data we hold about you, please let us know and we will take reasonable steps to respond to your request in accordance with legal requirements.

    If the personal data we collect is no longer needed for any purposes and we are not required by law to retain it, we will do what we can to delete, destroy or permanently de-identify it.

    The right to restriction of processing

    You have the right to restrict the processing of your personal data if

    1. you do not believe the personal data we have about you is accurate; or
    2. the personal data is not being processed lawfully, but instead of deleting the personal data, you would prefer us to restrict processing instead; or
    3. we no longer need your personal data for the purposes we collected it, but you require the data in order to establish, exercise or defend legal claims; or
    4. you have objected to the processing of your personal data and are awaiting verification on whether your interests related to that objection outweigh the legitimate grounds for processing your data.

    If you wish to restrict our processing of your personal data, please let us know and we will take reasonable steps to respond to your request in accordance with legal requirements.

    The right to object

    You have the right to object to the processing of your personal data at any time. Please contact us via our contact page.

    The right to lodge a complaint with a supervisory authority

    You have the right to lodge a complaint directly with supervisory authority about how we process personal data.

    How we protect your personal data

    We understand that the security of your personal data is important. We make our best efforts to protect your personal data from misuse, interference, loss, unauthorized access, modification or disclosure. We have implemented a number of security measures to help protect your personal data. For example, we implement access controls, use firewalls and secure servers, and we encrypt personal data.

    Sharing of your personal data

    When we share your personal data with affiliates and other organizations, we make sure we only do so with organizations that safeguard and protect your personal data and comply with applicable privacy laws in the same or similar way that we do.

    Your personal data will not be shared, sold, rented or disclosed other than as described in this Privacy Statement. We may, however, share your data when required by law and/or government authorities.

    Your personal data will be shared with the following third parties for the purposes described:

                                                       
    Category of third parties:Data type:Purposes:
    Email Marketing PlatformsName and Email AddressFor subscription to the newsletter
    Email Marketing PlatformsName, Address, Patient Name and address, product requestedFor the management and fulfillment of sample requests.

    Automated decision-making and profiling

    For some services and products we may process your personal data using automated means. Essentially this means that decisions are taken automatically without human intervention.

    We may also process your personal data for profiling purposes to predict your behavior on our website or products that may be of interest to you

    If we intend to make use of such methods, we will of course inform you and we will give you an opportunity to object to these processes in advance. You are also free to contact us for further information on such processing.

    Cookies and other technologies

    We may also collect personal data about you through the use of cookies and other technologies. This may occur when you visit our sites or third-party sites, view our online promotions, or use our/third-party mobile applications and may include the following information:

    1. Information about your device browser and operating system;
    2. The IP address of the device you are using;
    3. Web pages of ours that you view;
    4. Links that you click while interactive with our services.

    Please see our cookie statement for more information on this

    How to contact us

    If you have any questions, comments or complaints regarding this Privacy Statement or the processing of your personal data, please contact us via our contact page.