• Een paar graden meer? Achtergronden en ontwikkelingen van het broeikaseffect door CO2

      Zwerver S; Swart R; Ulden AP van (Rijksinstituut voor Volksgezondheid en Milieuhygiene RIVMKoninklijk Nederlands Meteorologisch Instituut KNMI, 1989-05-10)
      Abstract not available
    • Paediatric surveillance of Acute Flaccid Paralysis in the Netherlands in 1997

      Abbink F; Conyn-van Spaendonck MAE; Suijkerbuijk AWM; CIE (1999-10-31)
      The main goal of AFP surveillance in the Netherlands is to qualify for WHO certification as a polio-free country. Surveillance for AFP has been established in the Netherlands as part of the NSCK surveillance system since October 1992. The NSCK surveillance system is an activity of the Dutch Paediatric Association using an 'active' surveillance approach to monitor rare disorders in the child population. The survey on AFP carried out by the RIVM comprises a collection of additional information on clinical and laboratory findings, vaccination status and remaining complaints from the reported AFP cases through questionnaires. Compliance with the scheme in general is high (91% in 1997) but AFP reporting is still lagging behind. We can conclude that although the required non-polio AFP rate of 1 per 100,000 children has not been reached yet, a slow but steady increase has been reported over the years, from 0.39 in 1995, to 0.56 in 1996 and 0.63 in 1997. Thanks to the implementation of recommendations made in previous reports, progress has also been made for adopting all performance criteria used by WHO in the certification process. Therefore we suggest that the implementation of recommendations be continued, including the extension of the system to neurologists and a further improvement in its efficiency. The need for adequate and timely faecal sampling should continue to be stressed as well as the timely provision of case-specific information.
    • Paediatric surveillance of Acute Flaccid Paralysis in the Netherlands in 1997

      Abbink F; Conyn-van Spaendonck MAE; Suijkerbuijk AWM; CIE (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1999-11-00)
      The main goal of AFP surveillance in the Netherlands is to qualify for WHO certification as a polio-free country. Surveillance for AFP has been established in the Netherlands as part of the NSCK surveillance system since October 1992. The NSCK surveillance system is an activity of the Dutch Paediatric Association using an 'active' surveillance approach to monitor rare disorders in the child population. The survey on AFP carried out by the RIVM comprises a collection of additional information on clinical and laboratory findings, vaccination status and remaining complaints from the reported AFP cases through questionnaires. Compliance with the scheme in general is high (91% in 1997) but AFP reporting is still lagging behind. We can conclude that although the required non-polio AFP rate of 1 per 100,000 children has not been reached yet, a slow but steady increase has been reported over the years, from 0.39 in 1995, to 0.56 in 1996 and 0.63 in 1997. Thanks to the implementation of recommendations made in previous reports, progress has also been made for adopting all performance criteria used by WHO in the certification process. Therefore we suggest that the implementation of recommendations be continued, including the extension of the system to neurologists and a further improvement in its efficiency. The need for adequate and timely faecal sampling should continue to be stressed as well as the timely provision of case-specific information.
    • Paediatric surveillance of Acute Flaccid Paralysis in the Netherlands in 1995 and 1996

      Conyn-van Spaendonck MAE; Geubbels ELPE; Suijkerbuijk AWM; CIE; NSCK (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1998-01-31)
      The surveillance of Acute Flaccid Paralysis (AFP) is included in the Dutch Paediatric Surveillance System (NSCK) since October 1992. Paediatricians in hospitals report a list of rare diseases on a monthly basis as part of an active surveillance scheme. After the initial report, additional information on clinical presentation, diagnostic results and vaccination history is collected through a questionnaire. In 1995 11 cases conforming to the case-definition were reported, and in 1996 15, resulting in an AFP-rate of 0.39 per 100,000 in 1995 and 0.53 per 100,000 in 1996. No cases of AFP caused by polio infection were observed. In about 50% of the reported AFP cases Guillain-Barre Syndrome was diagnosed. To date, the AFP surveillance in the Netherlands does not meet the WHO criteria for adequate surveillance for certification as polio-free according to the polio eradication initiative. An observed AFP-rate of at least 1 per 100,000 is accepted as proof of sufficient sensitivity of the surveillance system. Along with timeliness of the reports, we are concerned of the low proportion of cases of whom faecal samples are adequately virologically investigated (58% one faecal sample, of which 51% within 14 days after onset of disease; 11% two samples). Recommendations for optimalisation: introducing initial reporting by telephone (immediate reporting and advice on adequate specimen collection); improved information of the paediatricians through NSCK newsletters, presentations and publications extending of the surveillance to neurologists.<br>
    • Paediatric surveillance of invasive infections by Haemophilus influenzae in 1995 in the Netherlands

      Talsma E; Conyn-van Spaendonck MAE; Geubbels ELPE; Suijkerbuijk AWM; CIE (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1996-10-31)
      Following the recommendation of the National Health Council to include immunisation against Hib in the National Immunisation Programme to prevent mortality, severe morbidity and permanent disability due to invasive Hib infection, the vaccine is offered to all children born after 1 April 1993. To assess the effectiveness of this immunisation, surveillance has to be carried out. In this annual report on the Hi(b) surveillance in 1995 done by the Dutch Paediatric Surveillance Centre (NSCK) progressive effects of Hib vaccination became evident. Forty-one invasive Hi infections were registered: 28 meningitis, 8 epiglottitis, 2 arthritis and 3 sepsis. This means a substantial reduction compared with 1994 (129 cases) and the estimated numbers before the start of vaccination. Three cases of true vaccine-failures occurred and no possible or apparent vaccine-failures. Since 1 January 1995 the case-definition was changed to invasive Hi disease irrespective of serotype. As a result it is possible to study invasive Hi disease caused by non-serotype b strains as well. Cellulitis was included into the case-definition since 1 January 1995. No cases of cellulitis as the only sign were reported in 1995. The coverage of the paediatric surveillance scheme was estimated through comparison of the records of meningitis cases with the laboratory records of the Netherlands Reference Laboratory for Bacterial Meningitis (RBM).<br>
    • Paediatric surveillance of invasive infections by Haemophilus influenzae serotype b in 1994 in the Netherlands

      Geubbels ELPE; Conyn-van Spaendonck MAE; Suijkerbuijk AWM; CIE (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1995-07-31)
      Following the recommendation by the National Health Council to include immunisation against Hib in the National Immunisation Programme in order to prevent mortality, severe morbidity and permanent disability as a consequence of invasive Hib infection, all children born after 1 April 1993 are offered immunisation. To assess the efficacy of this immunisation, surveillance has to be carried out. Apart from data on meningitis collected by the Netherlands Reference Laboratory for Bacterial Meningitis (RBM), data are needed on the incidence of other invasive Hib infections, as well as additional information on the cases, like vaccination status. Therefore since October 1993 active paediatric surveillance on invasive Hib infections is carried out by the RIVM via the Dutch Paediatric Surveillance Unit (NSCK). In this annual report on the Hib surveillance in 1994, the first effects of immunisation are described and a comparison is made of data collected through surveillance by paediatricians, public health laboratories and the RBM. A total of 129 paediatric reports of invasive infection by H. influenzae concerned 50 cases of just meningitis, 31 of meningitis with sepsis, 1 of meningitis with arthritis, 1 of meningitis with arthritis and osteomyelitis, 32 of epiglottitis including two cases with sepsis, 9 of only sepsis, 4 of only arthritis and 1 of only osteomyelitis. All proven infections occurred in children who had not or incompletely been vaccinated. One child with sepsis had had 3 vaccinations and became ill 7 months later ; the isolated Hi strain was not serotyped. Typing was performed in 85% of all isolates, of which 97% were of type b. Appropriate culturing was often omitted in cases of epiglottitis. The RBM seems to provide the most complete registration of meningitis/sepsis by Hib, the additional value of paediatric surveillance consists mainly in its ability to collect additional information on the cases and data on invasive infections other than meningitis/sepsis. The effect of immunisation against Hib became apparent in the number of cases of invasive infections which was lower than the estimated number before vaccination was introduced. Furthermore the peak incidence for meningitis no longer appeared in children aged 0, but in children aged one year. Adequate culturing and typing of specimen from a normally sterile site is essential ; since 1994 all such isolates can be send to the RBM for typing. As from 1 January 1995 the case definition for the paediatric surveillance is no longer restricted to type b infections ; this offers the opportunity to study changes in prevailing serotypes of Hi as well. Furthermore cellulitis is explicitly included in the case definition. Continuation of surveillance, at least until immunisation has covered the total risk group (children aged 0-5 years), is indicated to confirm the first effects of the inclusion of Hib vaccination in the NIP. The complementary systems of surveillance are appropriate to doing this.
    • Paediatric surveillance of pertussis in 1998

      Melker HE de; Neppelenbroek SN; Schellekens JFP; Suijkerbuijk AWM; Conyn- van Spaendonck MAE; CIE; LIS (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2000-06-16)
      Doel: Inzicht verkrijgen in de ernst van kinkhoest onder kinderen opgenomen in het ziekenhuis wegens kinkhoest. Methoden: In 1998 werd met behulp van pediatrische surveillance gegevens verzameld van ziekenhuisopnamen. Resultaten: Van de 115 ziekenhuisopnamen was 55% jonger dan 3 maanden en ongevaccineerd; 12% was 3-5 maanden oud waarvan 50% onvolledig gevaccineerd; 33% was 6 maanden en ouder waarvan 61% gevaccineerd. Bij 46% werd de diagnose bevestigd door positieve kweek of PCR; bij 44% door positieve serologie. Drie ongevaccineerde kinderen jonger dan 3 maanden overleden. Cyanose, apneu, zuurstoftoediening, kunstmatige beademing en bradycardie werd vaker gerapporteerd voor ongevaccineerde patienten en de opnameduur was langer (10 versus 4,5 dagen) dan voor gevaccineerde patienten. Hoewel complicaties niet frequent werden gemeld voor gevaccineerden was de enige patient met encephalopathie gevaccineerd. Ook had 17% van de gevaccineerde patienten longontsteking. Conclusie: Het lagere aantal meldingen in 1998 lijkt de lagere kinkhoest incidentie in 1998 t.o.v. 1997 te reflecteren die ook in de routine surveillance van aangiften en positieve serologie werd waargenomen. Evenals in 1997 was kinkhoest het meest ernstig en kwamen complicaties vaker voor bij ongevaccineerde zuigelingen jonger dan 3 maanden. Echter, typische en ernstige kinkhoestklachten kwamen ook onder gevaccineerden voor. Pediatrische surveillance wordt gebruikt om trends uit routine surveillance te verifieren; interpretatie van routine surveillance wordt bemoeilijkt door de nieuwe aangifte-wet en decentralisatie van serologie.
    • Paediatric surveillance of pertussis in 1998

      de Melker HE; Neppelenbroek SN; Schellekens JFP; Suijkerbuijk AWM; Conyn-van Spaendonck MAE; CIE; LIS (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2000-06-16)
      Objective: To gain insight into the severity of pertussis in hospitalised cases. Methods: In 1998, hospitalisation data were collected through paediatric surveillance. Results: From 115 hospitalisation admissions collected, 55% of the patients were younger than 3 months of age and not vaccinated; 12% were 3-5 months of age and of these, 50% were incompletely vaccinated; 33% were 6 months and older and of these, 61% were vaccinated. Fourty-six percent of the patients were diagnosed as having pertussis, confirmed by a positive culture or PCR, and 44% by positive serology. Three unvaccinated cases less than three months old died. Cyanosis, apnoea, administration of oxygen, artifical respiration and bradycardia were more frequently reported for unvaccinated cases compared to vaccinated cases and the hospitalisation time was longer (median 10 days vs. 4.5 days). Although complications were not often reported for vaccinated cases, the only case with encephalopathy was vaccinated and 17% of vaccinated cases had pneumonia. Conclusion: The lower number of reported cases in 1998 seems to reflect the lower pertussis incidence that was also observed in routine surveillance of notifications and cases with positive serology. Like in 1997 pertussis was most severe and complications were more frequently reported in young unvaccinated infants less than three months of age. However, also typical and severe pertussis cases occurred among vaccinated individuals. Active monthly paediatric surveillance is useful to verify trends in routine surveillance; interpretation of the routine sources is hampered by changes in the notification law and decentralisation of serology.<br>
    • Paint Products Fact Sheet. To assess the risks for the consumer. Updated version for ConsExpo 4

      Bremmer HJ; van Engelen JGM; SIR (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2007-08-02)
      Exposure to compounds in consumer products is assessed using the computer program ConsExpo (Consumer Exposure). Given the huge number of consumer products, it is not possible to calculate the exposure for each separate product, so a limited number of groups containing similar products are defined. The information for each group of products is described in a fact sheet. Pest control products, cosmetics and cleaning products are examples fact sheets, which have been published already. This fact sheet covers the use of paint products by consumers. In the fact sheet, 7 product categories are described, including brushing / rolling of several types of paint products and spraying paints with an aerosol spray can and pneumatic using a compressor. To assess exposure to compounds in paint products, default values for all 7 product categories have been determined.
    • PAK in oppervlaktewater: bronnen en maatregelen. SPEED werkplan PAK

      Campen ALBM van; Quarles van Ufford CHA; Berbee RPM; Luijten LAM; Schwartz MJC (1991-06-30)
      This plan of action is a product of SPEED (Source reduction cooperation Project aimed at Effective Emission reduction of Diffuse sources). For two polycyclic aromatic hydrocarbons, i.c. benzo(a)pyrene (BAP) and fluoranthene (FLU) dutch emissions to air and water reduction measures are presented. Using the STRAVERA model the future developments of the emissions and the surface water load are calculated for three situations: autonomous (1), planned policy (2) and extra measures (3). In the first two situations an increase of the surface water load is expected of 30 to 65%, mainly due to the expected increase of shipping. Assuming foreign emissions are reduced with the same percentage as in the Netherlands in 2000, the additional measures in this plan of action will result in reductions of the surface water load of 50% in 2010. In spite of the inaccuracy of the emission data, it can be concluded that these measures fail to reacht the governmental policy targets of 90% reduction. In action table is indicated which organisations should take initiative in reducing PAH emissions. A committee in which several departments are represented will supervise the progress of the emission reduction measures.
    • PAK in stedelijke omgeving, benzo[a]pyreen en mogelijke alternatieven als gidsstof voor PAK

      Velze K van; LLO (1996-10-31)
      PAH concentrations were measured in city areas on nine days with calm weather at three types of sites (rural backgound, city background, road with heavy traffic) were statistically analyzed. Twenty-two PAHs were examined individually to determine the utility of each as an indicator of the carcinogenic potency of a PAH mixture. Benzo[e]pyrene, chrysene and benzo[a]anthracene scored the highest, along with the current PAH indicator, benzo[a]pyrene. Furthermore, a survey on possibilities for maintaining the PAH standard with the aid of other compounds (black smoke, PM-10, CO, NOx, SO2) showed the best results with black smoke and NOx.
    • PAK in stedelijke omgeving, benzo[a]pyreen en mogelijke alternatieven als gidsstof voor PAK

      Velze K van; LLO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1996-10-31)
      Resultaten van metingen van PAK concentraties op negen dagen op drie typen lokaties (landelijke achtergrond, stadsachtergrond, drukke verkeersstraat) zijn statistisch geanalyseerd. Onderzocht is de bruikbaarheid van individuele PAK (22 componenten) als indicator voor de carcinogene potentie van het PAK-mengsel. Het best voldoen benzo[e]pyreen, chryseen en benzo[a]antraceen. Benzo[a]pyreen, de huidige PAK-gidsstof, voldoet eveneens. Voorts zijn de mogelijkheden onderzocht voor bewaking van de PAK-norm met behulp van andere luchtverontreinigende stoffen (zwarte rook, PM-10, CO, NOx, SO2). Zwarte rook en NOx toonden de beste resultaten.
    • Papier- en kartonindustrie

      Huizinga K; Verburgh JJ; Matthuizen AJCM (1992-12-31)
      This document on paper and cardboard industry has been published within the SPIN project. In this project information has been collected on industrial plants or industrial processes to afford support to governmental policy on emission reduction. This document contains information on the processes, emission sources, emissions to air and water, waste, emission factors, use of energy and energy factors, emission reduction, energy conservation, research on clean technology and standards and licences.
    • Paralytic shellfish poisoning; A review

      Mons MP; Egmond HP van; Speijers GJA; CSR (1998-09-15)
      Paralytic shellfish poisoning (PSP) is caused by ingestion of shellfish containing PSP toxins. The PSP toxins are a group of 18 closely related tetrahydropurines. The first PSP toxin chemically characterised was saxitoxin. The various PSP toxins significantly differ in toxicity, with saxitoxin being the most toxic. The presence of PSP toxins in shellfish can be demonstrated with the mouse bioassay, a non-selective testing procedure, with animal death as toxicity criterion. The test is currently used in many countries for checking the toxicity of shellfish but international pressure a.o. of animal welfare groups has led to stimulation of research to replace the mouse bioassay by chemical methods of analysis. It is expected, however, that several more years of intensive investigations will be needed, before a selective, sensitive and validated method of analysis becomes available and accepted. Although promising developments have been made, limited supplies of purified toxin standards are still delaying rapid progress. The PSP toxins are produced mainly by dinoflagellates belonging to the genus Alexandrium, which may occur both in the tropical and moderate climate zones. Shellfish grazing on these algae can accumulate the toxins , but most of them are rather resistent to the harmful effects of these toxins. The highest concentrations in shellfish are found during or directly after an algal bloom. People consuming the contaminated shellfish can become intoxicated. The primary mode of action of PSP toxins in mammals is their binding to sodium channels in nerve cell membranes, readily at nanomolar concentration. This leads to inhibition of impulses along the nerves, resulting in paralysis, respiratory depression and circulatory failure. Symptoms of human PSP intoxication vary from a slight tingling or numbness to complete respiratory paralysis. In fatal cases, respiratory paralysis occurs within 2-12 hours of consumption of the PSP containing food. During the last 20 years there seems to be an increase in intoxications, caused by PSP. Currently, some 25 countries have regulations for PSP. Most regulations are set for paralytic shellfish poisoning as a group, but some countries indicate specific regulations for one of the PSP toxins, mostly saxitoxin.
    • Paralytic shellfish poisoning; A review

      Mons MP; Egmond HP van; Speijers GJA; CSR (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1998-09-15)
      Paralytic shellfish poisoning (PSP) wordt veroorzaakt door consumptie van schelpdieren die PSP toxinen bevatten. Er zijn 18 verschillende PSP toxinen, waarvan saxitoxine de meest bekende en de meest toxische is. PSP toxinen kunnen worden aangetoond met de muis bioassay, waarbij de dood van het dier als toxiciteitscriterium geldt. Deze methode wordt op dit moment nog veel toegepast, maar de internationale druk die wordt uitgeoefend door o.a. de dierenbeschermingsorganisaties stimuleert het onderzoek naar chemische analysemethoden om de muis bioassay te vervangen. Hoewel er verschillende methoden voorhanden zijn, heeft elke methode wel zwakke punten. Het grootste probleem is dat er weinig analytische standaarden en gecertificeerde referentiematerialen voorhanden zijn, alhoewel er wel veelbelovende ontwikkelingen op dit gebied zijn. De PSP toxinen worden voornamelijk geproduceerd door zogeheten dinoflagellaten van het geslacht Alexandrium. Deze soort komt zowel in tropische gebieden als in de gematigde zones voor en wanneer schelpdieren zich voeden met deze algen, kunnen de toxinen accumuleren in de schelpdieren. De hoogste concentraties toxinen komen voor tijdens, of vlak na een algenbloei, maar zelf ondervinden de schelpdieren bijna geen effect van de toxinen. Wanneer mensen de verontreinigde schelpdieren opeten kunnen ze vergiftigd raken met de PSP toxinen. De effecten zijn aanvankelijk het waarnemen van tintelingen en gevoelloosheid maar uiteindelijk kan verlamming optreden en in ernstige gaveling an dit tot tot de dood leiden doordat ook de ademhalingsspieren verlamd raken. De laatste jaren lijkt het alsof er een toename in het aantal intoxicaties, veroorzaakt door PSP, plaatsvindt.Op dit moment zijn er 25 landen met wetgeving op het gebied van PSP. De meeste landen hebben wetgeving voor PSP in het algemeen, maar sommige landen hebben ook specifieke wetgevingen voor een of meer PSP toxinen.
    • Parameters needed to estimate the global burden of peanut allergy : Systematic literature review

      Ezendam J; van Loveren H; GBO; vgc (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2012-04-23)
      The symptoms of peanut allergy vary from mild to severe, from swollen lips, shortness of breath to an anaphylactic shock, which is potentially fatal. The National Institute for Public Health and the Environment (RIVM) has investigated which factors have an impact on the burden of disease for peanut allergy. The most important parameters were found to be the number of people who suffer from a peanut allergy and the impact it has on their quality of life. Burden of disease is a measure to quantify the consequences of a disease by combining the loss of health from impaired quality of life and premature mortality. This systematic literature review was performed within the framework of the Foodborne Epidemiology Reference Group of the World Health Organisation that is dedicated to estimating the global burden of disease for several food borne diseases. Examples are pathogens, such as parasites and bacteria or toxic chemicals that are present in food as contaminants. Peanut allergy has been included in this initiative because of the severe symptoms that can occur. Prevalence of peanut allergy: In Western countries, peanut allergy affects 0.5 to 1.5 per cent of the population. There is a lack of prevalence data from developing countries. Geographical differences in the prevalence appear to exist, since peanut allergy is uncommon in Turkey and Israel. Peanut allergy limits quality of life: Symptoms of the allergy are only induced when people with a peanut allergy eat products that contain peanuts. Although they can be severe, the symptoms are usually short-lasting. Consequently, they will not have an impact on the burden of disease. The number of people who die due to a peanut allergy is low; this also has a limited impact on burden of disease. The quality of life of people with a peanut allergy is impaired, for example, because they are anxious about accidentally eating products that contain peanut. This impairment of quality of life is important in the burden of disease.
    • Parametrization of NO2 photodissociation rate

      de Leeuw FAAM; LLO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1995-12-31)
      The NO2 photodissociation rate, j(NO2), plays a key role in atmospheric chemistry. It is one of the most sensitive parameters in atmospheric photochemical transport models. In transport models estimates of the photolysis rates are generally based on radiation transfer (sub-) models or on empirical relations. The theoretical determination of j(NO2) is in general too complex for implementation in atmospheric transport models. For application in transport models it is convenient to have a simple, analytical expression that adequately relates j(NO2) to routinely available meteorological parameters (global radiation, cloud cover, zenith angle). In this report j(NO2) - estimated from hourly measured concentrations of NO, NO2 and O3 - is related to the measured global radiation and to the solar zenith angle. The derived empirical relations show a good agreement between observed and calculated values with an estimated relative error of ca 25%. For partly clouded skies (cloud covers N < 0.5) the attenuation of j(NO2) is small ; for overcast situations j(NO2) is reduced to ca. 50% of its clear sky value. Cloud cover more strongly attenuates global radiation than j(NO2).<br>
    • Parasitologisch en serologisch onderzoek naar het voorkomen van Trichinella spiralis bij Nederlandse slachtvarkens

      Knapen F van; Franchimont JH; Fenigsen-Narucka U (1987-12-31)
      Abstract not available
    • Parasitologisch onderzoek bij vissen bestemd voor consumptie

      Franssen FFJ; van der Giessen JWB; LZO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2010-02-16)
    • Part I. Feasibility Study for a Plan of Action to Investigate the Effects of Air Pollution on Health in PHARE Countries Part II. Air Pollution and Health. Country Descriptions for the PHARE countries. Bulgaria, Romania, Hungary, Czech Republic, Poland and Slovak Republic

      Lebret E; Wolters N; Elliott P; Fletcher T (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1993-11-30)
      The feasibility study was carried out on behalf of CEC-DG-I(OPS) in the PHARE countries Bulgaria, Czech Republic, Hungary, Poland, Romania and the Slovak Republic. Two country visits to each of the countries were involved. On the basis of information supplied by experts met during these visits and a review of published sources, the Regional Programme EHAP was prepared. The overall aim of the Programme was to strengthen the capacity of the individual Central and Eastern European Countries to undertake high quality studies on EHAP, in order to better inform the scientific evaluation of policies for the protection of human health. The programme, which will be carried out during the period 1994-1996 on a budget of 2,8 million ECU, includes the following three projects: 1.A study on air pollution and respiratory disease in children. 2. A quality assurance activity. 3. A risk perception and communication study. The outline of the Programme has been reviewed by CEC DG-I and DG-12, representatives of the Ministry of Environment and the Ministry of Health of the countries involved and by consultants of RIVM/LSHTM on a one-day workshop on September 24 1993 at the RIVM, Bilthoven.<br>