• The impact of urban regeneration programmes on health and health-related behaviour: Evaluation of the Dutch District Approach 6.5 years from the start.

      Ruijsbroek, Annemarie; Wong, Albert; Kunst, Anton E; van den Brink, Carolien; van Oers, Hans A M; Droomers, Mariël; Stronks, Karien (2017)
      Large-scale regeneration programmes to improve the personal conditions and living circumstances in deprived areas may affect health and the lifestyle of the residents. Previous evaluations concluded that a large-scale urban regeneration programme in the Netherlands had some positive effects within 3.5 years. The aim of the current study was to evaluate the effects at the longer run.
    • Impact of vertebrate communities on Ixodes ricinus-borne disease risk in forest areas.

      Takumi, Katsuhisa; Sprong, Hein; Hofmeester, Tim R (2019-09-06)
    • Impact of water chemistry on the behavior and fate of copper nanoparticles.

      Xiao, Yinlong; Vijver, Martina G; Peijnenburg, Willie J G M (2018-03)
      A full-factorial test design was applied to systematically investigate the contribution and significance of water chemistry parameters (pH, divalent cations and dissolved organic carbon (DOC) concentration) and their interactions on the behavior and fate of copper nanoparticles (CuNPs). The total amount of Cu remaining in the water column after 48 h of incubation was mostly influenced by divalent cation content, DOC concentration and the interaction of divalent cations and DOC. DOC concentration was the predominant factor influencing the dissolution of CuNPs, which was far more important than the effect of pH in the range from 6 to 9 on the dissolution of the CuNPs. The addition of DOC at concentrations ranging from 5 to 50 mg C/L resulted in a 3-5 fold reduction of dissolution of CuNPs after 48 h of incubation, as compared to the case without addition of DOC. Divalent cation content was found to be the most influential factor regarding aggregation behavior of the particles, followed by DOC concentration and the interaction of divalent cations and DOC. In addition, the aggregation behavior of CuNPs rather than particulate dissolution explained most of the variance in the sedimentation profiles of CuNPs. These results are meaningful for improved understanding and prediction of the behavior and fate of metallic NPs in aqueous environments.
    • Impact of water chemistry on the particle-specific toxicity of copper nanoparticles to Daphnia magna.

      Xiao, Yinlong; Peijnenburg, Willie J G M; Chen, Guangchao; Vijver, Martina G (2018-01-01)
      Toxicity of metallic nanoparticle suspensions (NP(total)) is generally assumed to result from the combined effect of the particles present in suspensions (NP(particle)) and their released ions (NP(ion)). Evaluation and consideration of how water chemistry affects the particle-specific toxicity of NP(total) are critical for environmental risk assessment of nanoparticles. In this study, it was found that the toxicity of Cu NP(particle) to Daphnia magna, in line with the trends in toxicity for Cu NP(ion), decreased with increasing pH and with increasing concentrations of divalent cations and dissolved organic carbon (DOC). Without the addition of DOC, the toxicity of Cu NP(total) to D. magna at the LC50 was driven mainly by Cu NP(ion) (accounting for ≥53% of the observed toxicity). However, toxicity of Cu NP(total) in the presence of DOC at a concentration ranging from 5 to 50mg C/L largely resulted from the NP(particle) (57%-85%), which could be attributable to the large reduction of the concentration of Cu NP(ion) and the enhancement of the stability of Cu NP(particle) when DOC was added. Our results indicate that water chemistry needs to be explicitly taken into consideration when evaluating the role of NP(particle) and NP(ion) in the observed toxicity of NP(total).
    • Implementation of a guideline for local health policy making by regional health services: exploring determinants of use by a web survey.

      Kuunders, Theo J M; Jacobs, Monique A M; Goor, Ien A M van de; Bon-Martens, Marja J H van; Oers, Hans A M van; Paulussen, Theo G W M (2017-08-15)
      Previous evaluation showed insufficient use of a national guideline for integrated local health policy by Regional Health Services (RHS) in the Netherlands. The guideline focuses on five health topics and includes five checklists to support integrated municipal health policies. This study explores the determinants of guideline use by regional Dutch health professionals.
    • Implementation of latent tuberculosis infection screening and treatment among newly arriving immigrants in the Netherlands: A mixed methods pilot evaluation.

      Spruijt, Ineke; Erkens, Connie; Suurmond, Jeanine; Huisman, Erik; Koenders, Marga; Kouw, Peter; Toumanian, Sophie; Cobelens, Frank; van den Hof, Susan (2019-01-01)
    • Implementation of MenACWY vaccination because of ongoing increase in serogroup W invasive meningococcal disease, the Netherlands, 2018.

      Knol, Mirjam J; Ruijs, Wilhelmina Lm; Antonise-Kamp, Laura; de Melker, Hester E; van der Ende, Arie (2018-04)
      The annual incidence rate of serogroup W invasive meningococcal disease in the Netherlands increased from < 0.05/100,000 (n < 10) before 2015 to 0.5/100,000 (n = 80) in 2017. Most isolates (94%) belong to clonal complex 11. The incidence rate is highest among  < 5 year-olds and 15-24 year-olds. The case fatality rate was 12% (17/138) in 2015-2017. From May 2018, MenACWY vaccination replaces MenC vaccination at age 14 months and from October 2018, 13-14 year-olds are offered MenACWY vaccination.
    • Implementation of point-of-care testing and a temporary influenza ward in a Dutch hospital.

      Lankelma, J M; Hermans, M H A; Hazenberg, E H L C M; Macken, T; Dautzenberg, P L J; Koeijvoets, K C M C; Jaspers, J W H; van Gageldonk-Lafeber, A B; Lutgens, S P M (2019-04-01)
    • Implementing infection prevention practices across European hospitals: an in-depth qualitative assessment.

      Clack, Lauren; Zingg, Walter; Saint, Sanjay; Casillas, Alejandra; Touveneau, Sylvie; da Liberdade Jantarada, Fabricio; Willi, Ursina; van der Kooi, Tjallie; Damschroder, Laura J; Forman, Jane H; et al. (2018-06-27)
      The Prevention of Hospital Infections by Intervention and Training (PROHIBIT) project included a cluster-randomised, stepped wedge, controlled study to evaluate multiple strategies to prevent catheter-related bloodstream infection. We report an in-depth investigation of the main barriers, facilitators and contextual factors relevant to successfully implementing these strategies in European acute care hospitals.
    • Implementing wildlife disease surveillance in the Netherlands, a One Health approach.

      Maas, M; Gröne, A; Kuiken, T; Van Schaik, G; Roest, H I J; Van Der Giessen, J W B (2016-12)
      The surveillance of (emerging) wildlife diseases can provide important, objective evidence of the circulation of pathogens of interest for veterinary and/or public health. The involvement of multiple research institutions in wildlife disease surveillance can ensure the best use of existing knowledge and expertise, but can also complicate or add challenges to the integration of wildlife disease surveillance components into a national programme. Documenting the existing efforts in a country's surveillance of wildlife diseases, including the institutes in which it takes place, provides a basis for policy-makers and authorities to identify gaps and priorities in their current surveillance programmes. This paper describes the wildlife disease surveillance activities taking place in the Netherlands. The authors recommend that, in addition to funding these current activities, surveillance resources should be allocated with the flexibility to allow for additional targeted surveillance, to detect and adequately respond to newly introduced or emerging pathogens. Similar structured overviews of wildlife disease surveillance in other countries would be very useful to facilitate international collaboration.
    • Importance of details in food descriptions in estimating population nutrient intake distributions.

      Zhang, Liangzi; Geelen, Anouk; Boshuizen, Hendriek C; Ferreira, José; Ocké, Marga C (2019-03-15)
      National food consumption surveys are important policy instruments that could monitor food consumption of a certain population. To be used for multiple purposes, this type of survey usually collects comprehensive food information using dietary assessment methods like 24-h dietary recalls (24HRs). However, the collection and handling of such detailed information require tremendous efforts. We aimed to improve the efficiency of data collection and handling in 24HRs, by identifying less important characteristics of food descriptions (facets) and assessing the impact of disregarding them on energy and nutrient intake distributions. In the Dutch National Food Consumption Survey 2007-2010, food consumption data were collected through interviewer-administered 24HRs using GloboDiet software in 3819 persons. Interviewers asked participants about the characteristics of each food item according to applicable facets. Food consumption data were subsequently linked to the food composition database. The importance of facets for predicting energy and each of the 33 nutrients was estimated using the random forest algorithm. Then a simulation study was performed to determine the influence of deleting less important facets on population nutrient intake distributions. We identified 35% facets as unimportant and deleted them from the total food consumption database. The majority (79.4%) of the percent difference between percentile estimates of the population nutrient intake distributions before and after facet deletion ranged from 0 to 1%, while 20% cases ranged from 1 to 5% and 0.6% cases more than 10%. We concluded that our procedure was successful in identifying less important food descriptions in estimating population nutrient intake distributions. The reduction in food descriptions has the potential to reduce the time needed for conducting interviews and data handling while maintaining the data quality of the survey.
    • The importance of estimating selection bias on prevalence estimates shortly after a disaster.

      Grievink, Linda; Velden, Peter G van der; Yzermans, C Joris; Roorda, Jan; Stellato, Rebecca K (2006-10-01)
      PURPOSE: The aim was to study selective participation and its effect on prevalence estimates in a health survey of affected residents 3 weeks after a man-made disaster in The Netherlands (May 13, 2000). METHODS: All affected adult residents were invited to participate. Survey (questionnaire) data were combined with electronic medical records of residents' general practitioners (GPs). Data for demographics, relocation, utilization, and morbidity 1 year predisaster and 1 year postdisaster were used. RESULTS: The survey participation rate was 26% (N = 1171). Women (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.28-1.67), those living with a partner (OR, 2.00; 95% CI, 1.72-2.33), those aged 45 to 64 years (OR, 2.00; 95% CI, 1.59-2.52), and immigrants (OR, 1.50; 95% CI, 1.30-1.74) were more likely to participate. Participation rate was not affected by relocation because of the disaster. Participants in the survey consulted their GPs for health problems in the year before and after the disaster more often than nonparticipants. Although there was selective participation, multiple imputation barely affected prevalence estimates of health problems in the survey 3 weeks postdisaster. CONCLUSIONS: Estimating actual selection bias in disaster studies gives better information about the study representativeness. This is important for policy making and providing effective health care.
    • Importance of exposure dynamics of metal-based nano-ZnO, -Cu and -Pb governing the metabolic potential of soil bacterial communities.

      Zhai, Yujia; Hunting, Ellard R; Wouterse, Marja; Peijnenburg, Willie J G M; Vijver, Martina G (2017-11)
      Metal-based engineered nanomaterials (ENMs) are known to affect bacterial processes and metabolic activities. While testing their negative effects on biological components, studies traditionally rely on initial exposure concentrations and thereby do not take into consideration the dynamic behavior of ENMs that ultimately determines exposure and toxicity (e.g. ion release). Moreover, functional responses of soil microbial communities to ENMs exposure can be caused by both the particulate forms and the ionic forms, yet their relative contributions remain poorly understood. Therefore, we investigated the dynamic changes of exposure concentrations of three different types of ENMs (nano-ZnO, -Cu and -Pb) and submicron particles (SMPs) in relation to their impact on the capacity of soil bacterial communities to utilize carbon substrates. The different ENMs were chosen to differ in dissolution potential. The dynamic exposures of ENMs were considered using a time weighted average (TWA) approach. The joint toxicity of the particulate forms and the ionic forms of ENMs was evaluated using a response addition model. Our results showed that the effect concentrations of spherical nano-ZnO, -Cu and SMPs, and Pb-based perovskites expressed as TWA were lower than expressed as initial concentrations. Both particulate forms and ionic forms of spherical 18nm, 43nm nano-ZnO and 50nm, 100nm nano-Cu contribute to the overall response at the EC50 levels. The particulate forms for 150nm, 200nm and 900nm ZnO SMPs and rod-shaped 78nm nano-Cu mainly affected the soil microbial metabolic potential, while the Cu ions released from spherical 25nm nano-Cu, 500nm Cu SMPs and Pb ions released from perovskites mainly described the effects to bacterial communities. Our results indicate that the dynamic exposure of ENMs and relative contributions of particles and ions require consideration in order to pursue a naturally realistic assessment of environmental risks of metal-based ENMs.
    • The importance of inclusion of kinetic information in the extrapolation of high-to-low concentrations for human limit setting.

      Geraets, Liesbeth; Zeilmaker, Marco J; Bos, Peter M J (2018-01-05)
      Human health risk assessment of inhalation exposures generally includes a high-to-low concentration extrapolation. Although this is a common step in human risk assessment, it introduces various uncertainties. One of these uncertainties is related to the toxicokinetics. Many kinetic processes such as absorption, metabolism or excretion can be subject to saturation at high concentration levels. In the presence of saturable kinetic processes of the parent compound or metabolites, disproportionate increases in internal blood or tissue concentration relative to the external concentration administered may occur resulting in nonlinear kinetics. The present paper critically reviews human health risk assessment of inhalation exposure. More specific, it emphasizes the importance of kinetic information for the determination of a safe exposure in human risk assessment of inhalation exposures assessed by conversion from a high animal exposure to a low exposure in humans. For two selected chemicals, i.e. methyl tert-butyl ether and 1,2-dichloroethane, PBTK-modelling was used, for illustrative purposes, to follow the extrapolation and conversion steps as performed in existing risk assessments for these chemicals. Human health-based limit values based on an external dose metric without sufficient knowledge on kinetics might be too high to be sufficiently protective. Insight in the actual internal exposure, the toxic agent, the appropriate dose metric, and whether an effect is related to internal concentration or dose is important. Without this, application of assessment factors on an external dose metric and the conversion to continuous exposure results in an uncertain human health risk assessment of inhalation exposures.
    • Improved inference of time-varying reproduction numbers during infectious disease outbreaks.

      Thompson, R N; Stockwin, J E; van Gaalen, R D; Polonsky, J A; Kamvar, Z N; Demarsh, P A; Dahlqwist, E; Li, S; Miguel, E; Jombart, T; et al. (2019-08-26)
    • An improved life cycle impact assessment principle for assessing the impact of land use on ecosystem services.

      Othoniel, Benoit; Rugani, Benedetto; Heijungs, Reinout; Beyer, Marco; Machwitz, Miriam; Post, Pim (2019-07-13)
    • Improved prediction of gestational hypertension by inclusion of placental growth factor and pregnancy associated plasma protein-a in a sample of Ghanaian women.

      Antwi, Edward; Klipstein-Grobusch, Kerstin; Browne, Joyce L; Schielen, Peter C; Koram, Kwadwo A; Agyepong, Irene A; Grobbee, Diederick E (2018-03-27)
      We assessed whether adding the biomarkers Pregnancy Associated Plasma Protein-A (PAPP-A) and Placental Growth Factor (PlGF) to maternal clinical characteristics improved the prediction of a previously developed model for gestational hypertension in a cohort of Ghanaian pregnant women.
    • Improving early detection initiatives: a qualitative study exploring perspectives of older people and professionals.

      Lette, Manon; Stoop, Annerieke; Lemmens, Lidwien C; Buist, Yvette; Baan, Caroline A; de Bruin, Simone R (2017-06-23)
      A wide range of initiatives on early detection and intervention have been developed to proactively identify problems related to health and wellbeing in (frail) older people, with the aim of supporting them to live independently for as long as possible. Nevertheless, it remains unclear what the best way is to design such initiatives and how older people's needs and preferences can be best addressed. This study aimed to address this gap in the literature by exploring: 1) older people's perspectives on health and living environment in relation to living independently at home; 2) older people's needs and preferences in relation to initiating and receiving care and support; and 3) professionals' views on what would be necessary to enable the alignment of early detection initiatives with older people's own needs and preferences.
    • Improving environmental risk assessments of chemicals: Steps towards evidence-based ecotoxicology.

      Martin, Olwenn V; Adams, Julie; Beasley, Amy; Belanger, Scott; Breton, Roger L; Brock, Theo C M; Buonsante, Vito A; Galay Burgos, Malyka; Green, John; Guiney, Patrick D; et al. (2019-07-01)