• Parasitologisch onderzoek bij vissen bestemd voor consumptie

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

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

      Elvers LH; Somers HHJ; Loeber JG (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1988-10-31)
      Van de "voorgestelde" IS voor hypofysair LH werden twee batches, 80/552 en 81/535, geijkt in drie RIA-systemen en een in vivo biologische bepaling (OAAD). De RIA's zijn specifiek voor respectievelijk hLH (code 8383), de hLH-alfa-subunit (8082) en de hLH-beta-subunit (8095). De RIA-systemen werden gekarakteriseerd m.b.v. de volgende preparaten: hLH-alfa-78/554, hLH-beta 78/556, hFSH 83/575, hTSH 81/502 en twee sera X en Y. Bovendien werden de preparaten LH-A, B, C en D bepaald, als deel van een versnelde degradatiestudie. De sterkte verhouding (IU/ampul (95% CL ; df) voor 80/552 en 81/535 t.o.v. LH 68/40 was in de hLH RIA 40,7 (38.6 - 42.8 ; 27) respectievelijk 39.5 (37.5 - 41.6 ; 27). De sterkteverhouding voor 80/552 en 81/535 was in hLH-alfa-RIA (t.o.v. 78/554) 0,55 (0,52 - 0,59 ; 21) respectievleijk 0,52 (0,48 - 0,55; 21) en in de hLH-beta-RIA (t.o.v. 78/556) 0,83 (0,78 - 0,88 ; 25) respectievelijk 0,76 (0.71 - 0,82 ; 25). In de OAAD was de sterkteverhouding t.o.v. LH 68/40 ; 42,0 (25,2 - 70,0 ; 54) voor 80/552 en 35,0 (21,4 - 57,1 ; 60) voor 81/535.<br>
    • Participeren in onzekerheid: Literatuuronderzoek naar het inzetten van participatie in wetenschappelijke beleidsadvisering

      Turnhout E; Leroy P - Petersen AC (eds); IMP (Leerstoelgroep Milieu en BeleidRadboud Universiteit Nijmegen, 2005-02-21)
      When politicians, policy makers, stakeholders, citizens and scientists are confronted with complex policy problems, such as environmental, nature and sustainability issues, they do not always agree on the real problem. Furthermore, once a shared problem definition has been agreed on, discussion on solutions may remain. Depending on how the relationship between science and policy is viewed, ways can be determined to involve stakeholders in the process of delivering scientific policy advice. Here, the basic assumption is that it may well be desirable in decision-making to have 'boundary organisations' between science and policy, such as the Netherlands Environmental Assessment Agency (MNP) - RIVM, which would take into account the plurality in value orientations and scientific insights in delivering their advice. A Guidance for Uncertainty Assessment and Communication has been introduced at the MNP-RIVM to facilitate this function, but in order for the process to be sustained, the Guidance should be considered, in particular, as an instrument to stimulate reflection. Participatory strategies and practices need to be studied more closely if the Guidance is to be elaborated with respect to 'participation of stakeholders'.
    • Participeren in onzekerheid: Literatuuronderzoek naar het inzetten van participatie in wetenschappelijke beleidsadvisering

      Turnhout E; Leroy P; Petersen AC; Leerstoelgroep Milieu en Beleid, Radboud Universiteit Nijmegen; IMP (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2005-02-21)
      Bij complexe beleidsproblemen, zoals milieu-, natuur- en duurzaamheidsvraagstukken, zijn politici, beleidsmakers, stakeholders, burgers en wetenschappers het er vaak niet over eens wat nu eigenlijk het probleem is. Ook als er wel een gedeelde probleemdefinitie is, kan er discussie blijven over de oplosssingen. Afhankelijk van hoe naar de verhouding tussen wetenschap en beleid wordt gekeken, kan gekozen worden voor het op een bepaalde wijze betrekken van stakeholders in de totstandkoming van wetenschappelijke beleidsadviezen. Uitgangspunt is dat het voor de besluitvorming wenselijk kan zijn dat grensorganisaties tussen wetenschap en beleid, zoals het Milieu- en Natuurplanbureau (MNP) van het RIVM, in hun advisering rekening houden met de pluraliteit in waarde-orientaties en wetenschappelijke inzichten. De in het MNP-RIVM ingevoerde Leidraad voor Omgaan met Onzekerheden biedt daar een eerste aanzet toe, mits deze vooral wordt gebruikt als instrument dat reflectie stimuleert. Een uitwerking van deze Leidraad op het onderwerp 'participatie van stakeholders' vereist een nadere bestudering van participatiestrategieen en -praktijken
    • Particulate Matter: a closer look

      Buijsman E; Beck JP; van Bree L; Cassee FR; Koelemeijer RBA; Matthijsen J; Thomas R; Wieringa K; LED; MGO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2005-11-10)
      The summary in booklet form 'Fijn stof nader bekeken' (Particulate Matter: a closer look) , published in Dutch by the Netherlands Environmental Assessment Agency (MNP) and the Environment and Safety Division of the National Institute for Public Health and the Environment (RIVM), has been designed to present the facts on particulate matter in a coherent framework. Current knowledge on particulate matter is conveyed here under the headings: What is known? What is unknown? What are the uncertainties? The background to this publication is the current social and political debate on the consequences of the Netherlands air quality legislation, which, in turn, is based on European legislation. The fact that new spatial developments and infrastructural projects are at risk of not being realized due to the large-scale exceedances of limit values for particulate matter occurring in the Netherlands is leading to serious social effects. Moreover, airborne particulate matter poses serious risks to human health. The particulate matter subject is complicated and accompanied by administrative dilemmas, legally binding limit values, concerns of citizens, scientific uncertainties and spatial-economic consequences. Many questions and current discussions have provided reasons enough to compose this scientific summary on particulate matter. Although this booklet does not present new information, it has succeeded in bringing together all the published information on particulate matter referring to the situation in the Netherlands.
    • Particulate Matter: a closer look

      Buijsman E; Beck JP; Bree L van; Cassee FR; Koelemeijer RBA; Matthijsen J; Thomas R; Wieringa K; LED; MGO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2005-11-10)
      Het Milieu- en Natuurplanbureau en de sector Milieu en Veiligheid van het Rijksinstituut voor Volksgezondheid en Milieu presenteren met het boekje 'Fijn stof nader bekeken' de feiten over fijn stof in samenhang. Deze uitgave laat zien wat de stand van zaken is in het fijnstofdossier: wat weten we wel, wat weten we niet, waar zitten de onzekerheden? Aanleiding voor deze uitgave is het huidige maatschappelijke en politieke debat over de gevolgen van de implementatie van het Nederlandse Besluit Luchtkwaliteit, dat gestoeld is op richtlijnen van de Europese Unie. Overschrijdingen van de grenswaarden voor fijn stof komen op grote schaal voor in Nederland. De maatschappelijke gevolgen hiervan zijn ingrijpend, doordat nieuwe ruimtelijke ontwikkelingen, zoals woningbouw en infrastructuurprojecten, in het gedrang komen. Aan de andere kant zijn er belangrijke gezondheidseffecten door fijn stof. Het dossier fijn stof is complex en omvat bestuurlijke dilemma's, juridisch bindende grenswaarden, zorgen van burgers, wetenschappelijke onzekerheden en ruimtelijk-economische gevolgen. De vele vragen en de huidige discussies zijn redenen geweest om een wetenschappelijk overzichtsrapport op te stellen over het fijnstofdossier. Deze uitgave bevat geen nieuwe informatie, maar is een samenvatting van bestaande rapporten op het gebied van fijn stof.
    • Particuliere grondwaterwinning ; - indicatie waterkwaliteit ; - modellering grondwaterstroming en stoftransport

      Harsono W; Mulschlegel JHC (1991-07-31)
      A global overview will be given of the water quality of the private-groundwaterwinnings in the Netherlands. Although the overview is far from complete, is becomes apparent that the water quality of most winnings does not satisfy the legally established requirements for drinking water. Especially, the high nitrate concentrations and the low pH-value, due to acidification (and related to this, the concentrations of aluminium) are the cause of the water not satisfying the requirements. Also three-dimensional groundwaterflow and matter transport will be modelled near an abstraction site. Concentration-courses are calculated for nitrate and atrazin, for two types of scenio's. In the first type, no reduction or prohibition measures will be taken. In the second type, these measures will be taken in 1995. It becomes apparent that after 15 years, these measures will have their full effect.
    • Partnerwaarschuwing bij SOA/HIV in Nederland : Stand van zaken bij soa-centra en aanbevelingen

      Op de Coul ELM; SOA; I&V (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2014-01-01)
      It is essential that people who have been infected with HIV or another sexually transmitted infection (STI) notify their partners on time in order to prevent the disease from spreading further. One third of all STIs are picked up at the Dutch centres for STI via this route. Partners are notified by those who are diagnosed with an STI or via an STI nurse at the centre where the infection was diagnosed. More attention has been paid to partner-notification in the last years; however, there is still room for improvement. The RIVM therefore has examined the results and the constraints of partner notification at STI centres in order to formulate recommendations for further improvement. The STI centres offer low threshold test services to high risk groups, for example men who have sex with men (MSM) or those who have multiple partners. Constraints and results One of the most important constraints of partner notification for MSM is the difficulty in tracing the great number of (often) anonymous partners. Of the MSM with an STI, 46 per cent of the partners could be traced. Of the heterosexual women with an STI, 87 per cent of the partners could be traced; for heterosexual men this was 63 per cent. The MSM partners who could be traced were almost always notified (92 per cent of cases). This percentage was lower for heterosexual men (76 per cent) and women (83 per cent). An STI was detected in 33 to 50 per cent of the notified partners, depending on the group at risk. Another important constraint is the lack of time available to STI nurses at the centres. In fact, there is little time during consultations to discuss partner notification. Also clients can be reluctant to notify their (ex) partners. For HIV infections this is also complicated by the severity of the diagnosis; the client simply does not have enough 'mental-space' to think about possible (ex-)partners. Measures In order to prevent the topic being forgotten, questions regarding partner notification have been added to the electronic STI file. In addition, a special course has been developed for STI nurses which focuses on helping them more effectively providing the client with insights in the value and tools of partner notification.
    • PAS Monitoringsrapportage Stikstof : Addendum op de stand van zaken 2016

      van Alphen A; Berkhout JPJ; LKG; M&amp;V (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-02-28)
      The Nitrogen Action Programme (PAS) was launched in order to realise nature policy goals in the Netherlands and, within the framework of these goals, to also facilitate economic development. Nitrogen is a nutrient for plants, but too much nitrogen can cause damage to nature and reduce biodiversity. <br> <br>By implementing existing policy and taking additional measures to reduce nitrogen emissions, new economic activities would be possible within the framework of the PAS subject to specific conditions. One condition is that measures are taken to maintain or strengthen the quality of the natural environment. The PAS went into effect on 1 July 2015. <br> <br>At the request of the PAS Agency, RIVM submits an annual report on the expected developments with regard to the emission and deposition for the reference years 2020 and 2030 in comparison to the PAS reference year 2014. The reason for the interim report at hand is the availability of new information on the habitats of species. As a result, the number of locations where the expected deposition is monitored has been increased by 50%. The expansion and addition of habitats to the Nitrogen Action Programme has provided additional insight into the habitats of plants and animals that are sensitive to nitrogen. This expansion of the monitoring methodology has not made it necessary to modify the conclusions already presented in the previous M16 report regarding the trends in emission and deposition. <br> <br>Compared to 2014, a slight increase in the emission of nitrogen oxide is projected until 2020 as a result of the growth of maritime shipping and industry. Over the longer term, between 2020 and 2030, a decrease in emissions of 43 kilotonnes is expected, in part due to reduced emissions from traffic. The calculated emission of ammonia is expected to decrease by 12 kilotonnes between 2014 and 2030. Between 2014, the PAS reference year, and 2030, the calculated nitrogen deposition (nitrogen oxides and ammonia) is expected to decrease by 15%. <br>
    • PAS Monitoringsrapportage Stikstof : Stand van zaken 2016

      Sterkenburg A; van Alphen A; DMO; M&V (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2017-09-25)
      The Nitrogen Action Programme (PAS) was launched in order to facilitate economic development while at the same time realising the nature policy goals for the 'Natura 2000' areas. The programme contains measures for reducing nitrogen emissions so that less nitrogen will be deposited from the air on these areas. This creates opportunities for new economic activities. In addition, the PAS contains measures aimed at strengthening the ability of nature in these areas to recover their natural functions. The PAS went into effect on 1 July 2015. In this monitoring round, the pattern of nitrogen deposition over the years is rather variable. For 2030, the predicted deposition from the main roads and the agricultural sector as well as the contribution from outside the country will, on average, decrease. However, other sectors present a less favourable picture. Overall, the average deposition decreases by 14%. In view of the expected decrease in deposition in future, the PAS makes it possible for existing activities to be expanded or for new activities to be initiated. By taking into account this so-called 'deposition buffer', the PAS makes further economic development possible, subject to the following conditions: a) the total nitrogen deposition continues to decrease, and b) the maintenance goals for the 'Natura 2000 areas' are not compromised. With regard to new economic activities, a distinction is made between activities that need to be reported, as they result in only a minor amount of nitrogen deposition, and activities for which a permit is required. Roughly 55% of the buffer or margin that is available throughout the Netherlands for activities that need to be reported has already been utilised. Roughly 30% of the buffer available for activities that require a permit has been utilised. Most of the new activities involve the agricultural sector. At the request of the PAS Agency, RIVM submits an annual report on the nitrogen deposition, as part of the total PAS monitoring effort. For that purpose, it uses the latest data on nitrogen emissions and the latest models and calculation methods. Each report describes the expected developments for the reference years 2020 and 2030 in relation to the situation that existed before the PAS (2014).
    • PAS Monitoringsrapportage stikstof Stand van zaken inwerkingtreding PAS en eerste monitoringsronde 2015

      van Alphen A; Maltha-Nix EJ; van der Maas CWM; DMO; M&V (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2017-02-08)
      The Nitrogen Action Programme (PAS) was launched in order to reduce the nitrogen loads in 'Natura 2000' areas and at the same time to facilitate spatial planning and economic development. The PAS went into effect on 1 July 2015. At the request of the PAS Agency, RIVM will submit an annual report to the Dutch government on the calculated amount of nitrogen that is deposited on the soil from the air (deposition). This information can be used to evaluate whether the programme needs to be adjusted. The first monitoring report includes the 'zero measurement' (initial situation) and the changes in the amount of nitrogen during the first half year in the Natura 2000 areas. The report indicates that the calculated amount of nitrogen deposited over the years is decreasing, even as the area available for economic activity is being utilised. The results are in line with the prognoses made when the PAS went into effect. The calculated decrease is not yet reflected everywhere in the measurements of the ammonia concentrations during the past years. Based on the measurements, a trend of increasing concentrations can actually be seen in some parts of the Netherlands. At the request of the Ministry of Economic Affairs, RIVM is investigating the difference between the calculations and the measurements. This report on nitrogen is part of the overall annual PAS monitoring report. The other parts consist of similar reports focusing on nature (for which the PAS Agency is responsible) and a framework memorandum on the overall PAS monitoring report
    • Pathobiochemical effects in rat lung related to episodic ozone exposure

      van Bree L; Rombout PJA; Rietjens IMCM; Dormans JAMA; Marra M (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1989-02-28)
      Correlatie van luchtmetingen van ozon met gegevens over gezondheidseffecten suggereren dat de huidige ozonnorm de volksgezondheid onvoldoende beschermt. Om expositie-effect relaties voor ozon te ontwikkelen, werd de huidige studie opgezet, waarbij ratten werden blootgesteld gedurende een aantal opeenvolgende dagen, daarmee een luchtverontreinigingsepisode simulerend. De acute longschade en onsteking na expositie aan 0.4 ppm ozon bleek voornamelijk veroorzaakt te worden door de eerste expositiedag en bleek bovendien volledig reversibel te zijn ondanks voortdurende blootstelling. Langs biochemische en morfologische weg werden bij langer durende blootstellingen aan 0.8 en 0.75 ppm (intra)- cellulaire veranderingen aangetoond, welke in eerste instantie duiden op herstel van oorspronkelijke schade. Sommige veranderingen kunnen echter toxicologische consequenties hebben. Samenvattend kan gesteld worden dat er een noodzaak is voor uitbreiding van het onderzoek betreffende schadelijke effecten van ozon tijdens episoden van luchtverontreiniging, zodat meer realistische evaluaties van de gezondheidsrisico's mogelijk worden.<br>
    • Pathogene micro-organismen in zwemwater in relatie tot indicatoren voor fecale verontreiniging

      Schets FM; Berg HHJL van den; Lodder WJ; Docters van Leeuwen AE; Roda Husman AM de; MGB (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2006-06-09)
      In zwemwater wat voldeed aan de normen voor microbiologische kwaliteit uit de huidige Zwemwaterrichtlijn 76/160/EEG werden micro-organismen aangetroffen die infectieziekten zoals gastro-enteritis of oorontsteking kunnen veroorzaken. Op basis van de strengere normen uit de herziene Zwemwaterrichtlijn 2006/7/EC werd de kwaliteit van dit zwemwater minder gunstig beoordeeld. Op twee officiele Nederlandse zwemlocaties, Katwijk-Noord en Vinkeveenseplassen (bij eiland 1), is de aanwezigheid van (potentieel) pathogene micro-organismen onderzocht en gerelateerd aan de huidige en de herziene Europese zwemwaternormen; voor de parameters uit de herziene Zwemwaterrichtlijn werden twee verschillende (toegestane) detectiemethoden toegepast. De ziekteverwekkende micro-organismen Staphylococcus aureus, Pseudomonas aeruginosa, Vibrio, Cryptosporidium en Giardia werden op beide locaties aangetroffen. Campylobacter werd niet gevonden bij Katwijk-Noord, maar wel in de Vinkeveenseplassen. Salmonella, norovirus en enterovirus werden op geen van beide locaties aangetroffen, terwijl rotavirus eenmaal bij Katwijk-Noord en adenovirus eenmaal in de Vinkeveenseplassen werd aangetoond. Volgens de huidige Zwemwaterrichtlijn was de waterkwaliteit bij Katwijk-Noord 'uitstekend' en in de Vinkeveenseplassen 'goed'. Voor de parameters uit de herziene Zwemwaterrichtlijn bestond er verschil in beoordeling bij gebruik van de verschillende methoden: op basis van membraanfiltratie was de waterkwaliteit bij Katwijk-Noord 'goed', terwijl deze op basis van MPN resultaten 'aanvaardbaar' was. De zwemwaterkwaliteit in de Vinkeveenseplassen werd op basis van beide methoden als 'slecht' beoordeeld. Er zijn aanwijzingen verkregen dat de beoordeling van de waterkwaliteit op Nederlandse zwemlocaties volgens de herziene Zwemwaterrichtlijn afhankelijk is van de toegepaste detectiemethode (membraanfiltratie of MPN). Het voldoen aan de Europese Zwemwaterrichtlijn garandeert niet de afwezigheid van voor de mens ziekteverwekkende micro-organismen in zwemwater.
    • Pathogene micro-organismen in zwemwater in relatie tot indicatoren voor fecale verontreiniging

      Schets FM; van den Berg HHJL; Lodder WJ; Docters van Leeuwen AE; de Roda Husman AM; MGB (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2006-06-09)
      Micro-organisms possibly causing infectious diseases such as gastroenteritis or inflammation of the ear were detected in bathing water that complied with the current European Bathing Water Directive 76/160/EEG. On the basis of the stricter guidelines in the revised Bathing Water Directive 2006/7/EC, the quality of these bathing waters was assessed as being less favourable. In this study, the presence of pathogenic micro-organisms was related to the current and revised European bathing water guidelines at two official bathing sites in the Netherlands, Katwijk-Noord and Vinkeveenseplassen (island 1). Indicator parameters in the revised Bathing Water Directive were analysed by using two different (permitted) detection methods. The (potentially) pathogenic micro-organisms Staphylococcus aureus, Pseudomonas aeruginosa, Vibrio, Cryptosporidium and Giardia were detected at both sampling sites. Campylobacter was not found at Katwijk-Noord, but was detected at Vinkeveenseplassen. Salmonella, norovirus and enterovirus were not detected at either site, whereas rotavirus was detected once at Katwijk-Noord and adenovirus once at Vinkeveenseplassen. According to the current Bathing Water Directive, water quality was 'excellent' at Katwijk-Noord and 'good' at Vinkeveenseplassen. The use of different methods for detecting the revised Bathing Water Directive parameters resulted in deviant assessments of water quality. Based on membrane filtration results, water quality at Katwijk-Noord was rated 'good', whereas on the basis of MPN results it was 'acceptable'. Bathing water quality at Vinkeveenseplassen was assessed 'poor' by either method. The assessment of bathing water quality at Dutch bathing sites was, according to the revised Bathing Water Directive, indicated as being dependent on the detection method used for faecal indicators. Compliance with the European bathing water guidelines does not guarantee the absence of human pathogenic micro-organisms in water.
    • The pathogenic mechanism of the diarrheal syndrome caused by Bacillus cereus

      Wijnands LM; Dufrenne JB; Leusden FM van; MGB (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2002-11-22)
      Bacillus cereus is de veroorzaker van twee verschillende soorten voedselgerelateerde aandoeningen. In het ene geval gaat het om een braaksyndroom. In het andere geval gaat het om een diarreesyndroom. Het diarreesyndroom kan veroorzaakt worden door vier enterotoxinen: enterotoxine-T, cytotoxine-K, haemolysine BL (HBL) en non-haemolytisch enterotoxine (NHE). In dit rapport staat een beschrijving van het pathogene mechanisme van HBL en NHE centraal en wordt ingegaan op de mogelijke bijdragen van het micro-organisme en de enterotoxinen aan het pathogene mechanisme. Een beter begrip van het pathogene mechanisme is om twee redenen van belang. Ten eerste voor een betere beschrijving van dosis-respons relaties: wat is de kans om ziek te worden bij inname van een bepaalde dosis. Ten tweede kan het, in combinatie met kwantitatieve gegevens omtrent voorkomen van ziekteverwekkende B. cereus stammen, bijdragen aan een bijstelling van de criteria die gesteld zijn ten aanzien van het mogen voorkomen van B. cereus in levensmiddelen. Daarnaast wordt een voorstel gedaan voor verder onderzoek om het pathogene mechanisme achter het diarreesyndroom op te helderen.
    • The pathogenic mechanism of the diarrheal syndrome caused by Bacillus cereus

      Wijnands LM; Dufrenne JB; van Leusden FM; MGB (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2002-11-22)
      As a contaminant of food commodities, Bacillus cereus may produce several enterotoxins that are responsible for the development of a diarrhaeal syndrome. Although four enterotoxins -haemolysin BL (HBL), non-haemolytic enterotoxin (NHE), enterotoxin-T, and cytotoxin-K- have been described as possibly responsible for this syndrome, the two most important enterotoxins are the three-component HBL and NHE. However, their mode of action is unclear. Insight into the pathogenic mechanism is of great importance. It may help to clarify questions related to dose-response relationships, such as the chance of symptoms when exposed to a certain amount of enterotoxin. Also, in combination with quantitative data on the occurrence of pathogenic B. cereus strains in food, it may contribute to re-evaluation of the tolerance levels set for B. cereus in food commodities. Suggestions are given here for further research aimed at elucidating the pathogenic mechanism of the diarrheal syndrome using human and animal cell lines.<br>
    • Patientenparticipatie bij organisatorische besluitvorming in zorggroepen : Inzichten en aanbevelingen op basis van literatuuronderzoek en ervaringen van zorggroepen en patiëntenvertegenwoordigers

      Lemmens LC; de Bruin SR; Struijs JN; Baan CA; PZO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2012-11-23)
      In 2010, the Ministry of Health, Welfare and Sport introduced a new funding system for the care for people with a chronic disease such as diabetes. The purpose of this so-called bundled payment scheme is to improve the quality of care and to facilitate cooperation between health care providers. With the introduction of bundled payment care groups have come into existence. A care group usually consists of general practitioners, and negotiates with health insurers about disease management programmes for a number of chronic diseases. It also makes agreements with various health care providers, including dieticians and internists, about the care to be provided. Involvement of patients in care groups still limited Patients are yet hardly or not at all involved in the decision-making regarding content and organisation of care within care groups. Patient participation is desirable, as it would allow care to be tailored better to patient needs. This study looked at ways to improve patient participation in care groups, by identifying the wishes of both care groups and patient representatives. It shows that both care groups and patients are in favour of a more active role of patients in organisational decision-making. Wishes of care groups and patients in agreement The wishes of patients and care groups regarding enhancing patient participation are largely similar. Both parties want to cooperate in concrete projects such as on how they can support patients to improve their self-management. There is also a need for ongoing consultations between care groups and patient representatives. Thirdly, they want to use social media to reach patients better. Finally, both parties want to collaborate with patient associations for chronic diseases. This collaboration would enable patient groups to exchange experiences and to represent the interests of patients better. Some matters still unclear In further shaping the role of patients in care groups some questions still need to be answered. For example, it is not clear how patient participation will influence the quality of care. In addition, as yet care groups' responsibilities regarding patient participation have been insufficiently detailed.
    • Patiëntenperspectief op veilige zorg rondom medicijnen

      Lemmens LC; Weda M; EVG; V&Z (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2016-09-22)
      Patients express that they do not always receive sufficient information about the medicines prescribed for them and why these are chosen. In addition, they are not fully informed about possible side effects in advance. This makes it difficult for them to share in decision-making on which medicines they can use the best in case various options exist. Further, it appears that adjustments to their medication in the hospital are not always communicated quickly and accurately to the general practitioner (GP). However, patients are satisfied about the way in which community pharmacies are monitoring whether medicines can be combined. These are the findings of a study of the Dutch National Institute for Public Health and the Environment (RIVM), commissioned by the Dutch Health Care Inspectorate. Patients taking many medicines were interviewed for this purpose. Patients also indicate that it is often unclear to them who is ultimately responsible for the overall package of prescribed medicines. When they get the medicines prescribed by a specialist, they are often not told who to approach in case of any problems or questions. They prefer to go to their GP or pharmacist for this. A part of the patients using many medicines already for a longer period, want to make a shared decision about their medication. Another part however does not, and rather leave this to the physicians. Those who want to have a say because of their long experience with the medication, indicate that they would like to have the ability to customize the use of their medication in consultation with the physician. This concerns, for example, the dosage or the moment of intake. A so-called medication review would provide this opportunity, but patients do not always know that this possibility exists. Patients would also like clarification on whether they are allowed to bring and use their own medicines from home during hospitalization. Currently it varies by hospital, and even by hospital ward, whether this is allowed or not.
    • Patterns of low-frequency climate variability: a model-paleodata comparison

      Weber SL; Shabalova MV; NOP (Koninklijk Nederlands Meteorlogisch Instituut (KNMI), 2001-02-23)
      Patterns of temperature variability on interdecadal and longer timescales are derived from empirical and simulated data for the region centered around the North Atlantic ocean. The empirical dataset consists of long early-instrumental records and high-quality proxy data. The simulated data is obtained from a long integration of the coupled intermediate-complexity model ECBilt. A combination of classical statistical tools and modern spectral methods is used in the analysis. Both in the empirical and simulated data, temperature variability is found to be season dependent. In the empirial data, two distinct statistically significant spatio-temporal modes of temperature variability are identified on timescales longer than 50 years. The simulated data do not exhibit any dominant timescale of variability in the considered range, which might be due to the absence of external periodic forcing in the model experiment. In summer, there is a promising similarity between empirical and simulated patterns of temperature variability.