Machine learning for predicting chronic diseases: a systematic review.

OBJECTIVES: We aimed to review the literature regarding the use of machine learning to predict chronic diseases. STUDY DESIGN: This was a systematic review. METHODS: The searches included five databases. We included studies that evaluated the prediction of chronic diseases using machine learning models and reported the area under the receiver operating characteristic curve values. The Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis scale was used to assess the quality of studies. RESULTS: In total, 42 studies were selected. The best reported area under the receiver operating characteristic curve value was 1, whereas the worst was 0.74. K-nearest neighbors, Naive Bayes, deep neural networks, and random forest were the machine learning models most frequently used for achieving the best performance. CONCLUSION: We found that machine learning can predict the occurrence of individual chronic diseases, progression, and their determinants and in many contexts. The findings are original and relevant to improve clinical decisions and the organization of health care facilities.

Effect of sublethal concentrations of the antiparasitic ivermectin on the polychaeta species Hediste diversicolor: biochemical and behavioral responses.

Pharmaceutical drugs have emerged as major micropollutants in aquatic ecosystems. Their presence has been systematically reported in monitoring surveys, and their wide distribution and constant presence in the wild is a direct consequence of their massive use, in both human and veterinary therapeutics. Drugs used to treat parasitic infections in livestock are major contaminants, given the amounts in which they are administered, and reach the aquatic compartment in high amounts, where they may affect non target species. Some of these drugs are prone to find their final deposit in sediments of estuarine areas, exerting their toxic effects preferentially at these locations. Sediment dwelling organisms of coastal areas, such as polychaetas, are especially prone to have their major physiological functions compromised after being exposed to pharmaceutical drugs. Ivermectin is one of the most used antiparasitic drugs, and its effects are not limited to biochemical traits, but also behavioral features may be compromised considering their neurotoxic actions. Despite these putative effects, little is known about their toxicity on polychaetas. The present study aimed to characterize the toxicity of realistic levels of ivermectin on the polychaeta Hediste diversicolor, in biochemical and behavioral terms. The obtained results showed that low levels of ivermectin are capable of causing significant disturbances in mobility and burrowing activity of exposed worms, as well as alterations of metabolic and anti-oxidant defense efficacy of exposed animals, suggesting that its environmental presence may mean a major environmental concern.

Assessing the use and understanding of the Portuguese heat-health warning system (ÍCARO).

BACKGROUND: Heatwaves can lead to increased mortality. In the Portuguese heat-health warning system (HHWS), ÍCARO, a daily report with heat-related mortality prediction is sent to heat-health action plan (HHAP) practitioners. HHAP practitioners assess risk and implement measures to prevent heatwave-related impact, but ÍCARO's use and understanding are unknown. We assessed ÍCARO's use and understanding by key HHAP practitioners. METHODS: We conducted semi-structured interviews with national/regional HHAP practitioners. Interviews were recorded, transcribed and analysed using thematic content analysis. To maximize credibility a validation process was implemented through researcher triangulation; a sample of 30 segments was recorded by independent researchers. RESULTS: We conducted six interviews with nine professionals (mean time 52 min) from five regions. We identified four categories: report's content and presentation, report's reception and communication, ÍCARO and risk assessment and other issues. Practitioners use ÍCARO and perceived it as relevant; they raised issues on its interpretation and felt these were not fully addressed, given researchers' use of statistical/epidemiological terms. We identified the need for improved communication and report's clarity. CONCLUSIONS: Our study stresses the need for collaboration between experts within HHWS/HHAP. Despite ÍCARO's understanding being challenging, practitioners consider it a relevant tool. Researchers should use less statistical language and clarify ÍCARO's interpretation. Practitioners' needs should be considered when developing/revising tools.

Geographical patterns of the incidence and mortality of colorectal cancer in mainland Portugal municipalities (2007-2011).

BACKGROUND: Cancer is a leading cause of morbidity and mortality in the world. In Portugal, colorectal cancer is one of the most incident cancers; thus, it is crucial to act to fight it. Knowledge of the geographical distribution of the incidence and mortality of colorectal cancer can facilitate the execution of these actions and make them more effective. METHODS: Our paper aims to describe and discuss the geographical patterns of colorectal cancer incidence and mortality in mainland Portugal municipalities (2007-2011). We used the Besag, York and Mollié (BYM) model to compute the relative risk (RR) and posterior probability (PP). We performed a cluster analysis with Global Moran's Index and Local Moran's Index (LISA). We ran a geographically weighted regression (GWR) to compare incidence and mortality patterns. RESULTS: Incidence and mortality have different distributions of RR values. The interval of RR concerning incidence was higher than the interval of RR concerning mortality. PP values reinforce the finding of higher heterogeneity of the incidence of colorectal cancer. The comparison of the cluster maps for incidence and mortality shows a few municipalities classified with the same cluster type in both maps. Additionally, the GWR results show that the percentage of RR mortality explained by RR incidence differs throughout mainland Portugal. From the comparison of our results with the prevalence of risk factors (at NUTS II level), the need to be aware of smoking habits, alcohol consumption and the unhealthy diet of the Portuguese population stands out. CONCLUSIONS: There are differences in the geographical distribution of the RR incidence and RR mortality of colorectal cancer in mainland Portugal municipalities. Likewise, it is relevant to highlight the cluster of two municipalities with high RR values concerning colorectal cancer's incidence and mortality. Future research is necessary to explain the geographical differences in the distribution of colorectal cancer in mainland Portugal municipalities. Based on our findings, it may be interesting to examine the influence of smoking, alcohol consumption, diet and screening on colorectal cancer in greater detail. Additionally, it may be relevant to develop an analysis focused on municipalities where the incidence values explain the mortality values poorly (or well).

Effects of diclofenac and salicylic acid exposure on Lemna minor: Is time a factor?

The global occurrence of pharmaceuticals in the aquatic environment has been considered a particularly concerning problem with unknown consequences. Non-steroidal anti-inflammatory drugs (NSAIDs) including diclofenac (DCF) and salicylic acid (SA), are among the most frequently prescribed drugs in the world, being consequently commonly found in the aquatic environment. Prolonged experiments (with duration of exposure that surpass those recommended by already established testing guidelines) are important to obtain ecologically relevant data to address the issue of NSAIDs ecotoxicity, because by being more realistically (namely in terms of levels and durations of exposure), such tests may indicate realistic challenges posed to aquatic organisms. Among the most common test species that are used for assessing environmental quality, plants play a leading role. Lemna species are among the most important plants used for ecotoxicity testing. Therefore, the aim of this study was to evaluate the temporal effect of a prolonged exposure of DCF and SA on Lemna minor. To attain this purpose, L. minor plants were chronically exposed to 0, 4, 20, and 100 µg/L of both pharmaceuticals, and samplings were performed at 6, 10 and 14 days of exposure. The analyzed endpoints were: levels of chlorophyll a, b and total, carotenoids; and enzymatic biomarkers, such as catalase, ascorbate peroxidase and glutathione-S-transferases. Diclofenac was responsible for alterations in all analyzed parameters in different intervals of exposure. Salicylic acid exposure was not capable of causing alterations on pigment contents of L. minor, however, enzymatic biomarkers were altered at all sampling intervals. Thus, it is possible to conclude that both pharmaceuticals can cause damage on the tested macrophyte species, biochemical parameters being more sensitive than physiological ones. Additional prolonged experiments are required to understand the chronic effects of different pharmaceuticals in the aquatic environment, especially in plants.

Oxytetracycline effects in specific biochemical pathways of detoxification, neurotransmission and energy production in Oncorhynchus mykiss.

Oxytetracycline (OTC) is a tetracycline antibiotic, widely used in human and veterinary medicines, including in aquaculture. Given this use, OTC has been detected in different aquatic environments. Some recent works have demonstrated unintentional biological activity of OTC in non-target aquatic organisms. This study investigated the acute and chronic effects of OTC on the physiology of the fish species Oncorhynchus mykiss (rainbow trout), namely through the quantification of the activity of enzymes involved in different biochemical pathways, such as detoxification (phase II - glutathione S-transferases - GSTs, uridine-diphosphate-glucuronosyltransferases - UGTs), neurotransmission (acetylcholinesterase - AChE) and energy production (lactate dehydrogenase - LDH). The here-obtained data demonstrated the induction of GSTs activity in gills, and inhibition of AChE activity in eyes tissue, in chronically exposed organisms, as well as alterations in LDH activity following both exposures. Considering this set of results, we can infer that OTC exposure may have induced the glutathione pathway of detoxification in gills with the involvement of GSTs, or indirectly due to the metabolites that may have been produced. In turn, these metabolites may have interfered with the mechanism of neurotransmission, also causing physiological and biochemical disturbances in rainbow trout after OTC exposure, namely disturbances in energetic metabolism. In addition, it is important to stress that such occurrences took place at low, environmentally realistic levels of OTC, suggesting that organisms exposed in the wild may be putative targets of toxic effects by commonly used drugs such as antibiotics.

Transgenerational Effects of Toxicants: An Extension of the Daphnia 21-day Chronic Assay?

The assessment of transgenerational effects should be incorporated in standard chronic toxicity protocols for the sake of a realistic extrapolation of contaminant effects to the population level. We propose a simple add-on to the standard 21-day chronic Daphnia magna assay, allowing the assessment of the reproductive performance of the offspring (F1 generation) born from the first clutch of the parental (F0) generation. The extended generational assay was performed simultaneously with the standard reproduction assay. With this design, we evaluated the lethal, reproductive, and transgenerational effects of four widespread and extensively used substances: a biocide/anti-fouling (copper sulphate), an industrial oxidizing agent (potassium dichromate), a pharmaceutical (paracetamol), and a quaternary ammonium compound (benzalkonium chloride). Benzalkonium chloride was the most toxic in terms of lethality, whereas paracetamol, copper sulphate, and potassium dichromate caused deleterious effects in the reproductive performance of exposed D. magna. Adverse effects in the fitness of the daughter (F1) generation were observed in the case of maternal exposure to paracetamol and copper sulphate, although they were not very pronounced. These findings highlight the usefulness of our approach and reinforce the view-shared by other authors-of the need for a generalised formal assessment of the transgenerational effects of pollutants.

Assessment of ecotoxicological effects of ciprofloxacin in Daphnia magna: life-history traits, biochemical and genotoxic effects.

Antibiotics (e.g. ciprofloxacin) have been detected in surface water and groundwater for several decades. In order to understand the potential impact of the continuous exposure of aquatic organisms to ciprofloxacin, a chronic assay was carried out with Daphnia magna. This approach allowed evaluation of the effects of ciprofloxacin on life-history and sub-individual parameters (antioxidant status and metabolic response: activities of catalase and glutathione S-transferases - GSTs; peroxidative damage; thiobarbituric acid reactive substances and genotoxic effects (genetic damage index, measured by the comet assay). Life-history parameters of D. magna showed no significant effects after ciprofloxacin exposure. Concerning oxidative stress and metabolism parameters, no significant alterations were reported for catalase and GSTs activities. However, a dual response was observed, with a significant decrease in lipid peroxidation levels at low ciprofloxacin concentrations (<0.013 mg/L), while a significant increase was verified at high ciprofloxacin concentrations (0.078 mg/L). The genotoxicity assay detected a significant increase in genetic damage index up to 0.013 mg/L of ciprofloxacin. The here-tested ciprofloxacin concentrations, which are ecologically relevant, did not cause significant impacts concerning the life-history parameters of D. magna; however, at the same levels of ciprofloxacin an oxidative stress and genotoxic damage scenarios were recorded.

Beliefs and attitudes towards the influenza vaccine in high-risk individuals.

Societal and economic impact of influenza is mainly due to influenza infection of specific groups, who are at higher risk of health complications leading up to hospitalisation or death. In this study we applied the health belief model (HBM) to evaluate beliefs and attitudes towards influenza disease and vaccine in community-dwelling high-risk individuals (aged 65 or more or having a chronic disease). We conducted a mixed-method study using data collected through a telephone survey of a household unit sample. We used thematic analysis to map responses to HBM dimensions and Poisson regression to model vaccine non-uptake prevalence. The main self-reported reason not to take the vaccine referred to the susceptibility dimension: 'considering oneself to be a healthy person' (29·8%, (95% confidence interval (CI) 22·1-38·7)). Bad experiences after vaccination - barriers dimension - were also commonly reported (17·0%, (95% CI 10·8-23·8)). Vaccine non-uptake prevalence was 22% higher in those who did not consider themselves susceptible to contract flu (Prevalence Ratio (PR) = 1·22, (95% CI 1·0-1·5)) and 18% lower in those who did not consider that the vaccine causes flu symptoms (PR = 0·82, (95% CI 0·68-0·99)). Results suggest that high-risk individuals do not think of themselves susceptible to influenza infection and fear adverse events following immunisation.

Biomonitoring of environmental stress in Pollicipes pollicipes from the northern coast of Portugal: a non-destructive approach using haemolymph.

In the intertidal area, the interactions between anthropogenic contaminants and natural variations (biotic and abiotic factors) are poorly understood. Consequently, there is a great need for new assessment procedures to characterize the biological responses occurring in organisms from this extreme environment. Considering the intrinsic inter-individual variations among organisms from a single population, it is important to propose new methods that address this variability, by validating a sampling strategy in target groups of organisms, encompassing seasonal fluctuations. This strategy must however be less invasive than traditional methods, avoiding the mandatory sacrifice of the sampled organisms. By doing so, it is also possible to increase the ecological relevance of obtainable data, and contribute to minimize damage to endangered species. The main purpose of the present study was to assess the influence of seasonal variations in the responses elicited by anthropogenic compounds on a marine crustacean species, by using a biomarker-based approach. According to this purpose, the seasonal variations in key physiological responses (biomarkers) were investigated in the crustacean Pollicipes pollicipes from the Northern coast of Portugal. Biomarkers used for this purpose were the activity of the phase II biotransformation isoenzymes glutathione-S-transferases (GSTs), the activity of cholinesterases (ChEs), and the levels of lipid peroxidation (TBARS). All biomarkers were quantified in distinct tissues (such as cirri, and peduncle) and haemolymph (a non-destructive source of biological samples). The glycogen content in peduncle tissue, and the variation in haemocyte number in haemolymph were also analyzed. Samples were collected monthly, during a year, in Lavadores, located in the proximity of an estuarine area (Douro River). The results showed a seasonal pattern in all tested biomarkers. The results also showed a significant increase in GSTs activities, and in peroxidative damage, especially during warmer months. The lowest ChEs values were recorded during the rainy season. The results also showed a similar pattern among all tested tissues, validating the proposed use of the haemolymph as a source tissue for non-lethal sampling strategy for biomarker determinations. Glycogen content was apparently related to the reproductive cycle, with lower values being observed in spring and summer. Total haemocyte count (THC) increased during summer months. The results pointed to an influence of natural variations in the levels of biomarkers in P. pollicipes, highly dependent upon abiotic factors, a factor that must be considered when interpreting biological responses elicited by anthropogenic contaminants from the marine coastal environment. The validation of haemolymph as a non-lethal source tissue for the quantification of biomarkers was successfully attained, opening the possibility of less invasive and almost unlimited sampling in a small number of organisms.

Whole-organism and biomarker endpoints in Daphnia magna show uncoupling of oxidative stress and endocrine disruption in phenolic derivatives.

During the past century, the amount of chemicals released into water bodies has increased, with particular emphasis being attributed to xenobiotics with endocrine disruption properties and/or pro-oxidant effects. Among these, it is possible to identify a specific chemical class, alkylphenols, which are of widespread use, and include a variety of chemicals with multiple uses. Bisphenol A is an important chemical used in industrial production of plastics, and has been extensively described as an endocrine disruptor. Paracetamol is a pharmaceutical compound used in human medicine, known for its therapeutic action but also for its evident pro-oxidant features. Additionally, previous studies have suggested that paracetamol may also exert endocrine disruption. The main goal of this study was to assess the effects of both paracetamol and bisphenol A as endocrine disruptors, and as promoters of oxidative stress and damage, on the freshwater microcrustacean Daphnia magna. The obtained results showed that bisphenol A was capable of altering population traits of exposed organisms, by impairing molting. On the contrary, paracetamol was not causative of any significant change in this parameter, despite having caused extensive oxidative stress.

Ecotoxicological effect of zinc pyrithione in the freshwater fish Gambusia holbrooki.

Currently diverse biocidal agents can be used for distinct applications, such as personal hygiene, disinfection, antiparasitic activity, and antifouling effects. Zinc pyrithione is an organometallic biocide, with bactericidal, algicidal and fungicidal activities. It has been recently incorporated in antifouling formulas, such as paints, which prevent the establishment of a biofilm on surfaces exposed to the aquatic environment. It has also been used in cosmetics, such as anti-dandruff shampoos and soaps. Previously reported data has shown the presence of this substance in the aquatic compartment, a factor contributing to the potential exertion of toxic effects, and there is also evidence that photodegradation products of zinc pyrithione were involved in neurotoxic effects, namely by inhibiting cholinesterases in fish species. Additional evidence points to the involvement of zinc pyrithione in alterations of metal homeostasis and oxidative stress, in both aquatic organisms and human cell models. The present work assesses the potential ecotoxicity elicited by zinc pyrithione in the freshwater fish Gambusia holbrooki after an acute (96 h) exposure. The oxidative stress was assessed by the quantification of the activities of specific enzymes from the antioxidant defense system, such as catalase, and glutathione-S-transferases; and the extent of peroxidative damage was quantified by measuring the thiobarbituric acid reactive substances levels. Neurotoxicity was assessed through measurement of acetylcholinesterase activity; and a standardized method for the description and assessment of histological changes in liver and gills of was also used. Zinc pyrithione caused non-specific and reversible tissue alterations, both in liver and gills of exposed organisms. However, histopathological indices were not significantly different from the control group. In terms of oxidative stress biomarkers, none of the tested biomarkers indicated the occurrence of pro-oxidative effects, suggesting that the oxidative pathway is not the major toxicological outcome of exposure to zinc pyrithione.

Excess mortality among the elderly in European countries, December 2014 to February 2015.

Since December 2014 and up to February 2015, the weekly number of excess deaths from all-causes among individuals ≥ 65 years of age in 14 European countries have been significantly higher than in the four previous winter seasons. The rise in unspecified excess mortality coincides with increased proportion of influenza detection in the European influenza surveillance schemes with a main predominance of influenza A (H3N2) viruses seen throughout Europe in the current season, though cold snaps and other respiratory infections may also have had an effect.

Acute effects of tetracycline exposure in the freshwater fish Gambusia holbrooki: antioxidant effects, neurotoxicity and histological alterations.

A large body of evidence was compiled in the recent decades showing a noteworthy increase in the detection of pharmaceutical drugs in aquatic ecosystems. Due to its ubiquitous presence, chemical nature, and practical purpose, this type of contaminant can exert toxic effects in nontarget organisms. Exposure to pharmaceutical drugs can result in adaptive alterations, such as changes in tissues, or in key homeostatic mechanisms, such as antioxidant mechanisms, biochemical/physiological pathways, and cellular damage. These alterations can be monitored to determine the impact of these compounds on exposed aquatic organisms. Among pharmaceutical drugs in the environment, antibiotics are particularly important because they include a variety of substances widely used in medical and veterinary practice, livestock production, and aquaculture. This wide use constitutes a decisive factor contributing for their frequent detection in the aquatic environment. Tetracyclines are the individual antibiotic subclass with the second highest frequency of detection in environmental matrices. The characterization of the potential ecotoxicological effects of tetracycline is a much-required task; to attain this objective, the present study assessed the acute toxic effects of tetracycline in the freshwater fish species Gambusia holbrooki by the determination of histological changes in the gills and liver, changes in antioxidant defense [glutathione S-transferase (GST), catalase (CAT), and lipoperoxidative damage] as well as potential neurotoxicity (acetylcholinesterase activity). The obtained results suggest the existence of a cause-and-effect relationship between the exposure to tetracycline and histological alterations (more specifically in gills) and enzymatic activity (particularly the enzyme CAT in liver and GST in gills) indicating that this compound can exert a pro-oxidative activity.

Influenza vaccine effectiveness estimates in Europe in a season with three influenza type/subtypes circulating: the I-MOVE multicentre case-control study, influenza season 2012/13.

In the fifth season of Influenza Monitoring Vaccine Effectiveness in Europe (I-MOVE), we undertook a multicentre case-control study (MCCS) in seven European Union (EU) Member States to measure 2012/13 influenza vaccine effectiveness against medically attended influenza-like illness (ILI) laboratory confirmed as influenza. The season was characterised by substantial co-circulation of influenza B, A(H1N1)pdm09 and A(H3N2) viruses. Practitioners systematically selected ILI patients to swab ≤7 days of symptom onset. We compared influenza-positive by type/subtype to influenza-negative patients among those who met the EU ILI case definition. We conducted a complete case analysis using logistic regression with study as fixed effect and calculated adjusted vaccine effectiveness (AVE), controlling for potential confounders (age, sex, symptom onset week and presence of chronic conditions). We calculated AVE by type/subtype. Study sites sent 7,954 ILI/acute respiratory infection records for analysis. After applying exclusion criteria, we included 4,627 ILI patients in the analysis of VE against influenza B (1,937 cases), 3,516 for A(H1N1)pdm09 (1,068 cases) and 3,340 for influenza A(H3N2) (730 cases). AVE was 49.3% (95% confidence interval (CI): 32.4 to 62.0) against influenza B, 50.4% (95% CI: 28.4 to 65.6) against A(H1N1)pdm09 and 42.2% (95% CI: 14.9 to 60.7) against A(H3N2). Our results suggest an overall low to moderate AVE against influenza B, A(H1N1)pdm09 and A(H3N2), between 42 and 50%. In this season with many co-circulating viruses, the high sample size enabled stratified AVE by type/subtype. The low estimates indicate seasonal influenza vaccines should be improved to achieve acceptable protection levels.

A large community outbreak of Legionnaires disease in Vila Franca de Xira, Portugal, October to November 2014.

An outbreak of Legionnaires' disease with 334 confirmed cases was identified on 7 November 2014 in Vila Franca de Xira, Portugal and declared controlled by 21 November. Epidemiological, environmental and microbiological analysis identified industrial wet cooling systems to be the probable source of infection. Preliminary results from sequence-based typing of clinical specimens and environmental isolates confirmed this link. A series of meteorological phenomena are likely to have contributed to the scale of this outbreak.

The Gooseneck Barnacle (Pollicipes pollicipes) as a candidate sentinel species for coastal contamination.

The assessment of toxic effects caused by complex mixtures of contaminants in the marine environment requires previous validation of toxicological criteria, which may include biomarker end points with distinct biological meanings. This is the case of oxidative stress/phase II detoxification (glutathione-S-transferases activity), oxidative damage (thiobarbituric acid reactive substances), and neurotransmission (cholinesterase activity), which are likely to be affected after toxic insults by common marine pollutants. The main purpose of the present study was to assess potential biological alterations in the mollusk species Pollicipes pollicipes (gooseneck barnacle) caused by human contamination and seasonality, during a period of 1 year, in three different areas of the North Atlantic shore of Portugal. Our results indicate that fluctuations of the mentioned biomarkers were strongly related to seasonality, but they may also suffer influence by the already documented patterns of chemical contamination. Organisms collected in contaminated sampling sites (urban areas and oil refinery) showed greater levels of metabolic enzymes and increased levels of lipid peroxidation. These alterations were more evident during the summer, and, in some cases, spring months, suggesting an association between the presence of chemical stressors and temperature-dependent seasonal physiological fluctuations, which contribute to the modulation of the toxic response. In general terms, P. pollicipes was shown to be a promising organism in coastal biomonitoring programs, with an adequate sensitivity toward contamination and/or seasonal fluctuations. However, it is of the utmost importance to consider seasonal fluctuations in physiological parameters that modulate the toxic response. These factors can ultimately compromise the development and interpretation of data from marine biomonitoring programs if a thorough characterization of biological responses is not previously performed.

Pooling European all-cause mortality: methodology and findings for the seasons 2008/2009 to 2010/2011.

Several European countries have timely all-cause mortality monitoring. However, small changes in mortality may not give rise to signals at the national level. Pooling data across countries may overcome this, particularly if changes in mortality occur simultaneously. Additionally, pooling may increase the power of monitoring populations with small numbers of expected deaths, e.g. younger age groups or fertile women. Finally, pooled analyses may reveal patterns of diseases across Europe. We describe a pooled analysis of all-cause mortality across 16 European countries. Two approaches were explored. In the 'summarized' approach, data across countries were summarized and analysed as one overall country. In the 'stratified' approach, heterogeneities between countries were taken into account. Pooling using the 'stratified' approach was the most appropriate as it reflects variations in mortality. Excess mortality was observed in all winter seasons albeit slightly higher in 2008/09 than 2009/10 and 2010/11. In the 2008/09 season, excess mortality was mainly in elderly adults. In 2009/10, when pandemic influenza A(H1N1) dominated, excess mortality was mainly in children. The 2010/11 season reflected a similar pattern, although increased mortality in children came later. These patterns were less clear in analyses based on data from individual countries. We have demonstrated that with stratified pooling we can combine local mortality monitoring systems and enhance monitoring of mortality across Europe.

Low and decreasing vaccine effectiveness against influenza A(H3) in 2011/12 among vaccination target groups in Europe: results from the I-MOVE multicentre case-control study.

Within the Influenza Monitoring Vaccine Effectiveness in Europe (I-MOVE) project we conducted a multicentre case­control study in eight European Union (EU) Member States to estimate the 2011/12 influenza vaccine effectiveness against medically attended influenza-like illness (ILI) laboratory-confirmed as influenza A(H3) among the vaccination target groups. Practitioners systematically selected ILI / acute respiratory infection patients to swab within seven days of symptom onset. We restricted the study population to those meeting the EU ILI case definition and compared influenza A(H3) positive to influenza laboratory-negative patients. We used logistic regression with study site as fixed effect and calculated adjusted influenza vaccine effectiveness (IVE), controlling for potential confounders (age group, sex, month of symptom onset, chronic diseases and related hospitalisations, number of practitioner visits in the previous year). Adjusted IVE was 25% (95% confidence intervals (CI): -6 to 47) among all ages (n=1,014), 63% (95% CI: 26 to 82) in adults aged between 15 and 59 years and 15% (95% CI: -33 to 46) among those aged 60 years and above. Adjusted IVE was 38% (95%CI: -8 to 65) in the early influenza season (up to week 6 of 2012) and -1% (95% CI: -60 to 37) in the late phase. The results suggested a low adjusted IVE in 2011/12. The lower IVE in the late season could be due to virus changes through the season or waning immunity. Virological surveillance should be enhanced to quantify change over time and understand its relation with duration of immunological protection. Seasonal influenza vaccines should be improved to achieve acceptable levels of protection.

Growth curves for ostriches (Struthio camelus) in a Brazilian population.

The objective of this study was to fit growth curves using nonlinear and linear functions to describe the growth of ostriches in a Brazilian population. The data set consisted of 112 animals with BW measurements from hatching to 383 d of age. Two nonlinear growth functions (Gompertz and logistic) and a third-order polynomial function were applied. The parameters for the models were estimated using the least-squares method and Gauss-Newton algorithm. The goodness-of-fit of the models was assessed using R(2) and the Akaike information criterion. The R(2) calculated for the logistic growth model was 0.945 for hens and 0.928 for cockerels and for the Gompertz growth model, 0.938 for hens and 0.924 for cockerels. The third-order polynomial fit gave R(2) of 0.938 for hens and 0.924 for cockerels. Among the Akaike information criterion calculations, the logistic growth model presented the lowest values in this study, both for hens and for cockerels. Nonlinear models are more appropriate for describing the sigmoid nature of ostrich growth.