Thomas Krafft

Comparing emergency medical service systems—A project of the European Emergency Data (EED) Project ☆

AIM The aim of this prospective study was the comparison of four emergency medical service (EMS) systems-emergency physician (EP) and paramedic (PM) based-and the impact of advanced live support (ALS) on patients status in preclinical care. METHODS The EMS systems of Bonn (GER, EP), Cantabria (ESP, EP), Coventry (UK, PM) and Richmond (US, PM) were analysed in relation to quality of structure, process and performance when first diagnosis on scene was cardiac arrest (OHCA), chest pain or dyspnoea. Data were collected prospectively between 01.01.2001 and 31.12.2004 for at least 12 month. RESULTS Over all 6277 patients were included in this study. The rate of drug therapy was highest in the EP-based systems Bonn and Cantabria. Pain relief was more effective in Bonn in patients with severe chest pain. In the group of patients with chest pain and tachycardia ≥ 120 beats/min, the heart rate was reduced most effective by the EP-systems. In patients with dyspnoea and S(p)O(2) <90% the improvement of oxygen saturation was most effective in Bonn and Richmond. After OHCA significant more patients reached the hospital alive in EMS systems with EPs than in the paramedic staffed (Bonn = 35.6%, Cantabria = 30.1%; Coventry = 11.9%, Richmond = 9.2%). The introduction of a Load Distributing Band chest compression device in Richmond improved admittance rate after OHCA (21.7%) but did not reach the survival rate of the Bonn EMS system. CONCLUSIONS Higher qualification and greater training and experience of ALS unit personnel increased survival after OHCA and improved patients status with cardiac chest pain and respiratory failure.

Study on the association between ambient air pollution and daily cardiovascular and respiratory mortality in an urban district of Beijing.

The association between daily cardiovascular/respiratory mortality and air pollution in an urban district of Beijing was investigated over a 6-year period (January 2003 to December 2008). The purpose of this study was to evaluate the relative importance of the major air pollutants [particulate matter (PM), SO2, NO2] as predictors of daily cardiovascular/respiratory mortality. The time-series studied comprises years with lower level interventions to control air pollution (2003–2006) and years with high level interventions in preparation for and during the Olympics/Paralympics (2007–2008). Concentrations of PM10, SO2, and NO2, were measured daily during the study period. A generalized additive model was used to evaluate daily numbers of cardiovascular/respiratory deaths in relation to each air pollutant, controlling for time trends and meteorological influences such as temperature and relative humidity. The results show that the daily cardiovascular/respiratory death rates were significantly associated with the concentration air pollutants, especially deaths related to cardiovascular disease. The current day effects of PM10 and NO2 were higher than that of single lags (distributed lags) and moving average lags for respiratory disease mortality. The largest RR of SO2 for respiratory disease mortality was in Lag02. For cardiovascular disease mortality, the largest RR was in Lag01 for PM10, and in current day (Lag0) for SO2 and NO2. NO2 was associated with the largest RRs for deaths from both cardiovascular disease and respiratory disease.

European Emergency Data Project (EED Project): EMS data-based Health Surveillance System

Emergency Medical Services (EMS) constitute a unique component of health care at the interface between primary and hospital care. EMS data within the pre-hospital setting represents an unparalleled source of epidemiological and health care information that have so far been neglected for public health monitoring. The European Emergency Data Project (EED Project) thus intends to identify common indicators for European EMS systems and to evaluate their suitability for integration into a comprehensive public health monitoring strategy. The article provides a brief overview on objectives and methodology in the form of a progress report.

Effects of Several Environmental Factors on Longevity and Health of the Human Population of Zhongxiang, Hubei, China

Increasing human health and longevity is of global interest. Environmental, genetic, and stochastic factors all affect longevity. Among these factors, the environment is extremely important. To investigate the relationship between the environment and longevity, we studied the environment in Zhongxiang (China), where the inhabitants commonly have long life spans. Air was analyzed for negative oxygen ions, SO2, and inhalable particles, while drinking water and rice were analyzed for macro- and micro-elements. The air quality in this area was determined to be grade I with high negative oxygen ion content and low SO2 and inhalable particle contents. Apart from Fe, Mn, and F, all tested elements and the pH were within national standards and World Health Organization guidelines. The percentage of long-lived people in the area was closely related to the macro- and micro-element contents of their staple food, rice. The elements in rice could be classified into three categories according to their effect on longevity: Sr, Ca, Al, Mo, and Se, which were positively correlated with longevity; Fe, Mn, Zn, Cr, P, Mg, and K, which had a weak effect on local longevity, and Cu and Ba, which had a negative effect on longevity.

The Spatial Distribution of Hepatitis C Virus Infections and Associated Determinants--An Application of a Geographically Weighted Poisson Regression for Evidence-Based Screening Interventions in Hotspots.

Background Hepatitis C Virus (HCV) infections are a major cause for liver diseases. A large proportion of these infections remain hidden to care due to its mostly asymptomatic nature. Population-based screening and screening targeted on behavioural risk groups had not proven to be effective in revealing these hidden infections. Therefore, more practically applicable approaches to target screenings are necessary. Geographic Information Systems (GIS) and spatial epidemiological methods may provide a more feasible basis for screening interventions through the identification of hotspots as well as demographic and socio-economic determinants. Methods Analysed data included all HCV tests (n = 23,800) performed in the southern area of the Netherlands between 2002–2008. HCV positivity was defined as a positive immunoblot or polymerase chain reaction test. Population data were matched to the geocoded HCV test data. The spatial scan statistic was applied to detect areas with elevated HCV risk. We applied global regression models to determine associations between population-based determinants and HCV risk. Geographically weighted Poisson regression models were then constructed to determine local differences of the association between HCV risk and population-based determinants. Results HCV prevalence varied geographically and clustered in urban areas. The main population at risk were middle-aged males, non-western immigrants and divorced persons. Socio-economic determinants consisted of one-person households, persons with low income and mean property value. However, the association between HCV risk and demographic as well as socio-economic determinants displayed strong regional and intra-urban differences. Discussion The detection of local hotspots in our study may serve as a basis for prioritization of areas for future targeted interventions. Demographic and socio-economic determinants associated with HCV risk show regional differences underlining that a one-size-fits-all approach even within small geographic areas may not be appropriate. Future screening interventions need to consider the spatially varying association between HCV risk and associated demographic and socio-economic determinants.

The association between daily outpatient visits for allergic rhinitis and pollen levels in Beijing

To investigate the effects of aerosol pollen on human health, we carried out a time-series analysis of daily general practitioner consultations for allergic rhinitis (AR) in Beijing. The objective of this study was to assess the possible effects of pollen on clinic visits for allergic rhinitis in Beijing during the pollen season. We found a strong association between the concentration of pollen in ambient air and the number of consultations for allergic rhinitis. Females had significantly more outpatient visits than males when the levels of pollen increased. Young people (20-60 years old) had had significantly more outpatient visits than older people (over 60 years old) when the levels of pollen increased. After adjusting for air pollutants, the relative risks of pollen on daily number of outpatient for AR were increased.

A study of air pollutants influencing life expectancy and longevity from spatial perspective in China

Life expectancy and longevity are influenced by air pollutants and socioeconomic status, but the extend and significance are still unclear. Better understanding how the spatial differences of life expectancy and longevity are affected by air pollutants is needed for generating public health and environmental strategies since the whole of China is now threatened by deteriorated air quality. 85 major city regions were chosen as research areas. Geographically Weighted Regression (GWR) and Stepwise Regression (SR) were used to find the spatial correlations between health indicators and air pollutants, adjusted by per capita GDP(1). The results were, regions with higher life expectancy were mainly located in the east area and areas with good air quality, a regional difference of 10 μg/m(3) in ambient air SO2(2) could cause adjusted 0.28 years difference in life expectancy, a regional difference of 10 μg/m(3) in ambient air PM10(3) could lead to a longevity ratio difference of 2.23, and per capita GDP was positively associating with life expectancy but not longevity ratio, with a regional difference of 10,000 RMB(4) associating with adjusted 0.49 years difference in life expectancy. This research also showed the evidences that there exist spatially differences for ambient air PM10 and SO2 influencing life expectancy and longevity in China, and this influences were clearer in south China.

The lag effects and seasonal differences of air pollutants on allergic rhinitis in Beijing

To investigate the lag effects and seasonal differences of urban air quality change on human health, we carried out a time-series analysis of daily general practitioner consultations for allergic rhinitis (AR) in Beijing, China. In earlier publications we had assessed the relative risks of air pollutants on AR in Beijing during the period 2009-2010. This article analyzes for the same time period the lag effects of air pollutants and the seasonal effects on daily number of outpatient with allergic rhinitis; differences among age groups and gender groups were also taken into consideration. The results show that, the largest effect RRs of PM(10) were at lag01, lag0, lag01, lag01, and lag01 for the total population, male, female, young/middle aged people (20-60 years age group), and old people (more than 60 years age group), respectively. The largest associations of SO(2) were observed at lag3, lag1, lag3, lag0 and lag0 for the total population, male, female, young people/middle aged people (20-60 years age group), and old people (more than 60 years age group), respectively. The strongest effects of NO(2) were found at lag03 for the total population, female and the young/middle aged people; at lag0 for male and lag03 for elder people. RRs of the three pollutants for AR have shown a decreasing relevance from NO(2) to PM(10) to SO(2). The seasonal effect models show that PM(10), SO(2), and NO(2) had higher risk for AR in the warm season than in the cold season.

Structure modification and extracellular polymeric substances conversion during sewage sludge biodrying process

Biodrying, an economical and energy-saving biomass waste treatment, removes water from waste using the biological heat generated by organic matter degradation. Technical limitations associated with dewatering complicate the biodrying of sewage sludge. This study investigated the sludge alteration associated with its water removal, focusing on sludge form, extracellular polymeric substances, and free water release. An auto-feedback control technology was used for the biodrying; a scanning electron microscope was used to record the morphological change; three-dimensional excitation-emission matrix fluorescence spectroscopy was used to analyze extracellular polymeric substances (EPS) variation, and time domain reflectometry was used to assess the free water release. Over the 20-day biodrying, there was a 62% water removal rate during the first thermophilic phase. Biodrying created a hollow and stratified sludge structure. Aromatic proteins and soluble microbial byproducts in the EPS were significantly degraded. The thermophilic phase was the phase resulting in the greatest free water release.

Estimating the spatial distribution of acute undifferentiated fever (AUF) and associated risk factors using emergency call data in India. A symptom-based approach for public health surveillance

The System for Early-warning based on Emergency Data (SEED) is a pilot project to evaluate the use of emergency call data with the main complaint acute undifferentiated fever (AUF) for syndromic surveillance in India. While spatio-temporal methods provide signals to detect potential disease outbreaks, additional information about socio-ecological exposure factors and the main population at risk is necessary for evidence-based public health interventions and future preparedness strategies. The goal of this study is to investigate whether a spatial epidemiological analysis at the ecological level provides information on urban-rural inequalities, socio-ecological exposure factors and the main population at risk for AUF. Our results displayed higher risks in rural areas with strong local variation. Household industries and proximity to forests were the main socio-ecological exposure factors and scheduled tribes were the main population at risk for AUF. These results provide additional information for syndromic surveillance and could be used for evidence-based public health interventions and future preparedness strategies.