Metabolic plasticity for subcutaneous fat accumulation in a long-distance migratory bird traced by 2H2O.

The migrant black-tailed godwit (Limosa limosa) traditionally used natural wetlands in the Iberian Peninsula to prepare for migratory flights by feeding mainly in estuaries. In recent decades, this species has become increasingly dependent on rice fields, thereby relying on a plant-based diet for fuelling. Dietary fatty acids (FA) seem to be determinant to the composition of accumulated subcutaneous fat in migratory birds. It is still unclear whether metabolic plasticity allows for modification and/or synthesis of FA, contributing to a lipid profile that enables a successful migratory performance. Deuterated water was administered to captive black-tailed godwits submitted to two diets (fly larvae versus rice) and the incorporation of deuterium (2H) into subcutaneous triglycerides was analyzed by NMR. A recently developed localized biopsy method for sampling subcutaneous fat was employed with later successful release of all birds into the wild. The average chemical structure reflected mostly a mixture of saturated and monounsaturated 16- and 18-carbon FA, a profile frequently found in migrant birds. Significantly higher levels of polyunsaturated FA, as well as detectable levels of n-3 FA, were observed in fly-larvae-fed birds. Excess 2H-enrichments in FA revealed significantly higher rates of fractional de novo lipogenesis and FA desaturation capacity in rice-fed birds. This novel and non-lethal tracer method revealed the capacity of this species to alter its lipid metabolism to compensate for a poorer dietary lipid contribution. Because of its versatility, adapting this method to other scenarios and/or other migratory species is considered feasible and cost-effective.

No sex difference in preen oil chemical composition during incubation in Kentish plovers.

Preen oil, the secretion from the uropygial gland of birds, may have a specific function in incubation. Consistent with this, during incubation, the chemical composition of preen oil is more likely to differ between sexes in species where only one sex incubates than in species where both sexes incubate. In this study, we tested the generality of this apparent difference, by investigating sex differences in the preen oil composition of a shorebird species, the Kentish plover (Anarhynchus, formerly Charadrius, alexandrinus). As both sexes incubate in this species, we predicted the absence of sex differences in preen oil composition during incubation. In the field, we sampled preen oil from nine females and 11 males during incubation, which we analysed with gas chromatography-mass spectrometry (GC-MS). Consistent with predictions, we found no sex difference in preen oil composition, neither in beta diversity (Bray-Curtis dissimilarities) nor in alpha diversity (Shannon index and number of substances). Based on these results, we cannot conclude whether preen oil has a function during incubation in Kentish plovers. Still, we discuss hypothetical roles, such as olfactory crypsis, protection against ectoparasites or olfactory intraspecific communication, which remain to be tested.

Sex disparities and dyslipidemic control in a coronary rehabilitation program.

Lipid control is one of the most important secondary cardiovascular prevention targets. Although cardiovascular disease is the most common cause of death in both sexes, women are less likely to receive guideline-recommended secondary prevention medications. To compare sex disparities in dyslipidemia control in a secondary prevention population, we retrospectively analysed all patients who participated in a Coronary Rehabilitation Program (CRP) after an acute coronary syndrome (ACS) from January 2011 to October 2019. Of a total of 881 patients enrolled, mean age 55.0-year-old, 16.1% were female. At hospital admission, females and males had similar mean LDL-levels. Female patients received more high intensity therapy during follow-up (67.8% vs 53.9% at baseline, p = 0.015; 75.6% vs 59.0% after CRP, p = 0.003; and 79.8% vs 65.1% at 1-year-follow-up, p = 0.007). At the end of the CRP, male patients exhibit a better control of LDL [82.0 vs 75.6 mg/dL, t(597) = 2.4, p = 0.016)] with 12.8% vs 16.4% below 55 mg/dL and 29.8% vs 44.5% below 70 mg/dL (p = 0.008). At 1-year follow-up, both sexes exhibited similar LDL-control thanks to a worsening control of the male population (81.9 vs 80.6 mg/dL, t(540) = 0.52, p = 0.605). Only 13.3% of females had LDL below 55 mg/dL (vs 12.9%, p = 0.921) and 32.5% below 70 mg/dL (vs 37.0%, p = 0.432). This real-life study showed that guideline recommended LDL target is not achieved in the majority of patients. Unlike other reports, there were more women receiving more potent anti-dyslipidemic therapy. Nevertheless, women showed a poor control of LDL-concentration after three months of ACS and a similar control after 1-year.

High gene flow on a continental scale in the polyandrous Kentish plover Charadrius alexandrinus.

Gene flow promotes genetic homogeneity of species in time and space. Gene flow can be modulated by sex-biased dispersal that links population genetics to mating systems. We investigated the phylogeography of the widely distributed Kentish plover Charadrius alexandrinus. This small shorebird has a large breeding range spanning from Western Europe to Japan and exhibits an unusually flexible mating system with high female breeding dispersal. We analysed genetic structure and gene flow using a 427-bp fragment of the mitochondrial (mtDNA) control region, 21 autosomal microsatellite markers and a Z microsatellite marker in 397 unrelated individuals from 21 locations. We found no structure or isolation-by-distance over the continental range. However, island populations had low genetic diversity and were moderately differentiated from mainland locations. Genetic differentiation based on autosomal markers was positively correlated with distance between mainland and each island. Comparisons of uniparentally and biparentally inherited markers were consistent with female-biased gene flow. Maternally inherited mtDNA was less structured, whereas the Z-chromosomal marker was more structured than autosomal microsatellites. Adult males were more related than females within genetic clusters. Taken together, our results suggest a prominent role for polyandrous females in maintaining genetic homogeneity across large geographic distances.

Portuguese Cross-Cultural Adaptations of the Pediatric International Knee Documentation Committee Score.

INTRODUCTION: The aim of this study was to translate the Pediatric International Knee Documentation Committee Score (Pedi-IKDC) into European Portuguese language. The Pedi-IKDC was originally developed in the English language and its main construct is functional assessment of knee disorders in children and adolescents. MATERIAL AND METHODS: The original English version of the questionnaire was translated to European Portuguese using the forwardbackwards method. Patients aged eight to 17 with knee disorders were considered eligible for the study. An online platform was implemented to collect patient responses, including general patient information, the questionnaires Pedi-IKDC, EuroQol-5 Dimension Youth and Childhood Health Assessment Questionnaire. Three surveys were sent: at the moment of first evaluation (T0), after two (T1) and ten (T2) weeks. These surveys followed the Consensus-based Standards for the Selection of Health Measurement Instruments - COSMIN Checklist recommendations. The internal consistency, reliability, error of measurement, structural and construct validity (by means of correlation with previously validated scales), responsiveness and interpretability (floor/ceiling effects, MIC and ROC curve) were evaluated. RESULTS: Forty-seven patients completed T0, 42 patients completed T1 and 40 patients completed T2. The factorial analysis confirmed that the scale has one dimension. Cronbach alpha (α) was 0.94; interclass correlation coefficient was 0.92; smallest detectable change was 19.04 for individuals and 3.31 for groups; standard error of measurement was 6.87; minimum important change was 18.48; floor and ceiling effects were absent. More than 75% of the hypotheses tested for construct validity were confirmed, showing its adequacy. The variation of scores between T0 and T2 correlated with the clinical evolution of the participants (r = 0.421, p < 0.05). CONCLUSION: The Portuguese version of Pedi-IKDC demonstrated good psychometric properties, being a valuable tool for clinical assessment of pediatric patients with knee disorder.

Spatial and seasonal variation in macrozoobenthic density, biomass and community composition in a major tropical intertidal area, the Bijagós Archipelago, West-Africa.

The coastal intertidal ecosystem of the Bijagós Archipelago, Guinea-Bissau, one of the largest and most important in West Africa, sustains a considerable proportion of the migratory shorebird populations of the East Atlantic Flyway and operates as a nursery area for benthic fish in the region. The macrozoobenthos in these mudflats constitute the main food source for both groups so that spatial and temporal variation in their abundance and community composition is likely to influence the abundance and distribution of fish and birds. In this study we described the spatial and temporal dynamics in the density, biomass, and community composition of macrozoobenthos across six intertidal flats in three islands of the Bijagós Archipelago. Overall, the Bijagós Archipelago was characterised by a highly species-rich macrozoobenthic community, with ca. 88 taxa identified across all sites, reaching a mean density of 1871 ± 58.3 ind.m-2 (mean ± SE) and mean biomass of 5.65 ± 0.41 g of AFDM.m-2 (ash-free dry mass per m2), values much lower than what was described for nearby intertidal areas, namely the Band d'Arguin, Mauritania. Density and biomass of major macrozoobenthos classes (Bivalvia, Polychaeta, Malacostraca and Gastropoda) differed across sites and months, displaying an overall increase in density towards the final months of the dry season (March and April). Similarly, community composition also differed significantly between sites and throughout the season. The site with most distinct community composition (Adonga) supported low diversity and high abundance of a few bivalve species, whilst other two sites that hosted the most diverse communities, were also the most similar between them (Anrumai and Abu). These spatial and temporal patterns constitute an important baseline to improve knowledge of this intertidal ecosystem and will contribute towards a better understanding of the spatial and temporal distribution patterns of their consumers.

Age does not determine the physical, functional and psychosocial response to a cardiac rehabilitation program.

INTRODUCTION: Despite increasing prevalence of coronary heart disease among the elderly and their greater susceptibility to its clinical, functional and psychosocial sequelae, referral to and participation in cardiac rehabilitation programs (CRPs) remains low in this age group. We aimed to assess the effect of age on the hemodynamic, biochemical, anthropometric, functional and psychosocial response to a CRP. METHODS: We prospectively studied 105 patients admitted to a CRP within three months of a successful percutaneous cularization procedure after an acute coronary syndrome. The CRP included nutritional counseling, group psycho-educational sessions, and two months of twice-weekly supervised exercise sessions at an intensity of 60-80% of chronotropic reserve. Younger (<55 years) vs. older (> or = 55 years) patients were compared in terms of their baseline characteristics, differences after CRP and proportion of patients achieving secondary prevention goals at baseline and after CRP completion. RESULTS: At baseline older patients had a worse cardiovascular risk factor profile, with higher prevalence of previous coronary heart disease, hypertension, diabetes, overweight and inactivity, and lower functional capacity. The two groups showed similar improvements in anthropometric parameters (waist circumference: -1.20 cm [3.82], p < 0.05 in younger vs. -3.17 cm [3.49], p < 0.01 in older patients), lipid profile and quality of life scores (summary physical component: +3.65 [7.83], p < 0.01 vs. +3.23 [6.66], p < 0.01; summary mental component: +3.60 [10.01], p < 0.05 vs. +3.02 [11.92], p < 0.05, in younger and older patients, respectively). Neither group showed significant changes in blood pressure, high-density lipoprotein or depressive symptoms. Older patients, who were initially less physically active (median [interquartile range]: 693 [12.96-1929.5] vs. 2376 [205-4293] MET*min/week), showed a significant increase in physical activity (+267%, p < 0.001), which was not observed i younger patients (+4%, p = 0.68). The pro portion of patients achieving secondary prevention goals improved similarly in both groups for lipid profile, smoking cessation and minimum physical activity levels, with no improvement in blood pressure or anthropometric parameters. CONCLUSION: Participation in a CRP results in significant improvements in cardiovascular risk profile, functional capacity and quality of life, regardless of age. Specific strategies are needed to ensure adequate referral and participation of elderly patients in exercise-based CRPs.

Facemasks during aerobic exercise: Implications for cardiac rehabilitation programs during the Covid-19 pandemic.

INTRODUCTION AND OBJECTIVES: During the COVID-19 pandemic, among the safety measures adopted, use of facemasks during exercise training sessions in cardiac rehabilitation programs raised concerns regarding possible detrimental effects on exercise capacity. Our study examined the cardiorespiratory impact of wearing two types of the most common facemasks during treadmill aerobic training. METHODS: Twelve healthy health professionals completed three trials of a symptom-limited Bruce treadmill protocol: Without a mask, with a surgical mask and with a respirator. Perceived exertion and dyspnea were evaluated with the Borg Scale of Perceived Exertion and the Borg Dyspnea Scale, respectively. Blood pressure, heart rate and arterial oxygen saturation (SpO2) were measured at each 3-minute stage. RESULTS: Using a surgical mask or a respirator resulted in a shorter duration of exercise testing. At peak capacity, using a respirator resulted in higher levels of dyspnea and perceived exertion compared to not wearing a facemask. A significant drop in SpO2 was present at the end of exercise testing only when using a respirator. There were no differences in either chronotropic or blood pressure responses between testing conditions. CONCLUSIONS: Professionals involved in cardiac rehabilitation should be aware of the cardiorespiratory impact of facemasks. Future studies should assess whether exposure to these conditions may impact on the overall results of contemporary cardiac rehabilitation programs.

INTRODUÇÃO E OBJETIVOS: Durante a pandemia Covid-19 a utilização de máscaras faciais, incluindo durante o exercício terapêutico, faz parte das medidas de segurança adotadas. Este facto originou preocupação a nível das unidades de reabilitação cardíaca, uma vez que as máscaras faciais podem promover efeitos deletérios na capacidade de exercício. Este estudo avaliou o impacto da utilização das máscaras faciais durante o treino aeróbio em passadeira. MÉTODOS: Doze profissionais de saúde saudáveis completaram três provas em passadeira de acordo com o protocolo de Bruce: sem máscara, com máscara cirúrgica e com um respirador. A perceção de esforço e dispneia foi avaliada com a Escala de Perceção de Esforço de Borg e com a Escala de Dispneia de Borg, respetivamente. A pressão arterial, frequência cardíaca e saturação arterial de oxigénio (SpO2) foram registadas em cada estadio do protocolo. RESULTADOS: A utilização de máscara facial resultou numa menor duração da prova e, em determinados momentos, níveis de perceção de dispneia e de esforço mais elevados. Verificou-se uma descida significativa da SpO2 no final da prova com respirador. Não se verificaram diferenças na resposta cronotrópica ou da pressão arterial entre as diferentes condições de prova. CONCLUSÕES: Os profissionais envolvidos na reabilitação cardíaca devem reconhecer os impactos cardiorrespiratórios provocados pela utilização da máscara facial. São necessários mais estudos para determinar se a exposição a estas condições de treino pode ter impacto nos resultados dos programas de reabilitação cardíaca.

Facemasks during aerobic exercise: Implications for cardiac rehabilitation programs during the Covid-19 pandemic.

INTRODUCTION AND OBJECTIVES: During the COVID-19 pandemic, among the safety measures adopted, use of facemasks during exercise training sessions in cardiac rehabilitation programs raised concerns regarding possible detrimental effects on exercise capacity. Our study examined the cardiorespiratory impact of wearing two types of the most common facemasks during treadmill aerobic training. METHODS: Twelve healthy health professionals completed three trials of a symptom-limited Bruce treadmill protocol: Without a mask, with a surgical mask and with a respirator. Perceived exertion and dyspnea were evaluated with the Borg Scale of Perceived Exertion and the Borg Dyspnea Scale, respectively. Blood pressure, heart rate and arterial oxygen saturation (SpO2) were measured at each 3-minute stage. RESULTS: Using a surgical mask or a respirator resulted in a shorter duration of exercise testing. At peak capacity, using a respirator resulted in higher levels of dyspnea and perceived exertion compared to not wearing a facemask. A significant drop in SpO2 was present at the end of exercise testing only when using a respirator. There were no differences in either chronotropic or blood pressure responses between testing conditions. CONCLUSIONS: Professionals involved in cardiac rehabilitation should be aware of the cardiorespiratory impact of facemasks. Future studies should assess whether exposure to these conditions may impact on the overall results of contemporary cardiac rehabilitation programs.

Effectiveness of Tele-rehabilitation Programs in Heart Failure: A Systematic Review and Meta-analysis.

BACKGROUND: Tele-rehabilitation (TR) may be an effective alternative or complement to centre-based cardiac rehabilitation (CBCR) with heart failure (HF) patients, helping overcome accessibility problems to CBCR. The aim of this study is to systematically review the literature in order to assess the clinical effectiveness of TR programs in the management of chronic HF patients, compared to standard of care and standard rehabilitation (CBCR). METHODS AND RESULTS: We conducted a systematic review and meta-analysis of randomized controlled trials on the effect and safety of TR programs in HF patients, regarding cardiovascular death, heart failure-related hospitalizations, functional capacity and quality of life. We searched 4 electronic databases up until May 2020, reviewed references of relevant articles and contacted experts. A quantitative synthesis of evidence was performed by means of random-effects meta-analyses. We included 17 primary studies, comprising 2206 patients. Four studies reported the number of hospitalizations (TR: 301; Control: 347). TR showed to be effective in the improvement of HF patients' functional capacity in the 6 Minute Walk-Test (Mean Difference (MD) 15.86; CI 95% [7.23; 24.49]; I2 = 74%) and in peak oxygen uptake (pVO2) results (MD 1.85; CI 95% [0.16; 3.53]; I2 = 93%). It also improved patients' quality of life (Minnesota Living with Heart Failure Questionnaire: MD -6.62; CI 95% [-11.40; -1.84]; I2 = 99%). No major adverse events were reported during TR exercise. CONCLUSION: TR showed to be superior than UC without CR on functional capacity improvement in HF patients. There is still scarce evidence of TR impact on hospitalization and cv death reduction. Further research and more standardized protocols are needed to improve evidence on TR effectiveness, safety and cost-effectiveness.

Linking migratory performance to breeding phenology and productivity in an Afro-Palearctic long-distance migrant.

Understanding the relationship between migratory performance and fitness is crucial for predicting population dynamics of migratory species. In this study, we used geolocators to explore migration performance (speed and duration of migratory movements, migratory timings) and its association with breeding phenology and productivity in an Afro-Palearctic insectivore, the European bee-eater (Merops apiaster), breeding in Iberian Peninsula. Bee-eaters migrated at higher travel speeds and had shorter travel duration in spring compared to autumn. Individuals that departed earlier or spent fewer days in-flight arrived earlier to the breeding areas. Our results show overall positive, but year-specific, linkages between arrival and laying dates. In one year, laying was earlier and productivity was higher, remaining constant throughout the season, while in the subsequent year productivity was lower and, importantly, declined with laying date. These results suggest that arriving earlier can be advantageous for bee-eaters, as in years when breeding conditions are favourable, early and late breeders produce high and similar number of fledglings, but when conditions are unfavourable only early breeders experience high productivity levels.

Cardiac rehabilitation in older patients: Indication or limitation?

OBJECTIVE: To assess the clinical impact of a cardiac rehabilitation program in an older population. METHODS: This is a retrospective analysis of 731 coronary patients who attended phase 2 of a cardiac rehabilitation program between January 2009 and December 2016. We compared the response to the program of older (≥65 years) and younger (<65 years) patients, analyzing changes in metabolic profile (including body mass index, waist circumference and lipid profile), exercise capacity, cardiac autonomic regulation parameters (such as chronotropic index and resting heart rate), and health-related quality of life scores. RESULTS: Older patients represented 15.9% of our cohort. They showed significant reductions in waist circumference (male patients: 98.0±7.9 cm vs. 95.9±7.9 cm, p<0.001; female patients: 90.5±11.4 cm vs. 87.2±11.7 cm, p<0.001), LDL cholesterol (102.5 [86.3-128.0] mg/dl vs. 65.0 [55.0-86.0] mg/dl, p<0.001) and triglycerides (115.0 [87.8-148.5] mg/dl vs. 97.0 [81.8-130.0] mg/dl, p<0.001). Post-training data also showed a noticeable improvement in older patients' exercise capacity (7.6±1.8 METs vs. 9.3±1.8 METs, p<0.001), along with a higher chronotropic index and lower resting heart rate. Additionally, health-related quality of life indices improved in older subjects. However, our overall analysis found no significant differences between the groups in changes of the studied parameters. CONCLUSION: Older coronary patients benefit from cardiac rehabilitation interventions, similarly to their younger counterparts. Greater involvement of elderly patients in cardiac rehabilitation is needed to fully realize the therapeutic and secondary preventive potential of such programs.

Population- and age-specific patterns of haemosporidian assemblages and infection levels in European bee-eaters (Merops apiaster).

Amongst other factors, host behaviour critically determines the patterns with which blood parasites occur in wild host populations. In particular, migratory hosts that sequentially occupy distant sites within and across years are expected to show distinct patterns of blood parasitism depending on their population-specific schedules and whereabouts. Here, we monitored haemosporidian parasitism in two populations of European bee-eaters (Merops apiaster), breeding in Portugal and Germany, with fundamentally different spatiotemporal migration patterns and colonisation histories. We describe and compare the composition of their parasite fauna as well as host population-, age- and sex-specific patterns in the frequency and intensity of infections. We found haemosporidian prevalence to be higher in Portugal compared with Germany and the prevalence generally increased with host age in both populations. Bee-eaters breeding in Portugal and wintering in western Africa mostly hosted parasites of the genus Haemoproteus, while Plasmodium lineages prevailed in birds breeding in Germany and wintering in central Africa. We found 18 genetic lineages, of which nine uniquely occurred in Germany, three uniquely in Portugal and six occurred in both breeding populations. The infection intensities (= % infected per inspected erythrocytes) ranged from 0.002% up to maximally 2.5% in Portugal and 9.6% in Germany. The intensity was higher in Germany compared with Portugal, vastly varied between the parasite genera (Haemoproteus > Plasmodium), but also differed between lineages of the same genus. Our results suggest that populations from different parts of a host's breeding range differ in prevalence and the composition of their haemosporidian assemblages, rather than in the intensity of their infections. Whether these patterns are mainly caused by differential habitat use throughout the annual cycle and/or the population-specific co-evolutionary backgrounds of a host species in range expansion remains to be elucidated.

Role of Left Ventricle Function in Cardiac Rehabilitation Outcomes in Stage B Heart Failure Patients.

PURPOSE: To study the role of left ventricle systolic function in cardiac rehabilitation program (CRP) response in stage B heart failure patients. METHODS: A retrospective analysis was completed of 691 patients with previous myocardial infarction that underwent a CRP, classified in 3 groups: preserved ejection fraction (pEF), mid-range ejection fraction (mrEF), and reduced ejection fraction (rEF). We compared the response to CRP analyzing the relative changes of estimated cardiorespiratory fitness (CRFe), resting heart rate (HR), and chronotropic index (CI). RESULTS: After exercise training (median [interquartile range]) mrEF (23.9% [9.7, 40.8]) and rEF (23.9% [9.7, 41.2]) groups had a better CRFe response to CRP than pEF groups (17.6% [0.0, 35.9]), P = .009. CI increased similarly in all groups. We found a small effect of CRP on resting HR. CONCLUSION: Exercise-based CRP yields notable benefits to mrEF and rEF groups and the magnitude of its benefits is, at least, similar to that found in pEF patients.

Progression of aerobic exercise intensity in a cardiac rehabilitation program.

INTRODUCTION AND OBJECTIVES: To describe the progression of aerobic exercise intensity in patients on a cardiac rehabilitation (CR) program. METHODS: We conducted a retrospective analysis of a random sample of patients referred for CR after acute coronary syndrome between 2008 and 2016. The weekly peak exercise intensity achieved during aerobic exercise was estimated by treadmill speed and grade at peak effort and the corresponding perception of effort was assessed using the Borg scale. Initial exercise intensity was prescribed as 60-80% of reserve heart rate plus resting heart rate, and was modified according to perceived exertion. Peak heart rate/intensity and perceived exertion index were used as variables to characterize the response to the intensity achieved. Variables were compared at different time points: T1 (1st week), T2 (4th week) and T3 (8th week). RESULTS: Of the total of 868, 238 patients were randomly selected. At peak heart rate during the session, exercise intensity (in metabolic equivalents) was: T1: 7.2±2.0, T2: 9.0±2.2, and T3: 9.4±2.2 (p<0.01). The peak heart rate/intensity index was T1: 16.8±5.4, T2: 13.4±3.6 and T3: 13.1±3.8 (p<0.01) and the perceived exertion index was T1: 1.8±0.6; T2: 1.4±0.5; T3: 1.4±0.5 (p<0.01). CONCLUSIONS: Increasing exercise intensity during CR, associated with lower perception of effort and lower heart rate necessary to achieve such intensity, leads to significant improvement in functional capacity.

Internal deterministic record linkage using indirect identifiers for matching of same-patient hospital transfers and early readmissions after acute coronary syndrome in a nationwide hospital discharge database: a retrospective observational validation study.

OBJECTIVES: To assess validity of record linkage using multiple indirect personal identifiers to identify same-patient hospitalisations and definition of episode of care (EC) due to acute coronary syndrome (ACS). METHODS: Using national hospital discharge data to identify all admissions due to ACS, we used six different linkage rules using indirect identifiers with increasing level of detail and compared validity against a pseudonymised unique identifier used as gold standard (GS). Contiguous hospitalisations within each matched group of hospitalizations occurring within 28 days of each other were considered one EC. We classified hospitalisations according to time between the first pair of hospitalisations as hospital transfer (HT: ≤1 day), early readmission (ER: 2-28 days) or recurrent cases (>28 days). RESULTS: There were 146 671 hospitalisations (unlinked), 121 987 ACS 28-day EC (linked GS), with 18 398 HTs (≤1 day), and 6286 ERs (≤28 days). Linkage rules using demographic and residence code variables produced linkage rates with highest validity for rule using sex, date of birth and four-digit residence code with sensitivity of 98.4 (95% CI: 98.4 to 98.5); specificity of 97.8 (95% CI: 97.6 to 98.0) and Cohen's κ of 0.9 to detect ACS-EC, compared with GS linkage rule. Similarly, validity for HT and ER was high and of similar magnitude, with sensitivity ranging between 97.2% and 98.1%, and specificity between 98.8% and 99.9%, respectively. CONCLUSIONS: Our internal linkage validation study using indirect patient identifiers will allow calibration of incidence rates and performance indicators, accounting for the effect of HT and readmissions.

Understanding how birds rebuild fat stores during migration: insights from an experimental study.

Mechanisms underlying fat accumulation for long-distance migration are not fully understood. This is especially relevant in the context of global change, as many migrants are dealing with changes in natural habitats and associated food sources and energy stores. The continental Black-tailed godwit Limosa limosa limosa is a long-distance migratory bird that has undergone a considerable dietary shift over the past few decades. Historically, godwits fed on an animal-based diet, but currently, during the non-breeding period godwits feed almost exclusively on rice seeds. The latter diet may allow building up of their fuel stores for migration by significantly increasing de novo lipogenesis (DNL) activity. Here, we performed an experiment to investigate lipid flux and the abundance of key enzymes involved in DNL in godwits, during fasting and refueling periods at the staging site, while feeding on rice seeds or fly larvae. Despite no significant differences found in enzymatic abundance (FASN, ME1, ACC and LPL) in stored fat, experimental godwits feeding on rice seeds presented high rates of DNL when compared to fly-larvae fed birds (~35 times more) and fasted godwits (no DNL activity). The increase of fractional DNL in godwits feeding on a carbohydrate-rich diet can potentially be enhanced by the fasting period that stimulates lipogenesis. Although requiring further testing, these recent findings provide new insights into the mechanisms of avian fat accumulation during a fasting and refueling cycle and associated responses to habitat and dietary changes in a migratory species.

Benefits of Cardiac Rehabilitation in Coronary Artery Disease: DOES WEIGHT MATTER?

PURPOSE: To evaluate the response of patients with obesity to a cardiac rehabilitation program (CRP), compared with patients without obesity. METHODS: We performed a retrospective analysis of 731 patients who completed phase II of a CRP after an acute coronary syndrome. The response to the CRP was assessed using the relative changes in exercise capacity (EC), resting heart rate (HR), and chronotropic index (CI). RESULTS: Only 23% of patients had obesity. Patients with obesity showed lower EC and CI at baseline and at the end of phase II of the CRP. Despite that, we reported a higher relative improvement for EC in patients with obesity (median [interquartile range], 23.9% [5.2, 40.8] vs 17.6% [8.1, 35.9], P = .043) and similar improvements in CI (10.9% [-1.4 to 34.2] vs 7.1% [-7.1 to 28.2], P = .100), compared with patients without obesity. There were no significant changes in resting HR. CONCLUSION: Regardless of their lower exercise performance at baseline, patients with obesity had a remarkably positive response to the CRP compared with patients without obesity.

Neurocognitive impairment after acute coronary syndrome: Prevalence and characterization in a hospital-based cardiac rehabilitation program sample.

Introduction: Prospective studies have shown the relation between acute coronary syndrome (ACS) and neurocognitive dysfunction with prevalence ranging between 10.51% and 66.8%. The present study aims to determine the prevalence level of neurocognitive dysfunction; the relations between sociodemographic, clinical and emotional variables and neurocognitive functioning in a sample of ACS patients. Methods: The sample comprised of 53 patients engaged in cardiac rehabilitation within 3 months after an ACS. Patients with any medical history of neuropsychiatric problems prior to the ACS and illiterate subjects were not included in the study. Results: The majority of the sample (85%) exhibits some degree of cognitive impairment, with 84.8% showing verbal fluency impairment, 60.3% memory impairment and only 26,4% had language compromised. Neurocognitive general functioning was correlated with age. Memory domain was negatively correlated with the number of daily smoked cigarettes before the ACS. Verbal fluency was influenced by schooling. Language domain was correlated with mean diastolic pressure and with the type of profession, visuospatial domain was correlated with schooling, number of cardiovascular risk factors, distress, anxiety levels and type of ACS. Conclusion: Prevalence rate of neurocognitive dysfunction is considerably high. Besides global neurocognitive functioning, verbal fluency and memory are the most affected domains. Several variables were related to neurocognitive performance: sociodemographic; cardiovascular risk factors; clinical; psychological. The underlying mechanisms of neurocognitive dysfunction should be further explored.

Inequalities in access to cardiac rehabilitation after an acute coronary syndrome: the EPiHeart cohort.

OBJECTIVES: To estimate cardiac rehabilitation (CR) referral and participation rates among patients with acute coronary syndrome (ACS) and to identify their determinants, in two Portuguese regions. DESIGN: Prospective cohort study. SETTING: Patients consecutively admitted to the cardiology department of two hospitals, one in the district of Porto and one in the north-east region (NER) of Portugal, were enrolled in the EPIHeart cohort and then followed up for 6 months. PARTICIPANTS: Between August 2013 and December 2014, 939 patients were included in the cohort, and 853 were re-evaluated at 6-month follow-up. OUTCOME MEASURES: Referral rate was defined as the proportion of eligible patients who were referred to a CR programme, whereas participation rate was defined as the proportion of eligible patients who completed a CR programme, as was recommended by their physicians. RESULTS: Patients referred were 32.3% and 10.7% of those eligible in Porto and NER, respectively. In both regions, referral to CR decreased with age and with longer travel times to CR centres and increased with education or social class. At follow-up, 128 patients from Porto (26.2% of those eligible and 81.0% of those referred) and 26 from NER (7.1% of those eligible and 66.7% of those referred) reported actually participating in a CR programme. In Porto, the main barriers to participation were the long time until a programme was available and lack of perceived benefit. Patients in NER identified distance to CR and costs as the main barriers. CONCLUSIONS: CR remains clearly underused in Portugal, with major inequalities in access between regions. Achieving equitable and greater use of CR requires a multilevel approach addressing barriers related to healthcare system, providers and patients in order to improve provision, referral and participation.