• Observations on the methodology for quantitative risk assessment of dermal allergens

      ter Burg W; Wijnhoven SWP; Schuur AG; SIR; vgc (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2010-11-19)
      People can have allergic reactions when sensitised by a chemical substance, meaning that they have dermal complaints after the next contact with the substance. Presently, the threshold of this effect can be determined using a quantitative method. According to RIVM, it is important to implement this method for determining the risk on allergic reactions while using (fragrant) substances. A transparent guidance is required in order to be able to assess this risk. This conclusion is based on the literature review by RIVM, performed on request of the Ministry of Health, Welfare, and Sports. The observations are illustrated with a risk assessment of the fragrance citral, which is found in consumer products such as cosmetics, cleaning agents, and air fresheners. The quantitative method proposed by the International Fragrance Organization /Research Institute for Fragrance Materials (IRFRA/RIFM) in the basis is satisfactory. Some adaptations are considered to be necessary. The most important issue to be included in the QRA is the fact that people are often exposed to more than one source of allergens (aggregated exposure). An example is the use of several cosmetic products or cleaning agents.The total risk could be underestimated, when the risk is determined per product. The case study with citral underlines the findings from literature. To estimate the exposure of a substance from multiple sources, criteria are needed to determine the relevancy for skin allergy. Relevant parameters for further investigation are the exposed location on the body, and also the duration and repetition of exposure.
    • Occupational Exposure Limits and classification of 25 carcinogens

      van Kesteren PCE; Palmen NGM; Dekkers S; SIR; vgc (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2012-04-23)
      Occupational Exposure Limits (OELs) help to control exposure to dangerous substances in the workplace by setting the maximum amount of (air) concentration of a substance that can safely be allowed. These OELs can be laid down at a European level, national level or by industry. The regulations and interpretations of data for determining an OEL may vary between agencies, allowing the existence of multiple values for one substance within Europe. Besides the determination of OELs, substances are classified in a hazard class (classification). Also for classification different systems and different criteria exist within Europe. This letter report summarizes the OELs and carcinogenicity classification of 25 carcinogens. The data are obtained from the evaluations of the European Commission, the Scientific Committee on Occupational Exposure Limits (SCOEL), the International Agency for Research on Cancer (IARC), REACH1 registrants, the Netherlands, Germany and France. In addition, the Institute of Medicine (IOM) has estimated the impact of introducing an OEL on public health, health costs, the economy, society and the environment in Europe. The conclusions of the IOM are included in the overview. For each substance an overview of the current available data on OELs and carcinogenicity classes is given which allows a direct comparison between values or classifications.
    • Occupational health or occupational safety: which impact is larger?

      Uijt de Haag PAM; Bellamy LJ; Burdorf A; ter Burg W; Eysink P; Heederik DJJ; Klein Entink RH; Manuel HJ; Papazoglou IA; Pronk A; Smit LA; Tielemans E; Timmerman J; CEV; mev (Rijksinstituut voor Volksgezondheid en Milieu RIVMWhite Queen BVErasmus MCRotterdamIRASUtrecht UniversityTNODemokritosGreece, 2012-03-30)
      Employees can be exposed to different risks at the workplace, for example chronic exposure to harmful substances, physical stress and accidents. In 2010, the Occupational Health Impact Assessment (OHIA) model was developed to compare occupational health and occupational safety. The comparison is done by calculating their contributions to the burden of disease of employees. Model expanded with burden of disease due to hand eczema: In 2011, the OHIA model is expanded by the calculation of the burden of disease due to hand eczema. Furthermore, a few discussion points were resolved and the user requirements were specified for converting the model into a valuable software-tool. It is recommended to investigate the demand for the OHIA software-tool in industry sectors. Risks calculated with uncertainties: The model takes uncertainty into account to make comparisons more meaningful. To highlight the importance of uncertainty, the risks are calculated for four job titles with and without uncertainty. The job titles selected were tiler, road paver, carpenter and concrete driller, based on their high contribution to the total burden of disease in the construction sector. The occupational risks considered were the risks of accidents, lifting of heavy objects and exposure to silica. For tilers and road pavers, the exposure to silica has the highest contribution to the burden of disease if best estimates are used without uncertainty. However, taking uncertainty into account, the contributions of lifting heavy loads and accidents becomes comparable to the contribution of exposure to silica. For carpenters and concrete drillers, the uncertainties do not change the results significantly. The OHIA model is developed by RIVM in collaboration with experts from the University of Utrecht (IRAS), TNO, Erasmus Medical Center of Rotterdam and two consultants.
    • The occurrence of Carcinogenic, Mutagenic and Reprotoxic (CMR) substances in consumer preparations

      Muller JJA; Bos PMJ; SIR (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2004-05-04)
      Bescherming van de algemene bevolking tegen de gezondheidsnadelige effecten van Carcinogene, Mutagene en reproductietoxische stoffen wordt voor een belangrijk deel gerealiseerd door een verbod op de verkoop van producten die categorie 1 en 2 CMR-stoffen (Annex I of 67/548/EEC) boven de toegestane limiet bevatten. Het is derhalve belangrijk na te gaan in hoeverre deze stoffen voorkomen in consumenten preparaten en inzicht te verkrijgen in potentiele CMR-stoffen die niet voorkomen op Annex 1. Met behulp van elektronisch toegankelijke databases werd gezocht naar potentiele CMR-stoffen. Dit leverde een additionele lijst van 514 potentiele CMR-stoffen op die niet voorkomen op Annex 1. Het voorkomen van geclassificeerde en potentiele CMR-stoffen in consumentenpreparaten werd geverifieerd aan de hand van het Noord-Europese SPIN databestand. In totaal bleken 146 CMR-stoffen voorkomend op Annex I en 24 potentiele CMR-stoffen voor te komen in consumentenpreparaten. Het kan niet worden uitgesloten dat deze stoffen ook in Nederland kunnen voorkomen in consumenten-preparaten. Aangezien kwantitatieve gegevens over de gehalten van deze stoffen in de betreffende preparaten niet vrij toegankelijk zijn, is een kwantitatieve schatting van de blootstelling niet mogelijk.
    • The occurrence of Carcinogenic, Mutagenic and Reprotoxic (CMR) substances in consumer preparations

      Muller JJA; Bos PMJ; SIR (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2004-05-04)
      The general public is protected from the effects of Carcinogenic, Mutagenic and Reprotoxic (CMR) substances partly by banning the sale of preparations containing classified CMR substances (Annex I of 67/548/EEC) at levels above the limit concentration for exposure of the general public. It is therefore important that consumer preparations are checked for the presence of these substances and that, in addition, potential CMR substances are assessed for inclusion in Annex I of 67/548/EEC. A search was made for potential CMR substances in electronically accessible databases, after which a list of 514 potential CMR substances not found in Annex 1 could be compiled. The occurrence of CMR category 1 and 2 substances, and of additional potential CMR substances, in consumer preparations was checked against the SPIN database, an initiative of the Nordic countries. A total of 146 Annex I substances for the CMR categories 1 and 2, and 24 potential CMR substances were found to be present in consumer preparations used in the Nordic countries. It cannot be ruled out that these substances will also be present in consumer preparations used in the Netherlands. A quantitative estimate of the potential exposure to CMR substances was not possible due to the lack of an adequate database of consumer preparations showing actual concentrations.
    • Ocean-climate variability and sea level in the North Atlantic region since AD 0

      Plassche O van de; Edwards RJ; Wright AJ; Weber SL; Schrier G van der; Drijfhout SS; Gehrels WR; NOP (Vrije Universiteit amsterdamThe NetherlandsKNMI De BiltThe NetherlandsUniversity of Plymouth United Kingdom, 2002-01-23)
      We used reconstructed and model-simulated sea-level variations during the past 1000-3000 years to investigate their cause(s) and assess their suitability as proxy for ocean-related climate variations in the North Atlantic region. We studied salt-marsh deposits in North Carolina, Connecticut, Newfoundland, and Wales (UK). Sea-level reconstructions obtained so far (for Connecticut) show that mean high water varied on centennial and sub-centennial timescales on the order of cms-dms during the past 3000 years. The mean high water fluctuations correlate more or less positively with proxy records of temperature change, but this broad correlation does not hold for the entire record. The most significant correlation found is a consistent phase shift of ca. 125 years between changes in solar activity (as expressed in variations in residual delta 14C) and sea level, suggesting a linkage by one or more mechanisms with a corresponding response time. The fact that sea level continued to fluctuate during periods of low solar variability indicates, however, that other factors are also involved.Sea-level change due to changes in the thermohaline structure of the North Atlantic ocean has been calculated using a coupled ocean-atmosphere model of intermediate complexity (ECBilt). Two 1000-yr simulations are made, one using a constant solar forcing and one using an estimate of historic solar activity. In the solar forced simulation, sea-level variations are a proxy for climate variations. Anomalies in sea-surface temperature (SST) of the northern North Atlantic are generated by the solar radiation changes. These SST anomalies modulate the ocean thermohaline circulation, affecting surface salinities in the northern North Atlantic which are subsequently advected to the deep ocean. The associated deep ocean geopotential thickness anomalies dominate sea level in the northern North Atlantic. Comparison of the simulated steric sea-level variations in the Gulf Stream area for the past 1000 yr with the corresponding part of the mean high water reconstruction for Connecticut shows a satisfactory agreement, indicating that deep ocean salinity anomalies in the northern North Atlantic, induced by changes in irradiance, largely explains the timing of reconstructed mean high water variations. This result has relevance for predictions of sea-level change.
    • Oceanic uptake of anthropogenic CO2: mechanisms and modelling

      Klepper O; Haan BJ de; Saager P; Krol MS (1993-11-30)
      Within the framework of a research program directed towards the model-based assessment of the enhanced greenhouse effect this report gives an overview of the role of the oceans in the uptake of anthropogenic CO2 (i.e. CO2 released from industrial sources and changing landuse). Background information on chemical, physical and biological mechanisms is summarized. The role of the oceans in the CO2 cycle during the geological past provides an important clue to understanding their current role in the perturbated CO2 cycle. Based on these sources of information a model for the oceanic carbon cycle is formulated which forms part of the IMAGE system of models to assess the greenhouse effect. The model is used for a sensitivity study of the effect of global change on oceanic carbon uptake during the next century. The main conclusion of this study is that the oceanic CO2 uptake is (on the time-scale of interest) relatively insensitive to possible changes in external conditions. This implies that management possibilities are virtually absent: CO2 abatement policies should focus on terrestrial aspects (emissions and landuse) only. In terms of research priorities the implication of this study is that it may be possible to predict future oceanic CO2 uptake within reasonable uncertainty limits, even though we are not able to predict all aspects of ocean chemistry, biology and physics in detail.
    • Ochratoxine A in vleeswaren, varkensbloedplasma en varkensplasma- poeder

      Top HJ van den; Paulsch WE; Egmond HP van (1991-02-28)
      This report describes the investigations on the occurrence of ochratoxin A in 26 samples meat products, 2 samples porcine blood plasma and 2 samples porcine dried plasma. The method of analysis used, is described in the Standard Operating Protocol (SOP nr. ARO 091), added as an annex to this report. The results of the investigations have shown that ochratoxin A was not detectable in any of the analysed meat products. Ochratoxin A was detectable, however, in both samples of blood plasma and in both samples of dried plasma (concentration: 4 and 4.4 mug/kg dried plasma ; <0.5 mug/kg blood plasma). The limit of detection of the method of analysis used was 0.1 mug/kg (signal/noise <__3). The identity of ochratoxin A in the samples dried plasma was confirmed with a derivatization procedure. These results have led to the provisional conclusion, that there is currently no reason for concern about human exposure to ochratoxin A through consumption of meat products, sold in the Netherlands.
    • OECD 28-days oral toxicity study on fumonisin B1

      Nijs M de; Egmond HP van; Jong WH de; Loveren H van; LPI; ARO; MGB (1999-02-01)
      The experiment described was carried out to gain knowledge on the effects of low doses of fumonisin B1 on target organs and the immune system. Male rats (age three weeks) received oral (gavage) doses of 0, 0.19, 0.75 or 3 mg fumonisin B1 kg-1 body weight (BW) (dissolved in water) daily for four weeks. After 28 days of treatment, the animals were sacrificed and necropsied. Blood collected during necropsy was used for biochemical analysis. Additional blood and tissue from liver and kidney were collected for sphingolipid analysis. The presented study showed that the kidney and liver are the prime target organs for toxicity of low doses fumonisin B1. Exposure to low levels of fumonisin B1 induced continuous cell proliferation in the kidney tubules which might eventually result in tumour alterations in the proliferating cells. No clear effects on the immune system were observed. However, when combining the observed trends in this experiment with the results from other published experiments on the parameters of the immune system, potential immunotoxicity of fumonisin B1 cannot be ruled out. Further research needs to be carried out.
    • OECD International Collaborative Study on Acute Toxicity Testing

      Vermeire TG; de Vries T; Speijers GJA; Wester PW; de Liefde A; Beekhof PK; van der Heijden CA (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1989-05-31)
      Twintig stoffen zijn blind onderzocht op acute toxiciteit in het kader van een OESO-validatie van de zogenaamde "Fixed-Dose Procedure". Elke stof is per maagsonde toegediend in een dosering aan 5 mannelijke en 5 vrouwelijke ratten. Op gronden van een voortest was de dosering zo gekozen uit de vaste reeks van 5, 50, 500 en 2000 mg/kg lichaamsgewicht dat duidelijke toxische effecten waargenomen zouden worden, maar geen sterfte. Indien sterfte optrad ofwel duidelijke toxiciteit uitbleef werd de test herhaald bij de lagere, respectievelijk hogere dosering uit de vaste reeks. Voor 13 van de stoffen bleek een eerste herhalingstest noodzakelijk en voor 1 van deze 13 ook een tweede test. De ratten zijn frequent geobserveerd gedurende maximaal 14 dagen op tekenen van acute toxiciteit, zodat de effectfase en de eventuele seversibiliteit van de effecten konden worden vastgelegd. Op elk dier is ook autopsie verricht. Dieren die ernstig leden werden voortijdig gedood en droegen bij aan de stof-gerelateerde mortaliteit. De in dit rapport beschreven resultaten zullen samen met die van de andere 29 deelnemende laboratoria uit 12 landen en de resultaten van de door een laboratorium met alle stoffen uitgevoerde klassieke LD-50 test, welke als referentiepunt kan dienen, binnenkort geevalueerd worden.<br>
    • OECD pilot project: Phase 3 The Dutch contribution PYRIDATE

      Linders JBHJ; Wouters MFA; ACT (1994-07-31)
      This report is the Dutch contribution in the Pilot Project of OECD's Pesticide Program. The Netherlands acted as lead country for pyridate for the comparison of evaluations of six participating countries, including Australia, Canada, Germany, Switzerland, the Netherlands and the United States of America. The lay-out of reviews are compared with each other and it was shown that of all participating countries only the Netherlands summarize all studies on toxicology and ecotoxicology individually. Of all references of all countries together only 61 out of 372 references were reviewed by two or more countries. From the common studies the countries established always the same endpoints. Only for some studies different final fate and effect data were reported. But in all cases the differences were only small. It can be concluded that it seems possible for countries to use reviews prepared by other participating countries for establishing their own results. Standardization showed to be important for several subjects
    • OEFENING &quot;REFAJA&quot;: Oefening in de opvang en behandeling van slachtoffers na een chemisch ongeval, op 30 juni 1992 te Dordrecht

      Noordergraaf GJ; Deggens JW; Eijk KJ van der; Savelkoul TJF (1993-01-31)
      The Drechtsteden Hospital, location Refaja is the first to participate in a national network set up for the admission and treatment of groups of patients exposed to physical, biological or chemical agents. The training offered the hospital the opportunity to admit patients from a mass-casualty chemical incident. For this purpose the hospital had available written protocols and was supported by the National Poison Control Center (NVIC) and the Emergency Hospital Utrecht. Major goals for the training were: - to activate the hospital as a participant in the national network of hospitals for chemical accidents coordinated by the medical assistance team of the NVIC/-Emergency Hospital Utrecht - to evaluate the written protocols for mass-casualty accidents and observe procedures - to evaluate medical en nursing aspects in patient treatment. The planning and the execution of the training are described. Conclusions are formulated as to the procedural and medical aspects in the training. Some of these show possibilities for the improvement in efficiency by a recognizable coordinator, the need to adapt to the quantity of patients and the registration of relevant (medical) data. Some suggestions are made to strengthen the disaster management plan.
    • Oeverfiltraat en organische microverontreinigingen

      Versteegh JFM (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1989-01-31)
      Voor het conventionele zuiveringsproces geldt in het algemeen dat stoffen die tijdens infiltratie niet worden verwijderd ook tijdens het zuiveringsproces niet worden verwijderd. Een uitbreiding met ozon en actief kool zorgt voor een betere verwijdering van microverontreinigingen en voor een langere filterlooptijd. Hoog-polaire stoffen zullen ook met actief koolfiltratie niet worden verwijderd. Met de huidige isolatie- en analysetechnieken is het niet eenvoudig dit type verbindingen te detecteren. Een gezondheidskundige evaluatie van dit type stoffen is dan ook vrijwel onmogelijk. Er zal verder onderzoek moeten worden gedaan naar analysemethoden voor hoog-polaire stoffen ; bij voorkeur het ontwerpen van een somparameter voor deze klasse van verbindingen. Gezien de verschillende aspecten die aan oevergrondwater kleven is het wenselijk dat het oevergrondwater in de eerste plaats wordt gezien als onbeheersbaar, niet voorgezuiverd, geinfiltreerd oppervlaktewater en niet als grondwater. Hierbij past een zuivering welke de kwaliteit van het geproduceerde drinkwater waarborgt ; een actief koolfiltratie en eventueel een ozonisatie kunnen in een dergelijke zuivering belangrijke stappen zijn.<br>
    • Off-label gebruik van geneesmiddelen. Transparantie gewenst

      Caspers PWJ; Gijsen R; Blokstra A; KCF (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2008-01-09)
      Prescribing drugs off-label is commonplace within the medical profession. Indeed, when an off-label prescription is the treatment of choice within the relevant group of health professionals, it is even considered to be the preferred practice. These off-label prescriptions are medicines prescribed for indications for which these medicines have neither been approved nor assessed by the Dutch Medicines Evaluation Board. According to physicians, the prescription of off-label medicines is dictated mainly by professional guidelines, pharmo-therapeutic handbooks and scientific literature. This is in accordance with the views on off-label prescriptions held by the Dutch Medicines Evaluation Board, the Netherlands Health Care Inspectorate and the Dutch College of General Practitioners. This is also in accordance with the new Medicines Act (Geneesmiddelenwet), which came into effect on July 1st 2007. According to physicians experimental behaviour occurs 'rarely to sometimes'. On the other hand, experimentation based on 'one's own experience' or 'the experience of colleagues' occurs 'sometimes to regularly'. Physicians are duty bound to inform patients and request their permission when prescribing drugs off-label. However, this code of practice is only observed 'sometimes to regularly' by general practioners and paediatricians and 'regularly to often' by medical oncologists, dermatologists and neurologists. Approximately 50% of the physicians admit to either 'rarely or never' asking the patient for permission. The above information is the result of both a survey carried out among 464 general practitioners and 406 health care specialists, and a study of existing professional guidelines for physicians. The survey illustrates that there is a need among physicians for more information on off-label prescriptions. Depending on their specialism, 22% to 45% of the physicians indicate that they 'regularly' do not know whether a prescription is off-label. The groups of physicians involved in the survey all indicated an urgent need for a central reporting- and evaluation system within their professional group. General practitioners, in particular, indicated that they only 'rarely or sometimes' evaluate off-label use themselves or with fellow colleagues. It is still unclear whether or not off-label use leads to increased health risks. Proof of these increased risks is scarce in scientific literature, and these risks remain mainly presumed from theoretical considerations.
    • Off-label gebruik van medische hulpmiddelen : een verkenning

      Pot JWGA; de Vries CGJCA; GMT; vgc (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2013-01-28)
      In Dutch hospital care, the use of medical devices for other purposes than the intended use as indicated by the manufacturer occurs consciously or unconsciously. The frequency of occurance is unknown. This so-called off-label use entails risks and is generally not recommended. However, it can offer a solution in crisis situations when no alternative means are available and a patient's life is in danger for example. Furthermore, off-label use can lead to innovation in the field of medical devices. This is concluded from an exploratory study performed by the RIVM. In the Netherlands, no official position has been taken on off-label use of medical devices. The study was commissioned by the Health Care Inspectorate (IGZ). Twelve people who are closely involved in procurement, use and management of medical devices in hospitals participated in an interview. Care providers, such as medical specialists and nurses, did not participate in this study. Further research into their views about off-label use is recommended. To limit off-label use, structural attention regarding the proper use of medical devices is needed in training and retraining of care providers. The also applies for good information on the availability of medical devices in hospitals. This may be implemented through an accessible overview of available products, and information on the experiences with these products. In addition, it is recommended to establish criteria for justified off-label use of medical devices, combined with handling procedures, e.g. a risk assessment procedure by a multidiciplinary team before off label use and publication of experiences afterwards. This may reduce the risks of off-label use. It is therefore advisable to get an agreement on the matter with the parties concerned, i.e. patients, healthcare professionals, boards of hospitals, manufacturers and government.
    • Off-label use of coronary drug-eluting stents

      Roszek B; Water R de; Pot JWGA; Geertsma RE; BMT (2009-07-15)
      Abstract not available
    • Off-label use of coronary drug-eluting stents : Occurrence, safety, and effectiveness in 'real world' clinical practice

      Roszek BR; de Water R; Pot JWGA; van Domburg RT; Geertsma RE; BMT; vgc (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2012-06-05)
      Use of coronary drug-eluting stents (DES) for purposes other than their indications for use (off-label use) may push such devices beyond their design limits and thus potentially lead to increased risks. On the other hand, such use can be clinically relevant, treatment regimes may become a medically recognised standard and off-label use may be important for further innovation. Worldwide, the use of DES in patients with off-label characteristics is common in clinical practice, with frequencies varying from 47% to 81% of all patients. Offlabel use of DES in one large Dutch cardiovascular centre was estimated to be 68% in 2002. At a Dutch national level, no data could be found. Promising results of DES for on-label indications have led to the application of DES in more complex situations such as multiple lesions, lesions at bifurcations, and diabetes. In some cases, this is the only treatment option available. For unrestricted use of DES (covering off-label as well as on-label indications), there are no conclusive data from individual observational studies with regard to safety aspects compared with using a bare metal stent (BMS) for similar indications. However, in a meta-analysis by renowned investigators of observational studies and randomised clinical trials, unrestricted use of DES compared with BMS did not appear to be associated with adverse safety outcomes and was reported to be more effective. Some new-generation DES are more safe and effective when compared with first-generation DES.
    • Off-labelgebruik van geneesmiddelen : Verkenning van de complexiteit en problematiek

      Weda M; Molto-Puigmarti CP; Vonk RAA; Hoebert JM; EVG; GZB (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-01-17)
      Medicinal products may be prescribed for other diseases, or groups of patients, than the ones that they are approved for. This is what we call 'off-label use', a practice which is legally permitted under certain conditions and usually takes place when there are no other suitable treatment options available. Off-label use, for example, frequently occurs in the treatment of children or patients who have serious illnesses for which there is no approved therapy. The extent to which this course of action is taken differs per disease area but can be substantial. The off-label use of medicinal products thus fulfils a medical need, but can still be improved on in several ways. This has been illustrated in research conducted by RIVM. For example, in practice, doctors do not always inform their patients or ask for permission when prescribing medicines off-label, even though they are required to do so by law. Furthermore, it is important to make information about off-label applications more accessible to doctors and pharmacists; currently this knowledge is fragmented and availability is patchy. It is also important to increase levels of awareness about the efficacy of these medicines by keeping track of their performance and recording any possible side effects of off-label use. Of course, it is preferable to make off-label use of a medicinal product 'on label'. To do this, the drug manufacturer must take the initiative to provide proof of the product's efficacy and safety of use to the government. If a manufacturer does not take this initiative, the off-label use is not mentioned in the patient information leaflet. Manufacturers could be encouraged to provide proof. Whether this initiative could be taken by anyone other than the manufacturer might also be investigated.
    • OKZ binnen bereik? De toegankelijkheid van ouder- en kindzorg in geografisch perspectief

      Verheij RA; Boven PF van; Kosterman F; VTV (2001-11-22)
      To what extent do regional variations in supply match regional variations in demand in mother and child care? That is the question addressed in this report. Regional differences in physical accessibility of mother and child care, manpower and financial resources are examined by means of geographic maps.
    • OKZ binnen bereik? De toegankelijkheid van ouder- en kindzorg in geografisch perspectief

      Verheij RA; Boven PF van; Kosterman F; VTV (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2001-11-22)
      In welke mate zijn er regionale verschillen in de aansluiting tussen vraag en aanbod in de ouder- en kindzorg? Dat is de centrale vraag van het rapport "OKZ binnen bereik?" Met behulp van geografische kaarten is gekeken naar regionale verschillen in de spreiding van consultatiebureaus, de inzet van menskracht en de toedeling van financiele middelen in de ouder- en kindzorg. Het onderzoek laat onder andere zien dat het aantal consultatiebureaus in Nederland in de periode 1998-2000 met 4% is gedaald, maar ons land kent nog steeds een dicht net van consultatiebureaus. Een belangrijke aanbeveling geldt de verbetering van de informatievoorziening in de ouder- en kindzorg in het algemeen. Bijvoorbeeld regionale verschillen in het feitelijk gebruik van ouder- en kindzorg zijn op dit moment niet na te gaan. Het onderzoek werd uitgevoerd in opdracht van het Ministerie van VWS.