Monitoring influenza vaccine effectiveness using the national influenza surveillance system

Background: Flu vaccine composition is reformulated on a yearly basis. As such, the vaccine effectiveness (VE) from previous seasons cannot be considered for subsequent years, and it is necessary to monitor the VE for each season. This study (MonitorEVA- monitoring vaccine effectiveness) intends to evaluate the feasibility of using the national influenza surveillance system (NISS) for monitoring the influenza VE. Material and methods: Data was collected within NISS during 2004 to 2014 seasons. We used a case-control design where laboratory confirmed incident influenza like illness (ILI) patients (cases) were compared to controls (ILI influenza negative). Eligible individuals consisted on all aged individuals that consult a general practitioner or emergency room with ILI symptoms with a swab collected within seven days of symptoms onset. VE was estimated as 1- odds ratio of being vaccinated in cases versus controls adjusted for age and month of onset by logistic regression. Sensitivity analyses were conducted to test possible effect of assumptions on vaccination status, ILI definition and timing of swabs (<3 days after onset). Results: During the 2004-2014 period, a total of 5302 ILI patients were collected but 798 ILI were excluded for not complying with inclusion criteria. After data restriction the sample size in both groups was higher than 148 individuals/ season; minimum sample size needed to detect a VE of at least 50% considering a level of significance of 5% and 80% power. Crude VE point estimates were under 45% in 2004/05, 2005/06, 2011/12 and 2013/14 season; between 50%-70% in 2006/07, 2008/09 and 2010/11 seasons, and above 70% in 2007/08 and 2012/13 season. From season 2006/07 to 2013/14, all crude VE estimates were statistically significant. After adjustment for age group and month of onset, the VE point estimates decreased and only 2008/09, 2012/13 and 2013/14 seasons were significant. Discussion and Conclusions: MonitorEVA was able to provide VE estimates for all seasons, including the pandemic, indicating if the VE was higher than 70% and less than 50%. When comparing with other observational studies, MonitorEVA estimates were comparable but less precise and VE estimates were in accordance with the antigenic match of the circulating virus/ vaccine strains. Given the sensitivity results, we propose a MonitorEVA based on: a) Vaccination status defined independently of number of days between vaccination and symptoms onset; b) use of all ILI data independent of the definition; c) stratification of VE according to time between onset and swab (< 3 and ≥3 days).

Do hereditary syndrome-related gynecologic cancers have any specific features?

Hereditary syndromes are responsible for 10 % of gynaecologic cancers, among which hereditary breastovarian cancer and hereditary non-polyposis colon cancer syndromes, known as HBOC and Lynch syndromes respectively, present the highest relative risk. The latter predisposes to endometrial cancer and both contribute to ovarian cancer. Cowden syndrome-related endometrial cancer and the increased risk of ovarian, uterine and cervical cancers associated with Peutz-Jeghers syndrome, are also demonstrated, while Li-Fraumeni syndrome patients are prone to develop ovarian and endometrial cancers. Despite these syndromes’ susceptibility to gynaecologic cancers being consensual, it is still not clear whether these tumours have any epidemiologic, clinical, pathologic or imaging specific features that could allow any of the intervening physicians to raise suspicion of a hereditary syndrome in patients without known genetic risk. Moreover, controversy exists regarding both screening and surveillance schemes. Our literature review provides an updated perspective on the evidence-based specific features of tumours related to each of these syndromes as well as on the most accepted screening and surveillance guidelines. In addition, some illustrative cases are presented.

Intelligence, Surveillance & Reconnaissance como Agente de Mudança

O século XXI introduziu profundas mudanças no espaço onde a atuação militar se desenvolve. Esta mutação, que agora inclui o domínio físico e cognitivo na ação militar, impõe a adoção de novos conceitos de operação e estruturas organizacionais mais ágeis, de forma a fazerem face a um ambiente altamente volátil, imprevisível e complexo. Tal contexto torna as organizações, hoje mais do que nunca, dependentes de informação (e dos sistemas que as geram), e no âmbito das organizações militares, uma capacidade em particular assume, na atualidade, uma preponderância fulcral para o sucesso destas, que se designa por Intelligence, Surveillance & Reconnaissance (ISR). Considerando a complexidade de sistemas, processos e pessoas que envolvem toda esta capacidade, torna-se relevante estudar como a Força Aérea Portuguesa (FAP) está a acomodar este conceito no interior da sua estrutura, uma vez que a sua adaptação requer uma organização da era da informação, onde o trabalho em rede assume particular destaque. A presente investigação analisa formas de estruturas organizacionais contemporâneas e cruza-as com as recomendações da Organização do Tratado do Atlântico Norte (também designada por Aliança), comparando-as posteriormente com a atualidade da FAP. No final, são efetuadas propostas tangíveis, que podem potenciar as capacidades existentes, de onde se destaca a criação de uma matriz de análise quanto à eficiência organizacional, uma nova forma de organização das capacidades residentes no que ao ISR concerne, bem como o modo de potenciar o trabalho em rede com base nos meios existentes. Abstract: The 21st century has caused profound changes in the areas where military action takes place. This mutation, which now includes the physical and cognitive domain in military action, requires the adoption of new concepts of operation and more agile organizational structures in order to cope with a highly volatile, unpredictable and complex environment. Thus, more than ever, this makes the present organizations dependent of information (and the systems that generate them), in the case of military organizations, a particular capability undertakes today a strong impact on the success of military organizations. It is known as Intelligence, Surveillance& Reconnaissance (ISR). Taking into account the complexity of systems, processes and people involving all this capability, it is relevant to study how the Portuguese Air Force (PAF) is accommodating this concept within its structure, since the adaptation requires an organization adapted to the information era, where networking is particularly prominent. This research aims to analyze contemporary forms of organizational structures and cross them with the recommendations of the North Atlantic Treaty Organization (also known as Alliance), later comparing them with today's PAF. At the end of this investigation, some tangible proposals are made which can enhance existing capabilities: we can highlight the creation of an analysis matrix for organizational efficiency, a new form of organization of the resident capabilities in the ISR concerns, as well as the way of enhancing networking, based on existing means.