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Brisbois M, Silva H, Santos A, Canasta H, Feno A, Cabral L, Soares R. A Bridge to Wellness: Gains from a health fair among fishermen in the Port of New Bedford, USA. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Globally, it has been noted that fishermen have a higher mortality from cardiovascular disease, cancer, and injury from work-related accidents when compared to the general population. A potential increase in unemployment in fishermen in New Bedford could result in a lower income level which relates to an increase in risk behaviors, less health screenings, and negative health behaviors. While there is a lack of health-related data among fishermen across the globe, there is little information regarding the health among fishermen, who are predominantly immigrants, in the US.
Objectives
The objectives include designing a health promotion fair to prepare nursing students with the skills to educate fishermen associated with nutrition, diabetes mellitus, cancer and hypertension as identified by key informants in the community.
Results
Students expressed gains in achieving nursing competencies related to collaboration, communication, and teaching/learning by designing a fair with stations related to the four health topics with posters and activities. Educational materials were available in both Portuguese and English to support this aggregate who expressed learning new knowledge. Networking among local fishing agencies, nursing students and the fishermen supported this project from start to finish.
Conclusions
Despite limited access to this vulnerable group, learning nursing competencies and increased fishermen’s knowledge were realized. Connecting students with vulnerable populations is an effective way to promote learning for both groups.
Key messages
Multiple gains are noted when nursing students are paired with vulnerable community aggregates. Learning to work in the community with local agencies and groups is an effective teaching/learning pedagogy.
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Brisbois M, Silva H, Soares R, Cabral L, Canasta H, Feno A, Santos A. Bridging Generations: Sharing stories from the past with the future. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
As the immigration population continues to grow; little is known about this phenomenon from the immigrants’ perspective. In recent years, nurses have embraced narrative inquiry to better understand the human experience. When relaying their stories, vulnerable groups legitimize their behavior, share their emotional experiences, and amplify their voices that may have otherwise remained silent.
Objective
Eight elderly Portuguese women who immigrated to the United States (US) were interviewed about their experience of immigration by nursing students from Portugal and U.S., as part of a student exchange. The objective of this project was to better understand the impact of immigration through narrative inquiry.
Results
On average, the women lived in the US for approximately fifty years; immigrating in their early twenties. Most women arrived alone or accompanied by spouse and/or children. Their first memories were related to snow, and solitude of being in a new country. The participants attended classes to obtain documents or learn English. All worked in the textile industry; their greatest accomplishment was buying their own house. Challenges faced were related to language and difficult jobs. Overall, they had no regrets except in leaving family members behind. Their message to the students was that love and family are most important in the world. Students were able to realize emigration and immigration from their respective countries.
Conclusions
Rich descriptions provided an in-depth understanding of the details of the women’s experience. Student nurses gained valuable skills and knowledge to understand the impact of immigration among Portuguese women using narrative inquiry.
Key messages
The use of narrative inquiry proved to be a valuable method to interview Portuguese immigrant women. Every immigrant has a unique narrative to share that allowed for nursing student’s appreciation of the experience across generations.
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Anjo I, Amaral TF, Afonso C, Borges N, Santos A, Moreira P, Padrão P. Are hypohydrated older adults at increased risk of exhaustion? J Hum Nutr Diet 2019; 33:23-30. [PMID: 31578795 DOI: 10.1111/jhn.12702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dehydration appears to affect muscle strength and weakness, although its influence on exhaustion remains unclear. The present study aimed to quantify the association between hydration status and exhaustion among older adults. METHODS A cluster sampling approach was used, representing Portuguese older adults (≥65 years) according to age, sex, education level and region within the Nutrition UP65 cross-sectional study. A 24-h urine sample was collected to estimate free water reserve (FWR), which was categorised into tertiles according to sex. Subjects with incomplete 24-h urine and renal disease were excluded. From a sample size of 1500 subjects, 1143 were eligible. Exhaustion was self-reported according to the Center for Epidemiologic Studies Depression Scale. A logistic regression model was conducted to evaluate the association between FWR and exhaustion. Odds ratios and the respective 95% confidence intervals were calculated by sex and age. RESULTS Free water reserve median (interquartile range) was 0.52 (0.68) L in women and 0.36 (0.77) L in men. Hypohydration affected 11.6% of women and 25.1% of men, whereas exhaustion was reported by 39.3% of women and 25.1% of men. After adjusting for confounders, women ≥80 years classified in the highest tertile of FWR showed a decreased risk of exhaustion (third tertile: odds ratio = 0.38; 95% confidence interval = 0.15-0.96) compared to women in the lowest FWR tertile. No such significant association was observed in women with <80 years and in men. CONCLUSIONS These results show an association between worse hydration status and exhaustion in older women, highlighting the need to implement further studies clarifying this association.
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Da Silva V, Matos A, Pereira Da Silva A, Santos A, Soveral G, Bicho M, Rebelo I. Aquaporin-3 gene polymorphism may predict cardiovascular risk and hypertension. Pregnancy Hypertens 2019. [DOI: 10.1016/j.preghy.2019.08.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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80
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Santos A, Noronha K, Andrade M, Ruas C. PMH7 COST-EFFECTIVENESS AND INCORPORATION PRICE OF ARIPIPRAZOLE FOR SCHIZOPHRENIA IN BRAZIL: A SUBSTITUTE TECHNOLOGY APPROACH. Value Health Reg Issues 2019. [DOI: 10.1016/j.vhri.2019.08.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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81
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Rocha F, Poewe W, Rascol O, Lees A, Ferreira J, Santos A, Magalhaes D, Soares-da-Silva P. Opicapone odds ratio in relative off-time reduction: A post-hoc analysis from combined BIPARK-I and II data. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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82
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Ferreira J, Lees A, Poewe W, Rascol O, Santos A, Magalhaes D, Rocha F, Soares-da-Silva P. Switching entacapone ‘non-responders’ to open-label opicapone: Change in absolute off-time following the 1-year extension BIPARK-I study. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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83
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Rocha F, Stocchi F, Lees A, Ferreira J, Poewe W, Rascol O, Santos A, Magalhaes D, Soares-da-Silva P. Efficacy of opicapone in Parkinson’s disease patients with ‘early’ motor fluctuations: Patient and clinical global impression of change from the BIPARK-I double-blind experience. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lamarca A, Santos A, Utpatel K, La Casta A, Stock S, Forner A, Adeva Alfonso J, Folseraas T, Fabris L, Macias R, Krawczyk M, Krawczyk M, Cardinale V, Braconi C, Alvaro D, Evert M, Bañales J, Valle J. Liver metastases (LM) from intrahepatic cholangiocarcinoma (iCCA): Outcomes from the European Network for the study of cholangiocarcinoma (ENS-CCA) registry and implications on current American Joint Committee on Cancer (AJCC) staging. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Santos A, Terra A, Noronha K, Nogueira J, Andrade M. PIT4 SILICONE TAPES FOR PATIENTS WITH FRAGILE SKIN: A SYSTEMATIC REVIEW. Value Health Reg Issues 2019. [DOI: 10.1016/j.vhri.2019.08.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rocha F, Ferreira J, Lees A, Tolosa E, Stocchi F, Santos A, Magalhaes D, Soares-da-Silva P, Savic N. Switching from double-blind entacapone or placebo to open-label opicapone: UPDRS-II and III results from patients who ended 1-year BIPARK-I extension on opicapone 50 mg. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hauser R, Rascol O, Poewe W, Ferreira J, Lees A, Klepitskaya O, Liang G, Santos A, Magalhaes D, Rocha F, Soares-da-Silva P. Opicapone as a levodopa sparing agent: Pooled analysis of BIPARK-I and II double-blind trials. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Santos A, Lees A, Ferreira J, Rascol O, Antonini A, Gama H, Magalhaes D, Rocha F, Soares-da-Silva P. Influence of disease severity in the efficacy response of Parkinson's disease patients with motor fluctuations: Post-hoc analysis from combined BIPARK-I and II. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lees A, Ferreira J, Rascol O, Poewe W, Stocchi F, Santos A, Magalhaes D, Rocha F, Soares-da-Silva P. Efficacy of opicapone in Parkinson’s disease patients according to baseline pramipexole use: A post-hoc analysis from combined BIPARK-I and II. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Santos A, Guerra Junior A, Noronha K, Andrade M, Ruas C. PNS7 THE PRICE OF SUBSTITUTE TECHNOLOGIES. Value Health Reg Issues 2019. [DOI: 10.1016/j.vhri.2019.08.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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91
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Rocha F, Tolosa E, Ferreira J, Rascol O, Poewe W, Santos A, Magalhaes D, Soares-da-Silva P. Effect of opicapone in Parkinson’s disease patients with ‘early’ motor fluctuations: Parkinson’s disease questionnaire (PDQ-39) analysis from the BIPARK-I double-blind experience. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Haas E, Favarato D, Laurindo FRM, Saad MJA, Santos A, Serrano Jr CV, Cesar LAM, Isosaki M, Libby P, Da Luz PL. P2683Beneficial effects of red wine intake upon gut microbiota and parallel effects upon plasma metabolomics. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Evidence suggests that red wine (RW) components can influence favorably gut microbiota. However, Interactions of RW, gut microbiota and plasma metabolomics remain unclear.
Purpose
The goal of this study was to assess the effects upon gut microbiota and plasma metabolomic profile of short-term, moderate RW intake in patients (pts) with documented coronary artery disease (CAD)
Methods
Forty-two males aged 60.4±5.4 years (SD) with documented CAD by angiography underwent a randomized, crossover, controlled, interventional trial. They were assigned to either RW treatment or abstinence from any alcoholic beverage, as control. Each treatment was preceded by a 2-week washout period. During the RW intervention, subjects ingested 250 ml of RW per day/ 5 days a week/ 3 weeks. Fasting blood samples and fecal samples were collected 4 times, after washout and at the end of each 3-week intervention. Gut microbiota was analysed by 16 S rRNA gene sequences and plasma metabolomics was performed by Ultrahigh Performance Liquid Chromatography-Tandem Mass Spectroscopy. Twenty pts chosen randomly had their global metabolic profiles examined at all visits. Diet was carefully controlled and quantified by a 3 day/week questionnaire at beginning and end of the study. Prebiotics, probiotics were not allowed during the study. Patients in need for antibiotic therapy were not included.
Results
In the RW period compared to abstinence, fecal metagenomic revealed a decrease in abundance of Collinsella, a bacterial genus correlated with atherosclerosis; an increase in Eubacterium, genus related to fiber digestion and bile acid metabolism; and a significant increase in alpha diversity (p<0.05 for all). In plasma, trimethylamine N-oxide (TMAO), fell non-significantly post RW consumption. HDL and resveratrol increased after RW consumption (p<0.05). Plasma metabolomic analysis of 20 pts revealed microbiome related changes associated with RW consumption: decreased levels of phenylalanine, benzoate, tyrosine and tryptophan; lower levels of primary bile acids (BA) cholate, taurocholate, and also secondary BA deoxycholate and lithocholate sulfate. In parallel, RW elevated androgenic steroids and decreased beta oxidation (p<0.05 for all). Simultaneously total energy, proteins, carbohydrates and fat components of the diet did not change significantly.
Conclusions
Moderate RW ingestion augmented microbiota diversity, increased the proportion of putative anti-atherosclerotic bacteria and influenced plasma metabolomics. RW influenced energy metabolism through gut microbiota related plasma changes in amino acids, nucleotide profile, bile acids, androgenic steroids and beta-oxidation. These findings furnish some novel insight into mechanisms whereby RW may mitigate atherosclerosis.
Acknowledgement/Funding
FAPESP (Fundacao de Amparo à Pesquisa do Estado de Sao Paulo), IBRAVIN (Instituto Brasileiro do Vinho), Banco Bradesco SA
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Brennan PF, Wilson SJ, Alkhalil M, Santos A, McNiece A, Johnston NG, Jeganathan R, Owens CG, Manoharan G, Spence MS. P184511 years of transcatheter aortic valve implantation in a single centre and outcomes for all 1004 patient cases completed. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Long-term outcome data after TAVI is of key importance as indications have extended from high risk patients to intermediate risk alongside contemporary study of low risk patients.
Purpose
We report our complete 11 y experience of TAVI.
Methods
All patients (n=1004) treated with TAVI in our institution between Feb 2008 & Nov 2018 were included. Data was collected prospectively and all death certificates were reviewed. Independent predictors of mortality were determined by multivariable cox proportional hazard modelling. Annular sizing was performed via echocardiography +/or angiography until Aug 2012 after which time cardiac CT was used.
Results
Patients were 53% female & had mean age 81.9±6.6 y, logistic EuroScore 18.5%. 89% were NYHA >2, and 26.7% had a left ventricular ejection fraction (LVEF) of <50%. TAVI was performed for severe degenerative aortic valve disease (93.5%), while valve-in-valve (2.4%) bicuspid (2.1%) & rheumatic (2%) made up the remainder. Self-expanding valves were implanted in 73% cases. 98% cases were performed under local anaesthesia. A percutaneous transfemoral approach was used in 92% cases. For the first 6 y 19% procedures were performed for urgent inpatients, rising to 42% over the last 5 y. The mean time to discharge was 5.5 d, overall, & 60% cases were discharged within 72 h in the last 5 y. Mortality, for those at risk, was 3.2%, 12.8%, 53% & 88% at 30 d, 1 y, 5 y & 10 y. The median time to death was 2.6 y. Non-cardiac death accounted for 62% deaths, with sepsis being the main cause (55%). The main cause of cardiac death was heart failure (HF (53%)). Independent clinical predictors of death were increased age, atrial fibrillation, pulmonary disease & LVEF <50%. Use of a 2nd generation valve was associated with better survival at 5 y (p<0.001).
30 d new permanent pacemaker and stroke incidence were 13.7% and 2% respectively. 30 d readmission occurred in 13% patients. Independent clinical predictors of 1 y HF (7%) readmission were NYHA Class >2 and LVEF <50%. Endocarditis was seen in 1.6% during a mean follow-up 2,593 patient y. Mean aortic gradients at 1 y, 5 y & 10 y were 9.7mmHg, 8.4mmHg & 10.53mmHg. One patient had severe trans-aortic regurgitation during the follow-up. A 2nd TAVI procedure was performed in 5 patients with clinically significant paravalvular regurgitation, all within 30 d.
Figure 1. A. Survival. B. Predictors death
Conclusion
This comprehensive evaluation of all patients treated with this innovative technology provides reassurance regarding the long-term clinical efficacy of TAVI & gives insight into the evolution of our programme with time.
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Dyring-Andersen B, Coscia F, Santos A, Løvendorf M, BP Sørensen L, Niu L, Andersen JL, Clark R, Skov L, Teunissen M, Mann M. 262 A spatially resolved proteomic atlas of human skin and its associated immune system. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mota J, Martins C, Silva-Santos S, Santos A, Vale S. TV in bedroom, outdoor playtime and obesity status among preschool girls. Sci Sports 2019. [DOI: 10.1016/j.scispo.2018.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dyring-Andersen B, Løvendorf M, Santos A, Coscia F, BP Sørensen L, Niu L, Andersen JL, Teunissen M, Skov L, Mann M. 270 A spatially resolved proteomic atlas of psoriatic skin. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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97
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Lorenzo D, Romero A, Del-Arco L, Santos A. Linear Amides in Caprolactam from Linear Ketone Impurities in Cyclohexanone Obtained from Cyclohexane: Kinetics and Identification. Ind Eng Chem Res 2019. [DOI: 10.1021/acs.iecr.9b01997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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98
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Landa A, Sánchez B, Diaz M, Otaño M, Medina A, Catalán CF, Santos A, Izquierdo L, La Casta Muñoa A. Splanchnic vein thrombosis in cholangiocarcinoma. A retrospective observational study. Donostia University Hospital. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gonçalves C, Rodrigues M, Rodrigues C, Santos A, Godinho C, Figueiredo MC, Spínola A, Ferreira S. P5 Self-care nursing engagement interventions of the dependent elder in a community context: a scoping review. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz096.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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100
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de Celis M, Ruiz J, Martín-Santamaría M, Alonso A, Marquina D, Navascués E, Gómez-Flechoso MÁ, Belda I, Santos A. Diversity of Saccharomyces cerevisiae yeasts associated to spontaneous and inoculated fermenting grapes from Spanish vineyards. Lett Appl Microbiol 2019; 68:580-588. [PMID: 30929264 DOI: 10.1111/lam.13155] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 11/26/2022]
Abstract
The use of commercial yeast strains is a common practice in winemaking leading to a predictable quality in wine production, avoiding stuck or sluggish fermentations. However, the use of commercial yeasts leads to a consequent reduction in autochthonous microbial diversity. In this study, 1047 isolates from three Spanish appellations of origin were checked for fingerprinting on interdelta polymorphisms and the strain composition and diversity analysed using an extensible open-source platform for processing and analysis of an in-house polymorphism database developed for this study. Ancient vineyards managed with organic practices showed intermediate to low levels of strains diversity indicating the existence of stable populations of Saccharomyces cerevisiae strains. A drastic reduction in the number of different S. cerevisiae strains was observed in vineyards with cellars using a selected autochthonous S. cerevisiae strain for winemaking. Contrary, the use of allochthonous commercial strains in wineries did not seem to affect the native S. cerevisiae strain composition and diversity. SIGNIFICANCE AND IMPACT OF THE STUDY: The aim of this study was to compare different viticulture and oenological practices to determine their influence on the composition and diversity of Saccharomyces cerevisiae strains in wine fermentations. The study shows that the use of autochthonous strains of S. cerevisiae as starters for wine fermentation could have an important incidence on S. cerevisiae strains diversity in surrounding vineyards. The use of autochthonous strains of S. cerevisiae reduced the detected number of S. cerevisiae strains, a fact that was not observed when allochthonous commercial strains were used. Furthermore, vineyards managed with organic practices showed intermediate to low levels of S. cerevisiae strain diversity, whereas conventional practices showed higher levels.
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