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Background Due to the changes in demographics and morbidity, the demand for emergency medical services (EMS) in Germany continues to rise, which requires further enhancement of acute care structures especially between the sectors of outpatient and inpatient care. Therefore, the concept of the community paramedic (in German "Gemeindenotfallsanitater" [G-NFS]) was introduced in 2019 in the region of Oldenburg, Germany, as part of a pilot project with scientific supervision. Methods In this mixed-methods study, online focus group interviews (participation of 56.7% of all G-NFS) were conducted with all four regional groups of G-NFS (city of Oldenburg and the districts of Vechta, Cloppenburg, and Ammerland). In addition, a short online survey (participation of 53.3% of all G-NFS) was carried out with the same interviewees. The interviews and the online survey focused on the personal experiences of the G-NFS before and during the corona pandemic. The interview findings were analyzed based on thematic coding and subsequent evaluation. Results In all, 17 G-NFS participated in the interviews, and 16 G-NFS took part in the survey. According to the G-NFS, the EMS system (so far based on non-urgent and urgent care ambulances) is complemented by the G-NFS with a useful and skilled resource, which offers the necessary relief for urgent care ambulances. The indispensable cross-sectional collaboration with other services works target-oriented and efficiently but differs depending on the local setting. The same applies to the collaboration with the responsible dispatch centers. In addition, the G-NFS was dispatched to triage patients during the corona pandemic peaks and eased the burden on the overall EMS system in the region. Conclusion The G-NFS who participated believe that the concept has thus far in the project phase proven to be very useful. Based on the present experiences and results, the concept can be further developed.

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Purpose Narrow-diameter implants have become popular, as bone augmentation procedures can frequently be avoided. In order to provide implants with sufficient strength, a titanium-zirconium (Ti-Zr) alloy has recently been introduced purportedly showing improved mechanical properties as compared to commercially pure titanium (cpTi). This paper reports on the clinical and fractographic aspects of a fractured Ti-Zr implant, generally considered a rare event. Materials and methods A narrow-diameter Ti-Zr implant was placed in a patient aged 66 years in the area of the maxillary right canine and used to support a removable partial denture retained by cylindrical telescopic crowns placed on the implant and on the maxillary left canine. Eleven months after successful osseointegration, the patient presented with a horizontally fractured implant. The fractured part was retrieved for fractographic analysis. Results The implant fractured just apical to the abutment screw, where the wall thickness of the implant is minimal. Scanning electron microscopy (SEM) analysis revealed the starting point of the fracture at the palatal aspect of the implant. No fatigue striations could be observed, indicating a brittle fracture atypical for Ti-based alloys. Conclusions The fractographic observations correlate with the given loading situation, which is characterized by high levels of moment loading being imposed on the implant by a rigidly retained cantilever prosthesis. Mechanical overload going beyond the approved indications for Roxolid implants (Straumann) has to be seen as primary cause for this fracture.

Recently a number of innovative surveillance approaches have been piloted or implemented in several parts of the country. Though Chinese cities have usually a sufficient health infrastructure that is included in the national surveillance system, the differences in treatment seeking behavior of a diverse urban population and the still unresolved issue of affordability and or accessibility of care for the less affluent or the floating population still demand more comprehensive surveillance strategies. The aim of this chapter is to depict the role and potential of syndromic surveillance in enhancing the capacities for early detection of disease outbreaks

Infectious disease outbreaks like H1N1 and more recently Ebola, have once more highlighted that health surveillance and early detection are critical core functions to improve the capacity, preparedness and responsiveness of the Indian public health system. The systematic use of routinely collected health care information to enhance and complement the already existing data reporting systems and to strengthen the effectiveness and sustainability of local health systems remains almost untapped. In this book chapter the system for early-warning based on routinely collected emergency data from GVK EMRI is discussed and highlights the potential of routinely collected health information for health surveillance activities. The regional focus is the Indian state of Andhra Pradesh.

This paper studies the association between concentration of ambient air pollutants and daily mortality number in an urban area of Beijing. Different age and gender groups were taken into consideration. The results showed that, for all the groups, the average daily mortality number showed an increasing trend from June to January of next year, and a decreasing trend from February to June. When the concentration of air pollutants increased, the health risk also increased. In multi-pollutants models, the pollutants had a decreasing order NO2, PM10, SO2 for the different gender groups when the concentration of pollutants increased, and had a decreasing order NO2, PM10, SO2 for different age groups when the levels of pollutants increased. Lag effects of air pollutants and seasonal differences also were found. The results of our study could serve to strengthen the local evidence base for air pollution-related health effects that is imminently needed for better air quality management, and also adds valuable information from Beijing.

Migration and health in China: challenges and responses. IHDP Update 2011, 1:35-41.

Objetivos: La utilización por parte de la población de los recursos sanitarios se encuentra relacionada con los niveles de salud y con factores socioeconómicos. Los grupos de población con menor nivel socioeconómico tienen una mayor utilización de determinados recursos sanitarios; los servicios de urgencia podrían presentar un uso diferencial entre los distintos grupos de población. El presente estudio pretende identificar diferencias en el uso de los recursos de atención urgente entre grupos con diferentes características socioeconómicas. Material y métodos: Se realiza un estudio poblacional, en el que mediante el agrupamiento de las secciones censales de la ciudad de Santander, según variables sociodemográficas (edad, nivel de formación y nivel de empleo), se establecen áreas de la ciudad con similares características, mediante análisis de clusters. Se identifica el origen de los pacientes que consultan en el Servicio de Urgencias Hospitalarias (SUH) del Hospital Marqués de Valdecilla, y se calcula la tasa de demanda para cada una de las áreas sociodemográficas. Resultados: El análisis de clusters es capaz de identificar cuatro agrupaciones de diferentes características socioeconómicas que se ajustan a barrios de la ciudad de Santander. Se aprecia una mayor utilización del SUH en los grupos sociales más desfavorecidos y de mayor edad media (odds ratio [OR] = 1,91; intervalo de confianza [IC] del 95% 1,73-2,1) de la agrupación 1 con respecto a la 4. La proporción de ingresos es superior en las agrupaciones más favorecidas, mientras que el número de usuarios que realizan visitas repetidas proceden de agrupaciones con menor nivel socioeconómico. Conclusión: La utilización del SUH está condicionada por las características sociodemográficas del área de residencia, identificándose mayor uso entre los grupos de más bajo nivel socioeconómico. Objectives: Health resources utilization is related to health conditions and to the population's sociodemographic characteristics. Low socioeconomic groups show increased utilization of certain resources. Emergency department utilization could also be affected by socioeconomic factors. The aim of this study was to identify differences in emergency department utilization among different socioeconomic groups. Material and methods: A population-based study was performed. Census sections of the city of Santander in Spain were grouped according to sociodemographic variables (age, educational and professional attinment). Areas of the city with similar socioeconomic characteristics were established by cluster analysis. The place of residence of patients visiting the emergency department of th Hospital Marqués de Valdecilla was identified and the utilization rate was calculated for each cluster. Results: Cluster analysis was able to identify four different groups, each with different socioeconomic characteristics, which were closely related to the districts of Santander. Comparison of clusters 1 and 4 showed that increased emergency department utilization was found amongst groups with lowest socioeconomic status and higher mean age, with an odds ratio of 1.91 (95% CI: 1.73-2.1). Patients from higher socioeconomic groups were more likely to be admitted to hospital while those from lower socioeconomic groups made more repeat visits to the emergency department. Conclusion: Emergency department utilization is affected by the sociodemographic characteristics of patients' area of residence. Patients with lower socioeconomic status show greater use of the emergency department.