• Zeer Zorgwekkende Stoffen : Screening op aanwezigheid in het milieu

      van Leeuwen LC; ICH; M&V (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2015-11-25)
      The Dutch government takes priority action in reducing emissions of substances of very high concern ('ZZS substances'). ZZS substances are for example carcinogenic substances and substances that are very persistent, bio-accumulate in organisms and are toxic (PBT-substances). Examples of these substances are the solvent benzene or brominated flame retardants. The Dutch policy on ZZS substances aims to minimize the emissions of these substances to the environment as much as possible, such that their environmental concentrations in the Netherlands are brought (or maintained) below a negligible risk level. RIVM investigated which ZZS are relevant in the Dutch environment. Relevant ZZS are the ZZS which are emitted to the environment due to production and use, unintentional formation or ZZS which are found in the environment. The analysis showed that many of the ZZS are (potentially) relevant because environmental emissions cannot be excluded. The relevant ZZS have a varied use pattern, which gives difficulties in defining the next step in the process. RIVM suggests a number of possibilities for further research, including researching dyes, research into policy possibilities for sound management of ZZS and comparing various prioritization methods for substances of concern.
    • Zeer Zorgwekkende Stoffen: prioriteringsopties voor beleid

      de Poorter LRM; van Leeuwen LC; MSP; M&V (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2016-12-12)
      The Dutch government takes priority action in reducing emissions of substances of very high concern ('ZZS substances') as they are hazardous to people and the environment. Examples include substances that are carcinogenic or impede reproduction. The current list of ZZS comprises 1400 chemicals. Local authorities and the Ministry of Infrastructure and Environment have expressed their need for a more workable list for a further prioritisation within the list that better reflects the Dutch situation. This RIVM study shows that is difficult to achieve such focus. For the Netherlands territory, easily accessible information on production, use and emissions of many ZZS is not available. This is an obstacle to designate ZZS that require extra attention, such as local point source measures or a stimulus on innovative research towards safe alternatives. Therefore, RIVM recommends obtaining more information on these substances, for example, via a national substance registration system, which makes transparent which ZZS are being used in the Netherlands. This recommendation is based in part on the following two investigations into the potential to prioritize ZZS that need more attention within the ZZS policy. Ongoing RIVM projects on 'new and emerging risks of chemicals' (NERCs) provide a useful methodology to identify chemicals of risk, but again the information required for a thoroughly based prioritization for the Netherlands is often unavailable. An analysis of European legislation for (raw materials of) dyes on the ZZS list shows that for some of these substances no European legislation exists containing additional measures to mitigate further emissions. These substances are candidates for further ZZS policy. RIVM finally points out that attention is needed for (substitution) chemicals that may not (yet) have the ZZS status because of a data lack, but may be of equivalent concern owing to their chemical structure and use.
    • Zeeschepen: metingen van chemische stoffen in brandstoffen en rookgassen :

      Mooij M; Gerlofs-Nijland ME; Swart DPJ; IMG; mev (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2010-08-30)
      In 2008, commissioned by the VROM Inspectorate, RIVM measured the chemical composition of fuels and flue gases of sea-going vessels at the Western Scheldt and the North Sea Canal. The results showed that compared to diesel oil, heavy fuel oil contains more sulphur and heavy polycyclic aromatic hydrocarbons (PAH). The average sulphur content in fuels for vessels running on heavy fuel oil was higher than for vessels running on diesel oil (1.6 percent against 0.13 percent). For vessels in harbour with their auxiliary engines or generators running on diesel oil, the average fuel sulphur content was 0.21 percent. Relative to previous years, the average sulphur content in heavy fuel oil dropped from 2.2 to 1.6 percent, in line with prevailing policy. All kinds of pollutants adhere to particulate matter in flue gases from vessels. The results of the flue gases of sea-going vessels showed more PAH and sulphur for ships running on heavy fuel oil than those running on diesel oil. Although, we cannot conclude this for all the pollutants. It appeared that the particulates in flue gases were composed for 70 percent of ultrafine particles (PM0.1), for 28 percent of fine particles (PM0.1-2,5) and for 2 percent of coarse particles (PM2.5-10). Ultrafine dust with its smaller particle size is more harmful to health because it can penetrate deeper into the respiratory organs. Furthermore, the flue gases were measured for sulphur dioxide emissions. The average sulphur dioxide emission in flue gases was 15 grams per second. This survey was the last in a series of three. The 2006, 2007 and 2008 surveys were carried out in a similar setting. From 2007 onwards, particulates were studied as well.
    • Zeldzame aarden in drinkwater en drinkwaterbronnen

      Verweij W; van den Velde-Koerts T; de Boer JLM; Mennes W (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1994-01-31)
      A survey has been carried out to measure the concentrations of rare earth elements in drinking water and its cources in the Netherlands. Rare earth elements occur in the earth's crust and, by weathering, also in surface water and groundwater. In surface water rare earth elements were found in concentrations up to 1000 ng/L. In drinking water produced from surface water no concentrations above the detection limits were found. In many of the groundwater samples no rare earth elements were found at all. In a few samples, however, high concentrations of up to 30,000 ng/L were measured. No correlation was found between high concentrations and low pH, although this is sometimes suggested in the literature. High concentrations of rare earth elements were only found in phreatic water with low bicarbonate content collected at a relatively low depth. During purification the concentrations decreased to nearly zero at a few pumping stations, but remained high at a few others. The toxicological data on rare earth elements were evaluated, resulting in indicative admissible concentrations. A comparison, showed that at two of the twenty investigated pumping stations one or more indicative admissible concentrations were exceeded. A more detailed assessment of the concentrations of rare earth elements in Dutch drinking water and its sources is recommended.<br>
    • Zeldzame aarden in ruw en rein water van freatische grondwaterwinningen

      Verweij W; Velde-Koerts T van der; Ritsema R; Mons MN; LWD; LAC (1995-12-31)
      A survey was carried out to measure the concentrations of seven of the rare earth elements in both drinking and unpurified water at 36 pumping stations, using phreatic groundwater as a source. At 18 stations one or more (up to seven) of the rare earth elements were found in unpurified water in concentrations above the detection limit. At three stations rare earth elements were found in concentrations higher than Indicative Admissible Concentrations (IACs), values derived on a toxicological basis. At eight stations one or more (up to four) of the rare earth elements were found in drinking water in concentrations above the detection limit while none rare earth elements were found in concentrations higher than the IACs. The highest concentration of rare earth elements coincided with the lowest pH-values. At a pH below ca. 5.5, yttrium, lanthanum and cerium can be expected to exceed the IACs. It is recommended that at such pHs the concentrations of the rare earth elements in unpurified and drinking water should be measured to assess the necessity of additional measures.
    • ZEROCD and PROFCD, Description of Two Programs to Supply Quick Information with respect to the Penetration of Tracers into the Soil

      Veling EJM (1993-03-31)
      For a variety of environmental studies it is useful to get a quick impression of how certain tracers penetrate the soil. Under some restrictive assumptions, it is possible to predict the concentration and the amount of material which has passed, and which is present, below some level without the detailed knowledge of the structure of the soil matrix. In this report a survey is given of formulas describing the behaviour of a tracer without or with decay with linear adsorption in a one-dimensional semi-infinite medium with various boundary conditions. These boundary conditions are: instantaneous injection or exposure, continuous injection or exposure, or block pulse injection or exposure. Interest is focussed on the questions at what time a specified amount of material is present below or has passed a givin depth. A computer program is described which supplies an answer to this question (ZEROCD). Another computer program (PROFCD) visualizes all relevant results (resident and flux concentration, resident and transported mass, fraction of resident (or transported) mass to total injected amount). Although the underlying assumptions may be too simple for realistic situations, yet, by varying the input parameters, the user can find upper and lower bounds for various unknowns (e.g. concentration, time of arrival and so on), without much modelling effort, because the time of calculation of both programs is very short. The latter may also facilitate the performance of a formal uncertainty analysis. Furthermore, its very short calculation time makes this software package pre-eminently useful to produce a first, rapid assessment of the evolution of pollution in a wide range of typical soil profiles within the framework of large scale environmental studies. Another application of the programs is the possibility to serve as a reference for verification of numerical computer codes, a key element of the INTRAVEL project.
    • Zicht op zorg in de Drinkwatervoorziening: de distributie

      Jonker N; Lips F; Versteegh JFM; Kouwe PM; de Jonge JT; LWD (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1999-08-30)
      This report gives an overview of the present state of quality assurance in the drinking water production in the Netherlands. The Inspectorate for the environment visited in 1999 all drinking water companies with a distribution system. 22 drinking water companies were involved in this investigation. With a checklist the process of the distribution of drinking water was examined with special attention on quality assurance aspects, safety, hygienic aspects, communication and environmental aspects. Most of the companies are developping an accepted quality assurance system. Most procedures that are required to guarantee the continuance of good drinking water-quality are available at most companies. Still a lot of work has to be done to reach the level of an accepted quality- and environmental assurance system.<br>
    • Zicht op zorg in de drinkwatervoorziening: de zuivering

      Versteegh JFM; van Gaalen FW; Groen L; LWD (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1997-04-30)
      This report gives an overview of the present state of quality assurance in the drinking-water production in the Netherlands in 1996. The Netherlands Inspectorate for the Environment carried out an investigation at 49 drinking-water companies. The process of drinking-water treatment was examined using a checklist with special attention for quality assurance and hygienic aspects, safety, and communication and environmental aspects. Most of the companies stood on the side of quality assurance according to existing procedures ; employees were enthousiastic and well versed. Especially the technological and analytical aspects are well organised. However, still much work has to be done to reach the level of an accepted quality assurance system.<br>
    • Ziekenhuisopname en poliklinische behandeling in relatie tot ozonconcentraties in de buitenlucht ; een voorbeeldstudie van meta-regressie-analyse

      Preller EA; Hollander AEM de; Heisterkamp SH; Lezenne Coulander C de; CCM (1996-10-31)
      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 population, definitions of exposure and 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 showed a statistical significant increase of the hospital admission risk of 12% for an increase in ambient ozone concentrations of 100 mug/m3 as an 8 hour average (95% CI: 7-18%). The analysis indicated that the effect of ozone air pollution is most pronounced in children with respiratory diseases and in emergency room visits. Concurrent particulate air pollution did not seem to influence the association to a great extent.
    • De ziekte van Parkinson in Nederland. Ontwikkelingen in de kennis van de epidemiologie, etiologie en mogelijkheden voor preventie

      Harteloh PPM; VTV (1994-10-31)
      Since chronic diseases are becoming more prevalent in our society, there is a growing need for state-of-the-art reviews of developments in the knowledge of etiology, determinants and prevention of chronic diseases. This report is about Parkinson's disease. It is focused on the epidemiology of Parkinson's disease in the Netherlands, the etiology and determinants of the disease and possibilities of primary, secondary or tertiary prevention, especially in relation to life-style. In the Netherlands it is estimated that there are about 13.500 to 35.000 persons with Parkinson's disease and that every year 1.700 new cases of Parkinson's disease are diagnosed. These estimates are based on registration in general practice. In a population sample of elderly persons (55+) there appeared to be 11 per 1.000 men (95%-confidence interval 7-16) and 15 per 1.000 women (95%-confidence interval 11-19), which means 15.300 men and 26.300 women with Parkinson's disease. It makes Parkinson's disease one of the more common diseases in the elderly. A variety of factors contribute to the development of Parkinson's disease. These factors include combinations of genetic predisposition, aging and environment, and could vary between persons. To date the results of genetic research are inconclusive. So, many investigators postulate an important role for environmental factors in the development of Parkinson's disease. Proposals for specific putative environmental factors include viruses, metals and toxins. Smoking has often been reported to be less common in Parkinson's disease, and this has also been proposed to relate to its etiology. However, the cause of Parkinson's disease is unknown. Also there is not much knowledge of life-style as a cause of Parkinson's disease. Physical exercise and food constituents such as vitamin E might have a protective effect, but more research is still needed.Primary and secondary preventive measures aimed at life-style factors are hard to formulate. Tertiary prevention might be possible because physical exercise or speech therapy could prevent complications such as falling and swallowing the wrong way. The several possibilities still have to be examined on effectiveness and efficiency. More research on this topic is recommended.
    • De ziekte van Parkinson in Nederland. Ontwikkelingen in de kennis van de epidemiologie, etiologie en mogelijkheden voor preventie

      Harteloh PPM; VTV (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1994-10-31)
      Gezien de gestegen prevalentie van chronische ziekten in Nederland is er een toegenomen behoefte aan overzichten over de nieuwste ontwikkelingen in de kennis. Het voor u liggende rapport geeft een overzicht van de huidige kennis over een aantal aspecten van de ziekte van Parkinson. Nadruk ligt daarbij op de epidemiologie van de ziekte van Parkinson in Nederland, de etiologie van het ziektebeeld en de mogelijkheden voor preventie door interventie op leefstijlfactoren. De ziekte van Parkinson is een chronische ziekte waaraan naar schatting op basis van registratie in de huisartspraktijk tussen de 13.500 en 35.000 personen lijden. De huisarts registreert jaarlijks ongeveer 1.700 nieuwe gevallen van de ziekte van Parkinson. De eerste resultaten van een bevolkingsonderzoek in Nederland onder personen van 55 jaar en ouder tonen een prevalentie van 11 per 1.000 mannen (95%-betrouwbaarheidsinterval 7-16) en 15 per 1.000 vrouwen (95%-betrouwbaarheidsinterval 11-19), hetgeen overeenkomt met 15.300 mannen en 26.300 vrouwen. De ziekte van Parkinson is daarmee een regelmatig voorkomende ziekte onder ouderen. De ziekte van Parkinson wordt veroorzaakt door een combinatie van factoren zoals genetische aanleg, veroudering, en omgeving. Het huidige onderzoek geeft geen eenduidige aanwijzing over een genetische etiologie. Aan omgevingsfactoren in de vorm van een virus, metalen of andere toxische stoffen wordt in combinatie met veroudering een belangrijke rol toegekend. Over de invloed van leefstijlfactoren op het ontstaan van de ziekte van Parkinson is nog niet veel (met zekerheid) bekend. Associaties met roken, voeding (vitamine E) en lichamelijke activiteit worden onderzocht. Veel onderzoek speelt zich op biologisch niveau af waar ook de belangrijkste aangrijpingspunten voor therapeutisch ingrijpen zijn gelegen. De oorzaak van de ziekte van Parkinson is vooralsnog onbekend. Screening op grote schaal lijkt, gelet op de criteria van Wilson en Jungner, momenteel niet zinvol. Hoewel ervan wordt uitgegaan dat de ziekte van Parkinson een pre-klinisch stadium heeft en er, zij het nog niet op grote schaal toepasbare, redelijk betrouwbare screeningsinstrumenten voorhanden zijn, is het arsenaal aan therapeutische mogelijkheden momenteel nog te smal om screening aan de bevolking aan te bieden. Het is dan ook moeilijk om algemene maatregelen op het niveau van primaire of secundaire preventie aan te bevelen. Wat betreft tertiaire preventie gericht op leefstijlfactoren lijken fysiotherapie en logopedie zinvol. Complicaties als vallen en slikstoornissen kunnen erdoor worden voorkomen en het welzijn van de patient wordt erdoor vergroot. De verschillende vormen van in aanmerking komende fysiotherapie dienen echter nog op doeltreffendheid en doelmatigheid getoetst te worden. Een gerichte onderzoeksinspanning om dit te realiseren kan worden aanbevolen.
    • Ziektelast en kosten van letsel door geweld

      Snijders BEP; Gommer AM; Haagsma JA; Panneman MJ; Polinder S; van Beeck EF; VVG; V&Z (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2016-06-30)
      Disease burden is defined as the health impact of disease and premature death within a population. Up to now, the disease burden of "violence- related injuries" used to be defined as the number of people dying prematurely as a result of this type of injuries. The physical and psychological impact of (non-fatal) violence-related injuries are not yet included in the disease burden. If it were, the total disease burden of violence-related injuries would rise by 73 percent. Of this increase, 80 percent is attributable to physical violence and 20 percent to the psychological impact (PTSD and depression) on victims of violence. The above sums up the outcomes of a study commissioned by the Ministry of Health, Welfare and Sport and the Ministry of Security and Justice covering the period 2009 2013. The calculations presented in the study report enhance our insight in the disease burden of violence- related injuries. The results of the new calculations still represent an underestimation of the real figures because certain information, including data on victims not registered at emergency departments, is not known. The disease burden of violence-related injuries can be subdivided according to the type of violence depending on the purpose of the perpetrator: expressive violence (expressing emotions, 54 percent) and instrumental violence (aimed at (im)material gain, such as money and power, 12 percent). The types of violence at the root of the remaining portion of the disease burden are not known. In the Netherlands, the disease burden caused by violence represents 3 percent of the total disease burden for all types of injury, including traffic accidents, sports injuries and suicide attempts. This percentage is comparable to that in other European countries. The comparison is based on figures from the WHO's Global Burden of Disease (GBD) study. Estimates of the costs of medical care and absenteeism associated with physical violence-related injuries for the study period (2009-2013) average out at 30 million and 66 million euros per year, respectively. The estimated costs of the psychological impact of violence-related injuries (PTSD and depression) are considerably lower (5.2 million euros). This amount does not cover the costs resulting from intimidation (a very common form of violence), nor the societal costs of the impact on people close to the victims (relatives, witnesses). The study was conducted by the Erasmus University Medical Centre of Rotterdam (Erasmus MC) and the Dutch Consumer Safety Institute (Stichting VeiligheidNL) under the auspices of the National Institute for Public Health and the Environment (RIVM).
    • Ziektelast van effecten op de voortplanting ten gevolge van blootstelling aan stoffen op de werkplek. Best professional judgement

      Dekkers S; van Benthem J; Piersma AH; Eysink PED; Baars AJ; SIR; GBO; VTV (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2008-05-22)
      Paternal and maternal occupational exposure to chemicals may adversely affect human fertility and/or the development of the offspring of exposed individuals. To date, however, the data available are insufficient to enable all of the consequences of such work-related exposures to be quantified.<br>In order to obtain an indication of the significance of these consequences, the National Institute for Public Health and the Environment (RIVM) has estimated the burden of disease of five clinical outcomes (such as spontaneous abortion and congenital abnormalities) and four groups of substances (such as pesticides and solvents). Taken together, these factors account for approximately 400 disability-adjusted life years (DALYs), which is 1% of the total amount of DALYs associated with reproductive effects among the working population (regardless of cause). Due to a lack of data and the uncertainty in various assumptions, the uncertainty margin of this estimate is quite large.<br>The burden of disease is a concept used to quantify the consequences of illnesses relative to a disease-free situation. It is expressed in DALYs, a health gap measure which combines the time lived with disability (decreased quality of life) and the time lost due to untimely death.<br>Many experts actively participated in this project as consultants on the delineations, points of departure, assumptions and the methods of calculation. Opinions varied greatly on a number of topics, such as whether the burden of disease of a spontaneous abortion only applies to the woman or also to her partner and/or unborn child.<br>Only a few experts gave their opinion on the magnitude of total burden of disease of reproductive effects caused by chemical exposure in the workplace. These estimates varied between 100 and 10,000 DALYs. This range falls approximately in the middle of the range of the burdens of disease of nine other disorders caused by chemical exposure in the workplace that have previously been reported by RIVM.<br>
    • Ziektelast van ongunstige arbeidsomstandigheden in Nederland

      Eysink PED; Blatter BM; van Gool CH; Gommer AM; van den Bossche SNJ; Hoeymans N; VTV; PZO (Rijksinstituut voor Volksgezondheid en Milieu RIVMTNO-Kwaliteit van Leven, 2007-12-07)
      Occupational health risks cause 2 to 4% of the total burden of disease in the Netherlands. The concept of burden of disease is a criterion to express the consequences of disease. It combines the time lived with disability and the time lost due to premature mortality. A high workload, exposure to harmful chemicals (including environmental tobacco smoke) and working with a computer are the most unfavourable working conditions. They contribute most to the occupational burden of disease caused by: burn-out, chronic obstructive pulmonary disease, lung cancer and complaints of arm, neck and shoulder (CANS). The health benefits of work were not included in this report. For the first time, the RIVM shows in this study which occupational diseases contribute most to the burden of disease in the Netherlands. The data offer starting points for further research and measures to reduce the burden of disease caused by these complaints. This is good not only for employers and employees but also for public health and society as a whole: health is wealth. The World Health Organization (WHO) underestimated the occupational burden of disease in the Netherlands in its earlier burden of disease assessments. In the Netherlands, most of the burden of disease is not caused by the 'classical' risks and diseases like accidents and hearing impairment caused by noise. Rather 'new' diseases like burn-out and CANS cause considerable loss of health and were not taken into account in the assessments of the WHO. Unfavourable working conditions do not only have negative effects on health, but also have a disadvantageous effect on productivity, absenteeism and incapacity for work. In theory it is possible to estimate these adverse effects. We therefore advise to study whether estimating them is feasible in practice.
    • Ziektelast van ongunstige arbeidsomstandigheden in Nederland 2007

      Eysink PED; Dekkers S; Janssen P; Poos MJJC; Meijer SM; VTV; PZO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2012-12-31)
      Occupational health risks cause 3.9% (uncertainty 1.5%-7.2%) of the total burden of disease in the Netherlands. The concept of burden of disease is a measure to express the loss of health. It combines the time lost due to premature mortality, prevalence and seriousness of the health problems. A high workload, working with a computer and exposure to harmful chemicals are the most unfavourable working conditions leading to health problems. They contribute most to the occupational burden of disease caused by: burn-out, depression, complaints of arm, neck and shoulder (CANS), chronic obstructive pulmonary disease and lung cancer. The health benefits of work were not included in this report. In 2020, burn-out, depression and CANS also cause a high burden of disease in the working population, considering unchanged economical conditions, a retirement age of 65 and unchanged health and safety policy. In 2007, the RIVM showed for the first time which occupational conditions contributed most to the burden of disease in 2003. The current report provides an update of the occupational burden of disease with data from 2007, as well as a forecast to 2020 and an exploration of the burden of disease per occupational sector. These estimates give policy makers insight in the influence of occupational risks on the health of employees. The data offer starting points for measures to reduce the burden of disease caused by these complaints.
    • De ziektelast van suïcide en suïcidepogingen

      Hoeymans N; Schoemaker CG; VTV; vz (Rijksinstituut voor Volksgezondheid en Milieu RIVMTrimbos InstituutStichting Consument en VeiligheidVrije Universiteit Amsterdam, 2010-08-06)
      In the Netherlands, there are almost 1 500 deaths from suicide every year. Given that fact, suicide ranked 21 on the list of most important diseases in the Netherlands. However, also non-fatal suicide attempt cause suffering, both physical and mental. If this suffering is taken into account, 'suicide and suicide attempts' ascend to place 11 in this ranking of diseases. This is the result of a study performed by the National Institute for Public Health and the Environment (RIVM), in cooperation with the Netherlands Institute of Mental Health and Addiction (Trimbos-institute), the VU University Medical Center and the Consumer Safety Institute, and commissioned by the Ministry of Health, Welfare and Sport. In the Public Health Status and Forecast Report 2010, RIVM published a ranking of diseases causing the highest burden of disease in the Netherlands. Coronary heart disease, stroke and anxiety disorders rank 1 to 3 on this list. The burden of disease is high if many people die from the disease, many people suffer from the disease and/or the impact on the quality of life is high. Injuries caused by suicide attempts lead to 1 500 deaths, 15 000 treatments at the departments of emergency care and 9 000 hospital admissions. However, not every suicide attempt is treated in hospital and can be found in these statistics. According to surveys, each year almost 100 000 people in the Netherlands try to commit suicide. Based on these figures and on information about the severity of the injuries and psychological suffering, the new estimate of the burden of disease of suicide and suicide attempts is twice as high as the former estimate.
    • Ziektespecifieke vergelijking van de geregistreerde morbiditeit in vier huisartsenregistraties: een analyse ten behoeve van VTV-1997

      Gijsen R; Verkleij H; Dijksterhuis PH; van de Lisdonk EH; Metsemakers JFM; van der Velden J; VTV; Vakgroep Huisartsgeneeskunde; Sociale geneeskunde en Verpleeghuisgeneeskunde; Katholieke Universiteit Nijmegen; Vakgroep Huisartsgeneeskunde; Universiteit Maastricht; Vakgroep Huisartsgeneeskunde; Universiteit van Amsterdam; Nederlands Instituut voor Onderzoek van de Gezondheidszorg; NIVEL (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1997-08-31)
      To describe the occurrence of diseases (incidence and prevalence rates) in the Public Health Status and Forecast (PHSF) report, data of morbidity registrations in general practice are used. A problem for using these in the PHSF report is that the registrations differ from each other in the aim, the design, the operationalisation of the different concepts and the classification system. The consequence is that the morbidity figures are not at once comparable. That's why an analysis of the four most important morbidity systems was made, so we can get a better understanding of the incidence and prevalence rates. This analysis consisted of three parts. First, a general description was made of the characteristics of the four morbidity registrations, with special attention for the calculation of the incidence and prevalence rates on behalf of the PHSF project. Secondly, a large table was made in which incidence and prevalence rates of the morbidity systems were brought together. Thirdly a disease-specific comparison was made. In general terms it appeared not possible to typify one of the considered registrations as the best for the aims of the PHSF project. For most of the diseases more insight was obtained about the meaning of the figures. Sometimes differences in the figures could be explained more of less. Nevertheless for a number of diseases the differences appeared to be unaccountable large. We described some alternative possibilities for presenting figures from morbidity registrations in general practice in the PHSF report. Because the existing situation in the morbidity registration in general practice is far from ideal, it is recommended to explore the possibilities for coming to a better solution for PHSF-2001 and other PHSFs.<br>
    • Zijn de risico's van apparatuur voor thuisbeademing door de leveranciers overwogen en beperkt? Een studie van risicoanalyses en gebruiksaanwijzingen

      van Drongelen AW; Hilbers-Modderman ESM; BMT (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2008-03-03)
    • Zijn de risicos van de apparatuur voor thuisdialyse door de fabrikanten voldoende afgedekt?

      de Vries CGJCA; Hilbers-Modderman ESM; de Bruijn ACP; BMT (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2009-07-16)
    • Zoonoses and zoonotic agents in humans, food, animals and feed in the Netherlands 2003-2006

      Valkenburgh S; van Oosterom R; Stenvers O; Aalten M; Braks M; Schimmer B; van der Giessen A; van Pelt W; Langelaar M; LZO; EPI (Rijksinstituut voor Volksgezondheid en Milieu RIVMVoedsel en Waren Autoriteit VWS, 2007-11-30)
      The report 'Zoonoses and Zoonotic Agents in Humans, Food, Animals and Feed in The Netherlands 2003 - 2006' is based on data that is reported annually to the European Commission, in accordance with the Directive 2003/99/EC on the monitoring of zoonoses and zoonotic agents. They are supplemented with data from Dutch surveillance, monitoring and control programmes and relevant research projects concerning zoonoses and zoonotic agents by the different institutions that have contributed to the preparation of this report. The report also includes information on recent research on the antibiotic resistance of micro-organisms derived from human and animal material. Specific documentation and reports regarding the described programmes and research projects are available from the authors mentioned in the editorial list. The extended dataset on antimicrobial resistance and trends in the Netherlands has been published recently as a report: Maran 2003, 2004 and 2005.