Thomas Krafft

• Maastricht University

Background The World Health Organization Emergency Care Systems Framework (WHO ECSF) was designed to offer guidance in establishing and developing effective Emergency Medical Services (EMS) systems. However, evolving disease patterns, changing community needs, and a rising demand for emergency care services, highlight the need for more integrated a...

Emergency Medical Services (EMS) have developed from a war context into a complex scenario of rapid urbanization and great interconnectivity, which includes cross-border areas. Specificities of these areas are underrepresented in studies about EMS. The aim of this work is to provide a better comprehension of emergency care in cross-border settings....

Cities are recognized as significant contributors to carbon emissions due to their numerous productive enterprises and dense populations. Tackling climate change and achieving the transformation to low-carbon cities requires public participation. News media serve as the primary channel for the public to gain relevant information, and journalists’ a...

Climate change presents profound challenges to marine ecosystems and fisheries, necessitating effective management and adaptive strategies. Simultaneously, marine fisheries exacerbate climate change by emitting greenhouse gases through fuel combustion and electricity consumption. This article reviews 142 studies on the bidirectional interactions be...

Introduction The study of crisis events provides important lessons to prepare for upcoming events. The Great Recession’s impact on perinatal health in Europe can provide relevant insights into the healthcare and social protection systems’ response to protecting the health of the most vulnerable groups. Objective To assess time trends and internati...

Introduction The COVID-19 pandemic raised healthcare inequalities, affecting the most vulnerable groups. There is limited evidence of whether the COVID-19 measures and the health system’s preparedness for outbreaks among European countries were sufficient to cover the health access needs of PWDs. Aim To provide a structured overview of the COVID-1...

Introduction The study of crisis events provides important lessons to prepare for upcoming events. The Great Recession’s impact on perinatal health in Europe can provide relevant insights into the healthcare and social protection systems’ response to protecting the health of the most vulnerable groups. Objectives To assess time trends and internat...

The Sustainable Development Goals (SDGs) have set the agenda for 2030, calling for collective global efforts to deal with climate change while seeking a balance between economic development and environmental protection. Although many countries are exploring emission reduction paths, mainly from government and corporate perspectives, addressing clim...

Consistent greenhouse gas (GHG) emissions have induced irreversible impacts on ocean health, requiring urgent action to ensure the green development of the ocean. Marine fishing, a pillar ocean industry, is a major GHG emissions contributor to the ocean because of its heavy reliance on fuel combustion. However, the increasing GHG emissions from mar...

Background: Few studies examine the relationship between socioeconomic factors and trends in mortality in high-income European countries. Due to the lack of regional-level data, most recent studies on social inequality in Portugal do not investigate regional differences. This study analyses time trends and regional disparities in the evolution of p...

Introduction Ambient ozone pollution becomes critical in China. Conclusions on the short-term effects of ozone on cardiovascular mortality have been controversial and limited on cause-specific cardiovascular mortalities and their interactions with season and temperature. This research aimed to investigate the short-term effects of ozone and the mod...

Background Systems thinking can be used as a participatory data collection and analysis tool to understand complex implementation contexts and their dynamics with interventions, and it can support the selection of tailored and effective implementation actions. A few previous studies have applied systems thinking methods, mainly causal loop diagrams...

Introduction The study of crisis events provides important lessons to prepare for upcoming events. The Great Recession’s impact on perinatal health in Europe can provide relevant insights into the healthcare and social protection systems’ response to the protection of the health of the most vulnerable groups. Objective To assess time trends and in...

Background There is consensus that the 2008 financial and economic crisis and related austerity measures adversely impacted access to healthcare. In light of the growing debt caused by the COVID-19 crisis, it is uncertain whether a period of austerity will return. Objective This study aims to provide a structured overview of the impact of austerit...

Background Urinary tract infection (UTI) is particularly common in young women and the elderly. The Emergency Medical Services (EMS) in Copenhagen, Denmark can be reached by calling either of two dedicated telephone lines: 1–1-2 in case of an emergency and 1813 during general practitioner’s (GP) out-of-office hours (OOH). This study investigated ch...

Background and purpose Stroke recognition at the Emergency Medical Services (EMS) impacts the stroke treatment and thus the related health outcome. At the EMS Copenhagen 66.2% of strokes are detected by the Emergency Medical Dispatcher (EMD) and in Denmark approximately 50% of stroke patients arrive at the hospital within the time-to-treatment. An...

Background Many emergency medical services and out-of-hours systems are facing an increasing demand for primary, ambulance, and secondary care services caused by population aging and a higher prevalence of long-term and complex conditions. In order to ensure safety and efficiency for future demands, many systems are changing their dispersed healthc...

The Great Recession and the COVID-19 pandemic, two major crisis events with symmetries across Europe, hada multidimensional impact on access, quality, and outcomes of perinatal and maternal healthcare. It is time to look at what we can learn from these crisis events and to urgently focus on perinatal and maternal healthcare access and quality.

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 “Gemeindenotfallsanitäter...

Low-carbon city transformation is an important action area of China’s 14th Five-Year Plan (2021–2025) that aims to reach peak CO2 emissions by 2030 and achieve carbon neutrality before 2060. Responding to global climate change is not only a national responsibility but also an individual responsibility and very much depends on societal participation...

Background: Climate change, environmental change, and globalization affect the geographical distribution of vector-borne diseases. Temperate regions should be prepared for emerging diseases and learn from each other's experiences. Objectives: The vector-borne disease preparedness in two regions, Beijing and the Netherlands, were compared in orde...

Background: Urinary tract infection (UTI) is particularly common in young women and the elderly. The Emergency Medical Services (EMS) in Copenhagen, Denmark can be reached by calling either of two dedicated telephone lines: 1-1-2 in case of an emergency and 1813 during general practitioner’s (GP) out-of-office hours (OOH). This study investigated c...

Background In the Euregio-Meuse-Rhine (EMR), cross-border collaboration is essential for resource-saving and needs-based patient care within the emergency medical service (EMS) systems and interhospital transport (IHT). However, at the onset of the novel coronavirus SARS-COV-2 (COVID-19) pandemic, differing national measures highlighted the fragmen...

Background An effective emergency medical dispatch process is vital to provide appropriate prehospital care to patients. It increases patient safety and ensures the sustainable use of medical resources. Although Copenhagen has a sophisticated emergency medical services (EMS) system with a significant focus on public welfare, more than 10% of emerge...

This paper aimed to analyze the composition and pollution sources of particulate matter (PM) in the Beijing-Tianjin-Hebei region and its surrounding areas (henceforth the BTH region) during the heating season to support the mitigation and control of regional air pollution. Manual monitoring data from the China National Environmental Monitoring Netw...

Background Dengue is a prioritized public health concern in China. Because of the larger scale, more frequent and wider spatial distribution, the challenge for dengue prevention and control has increased in recent years. While land use and land cover (LULC) change was suggested to be associated with dengue, relevant research has been quite limited....

Objective An effective emergency medical dispatch process is vital to provide appropriate prehospital care to patients. It increases patient safety and ensures the sustainable use of medical resources. Although Copenhagen has a sophisticated emergency medical services (EMS) system with a significant focus on public welfare, more than 10% of emergen...

Background Though inconsistent, acute effects of ambient nitrogen oxides on cardiovascular mortality have been reported. Whereas, interactive roles of temperature on their relationships and joint effects of different indicators of nitrogen oxides were less studied. This study aimed to extrapolate the independent roles of ambient nitrogen oxides and...

Objective: The first wave of the coronavirus SARS-COV-2 pandemic has revealed a fragmented governance within the European Union (EU) to tackle public health emergencies. This qualitative study aims: 1) to understand the current EU position within the field of public health emergencies taking the case of the COVID-19 as an example by comparing and c...

Abstract: Climate change is putting the achievement of all Sustainable Development Goals at risk and leads to negative impacts on human health and well-being. Consequently, tremendous social responsibility lies with public health professionals and their associations. Therefore, this study addressed the following question: “How can the Association o...

Increasing numbers of disasters require comprehensive preparedness. Border regions are vulnerable as disasters might not halt at administrative borders. Cross-border coordination is therefore required. As integral part of cross-border collaborations initiative in the Meuse–Rhine Euregio (EMR), we reviewed published evidence informing on existing in...

Background The WHO identified the importance of macro-socioeconomic determinants and political context as interlinked key factors affecting healthcare quality and health equity. As a response to the recent economic and financial crisis, Portugal approved in 2011 the Economic Adjustment Programme (EAP) to obtain financial assistance from the Troika...

Vast differences in environmental exposures exist between socioeconomic groups at the global, regional, and local level. The associated adverse health outcomes are largely avoidable by policy decisions and therefore unfair and unjust. The definitions of environmental inequality and environmental justice are not clear-cut and depend on the local con...

Background: Climate change may contribute to higher incidence and wider geographic spread of vector borne diseases (VBDs). Effective monitoring and surveillance of VBDs is of paramount importance for the prevention of and timely response to outbreaks. Although international regulations exist to support this, barriers and operational challenges wit...

The aim of the UN Sustainable Development Goals (SDGs) is to achieve a better and more sustainable future for all by 2030. Since the majority of the global population lives in cities, it is crucial to identify, evaluate and implement urban interventions (such as such as zero carbon housing, active transport, better urban connectivity, air pollution...

Whereas the heart of the purpose and activity of the European Union is concerned with economic harmonisation, its internal market, and the freedom of movement of people, goods, services, and capital, necessarily require public health measures. The EU is committed to both human rights and to “Health in All Policies”. This paper considers how that ag...

Background Ambulance dispatches could be useful for syndromic surveillance of severe respiratory infections. We evaluated whether ambulance dispatch calls of highest urgency reflect the circulation of influenza A virus, influenza B virus, respiratory syncytial virus (RSV), rhinovirus, adenovirus, coronavirus, parainfluenzavirus and human metapneumo...

Social, economic, and environmental differences across the European Union significantly affect opportunities to move forward in achieving greater equity in health. Cohesion Policy (CP) funds can contribute positively through investments in the main determinants of health. The aim of this study is to analyze to what extent the planned investments fo...

Background: Following outbreaks in other parts of the Netherlands, the Dutch border region of South Limburg experienced a large-scale outbreak of human Q fever related to a single dairy goat farm in 2009, with surprisingly few cases reported from neighbouring German counties. Late chronic Q fever, with recent spikes of newly detected cases, is an...

"Ca. 30 Prozent der Rettungswagen-Einsätze in Deutschland werden ex-post nicht als Notfall klassifiziert [1]. An dieser Stelle setzt der Gemeindenotfallsanitäter (GNFS) an, um Patienten mit nicht lebensbedrohlichen Krankheitsbildern zu untersuchen und an die richtige Versorgungsstruktur zu verweisen [2]. Eine erste Evaluation soll darstellen, wie d...

This study summarized the history of ambient air quality monitoring and air pollution prevention and control, and it analyzed the spatiotemporal patterns of ambient air pollutants during 1981-2017 in China. The results showed that monitoring of ambient air quality has changed dramatically in terms of determinants, sampling methods, monitoring exten...

As the majority of people on earth live and work in cities, the health issues they are facing are strongly affected by social, physical, and ecological determinants, which shape their urban environments. The health of people living in cities and the health of cities being built and inhabited by people together constitute urban health. It is a compl...

Ambulance dispatches for respiratory syndromes reflect incidence of influenza-like illness in primary care. Associations are highest in children (15%-34% of respiratory calls attributable to influenza), out-of-office hours (9%), and highest urgency-level calls (9%-11%). Ambulance dispatches might be an additional source of data for severe influenza...

The WHO identified the importance of macro-socioeconomic determinants and political context such as governance, politics and economic influence, as interlinked key factors influencing health equity, health and healthcare system’s performance [1]. In the times of the 2008 crisis in Portugal, associated with a significant increase of preterm born inf...

The WHO identified the importance of macro-socioeconomic determinants and the political context as interlinked key factors affecting health equity. The 2008 economic crisis was associated with a significant low-birth-weight increase in Portugal, 2007-2014. The Economic Adjustment Programme (EAP), implemented to economize non-essential health care c...

Background: Syndromic surveillance can supplement conventional health surveillance by analyzing less-specific, near-real-time data for an indication of disease occurrence. Emergency medical call centre dispatch and ambulance data are examples of routinely and efficiently collected syndromic data that might assist in infectious disease surveillance...

Background: Since 2007, trivalent inactivated influenza vaccine (TIV) has been provided free-of-charge to primary, middle school and high school students in Beijing. However, there have been few school-based studies on influenza vaccine effectiveness (VE). In this report we estimated influenza VE against laboratory-confirmed influenza illness among...

Background: The ability to measure regional health inequalities across Europe and to build adequate population health indices depends significantly on the availability of reliable and comparable data at the regional level. Within the scope of the EU-funded project EURO-HEALTHY, a Population Health Index (PHI) was built. This model aggregates 39 in...

Objective We aim to assess whether influenza circulation, as measured through influenza-like-illness (ILI) in primary care, is reflected in ambulance dispatch (AD) calls.IntroductionSurveillance of severe influenza infections is lacking in the Netherlands. Ambulance dispatch (AD) data may provide information about severity of the influenza epidemic...

Background: While the 2015-2016 influenza season in the northern hemisphere was dominated by A(H1N1)pdm09 and B/Victoria viruses, in Beijing, China, there was also significant circulation of influenza A(H3N2) virus. In this report we estimate vaccine effectiveness (VE) against influenza A(H3N2) and other circulating viruses, and describe further c...

Background The current migration flow into Europe is leading to a growing ethnically diverse population in many European countries. Now more than ever, those populations have different healthcare needs, languages, traditions, and previous level of care. This higher level of diversity is likely to increase health inequalities that might challenge he...

Background: Stroke is the second leading cause of death in the world. It has multiple risk factors of which some, such as ambient temperature, are less well documented. Objective: We aimed to examine the association between diurnal temperature range (DTR) and stroke mortality, and to test the possible effect modification of this association acco...

Due to rapid urbanization, industrialization and motorization, a large number of Chinese cities are affected by heavy air pollution. In order to explore progress, remaining challenges, and sustainability of air pollution control in the Beijing-Tianjin-Hebei (BTH) region after 2013, a mixed method analysis was undertaken. The quantitative analysis c...

Despite the significant advances that have been made at the European Union (EU) level in terms of health inequality measurement, there is still a lack of comparable health-related data across countries and regions 1. Existing measures and indicators of health status and quality of life are considered inadequate2 to capture the holistic understandin...

Information on morbidity burden of seasonal influenza in China is limited. A multiplier model was used to estimate the incidence and number of outpatient visits for seasonal influenza by age group for the 2015–2016 season in Beijing, the capital of China, based on reported numbers of influenza-like illness consultations and proportions of positive...

Background: The recent economic and financial crisis in Portugal urged the Portuguese Government in April 2011 to request financial assistance from the troika austerity bail out program to get aid for its government debt. The troika agreement included health reforms and austerity measures of the National Health Service (NHS) in Portugal to save non...

Background National Mental Health Survey found that in India, the point prevalence of major depressive disorder (MDD) was 2.7% and the treatment gap was 85.2%, whereas in Madhya Pradesh the point prevalence of MDD was 1.4% and the treatment gap was 80%. Aims To describe the baseline prevalence of depression among adults, association of various dem...

Lignocellulose degradation is important when applying biodrying treatment to sewage sludge intended for land use. This study investigated lignocellulose degradation in the biodrying of sewage sludge and sawdust. The experiment analyzed lignocellulose content, lignocellulase activity, humic substances, and fungal communities. After biodrying, lignin...

This study investigated biodrying performance under variable and constant aeration. The matrix-related properties, air-related parameters, and bacterial community were assessed. Under variable aeration, the velocity and temperature of the air above the pile surface were high. Bacterial diversity indicated the biodrying was achieved during an establ...

Background Risk assessment and early warning (RAEW) are essential components of any infectious disease surveillance system. In light of the International Health Regulations (IHR)(2005), this study compares the organisation of RAEW in China and the Netherlands. The respective approaches towards surveillance of arboviral disease and unexplained pneum...

Infectious disease surveillance, timely detection and early warning of outbreaks present a complex challenge to health authorities in India. Approaches based on the use of unexplored data sources, like emergency medical services (EMS) data, can contribute to the further advancement of public health surveillance capacities in India and support and s...

In order to explore the temporal-spatial patterns and possible health effects of ozone in Shenzhen, daily concentrations of ozone and the daily mortality caused by cardiovascular and respiratory diseases were collected. Using Geographic Information System (GIS) and SPSS, the spatial and temporal patterns of ozone in Shenzhen were illustrated. Using...

Background: The aims of this study are to estimate the disease burden of allergic rhinitis (AR) patients and examine various underlying issues related to the symptoms and services of adult AR patients. Methods: Beijing hospital was picked as the surveillance area, and self-report questionnaires from the AR patients and data from medical examination...

Background Despite high vaccination coverage, pertussis incidence in the Netherlands is amongst the highest in Europe with a shifting tendency towards adults and elderly. Early detection of outbreaks and preventive actions are necessary to prevent severe complications in infants. Efficient pertussis control requires additional background knowledge...

Background: : Disparities in health between immigrants and their host populations have been described across countries and continents. Hence, interventions for improving health targeting general populations are not necessarily effective for immigrants. To conduct a systematic search of the literature evaluating health interventions for immigrants;...

Air pollution is an important public health problem in Europe and there is evidence that it exacerbates health inequities. This calls for effective strategies and targeted interventions. In this study, we conducted a systematic review to evaluate the effectiveness of strategies relating to air pollution control on public health and health equity in...

Background The provision of general practitioners (GPs) in Germany still relies mainly on the ratio of inhabitants to GPs at relatively large scales and barely accounts for an increased prevalence of chronic diseases among the elderly and socially underprivileged populations. Type 2 Diabetes Mellitus (T2DM) is one of the major cost-intensive diseas...

The factors that influence the length of human life are complex and longevity remains a controversial topic, particularly in China. This paper demonstrates the spatial patterns and changes of the elderly group (65 years old and over), the oldest old (80 years old and over) and the centenarians in China in the last decade, analyzes the influence of...

Introduction Syndromic surveillance aims at augmenting traditional public health surveillance with timely information. To gain a head start, it mainly analyses existing data such as from web searches or patient records. Despite the setup of many syndromic surveillance systems, there is still much doubt about the benefit of the approach. There are d...

List of publications included in data collection. (PDF)

Background Most studies on air pollution exposure and its associations with human health in China have focused on the heavily polluted industrial areas and/or mega-cities, and studies on cities with comparatively low air pollutant concentrations are still rare. Only a few studies have attempted to analyse particulate matter (PM) for the vibrant eco...

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...

In 2013, the German government published its national Global Health Strategy, outlining principles and focal topics for German engagement in global health. We asked the question of why Germany has decided to establish a national policy framework for global health at this point in time, and how the development process has taken place. The ultimate g...

Public Health Surveillance (PHS) is of primary importance in this era of emerging health threats like Ebola, MERS-CoV, influenza, natural and man-made disasters, and non-communicable diseases. Transforming Public Health Surveillance is a forward-looking, topical, and up-to-date overview of the issues and solutions facing PHS. Research and innovati...