Meeting the International Health Regulations (2005) surveillance core capacity requirements at the subnational level in Europe: the added value of syndromic surveillance

BACKGROUND: The revised World Health Organization's International Health Regulations (2005) request a timely and all-hazard approach towards surveillance, especially at the subnational level. We discuss three questions of syndromic surveillance application in the European context for assessing public health emergencies of international concern: (i) can syndromic surveillance support countries, especially the subnational level, to meet the International Health Regulations (2005) core surveillance capacity requirements, (ii) are European syndromic surveillance systems comparable to enable cross-border surveillance, and (iii) at which administrative level should syndromic surveillance best be applied? DISCUSSION: Despite the ongoing criticism on the usefulness of syndromic surveillance which is related to its clinically nonspecific output, we demonstrate that it was a suitable supplement for timely assessment of the impact of three different public health emergencies affecting Europe. Subnational syndromic surveillance analysis in some cases proved to be of advantage for detecting an event earlier compared to national level analysis. However, in many cases, syndromic surveillance did not detect local events with only a small number of cases. The European Commission envisions comparability of surveillance output to enable cross-border surveillance. Evaluated against European infectious disease case definitions, syndromic surveillance can contribute to identify cases that might fulfil the clinical case definition but the approach is too unspecific to comply to complete clinical definitions. Syndromic surveillance results still seem feasible for comparable cross-border surveillance as similarly defined syndromes are analysed. We suggest a new model of implementing syndromic surveillance at the subnational level. In this model, syndromic surveillance systems are fine-tuned to their local context and integrated into the existing subnational surveillance and reporting structure. By enhancing population coverage, events covering several jurisdictions can be identified at higher levels. However, the setup of decentralised and locally adjusted syndromic surveillance systems is more complex compared to the setup of one national or local system. SUMMARY: We conclude that syndromic surveillance if implemented with large population coverage at the subnational level can help detect and assess the local and regional effect of different types of public health emergencies in a timely manner as required by the International Health Regulations (2005)

Nuclear morphometry lacks prognostic value in squamous cell carcinoma of the oesophagus

In order to determine the possible influence in oesophageal squamous cell carcinoma of nuclear measurements on patients' postoperative survival and on various histological tumour features, we performed a nuclear morphometry study on 53 patients (50 males, 3 females) with a mean age of 57.4 years (37-79). A statistical correlation was revealed between area, perimeter and diameter and the analysis was, therefore, performed only in terms of nuclear area. No influence of nuclear area on postoperative survival was observed. Nor was a relationship fourld between rnean nuclear area and either involvement of the oesophageal wall or degree of histological differentiation. The tumours showing expansive growth had a larger mean nuclear area than those of the infiltrative growth type, although differences did not reach statistical significance. The nuclear area standard deviation (reflecting anisocytosis of the tumour) showed no correlation with sllrvivill. In conclusion. our data do not support that measurement of nuclear parameters by static methods is of any prognostic value in surgically-treated squamous cell carcinoma of the oesophagus

Selective nuclear morphometry as a prognostic factor of survival in renal cell carcinoma

In the present study, we sought to determine the predictive value of selective nuclear morphometry (SNM) for patient outcome in renal cell carcinoma (RCC). Tumor samples of 140 renal adenocarcinomas diagnosed and treated with radical nephrectomy and hilar lymphadenectomy between 1970 and 1988 with a minimum follow up of 5 years in all the cases were studied by SNM. The morphometric analysis was performed in the most malignant tumor selected zone. Selection was based on cytological criteria including nuclear grade. Nuclear morphometric features analyzed were: area, perimeter, major diameter, major and minor diameter of the equivalent ellipse, volume of the equivalent ellipse and sphere, circumference diameter, and shape factors. The results showed that in the selected zone tumor nuclei were larger than in the zones selected at random. There was an inverse correlation between morphometric parameters and survival and a direct one between tumoral grade and stage. Tumors of the longterm survival group of patients presented nuclei with smaller morphometric measurements than tumors of short term survival group, with significant differences between them (pe0.05). In the survival analysis carried out by the Kaplan-Meier method significant differences existed between different groups formed from break point for: area, perimeter, major diameter, major and minor diameter of the ellipse, volume of the ellipse and sphere, circumference diameter and perimeter shape factor. In the multivariate analysis carried out by the Cox method, the feature with the most predictable value related to survival, was the tumor stage. Morphometric value with the highest punctuation in the test was major nuclear diameter. The rest of the morphometric values (except elliptic shape factor and elongation factor) were also significant but they did not improve prognostic information of the major nuclear diameter. SNM offers a useful aid in a more objective grading of RCC. Multivariate Cox analysis revealed additional value of karyometry to tumor stage. SNM can be a useful tool for stratification of patients with RCC

New scopes for practice-interdisciplinary webinars for emergency medicine and biomedical informatics-health informatics

This paper presents the early outcomes of the educational cooperation between two European academic associations, namely the European Federation of Medical Informatics (EFMI) and European Society of Emergency Medicine (EUSEM). Two webinars were organized in December 2019 and June 2020 to explore areas where mutual education would be beneficial for interdisciplinary cooperation to advance the digitization of emergency departments for the benefit of patients, health professionals and the health system as a whole. Preliminary findings from the analysis of these two webinars are presented and the steps for further cooperation are outlined. © 2020 The European Federation for Medical Informatics (EFMI) and IOS Press

Local implementation of a syndromic influenza surveillance system using emergency department data in Santander, Spain

Background We assessed the local implementation of syndromic surveillance (SyS) as part of the European project 'System for Information on, Detection and Analysis of Risks and Threats to Health' in Santander, Spain. Methods We applied a cumulative sum algorithm on emergency department (ED) chief complaints for influenza-like illness in the seasons 2010-11 and 2011-12. We fine tuned the algorithm using a receiver operating characteristic analysis to identify the optimal trade-off of sensitivity and specificity and defined alert criteria. We assessed the timeliness of the SyS system to detect the onset of the influenza season. Results The ED data correlated with the sentinel data. With the best algorithm settings we achieved 70/63% sensitivity and 89/95% specificity for 2010-11/2011-12. At least 2 consecutive days of signals defined an alert. In 2010-11 the SyS system alerted 1 week before the sentinel system and in 2011-12 in the same week. The data from the ED is available on a daily basis providing an advantage in timeliness compared with the weekly sentinel data. Conclusions ED-based SyS in Santander complements sentinel influenza surveillance by providing timely information. Local fine tuning and definition of alert criteria are recommended to enhance validity

Raum-zeitliche Analysealgorithmen zur Früherkennung von Gesundheitsgefahren - Der SIDARTHa-Ansatz

Krafft T, Ziemann A, Tenelsen T, et al. Raum-zeitliche Analysealgorithmen zur Früherkennung von Gesundheitsgefahren - Der SIDARTHa-Ansatz. In: Strobl J, Blaschke T, Griesebner G, eds. Angewandte Geoinformatik 2009 : Beiträge zum 21. AGIT-Symposium Salzburg. Heidelberg: Wichmann; 2009: 238-243

A concept for routine emergency-care data-based syndromic surveillance in Europe

Ziemann A, Rosenkoetter N, Riesgo LG-C, et al. A concept for routine emergency-care data-based syndromic surveillance in Europe. Epidemiology and Infection. 2014;142(11):2433-2446.We developed a syndromic surveillance (SyS) concept using emergency dispatch, ambulance and emergency-department data from different European countries. Based on an inventory of sub-national emergency data availability in 12 countries, we propose framework definitions for specific syndromes and a SyS system design. We tested the concept by retrospectively applying cumulative sum and spatio-temporal cluster analyses for the detection of local gastrointestinal outbreaks in four countries and comparing the results with notifiable disease reporting. Routine emergency data was available daily and electronically in 11 regions, following a common structure. We identified two gastrointestinal outbreaks in two countries; one was confirmed as a norovirus outbreak. We detected 1/147 notified outbreaks. Emergency-care data-based SyS can supplement local surveillance with near real-time information on gastrointestinal patients, especially in special circumstances, e. g. foreign tourists. It most likely cannot detect the majority of local gastrointestinal outbreaks with few, mild or dispersed cases