• The cost-utility of stepped-care algorithms according to depression guideline recommendations - Results of a state-transition model analysis.

      Meeuwissen, Jolanda A C; Feenstra, Talitha L; Smit, Filip; Blankers, Matthijs; Spijker, Jan; Bockting, Claudi L H; van Balkom, Anton J L M; Buskens, Erik (2019-01-01)
      Evidence-based clinical guidelines for major depressive disorder (MDD) recommend stepped-care strategies for sequencing evidence-based treatments conditional on treatment outcomes. This study aims to evaluate the cost-effectiveness of stepped care as recommended by the multidisciplinary clinical guideline vis-à-vis usual care in the Netherlands.
    • Cost-effectiveness of a potential anti-tick vaccine with combined protection against Lyme borreliosis and tick-borne encephalitis in Slovenia.

      Mihajlović, J; Hovius, J W R; Sprong, H; Bogovič, P; Postma, M J; Strle, F (2019-01)
      This study assessed cost-effectiveness of a potential anti-tick vaccine that would protect against both Lyme borreliosis (LB) and tick-borne encephalitis (TBE) in a highly endemic setting of Slovenia. A Markov model was developed to estimate cost-effectiveness of a vaccine with potential combined protection against LB and TBE from the societal perspective. The model expressed time in annual cycles, followed a target population through their lifetime, and applied an annual discounting of 3%. A target population entered the model in a susceptible state, with time dependent probabilities to acquire LB/TBE. Disease manifestations were either resolved within one cycle, or a patient developed LB/TBE sequelae. The vaccination consisted of initial immunization and one revaccination. Estimates of LB/TBE direct and indirect costs, and data on natural course of LB/TBE were obtained from Slovenian databases. Effectiveness of the vaccine with potential combined protection against LB/TBE was derived from studies on existing TBE and LB vaccines, while utility estimates were collected from various literature sources. A vaccine with potential combined protection against LB/TBE was predicted to have an incremental cost of €771,300 per 10,000 vaccinated persons, an incremental utility of 17QALYs and a base-case incremental cost-effectiveness ratio (ICER) of 46,061€/QALY. Vaccine cost, effectiveness and discount rates were identified as the most influential model parameters. A wholesale price for a vaccine shot of €9.13 would lead to cost savings followed by health gains for the vaccination strategy. The base-case ICER was below commonly accepted thresholds of cost-effectiveness, indicating that a combined LB/TBE vaccine might be a cost-effective option in Slovenia. With early Health Technology Assessment becoming increasingly important, this analysis still represents a rare example of cost-effectiveness assessment prior to market authorisation. Although obviously in such a situation some key parameters are unknown, our model sets up a tool to analyse pharmacoeconomic criteria that can help development of a cost-effective health technology, in this case a combined tick-borne diseases vaccine.
    • Fate modelling of nanoparticle releases in LCA: An integrative approach towards “USEtox4Nano”

      Salieri, Beatrice; Hischier, Roland; Quik, Joris T.K.; Jolliet, Olivier (2019-01)
    • Chemical composition and source identification of PM 10 in five North Western European cities

      Hama, Sarkawt M.L.; Cordell, Rebecca L.; Staelens, Jeroen; Mooibroek, Dennis; Monks, Paul S. (2018-12)
    • The response of metal leaching from soils to climate change and land management in a temperate lowland catchment

      van der Perk, Marcel; Stergiadi, Maria; de Nijs, Ton C.M.; Comans, Rob N.J.; Bierkens, Marc F.P. (2018-12)
    • Phytotoxic effects of silver nanoparticles and silver ions to Arabidopsis thaliana as revealed by analysis of molecular responses and of metabolic pathways

      Ke, Mingjing; Qu, Qian; Peijnenburg, W.J.G.M.; Li, Xingxing; Zhang, Meng; Zhang, Zhenyan; Lu, Tao; Pan, Xiangliang; Qian, Haifeng (2018-12)
    • Oral bioaccessibility of silver nanoparticles and ions in natural soils: Importance of soil properties.

      Dang, Fei; Jiang, Yuanyuan; Li, Min; Zhong, Huan; Peijnenburg, WillieJ G M; Shi, Weilin; Zhou, Dongmei (2018-12)
      The abundance of silver nanoparticles (AgNPs) in consumer products has led to their environmental release and therefore to concern about their impact on human health. The ingestion of AgNP-contaminated soil from urban sites is an important exposure pathway, especially for children. Given the limited information on oral bioaccessibility of soil Ag, we used a physiologically based extraction test (PBET) to evaluate the bioaccessibility of AgNPs and AgNO3 from soil digestion. The AgNPs underwent several biochemical transformations, including their simultaneous dissolution and agglomeration in gastric fluid followed by the disintegration in the intestinal fluid of the agglomerates into NPs containing silver and chlorine. Therefore, Ag-containing soil exposed the intestine to nanoparticulate Ag in forms that were structurally different from the original forms. The bioaccessibility of AgNPs (0.5 ± 0.05%-10.9 ± 0.7%) was significantly lower than that of AgNO3 (4.7 ± 0.6%-14.4 ± 0.1%), as a result of the lower adsorption of nanoparticles to soil residues during the digestive process. For the soils tested, the bioaccessibility of AgNPs increased with decreasing clay contents and lower pH. By identifying the soil properties that control AgNP bioaccessibility, a more efficient and accurate screening can be performed of soil types that pose the greatest health risk associated with AgNP exposure.
    • The impact of social capital, land use, air pollution and noise on individual morbidity in Dutch neighbourhoods.

      Zock, Jan-Paul; Verheij, Robert; Helbich, Marco; Volker, Beate; Spreeuwenberg, Peter; Strak, Maciek; Janssen, Nicole A H; Dijst, Martin; Groenewegen, Peter (2018-12)
      Both social and physical neighbourhood factors may affect residents' health, but few studies have considered the combination of several exposures in relation to individual health status.
    • Associations of residential exposure to agricultural pesticides with asthma prevalence in adolescence: The PIAMA birth cohort.

      Bukalasa, Joseph S; Brunekreef, Bert; Brouwer, Maartje; Koppelman, Gerard H; Wijga, Alet H; Huss, Anke; Gehring, Ulrike (2018-12)
      It has been suggested that children who are exposed to agricultural pesticides have an increased risk of asthma, but evidence for associations betweeen residential pesticide exposure and childhood asthma is inconsistent.
    • Active commuting through natural environments is associated with better mental health: Results from the PHENOTYPE project.

      Zijlema, Wilma L; Avila-Palencia, Ione; Triguero-Mas, Margarita; Gidlow, Christopher; Maas, Jolanda; Kruize, Hanneke; Andrusaityte, Sandra; Grazuleviciene, Regina; Nieuwenhuijsen, Mark J (2018-12)
      Commuting routes with natural features could promote walking or cycling for commuting. Commuting through natural environments (NE) could have mental health benefits as exposure to NE can reduce stress and improve mental health, but there is little evidence. This study evaluates the association between NE and commuting, whether active or not, and the association between commuting (through NE), whether active or not, and mental health. We also evaluate the moderating effect of NE quality on the association between NE commuting and mental health.
    • Data on child complementary feeding practices, nutrient intake and stunting in Musanze District, Rwanda.

      Uwiringiyimana, Vestine; Ocké, Marga C; Amer, Sherif; Veldkamp, Antonie (2018-12)
      Stunting prevalence in Rwanda is still a major public health issue, and data on stunting is needed to plan relevant interventions. This data, collected in 2015, presents complementary feeding practices, nutrient intake and its association with stunting in infants and young children in Musanze District in Rwanda. A household questionnaire and a 24-h recall questionnaire were used to collect the data. In total 145 children aged 5-30 months participated in the study together with their caregivers. The anthropometric status of children was calculated using WHO Anthro software [1] according to the WHO growth standards [2]. The complementary feeding practices together with households' characteristics are reported per child stunting status. The nutrient intake and food group consumption are presented per age group of children. Also, the percentage contribution of each food groups to energy and nutrient intake in children is reported. The data also shows the association between zinc intake and age groups of children. Using multiple linear regression, a sensitivity analysis was done with height-for-age z-score as the dependent variable and exclusive breastfeeding, deworming table use, BMI of caregiver, dietary zinc intake as independent variables. The original linear regression model and a detailed methodology and analyses conducted are presented in Uwiringiyimana et al. [3].
    • Key criteria for developing ecosystem service indicators to inform decision making

      van Oudenhoven, Alexander P.E.; Schröter, Matthias; Drakou, Evangelia G.; Geijzendorffer, Ilse R.; Jacobs, Sander; van Bodegom, Peter M.; Chazee, Laurent; Czúcz, Bálint; Grunewald, Karsten; Lillebø, Ana I.; Mononen, Laura; Nogueira, António J.A.; Pacheco-Romero, Manuel; Perennou, Christian; Remme, Roy P.; Rova, Silvia; Syrbe, Ralf-Uwe; Tratalos, Jamie A.; Vallejos, María; Albert, Christian (2018-12)
    • Individual variation in temporal relationships between exposure to radiofrequency electromagnetic fields and non-specific physical symptoms: A new approach in studying 'electrosensitivity'.

      Bogers, R P; van Gils, A; Clahsen, S C S; Vercruijsse, W; van Kamp, I; Baliatsas, C; Rosmalen, J G M; Bolte, J F B (2018-12)
      Everyday exposure to radiofrequency electromagnetic fields (RF-EMF) emitted from wireless devices such as mobile phones and base stations, radio and television transmitters is ubiquitous. Some people attribute non-specific physical symptoms (NSPS) such as headache and fatigue to exposure to RF-EMF. Most previous laboratory studies or studies that analyzed populations at a group level did not find evidence of an association between RF-EMF exposure and NSPS.
    • Effects of lomefloxacin on survival, growth and reproduction of Daphnia magna under simulated sunlight radiation

      Luo, Tianlie; Chen, Jingwen; Li, Xuehua; Zhang, Shuying; Yao, Hongye; Peijnenburg, Willie J.G.M. (2018-12)
    • Chikungunya virus outbreak in Sint Maarten: Long-term arthralgia after a 15-month period.

      Peters, C M M; Pijnacker, R; Fanoy, E B; Bouwman, L J T; de Langen, L E; van den Kerkhof, J H T C; Reimerink, J; Pilot, E; Henry, M; Oostburg, V Asin; Braks, M A H (2018-11-19)
      The first chikungunya (CHIK) epidemic in the Americas was reported in December 2013. Chikungunya virus (CHIKV) causes an acute febrile illness and is transmitted to humans by Aedes mosquitoes. Although earlier studies have described long-term clinical manifestations of CHIK patients infected with the East/Central/South African (ECSA) genotype, little is known about persistent manifestations in the Caribbean region, for which the Asian genotype is responsible. The objective of this study was to describe the presence of persisting clinical manifestations, specifically arthralgia, in CHIKV-infected patients on the Caribbean Island, Sint Maarten, 15 months after onset of the disease.
    • Use of quantum-chemical descriptors to analyse reaction rate constants between organic chemicals and superoxide/hydroperoxyl (O2•-/HO2•).

      Nolte, Tom M; Peijnenburg, Willie J G M (2018-11-13)
      The reaction between superoxide (O2•-) and organic chemicals is of interest in many scientific disciplines including biology and synthetic chemistry, as well as for the evaluation of chemical fate in the environment. Due to limited data and lack of congeneric modelling, the involvement of superoxide in many complex processes cannot be adequately evaluated. In this study, we developed new quantitative structure-property relationship (QSPR) models for the prediction of the aqueous-phase rate constant for the reaction between superoxide and a wide variety of organic chemicals reacting via one-electron oxidation, reduction and hydrogen-transfer. It is shown that the relative importance of these pathways is related to frontier molecular orbital (FMO) interaction and to pH. The class-specific QSPRs developed have good statistics (0.84 ≤ R2 ≤ 0.92). For non-congeneric chemicals it is demonstrated that the reactivity toward superoxide can be described by applying explicit descriptions for competition kinetics and speciation. Therefore, the relationships developed in this study are useful as a starting point to evaluate more complex molecules having, for example, multiple reactive functional groups, labile H bonds, or delocalised cationic charges. However, additional kinetic data and more rigorous computation are needed to evaluate such molecules.
    • Evaluation of the Process of Implementing an Outdoor School Ground Smoking Ban at Secondary Schools.

      Rozema, Andrea D; Mathijssen, Jolanda J P; van Oers, Hans A M; Jansen, Maria W J (2018-11)
      Although outdoor smoking bans at school are becoming important, it remains unclear whether successful implementation is feasible and what conditions promote it. Therefore, this study evaluates the implementation process by identifying important factors.
    • Pro-inflammatory responses to PM 0.25 from airport and urban traffic emissions

      He, Rui-Wen; Shirmohammadi, Farimah; Gerlofs-Nijland, Miriam E.; Sioutas, Constantinos; Cassee, Flemming R. (2018-11)
    • Current EU research activities on combined exposure to multiple chemicals.

      Bopp, Stephanie K; Barouki, Robert; Brack, Werner; Dalla Costa, Silvia; Dorne, Jean-Lou C M; Drakvik, Paula E; Faust, Michael; Karjalainen, Tuomo K; Kephalopoulos, Stylianos; van Klaveren, Jacob; Kolossa-Gehring, Marike; Kortenkamp, Andreas; Lebret, Erik; Lettieri, Teresa; Nørager, Sofie; Rüegg, Joëlle; Tarazona, Jose V; Trier, Xenia; van de Water, Bob; van Gils, Jos; Bergman, Åke (2018-11)
      Humans and wildlife are exposed to an intractably large number of different combinations of chemicals via food, water, air, consumer products, and other media and sources. This raises concerns about their impact on public and environmental health. The risk assessment of chemicals for regulatory purposes mainly relies on the assessment of individual chemicals. If exposure to multiple chemicals is considered in a legislative framework, it is usually limited to chemicals falling within this framework and co-exposure to chemicals that are covered by a different regulatory framework is often neglected. Methodologies and guidance for assessing risks from combined exposure to multiple chemicals have been developed for different regulatory sectors, however, a harmonised, consistent approach for performing mixture risk assessments and management across different regulatory sectors is lacking. At the time of this publication, several EU research projects are running, funded by the current European Research and Innovation Programme Horizon 2020 or the Seventh Framework Programme. They aim at addressing knowledge gaps and developing methodologies to better assess chemical mixtures, by generating and making available internal and external exposure data, developing models for exposure assessment, developing tools for in silico and in vitro effect assessment to be applied in a tiered framework and for grouping of chemicals, as well as developing joint epidemiological-toxicological approaches for mixture risk assessment and for prioritising mixtures of concern. The projects EDC-MixRisk, EuroMix, EUToxRisk, HBM4EU and SOLUTIONS have started an exchange between the consortia, European Commission Services and EU Agencies, in order to identify where new methodologies have become available and where remaining gaps need to be further addressed. This paper maps how the different projects contribute to the data needs and assessment methodologies and identifies remaining challenges to be further addressed for the assessment of chemical mixtures.
    • Perceived usefulness of the International Classification of Functioning, Disability and Health (ICF) increases after a short training: A randomized controlled trial in master of advanced nursing practice students.

      Stallinga, Hillegonda A; Dijkstra, Pieter U; Napel, Huib Ten; Roodbol, Gabriël; Peters, Jeroen W B; Heerkens, Yvonne F; Roodbol, Petrie F (2018-11)
      The Master program of Advanced Nursing Practice (MANP) educates nurses to become a nurse practitioner. Nurse practitioners are health care professionals focusing on the intersection of cure and care. However, a clear model covering that area is lacking. The use of the International Classification of Functioning, Disability and Health (ICF) may be considered for incorporation in curricula due to its focus on the integration of cure and care. The purpose of this study is to test the effects of a short (= 4-h instructor-led) ICF training on perceived usefulness of the ICF. In a randomized controlled trial, 76 MANP students were randomly allocated to intervention or control group. Data were collected using an 'ICF survey and learning assessment tool'. Data of 56 students were included for analysis. Perceived usefulness of the ICF increased significantly in the intervention group immediately after training (p = 0.001) but no longer at 3-months follow-up (p = 0.388). Attitude and knowledge related to the ICF were significantly increased in the intervention group at both post-training assessments (p < 0.001 and 0.02). The positive influence of the ICF training on perceived usefulness of the ICF is relevant for including ICF in MANP curriculum.