• Achtergronddocument bij 'Cumulatie van milieurisico's voor de mens: geografische verschillen in Nederland'

      Pruppers MJM; LSO; ACT; CCM; LAE; LEO; LLO; TNO-MEP; TNO-PG; TNO-Voeding (Rijksinstituut voor Volksgezondheid en Milieu RIVMNederlandse organisatie voor toegepast-natuurwetenschappelijk onderzoek (TNO), 1996-07-31)
      The project 'Accumulation of environmental risks' aimed at identifying the locations in the Netherlands where human risks due to several types of environmental contamination accumulate. A large number of risk maps have been produced of the Netherlands. The risks are expressed as mortality risk (external safety, radiation and several substances), probability of other effects on human health (other substances) and probability of annoyance (noise). The risk maps have been collected in the main report no. 610127001, 'Accumulation of environmental risks to human health: geographical differences in the Netherlands'. The background document contains information on the methods used to choose sources and substances, and to produce maps. This background document discusses methods for calculating external safety risks, methods for calculating doses and risks due to exposure to radiation, methods for calculating concentrations of several substances in air on a scale of 500 by 500 m, the toxicological data of the substances under study and methods for calculating risks due to exposure to these substances, a possible method for combining different types of effects on human health, and finally, the method used to calculate annoyance due to noise and odour. This background document consists of several chapters which can be read independently.
    • The Aetiology of Gastric Cancer: the inhibition of the formation of N-nitroso compounds

      Zondervan K; Bueno de Mesquita HB; CCM (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1994-11-30)
      Until recently, gastric cancer was the leading cause of cancer mortality, but since the Second World War mortality rates have started to decline world-wide. Two types of gastric cancer have been identified, the diffuse type and the intestinal type, and they seem to be caused via different pathways. Diffuse gastric cancer is supposed to be more related to genetic susceptibility, while intestinal gastric cancer (the focus of this thesis) is supposed to be largely influenced by environmental factors. Some important risk factors that have been related to GC and its precursor lesions are the infection with H. pylori, a high salt and carbohydrate intake, a low intake of vegetables and fruit, and exposure to NOCs. The relative importance of these factors is likely to vary between populations. NOCs can be formed exogenously in foods and endogenously in the stomach from nitrite and nitrosatable compounds, through acid-catalysed nitrosation (ACN) and through bacteria-catalysed nitrosation (BCN). Inhibitors of the nitrosation reaction are ascorbic acid, tocopherols, and (poly)phenols, that apart from being potent antioxidants, also work as a substrate for nitrosating species under acidic conditions. Ascorbic acid can inhibit both ACN at low pH values and BCN at neutral pH values. A high intake of fruits and vegetables, important sources not only of ascorbic acid but also of other potential gastric carcinogenesis inhibitors such as beta-carotene, is likely to be protective and therefore recommendable in the early as well as the later stages of gastric carcinogenesis. Much research remains to be done to clarify the role of NOCs in gastric carcinogenesis. If NOCs play a role in the aetiology of gastric cancer, their composition most likely differs between countries. Thus, there is a special need for tests that can accurately assess endogenous formation of specific NOCs in the human stomach.<br>
    • Het Algemene Lineaire Model met de SAS procedure GLM

      Lezenne Coulander C de; CCM (1994-07-31)
      The SAS procedure GLM (General Linear Model) uses the method of least squares to fit general linear models. Among the statistical methods available in PROC GLM are regression, analysis of variance (especially for unbalanced data), analysis of covariance, multivariate analyses of variance and repeated measures analysis of variance. Special features in the SAS procedure GLM are: the four types of sum of squares and the estimable functions. Any degree of interaction can be specified, for instance: cross effects, nested effects and continuous-by-class effects.
    • Analyse van discrete variabelen met de SAS procedure CATMOD

      Lezenne Coulander C de; CCM (1994-07-31)
      the SAS procedure CATMOD fits linear models to functions of categorical data. By choosing appropriate response functions well known statistical procedures such as linear regression, anova, repeated measures, log-linear models and logistic regression are available. Still more can be done by using user-defined response functions (for instance proportional hazard models). The estimating methodes used by CATMOD are empirical generalized least squares (EGLS) and maximum likelihood (ML).
    • Annoyance, sleep disturbance, health aspects, perceived risk and residential satisfaction around Schiphol airport: Summary of results of a questionnaire

      TNO-PG; RIVM; CCM; IMA; TNO-PG (TNO-PG, 1999-02-12)
      As part of the Evaluation and Monitoring Programme for Schiphol airport, a questionnaire on the prevalence of self-rated annoyance, sleep disturbance, perceived general health, respiratory complaints, satisfaction in the study area was sent to a randomly selected sample of 30,000 people living within 25 km of Schiphol airport. The purpose of this study was to assess these factors in relation to the exposure to aircraft noise and air pollution. Exposure to aircraft noise was based on model calculations. The airport's proximity to the respondent's home was used as a proxy for air pollution caused by aircraft. The survey response rate was 39%. The results of this study show that annoyance from aircraft noise is greater than expected, also when the effect of selective non-response is taken into account. There is a relation between aircraft noise and noise annoyance, sleep disturbance, perceived health, use of medication, risk perception and residential satisfaction in the study area. The proximity of the airport was directly related to annoyance due to odours and soot from aircraft, respiratory complaints, and the use of medication for asthma and/or allergy.
    • Annoyance, sleep disturbance, health aspects, perceived risk and residential satisfaction around Schiphol airport: Summary of results of a questionnaire

      TNO-PG; RIVM; TNO-PG; CCM; IMA; TNO-PG (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1999-02-12)
      In het kader van de Gezondheidskundige Evaluatie Schiphol is door het RIVM en TNO-PG een onderzoek uitgevoerd naar ervaren hinder, slaapverstoring, gezondheids- en belevingsaspecten rond de luchthaven Schiphol. De gegevens voor dit onderzoek zijn verzameld met een schriftelijke vragenlijst. Van de 30.000 benaderde personen heeft 39 procent de vragenlijst teruggestuurd. Uit dit onderzoek bleek dat de hinder door vliegtuiggeluid rond de luchthaven Schiphol hoger was dan verwacht, ook wanneer rekening werd gehouden met mogelijk selectieve (non-) respons. Geluid door vliegtuigen leidde tot meer hinder en slaapverstoring, een vaker als slecht ervaren gezondheid en een toename in het gebruik van medicijnen. Ook ervaarde men meer risico's van het vliegverkeer en was men minder tevreden over de woonomgeving naarmate de geluidbelasting door vliegtuigen hoger is. Mensen die dichter bij de luchthaven wonen rapporteerden vaker hinder door geur en door stof/roet of rook van vliegtuigen en meer luchtwegklachten. Ook gebruikten meer mensen medicijnen tegen astma en/of allergie. Het aantal mensen dat aangaf erg gehinderd te zijn of in de slaap gestoord te worden door vliegtuiggeluid was in absolute aantallen het grootst buiten de wettelijke zones voor (nachtelijk) vliegverkeer. Ook werd op grotere afstand van de luchthaven nog hinder van geur en stof/roet of rook van vliegtuigen waargenomen.
    • Basisdocument fijn stof

      Annema JA; Booij H; Hesse JM; Meulen A van der; Slooff W; Fischer PH; Hollander AEM de; Noordijk H; Velze K van; CCM (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1994-01-31)
      An overview and evaluation is given of important environmental data of fine dust (PM10) in the Netherlands, such as emissions, possibilities for emission abatement, air quality, exposure, toxicology and epidemiology. These data can be used to define environmental policy to prevent negative effects from exposure to fine dust.
    • Berekening van het aantal geluidgehinderden door railverkeer in Nederland. Pilotstudie Landelijk Beeld Verstoring

      Rademaker BC; Schotten CGJ; Staatsen BAM; CCM; LBG (1996-03-31)
      In this pilot study an estimation has been made of the number of persons annoyed due to exposure to noise. As an example the extent of annoyance caused by noise of railway traffic in the Netherlands has been determined. Exposure-response relationships were derived from the literature and applied to data (model calculations) on noise levels near railways. The number of people (seriously) annoyed by train noise has been calculated per 500 x 500 m area. The results have been aggregated to percentages of people annoyed per municipality, county and for the Netherlands as a whole. Finally the estimated percentages of people potentially annoyed have been compared with data obtained from two national questionnaires which included questions concerning the degree of annoyance due to sound of railway traffic. Although the estimated number of people annoyed were somewhat lower than the percentages from questionnaire data, the percentages were in the same order of magnitude. The major advantage of this procedure is the possibility to make scenario calculations, predicting the effect of for instance (future) noise reduction measures. Furthermore, this method offers a cheap and uniform way to local, regional and national authorities to estimate and compare percentages of people annoyed. However, a periodic validation of the calculations by means of questionnaires and updating the used exposure-response relationships remains necessary.
    • Berekening van levensverwachting uit mortaliteits follow-up studies

      Hoogenveen RT; Schuit AJ; Visscher TLS; Feskens EJM; Nagelkerke NJD; CCM (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1998-06-30)
      Bij mortaliteitsanalyses op basis van longitudinale studies wordt veelal gebruik gemaakt van het Cox proportional hazards model. Sterfteverschillen tussen verschillende risicogroepen worden weergegeven in de vorm van geschatte regressiecoefficienten of relatieve risico's. De vraag is hoe mortaliteitsverschillen eruitzien voor een andere belangrijke maat als de levensverwachting. Beschreven wordt hoe deze geschat kan worden uitgaande van het Cox model. Verschillen in levensverwachting worden berekend voor twee voorbeeld-studies: tussen klassen van Body Mass Index op basis van gegevens uit de Zeven-Landen studie, en tussen klassen van lichamelijke activiteit op basis van gegevens uit de Zutphen-Ouderen Studie. De berekeningswijze is eenvoudig toepasbaar voor ook andere determinanten.
    • Berekening van levensverwachting uit mortaliteits follow-up studies

      Hoogenveen RT; Schuit AJ; Visscher TLS; Feskens EJM; Nagelkerke NJD; CCM (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1998-06-30)
      Survival analyses of longitudinal studies make often use of the Cox proportional hazards model. Mortality differences between risk groups are presented in terms of estimated regression coefficients or relative risks. The research question relates to the presentation of mortality differences in terms of life expectancy differences. The (rest) life expectancy can easily be calculated from the Cox model by using an exponential baseline hazard function. Two example applications for calculating life expectancy differences are presented. One for differences between Body Mass Index classes using data from the Seven-Countries study. The other for differences between physical activity classes using data from the Zutphen Elderly Study. The method can easily be applied to other mortality risk factors.<br>
    • Beschrijving bestaande gezondheidsregistratiesysteem voor gezondheidskundig onderzoek rondom Schiphol. Achtergrondrapport bij de Gezondheidskundige Evaluatie Schiphol

      Franssen EAM; CCM (1994-06-30)
      For the planned expansion of Schiphol airport an Environmental Impact Assessment (EIA) was legally required. As part of this EIA an assessment was made of the effects on public health caused by environmental pollution originating from airport activities. In this report the feasibility of current health databases for the assessment of the public health status around Schiphol Airport is evaluated. Databases which register data on the following health effects are studied: cardiovascular and respiratory diseases, cancer, birth-weight, psychological effects, sleep disturbance and medication use. The results show that only few existing health databases are feasible for the health status assessment. The Dutch Information System for Hospital Care and Day Nursing can be used to study the incidence of cardiovascular and respiratory diseases respectively. The Netherlands Cancer Registry can be used to study cancer incidence. The Dutch Obstetrics Registration is feasible for a study on birth-weight and pharmacy records can be used to study medication use. Data on sleep disturbance are not ruitinely registered. Also general practitioners can be an important source of information of data on relevant health effects. The feasibility of these data, however, has to be studied. To use data from general practice to study the public health effects of environmental pollution related to Schiphol airport, a special data base has to be develloped.
    • Biomerkers in neuslavage voor effecten van luchtverontreiniging bij gezonde personen en patienten met allergische en astmatische aandoeningen. (Een literatuurstudie)

      Steerenberg PA; Dormans JAMA; Fischer PH; van Bree L; van Loveren H; PAT; CCM; TOX (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1994-04-30)
      Several times per year the one-hour maximum ozone concentration of 240 mug/m3, which is the Dutch air quality guideline, is exceeded. Epidemiological studies show a relation between photochemical episodes, like ozone, and an increase in respiratory symptoms. It is important to show which effects ozone has on the respiratory tract and at which concentration these effects occur. In experimental studies in which humans are exposed to ozone, the lower airway is investigated by studying biopsies and bronchial lavage fluid (BAL). These techniques can not be applied in epidemiological studies with large healthy human populations, because the techniques are very time consuming and invasive. The nose is the prime port of entry for inspired air, and therefore, the first region of the respiratory tract that comes into contact with airborne pollutants. Nasal lavage (NAL) has helped to analyse the stage of infection, immune response or allergic reaction. A literature search was undertaken to investigate whether or not NAL is useful to determine effects of photochemical air pollution and biomarkers predicting the presence of effects of pollution in the lower respiratory tract. This literature search showed that in experimental studies to ozone and in epidemiological studies at increased concentrations of photochemical air pollution the number of polymorphonuclear cells (PMN's), like neutrophils, and to a lower extent eosinophils is increased in NAL. These were not only shown in NAL, but also in BAL.<br>
    • Blootstelling aan diesel en longkanker ; een voorbeeldstudie van meta-regressie-analyse

      Preller EA; Hollander AEM de; CCM (1996-12-31)
      This report outlines a meta-regression analysis of epidemiological studies on the association between occupational exposure to diesel emissions and lung cancer risk. The analysis was performed as a case-study to develop and evaluate a protocol for meta-regression analyses of observational epidemiological studies, including statistical procedures for Empirical Bayesian analysis. The proposed method of meta-regression analysis describes exposure-response relationships as a function of study characteristics. Thus, it allows straightforward evaluation of heterogeneity in study results due to differences in study characteristics, for instance with respect to the study population, level of exposure, definitions of health end-points, and confounding variables. The case-study clearly demonstrates that meta-analysis of observational studies may be useful as a tool for formal, quantitative literature review. The case study suggests an increase in cancer risk among exposed workers, ranging from 30% to 65%. These results were consistent with an exposure-response relationship, showing the highest lung cancer risk among the workers most heavily exposed during longer periods. The results indicate environmental exposure may lead to some increase of the lung cancer risk. The sensitivity of using various dependent effect estimates from each original study in meta-analysis (to increase statistical power) was analysed, assuming different levels of co-variance.
    • The chronic diseases modelling approach

      Hoogenveen RT; de Hollander AEM; van Genugten MLL; CCM (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1998-05-31)
      A mathematical model structure is described that can be used to simulate the changes of the Dutch public health state over time. The model is based on the concept of demographic and epidemiologic processes (events) and is mathematically based on the lifetable method. The population is divided over several states, risk factor classes and disease stadia. State transitions over time are possible due to birth, aging, migration, mortality, transitions between risk factor classes, disease incidence, progression and remission. The main model parameters are initial population numbers, initial risk factor class and disease stadium prevalence rates, one-year transition rates between the risk factor classes and disease stadia, and risk factor-cause-specific relative risks. The model is used to describe the public health effects of possible intervention programs. These effects can be defined in terms of classic epidemiologic morbidity and mortality figures, but also in terms of life and health expectancy. Several examples of model applications are described: comparing trend extrapolations and model predictions on cause-specific mortality, and comparing the effects of different intervention programs on population smoking and physical activity levels.<br>
    • The chronic diseases modelling approach

      Hoogenveen RT; Hollander AEM de; Genugten MLL van; CCM (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1998-05-31)
      Een wiskundige modelstructuur wordt beschreven waarmee veranderingen van de gezondheidstoestand van de Nederlandse bevolking gesimuleerd kunnen worden. Het model is gebaseerd op het concept van demografische en epidemiologische processen (gebeurtenissen) en is afgeleid van de overlevingstafel. De bevolking wordt verdeeld over verschillende mogelijke toestanden, namelijk voor onderscheiden risicofactoren in verschillende klassen en voor onderscheiden ziekten in een of meer stadia. Toestandsveranderingen zijn mogelijk ten gevolge van geboorte, veroudering, migratie, sterfte, verandering van risicofactor-klasse, incidentie, voortschrijding van de ziekte en remissie. De belangrijkste modelparameters zijn initiele bevolkingsaantallen, initiele risicofactor en ziekte-prevalentiefracties, eenjaars overgangskansen tussen de risicofactor-klassen en ziektestadia, en risicofactor-oorzaak-specifieke relatieve risico's. Het model wordt gebruikt om de gezondheidseffecten door te rekenen van mogelijke beleidsmaatregelen, interventies etc. Enkele voorbeelden worden beschreven van verschillende modeltoepassingen: een vergelijking van trendextrapolaties en modelmatige vooruit-berekeningen voor oorzaak-specifieke sterfte, en een vergelijking van de effectiviteit van verschillende mogelijke anti-roken en meer-bewegen campagnes.
    • Cumulatie van milieurisico&apos;s voor de mens: geografische verschillen in Nederland

      Pruppers MJM; van den Hout KD; Ale BJM; Buringh E; Miedema HME; LSO; ACT; CCM; LAE; LEO; LLO; TNO-MEP; TNO-PG; TNO-Voeding (Rijksinstituut voor Volksgezondheid en Milieu RIVMNederlandse organisatie voor toegepast-natuurwetenschappelijk onderzoek (TNO), 1996-07-31)
      The question whether there are correlations between observed geographical differences in human health and risks due to several types of environmental contamination led to the project 'Accumulation of environmental risks'. The project aimed, firstly, at developing methods to illustrate these geographical differences and, secondly, at applying these methods. The methods are applied to map the risks due to possible severe accidents (external safety), radioactive substances and radiation, substances in air, and environmental noise. The investigation resulted in two reports. The main report contains a general description of the methods applied and the maps created. The accompanying background document (report no. 610127002) focuses on the details of the methods and on the data used. In spite of the complexity of the discussions on risk-related subjects, it appears that by applying the methods developed insight has been obtained into the geographical distribution and the proportions of risks. These methods are based on the risk concept which is implemented in the environmental policy in the Netherlands. The geographical distribution of risks differs greatly between external safety and noise on the one hand and radiation and substances on the other hand. The maps for external safety and noise show high risks on a local scale ; there are areas where risk for these two categories is equal to zero (areas without sources of danger or disturbing noise). Spatial coincidence of external safety risks rarely occurs. Especially for noise the areas of zero risk are smaller than those shown by the maps because the lack of information made a significant part of the risk incalculable. Spatial coincidence of environmental noise occurs mainly near junctions of transport lines and near (large) airports. The risks due to radiation and substances, on the contrary, cover large parts of the Netherlands, with local increases near large (industrial) sources. Peaks in risks on scales less than 500 or 100 m, e.g. near road traffic, are not visible on the maps.<br>
    • Cumulatie van milieurisico's voor de mens: geografische verschillen in Nederland

      Pruppers MJM; Hout KD van den; Ale BJM; Buringh E; Miedema HME; Nederlandse organisatie voor toegepast-natuurwetenschappelijk onderzoek (TNO); LSO; ACT; CCM; LAE; LEO; LLO; TNO-MEP; TNO-PG; TNO-Voeding (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1996-07-31)
      De aanleiding voor het project 'Cumulatie van milieurisico's' was de vraag of er relaties bestaan tussen geconstateerde geografische verschillen in gezondheid van mensen en geografische verschillen in risico's als gevolg van diverse typen milieuverontreinigingen. Het project beoogde eerst het ontwikkelen van methoden om deze geografische verschillen in risico's in kaart te brengen en vervolgens het toepassen van deze methoden. De methoden zijn toegepast voor de volgende agentia: mogelijke grote ongevallen (externe veiligheid), radioactieve stoffen en straling, luchtverontreinigende stoffen en geluid. Het onderzoek heeft geleid tot twee rapporten. Het hoofdrapport bevat een algemene beschrijving van de gevolgde methoden en de geproduceerde kaarten. Het bijbehorende achtergronddocument (rapportnr. 610127002) gaat nader in op de details van de gevolgde methoden en de gebruikte gegevens. Ondanks de complexiteit van de discussies rond de risico-problematiek is gebleken dat met de ontwikkelde methoden op basis van het risico-concept dat in het Nederlandse milieubeleid wordt gehanteerd, inzicht is verkregen in de geografische verdeling en de onderlinge verhoudingen van risico's. De geografische verdeling van de risico's verschilt sterk tussen enerzijds externe veiligheid en geluid en anderzijds straling en stoffen. De kaarten voor externe veiligheid en geluid tonen zeer lokaal hoge risico's; daarnaast zijn er gebieden waar het risico voor deze twee categorieen gelijk is aan nul, namelijk die gebieden waar zich geen gevaren- en/of geluidsbronnen bevinden. Vooral voor geluid is het werkelijke 'schone' gebied veel beperkter dan de hier opgenomen kaarten tonen, omdat bij gebrek aan informatie een significant deel van de belasting niet kon worden berekend. Ruimtelijk samenvallen van de externe-veiligheidsrisico's treedt nauwelijks op. Voor geluid treedt ruimtelijk samenvallen vooral op nabij knooppunten van transportwegen en nabij (grote) vliegvelden. De risico's als gevolg van straling en stoffen daarentegen strekken zich uit over grote delen van Nederland, met lokaal verhogingen rond grote (industriele) bronnen. Risicopieken op een schaal kleiner dan 500 of 100 m, bijvoorbeeld nabij wegverkeer, zijn niet zichtbaar op de kaarten.
    • Definitierapport Graadmeters Volksgezondheid in de Milieubalans/Milieuverkenning (1e versie)

      de Hollander AEM; Lebret E; CCM (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1994-04-30)
      Every four years the National Institute of Public Health and Environmental Protection (RIVM) produces a National Environmental Outlook in which the present and future state of the environment is described using indicators to represent (natural) resources, emissions, environmental quality, public health and ecological effects. In the present report the possibilities are explored to define indicators for public health effects of environmental pollution to be used in these Environmental Outlooks.<br>
    • Developments in infants exposure to dioxins, furans and PCBs and potential health consequences in the Netherlands

      Cuijpers CEJ; Zeilmaker MJ; Molen GW van der; Slob W; Lebret E; CCM; LBO; Vrije Universiteit van Amsterdam, afdeling Theoretische Biologie. (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1997-11-30)
      De tijdtrends (m.b.v. PBPK modellering) en geassocieerde gezondheidseffecten, van pre- en postnatale blootstelling van zuigelingen aan dioxinen, furanen en PCBs werden ge-evalueerd. Op basis van de PBPK modellering wordt in 1998 een daling van ca. 20% in de dioxine gehalten in moedermelk verwacht, ten opzichte van 1993. In de evaluatie van de epidemiologische onderzoeken worden een aantal kritische kant-tekeningen geplaatst bij de blootstellingskarakterisering en de data-analyse van de studies. Door het ontbreken van duidelijke blootstellings-respons relaties kan geen kwantitatieve schatting van het gezondheidsrisico voor zuigelingen worden uitgevoerd. Gepoolde en/of her-analyse van de bestaande data zouden meer inzicht kunnen geven in de inconsistenties in de tot nu toe gerapporteerde data.
    • Developments in infants exposure to dioxins, furans and PCBs and potential health consequences in the Netherlands

      Cuijpers CEJ; Zeilmaker MJ; van der Molen GW; Slob W; Lebret E; CCM; LBO; Vrije Universiteit van Amsterdam; afdeling Theoretische Biologie. (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1997-11-30)
      This report describes the evaluation of the time trend by means of PBPK modelling, and the associated health effects of pre- and postnatal exposure of infants to dioxins, furans and PCBs. Using PBPK modelling there was an expected decrease of ca. 20% in dioxin levels in human milk shown for 1998 compared to 1993. Evaluation of the epidemiological literature resulted in critical remarks on the exposure characterisation and the data analyses of the studies. Lack of convincing exposure-response relationships meant that no quantitative assessment of the associated health risk in infants could be performed. Pooled and/or re-analysis of the existing data could shed some light on the apparant inconsistencies reported so far.<br>