The patients's perception during their stay in the intensive care unit

Este estudo procura identificar a percepção do paciente sobre sua permanência na UTI. A amostra constituiu-se de10 pacientes, submetidos à cirurgia cardíaca e que receberam intervenção psicológica somente após a alta da UTI. Para a coleta e análise dos dados, utilizou-se uma abordagem qualitativa (análise de conteúdo). Os resultados sugerem que o paciente possue uma visão esteriotipada da UTI, vinculada à ideia de sofrimento e morte; o enfermeiro ocupa um importante papel nos momentos de fragilidade, dependência física e emocional; a dor, por seu caráter subjetivo, individual e emocional, é inevitável por estar relacionada aos procedimentos e, muitas vezes, associada ao sofrimento físico.The purpose of this study is to identify the patients's perception during their stay in the ICU. The sample was composed by ten patients, who had gone to cardiac surgery. They received psychological assistance only after their discharge from the ICU. The data was obtained throw a qualitative approach, using a content analysis. The results suggest that the patients have a. stereotyped view about the ICU, linked with the idea of suffering and death; the nurses play an important role during fragility moments, physical and emotional dependence; the pain, by its subjective nature, individually and emotionaly, is inevitable, because it is related to procedure and usually it is associated to physical suffering

El efecto de la experiencia previa de trabajo en grupo sobre el rendimiento académico de los estudiantes en la disciplina de contabilidad

This paper analyses the implementation of cooperative learning techniques in accounting subjects to investigate whether students’ willingness to work in groups, based on their perceptions regarding this learning technique arising from previous group working experiences, are related to their academic performance. The findings reveal that students’ perceptions regarding their improved skills due to having worked in groups are positively and significantly related to their academic performance; meanwhile, students’ perceptions of having learnt from others are negatively and significantly related to their academic performance. Therefore, this study extends the existing literature on cooperative learning and students’ academic performance by considering students’ attitudes toward working in groups resulting from their prior experiences

Seguiment del medi marí al Parc Natural de Cap de Creus i al Parc Natural del Montgrí, les Illes Medes i el Baix Ter. Memòria 2018.

Aquesta memòria recull els resultats del grup de treball del Departament d’Ecologia de la Universitat de Barcelona relatiu al seguiment del medi marí al Parc Natural de Cap de Creus i al Parc Natural del Montgrí, les Illes Medes i el Baix Ter de l’any 2018, tal i com consta al plec de prescripcions amb expedient PTOP-2017-130 en compliment de la llei 19/1990 de 10 de desembre del Parlament de Catalunya, i amb les millores proposades a l’oferta tècnica homònima. Els resultats dels treballs de camp tenen com a objectiu central l’avaluació de l’estat de les poblacions i dels hàbitats marins en relació tant amb les activitats humanes que es duen a terme als espais naturals estudiats com amb els factors ambientals. Així mateix s’analitza la seva evolució en el temps dels descriptors i s’intenta avaluar l’efecte de la protecció. El darrer objectiu és de detectar altres situacions de risc pel patrimoni natural com podrien ser l’arribada d’espècies alienes o invasores o bé els possibles efectes del canvi climàtic

COVID-19: como se proteger e conter a propagação no trabalho?

The pandemic caused by COVID-19 is a major health challenge and has required the work process to be considered in the design and implementation of strategies to cope with it. The reduction of risks inherent to work, through hygiene and biosafety protocols is a constitutional right. In this sense, this booklet aims to disseminate guidelines related to biosafety practices in the field of occupational health with the adequacy of the environment and conducts for the gradual resumption of face-to-face activities in a pandemic period. This material is the result of an extension project entitled "Good Biosafety Practices and Occupational Health in Education with the advent of COVID-19: how to protect and contain the spread?", Which has contributed to the dissemination of information aimed at the reduction of damage to workers' health and psychosocial impacts. Considering Collective Health as a multi and transdisciplinary area, it has contributed to the education sector through health education strategies, aiming at adapting the conduct at work involving the different segments of workers.A pandemia causada pela COVID-19 é um grande desafio para a saúde e tem exigido que o processo de trabalho seja considerado na elaboração e implantação de estratégias para o seu enfrentamento. A redução dos riscos inerentes ao trabalho, por meio de protocolos de higiene e biossegurança é um direito constitucional. Nesse sentido, esta cartilha tem como objetivo divulgar orientações relacionadas às práticas de biossegurança no campo da saúde do trabalhador com a adequação do ambiente e de condutas para a retomada gradual das atividades presenciais em período de pandemia. Este material é resultado de um projeto de extensão intitulado "Boas Práticas de Biossegurança e a Saúde do Trabalhador na Educação com o advento da COVID-19: como se proteger e conter a propagação?", que tem contribuído para a disseminação de informações que visem à diminuição de danos à saúde do trabalhador e de impactos psicossociais. Considerando a Saúde Coletiva como uma área multi e transdisciplinar, ela tem contribuído para o setor da educação por meio de estratégias de educação em saúde, visando adequações das condutas no trabalho envolvendo os diferentes segmentos de trabalhadores

Kinetics of immune responses elicited after three mRNA COVID-19 vaccine doses in predominantly antibody-deficient individuals

Mass vaccination campaigns reduced COVID-19 incidence and severity. Here, we evaluated the immune responses developed in SARS-CoV-2-uninfected patients with predominantly antibody-deficiencies (PAD) after three mRNA-1273 vaccine doses. PAD patients were classified based on their immunodeficiency: unclassified primary antibody-deficiency (unPAD, n = 9), common variable immunodeficiency (CVID, n = 12), combined immunodeficiency (CID, n = 1), and thymoma with immunodeficiency (TID, n = 1). unPAD patients and healthy controls (HCs, n = 10) developed similar vaccine-induced humoral responses after two doses. However, CVID patients showed reduced binding and neutralizing titers compared to HCs. Of interest, these PAD groups showed lower levels of Spike-specific IFN-γ-producing cells. CVID individuals also presented diminished CD8+T cells. CID and TID patients developed cellular but not humoral responses. Although the third vaccine dose boosted humoral responses in most PAD patients, it had limited effect on expanding cellular immunity. Vaccine-induced immune responses in PAD individuals are heterogeneous, and should be immunomonitored to define a personalized therapeutic strategies.info:eu-repo/semantics/publishedVersio

Endoscopic treatment (endoscopic balloon dilation/self-expandable metal stent) vs surgical resection for the treatment of de novo stenosis in Crohn's disease (ENDOCIR study): an open-label, multicentre, randomized trial.

Background: Stenosis is one of the most common complications in patients with Crohn's disease (CD). Endoscopic balloon dilation (EBD) is the treatment of choice for a short stenosis adjacent to the anastomosis from previous surgery. Self-expandable metal stents (SEMS) may be a suitable treatment option for longer stenoses. To date, however, there is no scientific evidence as to whether endoscopic (EBD/SEMS) or surgical treatment is the best approach for de novo or primary stenoses that are less than 10 cm in length. Methods/design: Exploratory study as "proof-of-concept", multicentre, open-label, randomized trial of the treatment of de novo stenosis in the CD; endoscopic treatment (EBD/SEMS) vs surgical resection (SR). The type of endoscopic treatment will initially be with EDB; if a therapeutic failure occurs, then a SEMS will be placed. We estimate 2 years of recruitment and 1 year of follow-up for the assessment of quality of life, costs, complications, and clinical recurrence. After the end of the study, patients will be followed up for 3 years to re-evaluate the variables over the long term. Forty patients with de novo stenosis in CD will be recruited from 15 hospitals in Spain and will be randomly assigned to the endoscopic or surgical treatment groups. The primary aim will be the evaluation of the patient quality of life at 1 year follow-up (% of patients with an increase of 30 points in the 32-item Inflammatory Bowel Disease Questionnaire (IBDQ-32). The secondary aim will be evaluation of the clinical recurrence rate, complications, and costs of both treatments at 1-year follow-up. Discussion: The ENDOCIR trial has been designed to determine whether an endoscopic or surgical approach is therapeutically superior in the treatment of de novo stenosis in CD

Inter-Rater Variability in the Evaluation of Lung Ultrasound in Videos Acquired from COVID-19 Patients

12 páginas, 7 figuras, 1 tablaLung ultrasound (LUS) allows for the detection of a series of manifestations of COVID-19, such as B-lines and consolidations. The objective of this work was to study the inter-rater reliability (IRR) when detecting signs associated with COVID-19 in the LUS, as well as the performance of the test in a longitudinal or transverse orientation. Thirty-three physicians with advanced experience in LUS independently evaluated ultrasound videos previously acquired using the ULTRACOV system on 20 patients with confirmed COVID-19. For each patient, 24 videos of 3 s were acquired (using 12 positions with the probe in longitudinal and transverse orientations). The physicians had no information about the patients or other previous evaluations. The score assigned to each acquisition followed the convention applied in previous studies. A substantial IRR was found in the cases of normal LUS (κ = 0.74), with only a fair IRR for the presence of individual B-lines (κ = 0.36) and for confluent B-lines occupying 50% (κ = 0.50). No statistically significant differences between the longitudinal and transverse scans were found. The IRR for LUS of COVID-19 patients may benefit from more standardized clinical protocols.This research was partially funded by CDTI (Spanish acronym: Centre for Industrial Tech- nological Development), funding number COI-20201153. Partially supported by the Google Cloud Research Credits program with the funding number GCP19980904, by the project RTI2018-099118- A-I00 founded by MCIU/AEI/FEDER UE and by the European Commission–NextGenerationEU, through CSIC’s Global Health Platform (PTI Salud Global)

Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care

<p>Abstract</p> <p>Background</p> <p>Vaginitis is a common complaint in primary care. In uncomplicated candidal vaginitis, there are no differences in effectiveness between oral or vaginal treatment. Some studies describe that the preferred treatment is the oral one, but a Cochrane's review points out inconsistencies associated with the report of the preferred way that limit the use of such data. Risk factors associated with recurrent vulvovaginal candidiasis still remain controversial.</p> <p>Methods/Design</p> <p>This work describes a protocol of a multicentric prospective observational study with one year follow up, to describe the women's reasons and preferences to choose the way of administration (oral vs topical) in the treatment of not complicated candidal vaginitis. The number of women required is 765, they are chosen by consecutive sampling. All of whom are aged 16 and over with vaginal discharge and/or vaginal pruritus, diagnosed with not complicated vulvovaginitis in Primary Care in Madrid.</p> <p>The main outcome variable is the preferences of the patients in treatment choice; secondary outcome variables are time to symptoms relief and adverse reactions and the frequency of recurrent vulvovaginitis and the risk factors. In the statistical analysis, for the main objective will be descriptive for each of the variables, bivariant analysis and multivariate analysis (logistic regression).. The dependent variable being the type of treatment chosen (oral or topical) and the independent, the variables that after bivariant analysis, have been associated to the treatment preference.</p> <p>Discussion</p> <p>Clinical decisions, recommendations, and practice guidelines must not only attend to the best available evidence, but also to the values and preferences of the informed patient.</p

Protocolo de cribado, diagnóstico y tratamiento de la enfermedad de Chagas en mujeres embarazadas latinoamericanas y en sus hijos

Malaltia de Chagas; Dones embarassades llatinoamericanes; Salut maternoinfantilEnfermedad de Chagas; Mujeres embarazadas latinoamericanas; Salud maternoinfantilChagas disease; Latin american pregnant women; Maternal and child healthLa malaltia de Chagas (MCH) continua sent un problema important de salut pública. L’OMS estima que en el món hi ha 8 milions de persones infectades per Trypanosoma cruzi, la majoria a l’Amèrica Llatina. En països no endèmics, com és el cas del nostre entorn, l’MCH s’observa en persones infectades que provenen de països endèmics o en infants nascuts en països no endèmics, però la mare dels quals ha estat infectada (transmissió congènita). A Catalunya, per tal de fer el control i la vigilància de l’MCH, l’any 2010 es va posar en marxa el Programa de prevenció i control de la malaltia de Chagas congènita a Catalunya, coordinat pel Departament de Salut i que inclou el diagnòstic, el control, el seguiment i el tractament de l’MCH congènita dirigits a les dones embarassades i als seus fills. En el marc del Programa, es va elaborar el Protocol de cribratge i diagnòstic de malaltia de Chagas en dones embarassades llatinoamericanes i en els seus fills, que es va editar el 2010. Aquest document va ser fruit de l’esforç conjunt de professionals sanitaris experts en la malaltia, de diferents societats científiques i de professionals del Departament de Salut de la Generalitat de Catalunya, amb el suport del Grup de Treball de Països No Endèmics i del Departament de Control de Malalties Tropicals Oblidades de l’OMS. El Protocol que es presenta, a més d’incloure les mateixes línies que la primera edició, disposa d’actualitzacions de diferents aspectes clínics, de diagnòstic i de vigilància epidemiològica basats en l’experiència i l’evidència observades durant aquests vuit anys del Programa de prevenció i control de la malaltia de Chagas congènita a Catalunya. Durant aquests darrers anys, s’ha reforçat la perspectiva de salut pública en el Programa, en el qual han participat un gran nombre de professionals de la xarxa assistencial i agents comunitaris de salut amb l’objectiu de reduir l’efecte de la transmissió vertical de l’MCH a Catalunya. La primera part del document recull les característiques clíniques de l’MCH que, encara que és d’aparició relativament recent en el nostre entorn, gràcies a la informació facilitada tant en l’àmbit sanitari com en l’àmbit comunitari durant els últims anys, ha deixat de ser una malaltia oblidada i desconeguda a Catalunya. En els darrers anys, els avenços i l’experiència en el nostre entorn en el diagnòstic de l’MCH ens han fet arribar a un consens sobre la utilització de mètodes directes moleculars, tal com es descriu en aquest Protocol. Així mateix, la concreció de dades epidemiològiques sobre prevalença d’infecció i incidència de casos de la malaltia ha millorat molt gràcies a la vigilància i notificació de dades recollides en el marc del Programa de prevenció i control de la malaltia de Chagas congènita a Catalunya pels professionals que formen part del Grup de Treball de la Malaltia de Chagas Congènita. En aquest aspecte i per tal de millorar-ne el control s’han incorporat els metges de família i salut comunitària, ja que són uns dels professionals clau que es troben més propers als pacients. Un aspecte fonamental que es desprèn d’aquest document i del funcionament del Programa és la multidisciplinarietat. El repte del sistema de salut i de la vigilància de la salut pública és la coordinació i el treball dels professionals de diferents àmbits sanitaris, com poden ser els ginecòlegs, els microbiòlegs, els llevadors, els pediatres d’atenció primària i hospitalària, els metges de família i salut comunitària, el personal d’infermeria, els infectòlegs, els epidemiòlegs i els agents de salut comunitària que treballen de manera conjunta per a l’assoliment de l’objectiu plantejat. El present Protocol constitueix un document eminentment pràctic, mitjançant el qual els professionals sanitaris disposen dels elements essencials per a la realització del cribratge en la dona embarassada. A partir d’aquest Protocol s’espera també aconseguir la detecció i el tractament precoç dels casos d’MCH en la població pediàtrica, nadons i altres fills a Catalunya, amb l’objectiu últim de millorar la salut maternoinfantil a Catalunya.La enfermedad de Chagas (ECH) sigue siendo un problema importante de salud pública. La OMS estima que en el mundo hay 8 millones de personas infectadas por Trypanosoma cruzi, la mayoría en América Latina. En países no endémicos, como es el caso de nuestro entorno, la ECH se observa en personas infectadas que provienen de países endémicos o en niños nacidos en países no endémicos, pero cuya madre ha sido infectada (transmisión congénita). En Cataluña, para hacer el control y la vigilancia de la ECH, en 2010 se puso en marcha el Programa de prevención y control de la enfermedad de Chagas congénita en Cataluña, coordinado por el Departamento de Salud y que incluye el diagnóstico, el control, el seguimiento y el tratamiento de la ECH congénita dirigidos a las mujeres embarazadas y a sus hijos. En el marco del Programa, se elaboró el Protocolo de cribado y diagnóstico de enfermedad de Chagas en mujeres embarazadas latinoamericanas y en sus hijos, que se editó en 2010. Este documento fue fruto del esfuerzo conjunto de profesionales sanitarios expertos en la enfermedad, de diferentes sociedades científicas y de profesionales del Departamento de Salud de la Generalidad de Cataluña, con el apoyo del Grupo de Trabajo de Países No Endémicos y del Departamento de Control de Enfermedades Tropicales Olvidadas de la OMS. El Protocolo que se presenta, además de incluir las mismas líneas que la primera edición, dispone de actualizaciones de diferentes aspectos clínicos, de diagnóstico y de vigilancia epidemiológica basados en la experiencia y la evidencia observadas durante estos ocho años del Programa de prevención y control de la enfermedad de Chagas congénita en Cataluña. Durante estos últimos años, se ha reforzado la perspectiva de salud pública en el Programa, en el que han participado un gran número de profesionales de la red asistencial y agentes comunitarios de salud con el objetivo de reducir el efecto de la transmisión vertical del ECH en Cataluña. La primera parte del documento recoge las características clínicas de la ECH que, aunque es de aparición relativamente reciente en nuestro entorno, gracias a la información facilitada tanto en el ámbito sanitario como en el ámbito comunitario durante los últimos años, ha dejado de ser una enfermedad olvidada y desconocida en Cataluña. En los últimos años, los avances y la experiencia en nuestro entorno en el diagnóstico de la ECH nos han hecho llegar a un consenso sobre la utilización de métodos directos moleculares, tal como se describe en el presente Protocolo. Asimismo, la concreción de datos epidemiológicos sobre prevalencia de infección e incidencia de casos de la enfermedad ha mejorado mucho gracias a la vigilancia y notificación de datos recogidos en el marco del Programa de prevención y control de la enfermedad de Chagas congénita en Cataluña por los profesionales que forman parte del Grupo de Trabajo de la Enfermedad de Chagas Congénita. En este aspecto y para mejorar su control se han incorporado los médicos de familia y salud comunitaria, ya que son unos de los profesionales clave que se encuentran más cercanos a los pacientes. Un aspecto fundamental que se desprende de este documento y del funcionamiento del Programa es la multidisciplinariedad. El reto del sistema de salud y de la vigilancia de la salud pública es la coordinación y el trabajo de los profesionales de diferentes ámbitos sanitarios, como pueden ser ginecólogos, microbiólogos, comadrones, pediatras de atención primaria y hospitalaria, médicos de familia y salud comunitaria, personal de enfermería, infectólogos, epidemiólogos y agentes de salud comunitaria que trabajan de manera conjunta para el logro del objetivo planteado. El presente Protocolo constituye un documento eminentemente práctico, mediante el cual los profesionales sanitarios disponen de los elementos esenciales para la realización del cribado en la mujer embarazada. A partir de este Protocolo se espera también conseguir la detección y el tratamiento precoz de los casos de ECH en la población pediátrica, bebés y otros hijos en Cataluña, con el objetivo último de mejorar la salud maternoinfantil en Cataluña.Chagas disease (CHD) continues to be a major public health problem. The WHO estimates that there are 8 million people in the world infected with Trypanosoma cruzi, the majority in Latin America. In non-endemic countries, as is the case in our environment, CHD is seen in infected people who come from endemic countries or children born in non-endemic countries, but whose mother has been infected (congenital transmission). In Catalonia, in order to control and monitor the CHD, in 2010 the Program for the Prevention and Control of Congenital Chagas' Disease in Catalonia was launched, coordinated by the Department of Health and includes diagnosis, control, follow-up and treatment of congenital CHD directed at pregnant women and their children. Within the framework of the Program, the Protocol for the Screening and Diagnosis of Chagas' Disease in Latin American pregnant women and their children was prepared, which was published in 2010. This document was the result of the joint effort of health professionals who are experts in the disease, of different scientific societies and professionals of the Department of Health of the Government of Catalonia, with the support of the Working Group of Non-endemic Countries and the Department of Control of Forgotten Tropical Diseases of WHO. The Protocol that is presented, in addition to including the same lines as the first edition, has updates on different clinical, diagnostic and epidemiological surveillance aspects based on the experience and evidence observed during these eight years of the Prevention and Control Program. Congenital Chagas disease in Catalonia. During these last years, the perspective of public health in the Program has been reinforced, in which a large number of professionals of the health care network and community health agents have participated with the aim of reducing the effect of the vertical transmission of CHD in Catalonia. The first part of the document includes the clinical characteristics of the CHD that, although it is relatively recent in our environment, thanks to the information provided both in the health field and in the community in recent years, has ceased to be a disease forgotten and unknown in Catalonia. In recent years, the advances and experience in our environment in the diagnosis of CHD have led us to reach a consensus on the use of direct molecular methods, as described in this Protocol. Likewise, the specification of epidemiological data on prevalence of infection and incidence of cases of the disease has improved greatly thanks to the monitoring and reporting of data collected within the framework of the Program for the Prevention and Control of Congenital Chagas' Disease in Catalonia by professionals. that are part of the Working Group on Congenital Chagas Disease. In this aspect and to improve their control, family doctors and community health have been incorporated, since they are one of the key professionals who are closest to patients. A fundamental aspect that emerges from this document and the operation of the Program is multidisciplinarity. The challenge of the health system and public health surveillance is the coordination and work of professionals from different health areas, such as gynecologists, microbiologists, midwives, pediatricians of primary and hospital care, family physicians and community health , nurses, infectious disease specialists, epidemiologists and community health workers who work together to achieve the stated objective. This Protocol is an eminently practical document, through which health professionals have the essential elements for carrying out screening in pregnant women. Based on this Protocol, it is also expected to achieve the detection and early treatment of cases of CHD in the pediatric population, babies and other children in Catalonia, with the ultimate goal of improving maternal and child health in Catalonia

Dietary diversity and depression: cross-sectional and longitudinal analyses in Spanish adult population with metabolic syndrome. Findings from PREDIMED-Plus trial

Objective: To examine the cross-sectional and longitudinal (2-year follow-up) associations between dietary diversity (DD) and depressive symptoms. Design: An energy-adjusted dietary diversity score (DDS) was assessed using a validated FFQ and was categorised into quartiles (Q). The variety in each food group was classified into four categories of diversity (C). Depressive symptoms were assessed with Beck Depression Inventory-II (Beck II) questionnaire and depression cases defined as physician-diagnosed or Beck II >= 18. Linear and logistic regression models were used. Setting: Spanish older adults with metabolic syndrome (MetS). Participants: A total of 6625 adults aged 55–75 years from the PREDIMED-Plus study with overweight or obesity and MetS. Results: Total DDS was inversely and statistically significantly associated with depression in the cross-sectional analysis conducted; OR Q4 v. Q1 = 0·76 (95 % CI (0·64, 0·90)). This was driven by high diversity compared to low diversity (C3 v. C1) of vegetables (OR = 0·75, 95 % CI (0·57, 0·93)), cereals (OR = 0·72 (95 % CI (0·56, 0·94)) and proteins (OR = 0·27, 95 % CI (0·11, 0·62)). In the longitudinal analysis, there was no significant association between the baseline DDS and changes in depressive symptoms after 2 years of follow-up, except for DD in vegetables C4 v. C1 = (β = 0·70, 95 % CI (0·05, 1·35)). Conclusions: According to our results, DD is inversely associated with depressive symptoms, but eating more diverse does not seem to reduce the risk of future depression. Additional longitudinal studies (with longer follow-up) are needed to confirm these findings.T The PREDIMED-Plus trial was supported by the European Research Council (Advanced Research Grant 2013-2018; 340918) grant to Miguel Angel Martinez-Gonzalez, and by the official funding agency for biomedical research of the Spanish Government, ISCIII through the Fondo de Investigacion para la Salud (FIS), which is cofunded by the European Regional Development Fund (four coordinated FIS projects led by Jordi Salas-Salvado and Josep Vidal), including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926, The Especial Action Project entitled: 'Implementacion y Evaluacion de una intervencion intensiva sobre la actividad fisica Cohorte PREDIMED-Plus' grant to Jordi Salas-Salvado, the Recercaixa grant to Jordi Salas-Salvado (2013ACUP00194), grants from the Consejeria de Salud de la Junta de Andalucia (PI0458/2013; PS0358/2016; PI0137/2018), the PROMETEO/2017/017 grant from the Generalitat Valenciana, the SEMERGEN grant, and CIBEROBN and FEDER funds (CB06/03), ISCIII. International Nut&Dried Fruit Council-FESNAD N degrees 201302: Miguel Angel Martinez-Gonzalez (PI). None of the funding sources took part in the design, collection, analysis or interpretation of the data, or in the decision to submit the manuscript for publication. The corresponding author had full access to all the data in the study and had final responsibility to submit for publication