RIVM Publications Repository

Each year the Dutch National Institute for Public Health and the Environment (RIVM) produces numerous reports and publications on all aspects of public health, nutrition and food, health care, disaster management, nature and the environment. 
In addition, RIVM employees publish scientific articles in national and international journals.

Elk jaar brengt het Rijksinstituut voor Volksgezondheid en Milieu (RIVM) talloze rapporten en adviezen uit over volksgezondheid en gezondheidszorg, voeding, natuur en milieu en rampenbestrijding. 
Daarnaast publiceren RIVM-medewerkers wetenschappelijke artikelen in (inter-)nationale tijdschriften.

We are constantly working to improve the Repository. Please contact our administrator if you have any further questions or remarks. 

Recent Submissions

  • PublicationMetadata only
    Verkenning monitoring foliumzuurgebruik rondom de zwangerschap
    (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2025-01-17) ter Borg, S; de Jong, M; Verkaik-Kloosterman, J
    Foliumzuur is belangrijk voor de ontwikkeling van het ongeboren kind. Het RIVM onderzocht in hoeverre vrouwen met een kinderwens en zwangeren het advies opvolgen om voor en tijdens de zwangerschap foliumzuur te slikken. Eerder bleek al dat er weinig bekend is over de dosis en hoe lang vrouwen foliumzuur slikken. Daarom is nu nagegaan of in bestaande registraties aanvullende gegevens worden verzameld en of extra analyses meer inzicht zouden geven. Het blijkt nog niet mogelijk te zijn om de vraag te beantwoorden in welke mate het foliumzuursuppletie-advies precies wordt opgevolgd. Wel zijn er genoeg aanwijzingen dat dit nog te wensen over laat. Dit beeld lijkt sinds het advies van de Gezondheidsraad uit 2008 over foliumzuur niet veel te zijn veranderd. Daarom adviseert het RIVM inzicht te krijgen in factoren die het gebruik van foliumzuursupplementen voor en tijdens de zwangerschap, belemmeren of stimuleren. Dat kan bijvoorbeeld met gedragsonderzoek. Daarnaast is het belangrijk om de opvolging van suppletie-adviezen en de effectiviteit van het beleid regelmatig te monitoren. Vooral gegevens over de dosering ontbreken. 03-04-2026: Dit document is op 1 september 2025 technisch aangepast ter verbetering van de digitale toegankelijkheid.De inhoud en vormgeving zijn ongewijzigd.
  • PublicationOpen Access
    Verkenning Chemours en de Westerschelde; advies voor onderzoeken naar PFAS in deze regio’s
    (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2024-11-24) Elberse, J; Zonneveld, M; Von den Benken, M; Bogers, R; Bergstra, A; van de Weigert, V; Bekker, C; de Zwart, F; Houweling, D; Noorda, J; Wijten, J; Gooijer, L
    In deze verkenning heeft het RIVM in kaart gebracht wat de behoeften zijn aan onderzoek naar PFAS en gezondheid van omwonenden van Chemours en de Westerschelde. Dit met als doel om het ministerie van IenW te adviseren over mogelijke onderzoeken. Uit de verkenning onder ruim 4.300 omwonenden van Chemours en de Westerschelde blijkt dat zij meer duidelijkheid willen over hoeveel PFAS er in de leefomgeving en in het lichaam zit. Ook willen ze weten wat de mogelijke gevolgen zijn voor de gezondheid en wat de gezondheidssituatie in de regio nu is. De zorgen over PFAS in deze regio’s zijn niet nieuw. Wel maakt deze verkenning concreter welke vragen en zorgen dat zijn. Naast meer duidelijkheid over de huidige situatie van PFAS in de leefomgeving willen de meeste deelnemers ook dat er meer onderzoek gedaan wordt naar de effecten van PFAS op de gezondheid van mensen en het milieu. Daarnaast roepen veel deelnemers de overheid en bedrijven op om hun verantwoordelijkheid te nemen en de uitstoot en de lozingen van PFAS te stoppen. Ook de verwijdering van PFAS uit de leefomgeving en het lichaam wordt vaak genoemd. Er is behoefte aan begrijpelijke, betrouwbare en vindbare informatie over PFAS. Het RIVM heeft deze verkenning uitgevoerd in opdracht van het Ministerie van Infrastructuur en Waterstaat (IenW). De ministeries van IenW en VWS bepalen op welke wijze de adviezen uit deze verkenning worden opgevolgd. 03-04-2026: Dit document is op 4 augustus 2025 technisch aangepast ter verbetering van de digitale toegankelijkheid. De inhoud en vormgeving zijn ongewijzigd.
  • PublicationMetadata only
    Hybrid Care Modifications in the Delivery of Nonpandemic Care During the COVID-19 Pandemic: Scoping Review
    (2026-04-30) Sanchez Villalobos, Natalia; van Loenen, Tessa; Ngongalah, Lem; Connolly, Máire A; Stein, Mart L; Rovers, Chantal P; Timen, Aura
    BACKGROUND: The COVID-19 pandemic had an unprecedented impact on the delivery of health care, with digital interventions accelerating more than ever before. However, evidence of how hybrid care models, combining digital health interventions with in-person care, were implemented during the pandemic remains scattered. Understanding hybrid care models is imperative to build resilient health systems that can ensure access to care during crisis situations. OBJECTIVE: The study aimed to examine the implementation of hybrid care modifications to support the delivery of nonpandemic health care services in Europe during the COVID-19 pandemic. METHODS: A scoping review was conducted following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Systematic searches were conducted in PubMed or MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO on May 22, 2024, and updated on January 14, 2026. Studies were eligible if they included primary data on the use of digital care modifications implemented or scaled up during the COVID-19 pandemic for the delivery of nonpandemic health care services in Europe. Non-peer-reviewed publications and studies with a primary focus on mental health or pediatric care were excluded. Quality appraisal was conducted using the Mixed Methods Appraisal Tool. Descriptions of digital care modifications were inductively analyzed and used to create digital flows, combining telehealth systems, digital interventions, and care functions. Digital care modifications were categorized according to their hybrid care implementation (digital-only or hybrid). Study evaluations were extracted using the Kirkpatrick model. RESULTS: A total of 189 studies were included for analysis. Studies covered evidence from 2020 to 2024, a total of 23 countries, and 37 health care disciplines. Hybrid care implementation was reported in over 60% (115/189) of the studies, describing various forms of digital and in-person care. Care modifications incorporating in-person and digital care components were more commonly described in specialty care contexts. A total of 68 distinct digital flows were identified, with a limited number of telehealth systems allowing substantial variety in both interventions and care functions. Prominent digital flows included the use of online platforms to support video and messaging for follow-up care. Over half of the studies did not describe any kind of evaluation. CONCLUSIONS: This review has shown how few telehealth systems were able to support a variety of care functions in the delivery of nonpandemic care throughout the COVID-19 pandemic, underscoring their practical versatility. Integrating digital health as part of hybrid care models is essential in designing care pathways that can adapt to different contexts, including future health crises. Although a comprehensive search was conducted, the heterogeneous reporting of care modifications may have influenced the interpretation of the findings. In the future, research may expand the application of hybrid care models to innovative strategies for effective crisis management.
  • PublicationMetadata only
    Benchmark Response Values for Error-Corrected Sequencing Mutagenicity Assessment Technologies
    (2026-04) Mulugeta, Saron; Marchetti, Francesco; Chen, Guangchao; Chen, Connie; Puglisi, Raechel; White, Paul A
    The Benchmark Dose (BMD) approach is commonly used to determine Point-of-Departure (PoD) values for risk assessment and regulatory decision-making; however, choosing a suitable Benchmark Response (BMR) for continuous endpoints is a challenge. Earlier work established a BMR of 50% for selected in vivo mutagenicity endpoints (i.e., Transgenic Rodent and Pig-a). Error-corrected sequencing (ECS) technologies, such as Duplex Sequencing (DupSeq), Hawk-Seq, PECC-Seq, and PacBio HiFi, have emerged as powerful tools for mutagenicity assessment. This study applied and compared two approaches for defining BMR values for ECS technologies: the Effect Size (ES) theory of Slob (2017), and the one standard deviation approach of Zeller et al. (2017). A dose-response database of ECS studies was compiled to determine technology-specific within-group variance values (var) for BMR determination. Experimental factor influences on var, including species, rodent strain, administration route, application time, tissue type, tissue sampling time, and DNA fragmentation method, were examined; no significant influences were detected. The absence of covariate effects justified using typical, technology-specific var values for BMR determinations. Using these values, technology-specific BMRs were calculated as 27.7% for DupSeq, 16.6% for Hawk-Seq, and 23.3% for PECC-Seq. BMRs derived from negative control values were 22.6 to 28.8% for DupSeq, 5.6 to 13.8% for Hawk-Seq, 28.7 to 31.5% for PECC-Seq, and 9.5 to 22.8% for PacBio HiFi. These findings support adoption of a 30% BMR for in vivo ECS mutagenicity assessment technologies, providing a robust and consistent foundation for future dose-response modeling and human health risk assessment.
  • PublicationMetadata only
    A perfect storm: the immunological and pathophysiological landscape of pediatric post-COVID-19 condition
    (2026-04-10) Lap, Coen R; van Houten, Marlies; Bogaert, Debby; Biesbroek, Giske
    Pediatric Post-COVID Condition (PPCC) represents a significant and complex long-term sequela of SARS-CoV-2 infection, affecting a subset of children and adolescents even after mild acute disease. While acute COVID-19 is generally milder in children due to a more robust innate immune response, the mechanisms driving the persistence of symptoms in PPCC remain incompletely understood and likely multifactorial. This narrative review synthesizes current epidemiological data and explores the "perfect storm" of immunological and pathophysiological alterations underpinning the condition. We examine critical hypotheses including a dysregulated immune response characterized by altered T-cell subsets, monocyte activation, and autoantibody production. We discuss the potential role of persistent SARS-CoV-2 viral reservoirs in "sanctuary sites" like the gastrointestinal tract and the reactivation of latent viruses such as Epstein-Barr virus (EBV). Furthermore, the review details downstream pathogenic pathways, including vascular endothelial inflammation (thrombo-inflammation), neuroinflammation, and metabolic dysfunctions affecting the mitochondria and tryptophan-kynurenine pathway. Finally, we address the role of microbiome dysbiosis in perpetuating systemic inflammation and the gut-lung axis dysfunction. Given the heterogeneity of clinical presentations, we conclude that PPCC is likely a syndrome of overlapping biological phenotypes. Future research must prioritize identifying these specific biological endotypes to develop targeted diagnostic and therapeutic strategies for the pediatric population.
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