Now showing items 21-40 of 10827

    • Het amnionmembraan : Een verkenning

      de Vries C; Braakhuis HM (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-11-30)
      The National Institute for Public Health and the Environment (RIVM) has carried out an exploratory study into new developments and possible risks associated with the use of the so-called amniotic membrane, both in the Netherlands and elsewhere. For decades, the membrane has been used in ophthalmology as a graft to allow damaged corneas to heal. The amniotic membrane is a very thin membrane that is taken from the placenta. Its use is limited in the Netherlands. New developments concerning the amniotic membrane have mainly been described in the international literature. Research has been carried out into repairing damaged tissues by using stem cells obtained from comparable healthy tissue and growing them on amniotic membrane. The membrane with stem cells can then be placed on the damaged tissue. Another development currently being researched is the possibility of using stem cells from the amniotic membrane to repair damage to other tissues, such as muscles. In the Netherlands, amniotic membrane is mainly used to cover damage to the cornea of the eye. The literature reports only a limited number of risks, such as pain, associated with the use of amniotic membrane. As far as is known, in the Netherlands no complications have been reported concerning treatment with amniotic membrane.
    • The National Immunisation Programme in the Netherlands : Surveillance and developments in 2017-2018

      Schurink-van 't Klooster TM; de Melker HE; RVP; I&V (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-11-27)
      In 2017, about 760,000 children aged 0 to 19 years received a total of 2,140,000 vaccinations within the National Immunisation Programme (NIP). Participation in the NIP was high among children under 10 years of age, despite the drop by around 2-3% for most vaccinations since 2014. An exception in the high participation is the number of girls who was vaccinated against human papillomavirus (HPV), which has declined by 15% since 2016. The number of reports (1,383) of possible adverse events following immunisation in 2017 was lower than the number of reports in 2016 (1,483). <br> <br>NIP target diseases<br>There is an ongoing increase in the number of cases with meningococcal serogroup W (MenW) disease with 80 cases reported in 2017 and 78 up to August 2018. Because of this increase, since May 2018, the MenC vaccination given at 14 months of age has been replaced by a quadrivalent MenACWY vaccination. The case fatality of MenW disease (17%) was substantially higher than for other serogroups. <br> <br>In 2017, the number of measles cases was low (16 reported cases) but higher than in the previous two years. The number of pertussis reports in 2017 was comparable with 2016 (28.7 compared with 32.6 per 10,000). Three people died from pertussis, one infant and two elderly. The number of reports of acute hepatitis B infections stayed stable (0.7 per 100,000 population). Also, the incidence of vaccine type invasive pneumococcal disease (IPD) remained very low in 2017/2018. Once again, the number of reported cases were in 2017 low for mumps (46), Haemophilus influenzae type b (Hib; 46), meningococcal serogroep C (MenC; 9), diphtheria (4), tetanus (1), rubella (0) and polio (0). <br> <br>The inhabitants of Bonaire, St. Eustatius and Saba are predominantly well protected against NIP diseases. However, protection against measles and diphtheria is suboptimal for some age groups. Awareness is needed to prevent these diseases from spreading from neighboring countries, where outbreaks currently are observed. <br> <br>New advice and decisions<br>In July 2018, the Ministry of Health, Welfare and Sports decided to expand the MenACWY vaccination outbreak programme to 13-14 year olds. In 2019, there will be a catch up campaign for all 15-18 year olds. Furthermore, it was decided that vaccination against disease caused by rotavirus will be included in the NIP for risk groups, and that maternal pertussis vaccination in the NIP will be organised by youth health care organisations.The Dutch Health Council advises to offer vaccination against pneumococcal disease to the people 60 years and older. <br>
    • The National Immunisation Programme in the Netherlands : Surveillance and developments in 2017-2018

      Schurink-Van't Klooster, T M; de Melker HE (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-11-27)
      In 2017 kregen ongeveer 760.000 kinderen van 0 tot 19 jaar samen 2.140.000 vaccinaties vanuit het Rijksvaccinatieprogramma (RVP). De deelname aan het RVP is hoog onder kinderen jonger dan 10 jaar, ondanks de daling van ongeveer 2 tot 3 procent voor de meeste vaccinaties sinds 2014. Een uitzondering op de hoge deelname is het aantal meisjes dat zich tegen het humaan papillomavirus (HPV) heeft laten vaccineren, dat met 15 procent is gedaald sinds 2016. Het aantal meldingen (1383) van mogelijke bijwerkingen van vaccins in 2017 was lager dan het jaar ervoor (1483). RVP-ziekten Het aantal patiënten met meningokokkenziekte door MenW blijft stijgen, met 80 patiënten in 2017 en 78 tot en met augustus 2018. Daarom is sinds mei 2018 de MenC-vaccinatie op de leeftijd van 14 maanden vervangen door MenACWY-vaccinatie. Het percentage mensen dat aan MenW-ziekte overlijdt is aanzienlijk hoger (17 procent) dan bij andere meningokokken serogroepen. In 2017 was het aantal meldingen van mazelen met 16 gevallen laag, maar wat hoger dan in voorgaande twee jaren. Het aantal meldingen van kinkhoest was in lijn met 2016 (28,7 vergeleken met 32,6 per 10.000). Er overleden drie mensen aan kinkhoest, één jonge zuigeling en twee ouderen. Het aantal meldingen van acute hepatitis B bleef stabiel (0,7 per 100.000 populatie). Ook het aantal mensen dat ziek werd van een type pneumokokkenziekte waartegen het vaccin beschermt, bleef erg laag in 2017/2018. Net als voorgaande waren er in 2017 weinig meldingen van bof (46), Haemophilus influenzae type b (Hib; 46), meningokokken serogroep C (MenC; 9), difterie (4), tetanus (1), rodehond (0) en polio (0). De inwoners van Bonaire, St. Eustatius en Saba zijn overwegend goed beschermd tegen ziekten uit het RVP. Alleen de bescherming tegen mazelen en difterie is voor sommige leeftijdsgroepen niet optimaal. Alertheid is geboden om eventuele patiënten snel op te sporen om te voorkomen dat deze ziekten zich vanuit omliggende landen verspreiden. Daar zijn sinds kort uitbraken gaande. Nieuwe adviezen en besluiten In juli 2018 heeft de minister van Volksgezondheid, Welzijn en Sport (VWS) besloten om de MenACWY-vaccinatie vanaf oktober 2018 uit te bereiden naar 13-14- jarigen; in 2019 komt er een inhaalcampagne voor alle 15-18-jarigen. Ook is besloten om vaccinatie tegen het rotavirus aan te bieden aan risicogroepen en dat kinkhoestvaccinatie voor zwangeren via het RVP wordt georganiseerd door jeugdgezondheidszorg organisaties. De Gezondheidsraad adviseert vaccinatie tegen pneumokokken aan te bieden aan 60-plussers.
    • Ontwikkelingen in de stikstofdepositie

      Wichink Kruit RJ; van Pul WAJ; DMO; M&amp;V (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-11-26)
      RIVM has described the composition of the nitrogen that has settled on the surface (soil and plants) in the Netherlands between 2005 and 2016. It has also been reported how RIVM determines this so-called nitrogen deposition. This includes examining the extent to which ammonia contributes to the total nitrogen deposition. Ammonia is an important component of the total deposition of nitrogen. In the period studied, the total nitrogen deposition (N) consisted of two-thirds of ammonia (NH3-N) and one-third of nitrogen oxides (NOx-N). <br> <br>The national average nitrogen deposition in 1990 was more than 2700 moles of nitrogen per hectare. Since then, it has gradually declined to more than 1700 moles of nitrogen per hectare in 2016. The decline has levelled off in recent years. This is partly due to the fact that the ammonia emission no longer declined. According to the 'Emission estimates for air pollutants in the Netherlands - reporting 2017' from the Netherlands Environmental Assessment Agency (PBL) the total emission and therefore the nitrogen deposition will decline further in future. <br> <br>Ammonia emissions are used to calculate its concentrations in the air, and on this basis the ammonia deposition. The calculations are then corrected by the measured concentrations. The calculated ammonia emissions declined over the entire period between 2005 and 2016. The measured ammonia concentration over the same period increased slightly. These contrasting tendencies have been investigated further. <br> <br>Several factors influence the concentrations of ammonia in the air. Since in recent years the air contains less pollutants to which ammonia can bind, such as nitrogen and sulphur oxides, relatively more ammonia remains in the atmosphere. The divergence of trends in the reported emissions and the measured concentrations can therefore partly be explained by the decreased emissions of nitrogen and sulphur oxides. RIVM is currently investigating the emissions to find out whether these provide any explanations for the remaining difference between the reported emissions and the measured concentration of ammonia over the years. This investigation will be completed by the end of 2018. <br>
    • Geboortezorg in beeld : een nulmeting en eerste ervaringen met het werken met integrale bekostiging

      Struijs JN; de Vries EF; van Dorst HDCA; Over EAB; Baan CA; KZG; V&amp;Z (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-11-26)
      In recent years, various policies have been implemented to improve quality of maternity care and collaboration between maternity care providers aiming to lower the relatively high mortality rates in the Netherlands. Currently, within the existing payment model, providers are paid on a fee-for-service basis. In 2017, a voluntary payment reform was implemented to enhance the collaboration between care providers. The new payment model, a bundled payment model, includes all antenatal and perinatal care services delivered by midwives, obstetricians and maternity care assistance providers. The bundled payment model leads to a new provider-led entity, the integrated maternity care organization (imco) in which community midwives, obstetricians, a hospital and in most cases maternity care assistance providers (in Dutch: kraamzorgorganisaties) participate. <br> <br>Per 1 January 2017, six imco's have signed a bundled payment contract. We performed a baseline measurement in which we examined whether these six regions differed in terms of health outcomes, utilization and medical spending from the other regions in the period before the introduction of the bundled payments. This study showed that - corrected for case-mix - the six regions that have adopted the bundled payment model had lower birth care spending levels as compared to the other regions in the years before the implementation of the bundled payment model. On average the regions had about 180 (3.5%) lower expenditures per pregnancy in 2015 and 2016. Furthermore, future imco's executed more epidurals (25% vs. 21%), yet less C-sections (14% vs. 16%). No differences in health outcomes were observed. <br> <br>In interviews, all maternity care providers and managers reported a positive attitude towards working with the bundled payments model. The bundled payment has led to a more intense, more structured and less informal collaboration between the different providers in their region. The interviewees mentioned that the implementation was complex and time-consuming and there still is a need for in-depth knowledge regarding governance, taxes and finance. <br> <br>In the coming years, the National Institute for Public Health and the Environment will monitor developments regarding payment models for maternity care. A final report will be published in 2020. <br>
    • Geboortezorg in beeld : een nulmeting en de eerste ervaring

      Struijs JN; de Vries EF; van Over HDCA; Over EAB; Baan CA (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-11-26)
      In Nederland zijn de afgelopen jaren meerdere maatregelen genomen om de kwaliteit van de geboortezorg en de samenwerking tussen de verschillende zorgverleners te verbeteren. Aanleiding waren de relatief hoge sterftecijfers rond geboortes in Nederland. Om de samenwerking tussen zorgaanbieders te verbeteren kunnen alle onderdelen van de geboortezorg sinds 2017 gezamenlijk worden gecontracteerd in één zogenoemd integraal bekostigingscontract. Deze nieuwe bekostiging vraagt om organisatorische veranderingen, waaronder de vorming van een integrale geboortezorg organisatie (igo). Hier zijn de zorgaanbieders zoals verloskundigen, gynaecologen, kraamzorg, en een ziekenhuis in ondergebracht. In de bestaande bekostigingssystematiek vergoeden de zorgverzekeraars de onderdelen van de zorg rondom zwangerschap en geboorte afzonderlijk aan de verschillende zorgaanbieders. Per 1 januari 2017 hebben zes igo’s vrijwillig integrale-bekostigingscontracten gesloten met zorgverzekeraars. Als nulmeting heeft het RIVM de gezondheid, verrichtingen en zorguitgaven van de geboortezorg in kaart gebracht in de periode voorafgaand aan de overstap naar integrale bekostiging (2015-2016). Uit dit onderzoek blijkt dat de uitgaven aan de geboortezorg voor de igo’s in deze periode iets lager lijken te zijn (ongeveer 180 euro per zwangerschap minder) dan in de regio’s die niet zijn overgestapt in 2017. Verder verschillen de igo’s van de overige regio’s, in de periode voorafgaand aan de overstap in de zorg die zij leverden: meer ruggenprikken (25% versus 21%) en minder keizersneden (14% versus 16%)– de beschikbaarheid van ruggenprikken en zo min mogelijk keizersnedes zijn positieve graadmeters voor de kwaliteit van de zorg voor moeder en kind. Wat de gezondheid van moeder en kind betreft zijn er geen verschillen gevonden. De partijen die bij de igo’s zijn betrokken, zijn positief over het integrale tarief. Het levert in hun regio een intensievere, meer gestructureerde samenwerking tussen de zorgverleners op. Ook is de samenwerking minder vrijblijvend dan voorheen. Wel is het een zeer complexe en tijdrovende klus om de integrale bekostiging in te voeren. Specifieke kennis blijft nodig op organisatorisch, fiscaal en financieel vlak. Het RIVM monitort de komende jaren in opdracht van het ministerie van VWS de overgang naar integrale bekostiging in de geboortezorg. In 2020 wordt een eindrapport gepubliceerd, waarvoor de gegevens uit onderliggend onderzoek als nulmeting dienen.
    • Ontwikkelingen in de stikstofdepositie

      Wichink Kruit RJ; van Pul WAJ; DMO; MIL (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-11-26)
      RIVM has described the composition of the nitrogen that has settled on the surface (soil and plants) in the Netherlands between 2005 and 2016. It has also been reported how RIVM determines this so-called nitrogen deposition. This includes examining the extent to which ammonia contributes to the total nitrogen deposition. Ammonia is an important component of the total deposition of nitrogen. In the period studied, the total nitrogen deposition (N) consisted of two-thirds of ammonia (NH3-N) and one-third of nitrogen oxides (NOx-N). The national average nitrogen deposition in 1990 was more than 2700 moles of nitrogen per hectare. Since then, it has gradually declined to more than 1700 moles of nitrogen per hectare in 2016. The decline has levelled off in recent years. This is partly due to the fact that the ammonia emission no longer declined. According to the 'Emission estimates for air pollutants in the Netherlands - reporting 2017' from the Netherlands Environmental Assessment Agency (PBL) the total emission and therefore the nitrogen deposition will decline further in future. Ammonia emissions are used to calculate its concentrations in the air, and on this basis the ammonia deposition. The calculations are then corrected by the measured concentrations. The calculated ammonia emissions declined over the entire period between 2005 and 2016. The measured ammonia concentration over the same period increased slightly. These contrasting tendencies have been investigated further. Several factors influence the concentrations of ammonia in the air. Since in recent years the air contains less pollutants to which ammonia can bind, such as nitrogen and sulphur oxides, relatively more ammonia remains in the atmosphere. The divergence of trends in the reported emissions and the measured concentrations can therefore partly be explained by the decreased emissions of nitrogen and sulphur oxides. RIVM is currently investigating the emissions to find out whether these provide any explanations for the remaining difference between the reported emissions and the measured concentration of ammonia over the years. This investigation will be completed by the end of 2018.
    • Regio’s in beweging naar een toekomstbestendig gezondheidssysteem : Landelijke Monitor Proeftuinen –reflectie op 5 jaar proeftuinen

      Drewes HW; van Vooren NJE; Steenkamer B; Kemper PF; Hendrikx RJ; KZG; VPZ (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-11-26)
      In the Netherlands, initiatives have been implemented at the regional level to drive collaboration and create more sustainable healthcare systems. The Triple Aim: improving population health and the quality of care while reducing the cost growth, underpins these initiatives. With the recognition that health and wellbeing cannot be driven by the healthcare sector alone, organisations from different sectors, e.g. healthcare providers, health insurers, patient and public representatives and municipalities, have begun implementing different kinds of collaborative initiatives. The aim of these initiatives is to transition to a ‘health and wellbeing system’. Such initiatives consist of a variety of different interventions at the regional level, including for example, engaging communities, specialists providing care in GP practices, and interoperable data infrastructures. In 2013, the Ministry of Health, Welfare and Sport (VWS) selected nine regions, called the Dutch Monitor Pioneer sites for Population Management, to develop new and sustainable healthcare systems, which would act as an inspiration for the rest of the health system in the Netherlands. Commissioned by VWS, the National Institute for Public Health and the Environment (RIVM) monitored the Pioneer sites from 2013 to 2018 and mapped the pilots’ evolution. Based on this five-year evaluation, the RIVM has generated eight guiding principles for the successful implementation of regional collaborative initiatives. The principles provide guidelines for successfully shaping initiatives’ important aspects including governance, structures, and process. Commonly recurring themes within the principles include e.g. a shared vision, mutual trust, leadership, political support, and a shared data/knowledge infrastructure. The report highlights how the principles can best be implemented to form sustainable health and wellbeing systems. The Pioneer sites that took a step-by-step approach to the eight guiding principles made the most progress towards a sustainable and collaborative health and wellbeing system. All Pioneer sites underestimated the task ahead and found it more difficult than they expected beforehand. This explains why the Pioneer sites made significant gains at the intervention-level, but struggled to make any progress towards regional population health. Larger changes in the healthcare system, including for example the joining of budgets and the sharing of data and knowledge infrastructures, are not yet commonplace. In order to achieve larger scale changes, the collaborating partners will need to feel a greater sense of urgency for change. Regional and national stakeholders will need to support each other during this transition to a health and wellbeing system. Creating sustainable health and wellbeing systems is no small task, but by working together and giving each other the time and space to experiment, more opportunities can be created.
    • Geen relatie tussen veranderingen in organisatorische aspecten met betrekking tot vaccineren binnen de jeugdgezondheidszorg en ontwikkeling in aantal gevaccineerden 2013-2017

      Quee FA; Mollema L; van Vliet JA; de Melker HE; van Lier EA; RVP; I&amp;V (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-11-22)
      Over recent years, slightly fewer children are getting vaccinated against diseases through the National Immunisation Programme. The drop is stronger for the HPV vaccination that is only offered to girls. No definite explanation has yet been found for this. The National Institute for Public Health (RIVM) has investigated whether organisational changes in youth healthcare services (JGZ) could have affected this; they are responsible for the vaccinations, which are to a large extent given at child health clinics. The investigation showed that there have been both positive and negative organisational changes. No link was found with the fall in the number of vaccinations. About two thirds of youth healthcare organisations took part in this study, which therefore did not obtain a complete picture of the situation in the Netherlands. <br> <br>The message that came from the youth healthcare sector was that parents are coming to child health clinics less often and are seeing utilisation of youth healthcare services as less self-evident. This could be related to declining accessibility of the JGZ for the vaccinations. RIVM therefore created a picture of the organisational changes that have taken place in the youth healthcare sector between 2013 and 2017. Although a number of locations have been closed, average distances to the child health clinics have remained unchanged. The opening hours of the child health clinics have been extended with respect to 2000 (for example in the weekends and evenings as well). The number of children who came to the child health clinics was slightly lower in 2016 than in 2015. The number of visits to child health clinics has also been adjusted on a number of occasions to suit the parents' needs. The four 'contact moments' per year at which vaccinations are given to babies and toddlers have not changed. Moreover, more child health clinics have been sending reminders to parents before the visits. A number of organisations also offer extra information to parents about vaccinations. <br> <br>The JGZ itself considers the main causes to be the increasingly critical attitude among parents, the influence of fake news and reporting in the media, distrust of the governmental authorities and the pharmaceuticals industry, and a perceived lack of urgency because childhood diseases are on the wane. <br>
    • Geen relatie tussen veranderingen in organisatorische aspecten met betrekking tot vaccineren binnen de jeugdgezondheidszorg en ontwikkeling in aantal gevaccineerden 2013-2017

      Quee FA; Mollema L; van Vliet JA; de Melker HE; van Lier EA; RVP; EPI (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-11-22)
      De afgelopen jaren hebben iets minder kinderen zich laten vaccineren tegen ziekten vanuit het Rijksvaccinatieprogramma. De daling is sterker voor de HPV-vaccinatie die aan meisjes wordt aangeboden. Er is nog geen sluitende verklaring voor gevonden. Het RIVM heeft onderzocht of organisatorische veranderingen bij de Jeugdgezondheidszorg (JGZ) hier invloed op hebben; zij zijn verantwoordelijk voor de vaccinaties, die voor het merendeel via de consultatiebureaus worden gegeven. Uit het onderzoek blijkt dat er zowel positieve als negatieve organisatorische veranderingen zijn geweest. Er is geen verband gevonden met de daling in aantal vaccinaties. Ongeveer twee derde van de jeugdgezondheidsorganisaties heeft aan het onderzoek meegedaan, waardoor op basis van dit onderzoek geen volledig beeld van Nederland is gekregen. Vanuit de jeugdgezondheidszorg kwamen signalen dat ouders minder vaak op het consultatiebureau komen en zij het gebruik van JGZ minder als vanzelfsprekend zien. Dit zou te maken kunnen hebben met een afnemende toegankelijkheid van de Jeugdgezondheidszorg inzake de vaccinaties. Het RIVM heeft daarom in kaart gebracht welke organisatorische veranderingen tussen 2013 en 2017 bij de Jeugdgezondheidszorg hebben plaatsgevonden. Hoewel een aantal locaties zijn gesloten, is de gemiddelde afstand tot het consultatiebureau gelijk gebleven. De openingstijden van consultatiebureaus zijn verruimd ten opzichte van 2000 (bijvoorbeeld ook in de weekenden en 's avonds). Het aantal kinderen dat een consultatiebureau bezocht was in 2016 iets lager dan in 2015. Ook wordt het aantal bezoeken aan een consultatiebureau vaker aangepast aan de behoeften van de ouder. De vier 'contactmomenten' per jaar waarop de vaccinaties aan baby's en peuters worden toegediend, zijn niet veranderd. Verder hebben meer consultatiebureaus ouders een herinnering voorafgaand aan het bezoek gestuurd. Ook bieden een aantal organisaties extra voorlichting voor ouders over vaccinaties. De Jeugdgezondheidszorg noemt zelf als belangrijkste oorzaken de toenemende kritische houding van ouders, de invloed van fake news en berichtgeving in de media, het wantrouwen richting de overheid en de farmaceutische industrie, en een laag gevoel van urgentie doordat kinderziektes verdwijnen.
    • Verkenning van extreem-laagfrequente (ELF) magneetvelden bij verschillende bronnen. : Een aanvulling op eerdere metingen

      Dusseldorp A; Pruppers MJM; van Putten EM; CGM (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-11-19)
      In 2008/2009, RIVM performed pilot measurements of the ELF magnetic field in the neighbourhood of underground cables, substations, and household appliances. The measurements were made at the request of the Municipal Public Health Services (GGD). In 2017/2018, several supplementary measurements were conducted at the following locations: near chargers of electric cars and bicycles; at substations situated at solar parks; near solar inverters, where direct current is transformed into alternating current; near some additional household appliances. A magnetic field is present if the appliance or installation is switched on, the magnitude being dependent on the source and the distance. The pilot measurements give an impression of the field strength at different distances from these sources. The results should provide the GGD with information on ELF magnetic fields in order to answer questions from the public about sources other than overhead power lines. The Dutch government employs a precautionary policy of not building new homes near overhead power lines in the zone where the annual average magnetic field is stronger than 0.4 microtesla. In April 2018, the Dutch Health Council advised the government to continue this precautionary policy, and to consider expanding it to other possible sources of possible long-term exposure to magnetic fields. This is one of the reasons why people have raised questions about exposure to magnetic field other than those from overhead power lines. It was evaluated at what distance the magnetic field reaches 0,4 microtesla. For chargers of household appliances, this is the case up to a distance of several centimetres from the source; for transformers situated on solar power parks, up to several metres. The annual average value is lower than the measured values. An appliance or installation is not always used (at maximum capacity) and users are not always present near the appliance.
    • Verkenning van extreem-laagfrequente (ELF) magneetvelden bij verschillende bronnen. : Een aanvulling op eerdere metingen.

      Dusseldorp A; Pruppers MJM; van Putten EM; BDV (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-11-19)
      In 2008/2009, RIVM performed pilot measurements of the ELF magnetic field in the neighbourhood of underground cables, substations, and household appliances. The measurements were made at the request of the Municipal Public Health Services (GGD). In 2017/2018, several supplementary measurements were conducted at the following locations: near chargers of electric cars and bicycles; at substations situated at solar parks; near solar inverters, where direct current is transformed into alternating current; near some additional household appliances. A magnetic field is present if the appliance or installation is switched on, the magnitude being dependent on the source and the distance. <br> <br>The pilot measurements give an impression of the field strength at different distances from these sources. The results should provide the GGD with information on ELF magnetic fields in order to answer questions from the public about sources other than overhead power lines. <br> <br>The Dutch government employs a precautionary policy of not building new homes near overhead power lines in the zone where the annual average magnetic field is stronger than 0.4 microtesla. In April 2018, the Dutch Health Council advised the government to continue this precautionary policy, and to consider expanding it to other possible sources of possible long-term exposure to magnetic fields. This is one of the reasons why people have raised questions about exposure to magnetic field other than those from overhead power lines. <br> <br>It was evaluated at what distance the magnetic field reaches 0,4 microtesla. For chargers of household appliances, this is the case up to a distance of several centimetres from the source; for transformers situated on solar power parks, up to several metres. The annual average value is lower than the measured values. An appliance or installation is not always used (at maximum capacity) and users are not always present near the appliance.<br>
    • Pilot Belevingsthermometer : Peilen van de beleving van veiligheid bij omwonenden van chemische industrie

      Chambon M; Claassen EAM; Folkertsma E; Neuvel JMM; van Vliet AAC; Versluis S; Zonneveld M; MSO; VLH (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-11-19)
      The Ministry of Infrastructure and Water Management asked RIVM to develop a tool that can be used to gauge how safe persons living near chemical industry feel. A pilot was carried out to develop an initial version of the tool and to test the tool in two cities: one with a great deal of chemical industry in the vicinity (Zaandam), and one with a few chemical companies located in the city (Deventer). The main goal of this project was the development of a new tool. This tool consists of a questionnaire that provides insight into how safe persons living near chemical industry feel with regard to activities involving hazardous substances. The answers also indicate which factors are related with their feeling of safety. The questionnaire turns out to be a suitable tool for gauging feelings of safety. Measurements can also be repeated to reveal trends over time. However, the formulation and order of presentation of the questions can be improved. In addition, to ensure the effectiveness of the method, the sample of participants chosen must be sufficiently representative of the population. Besides the new tool, also some of the results of the questionnaire are presented. The substantive result of the pilot should be considered indicative, as the participants of the pilot did not form a sufficiently representative sample of the residents of the two cities. It might be obvious, however the answers indicate that residents of a city with a few chemical companies feel safer than residents of a city located near a great deal of chemical industry. The factor that is most closely related to the feeling of safety is the degree to which people are positive about their living environment. The more positive the experience of the living environment is, the more positive the feeling of safety is and vice versa. The degree to which people have confidence that government bodies and companies can prevent an accident from happening also relates to the feeling of safety. The more confidence there is, the greater the feeling of safety and vice versa. The same applies to the degree of confidence that emergency assistance services will be able to mitigate the consequences of an accident with hazardous substances. Finally, people also feel safer if they are confident that they can limit the consequences of a possible accident themselves.
    • Pilot Belevingsthermometer : Peilen van de beleving van veiligheid bij omwonenden van chemische industrie

      Chambon M; Claassen EAM; Folkertsma E; Neuvel JMM; van Vliet AAC; Versluis S; Zonneveld M; MSO; M&amp;V (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-11-19)
      The Ministry of Infrastructure and Water Management asked RIVM to develop a tool that can be used to gauge how safe persons living near chemical industry feel. A pilot was carried out to develop an initial version of the tool and to test the tool in two cities: one with a great deal of chemical industry in the vicinity (Zaandam), and one with a few chemical companies located in the city (Deventer). <br> <br>The main goal of this project was the development of a new tool. This tool consists of a questionnaire that provides insight into how safe persons living near chemical industry feel with regard to activities involving hazardous substances. The answers also indicate which factors are related with their feeling of safety. The questionnaire turns out to be a suitable tool for gauging feelings of safety. Measurements can also be repeated to reveal trends over time. However, the formulation and order of presentation of the questions can be improved. In addition, to ensure the effectiveness of the method, the sample of participants chosen must be sufficiently representative of the population. <br> <br>Besides the new tool, also some of the results of the questionnaire are presented. The substantive result of the pilot should be considered indicative, as the participants of the pilot did not form a sufficiently representative sample of the residents of the two cities. It might be obvious, however the answers indicate that residents of a city with a few chemical companies feel safer than residents of a city located near a great deal of chemical industry. <br> <br>The factor that is most closely related to the feeling of safety is the degree to which people are positive about their living environment. The more positive the experience of the living environment is, the more positive the feeling of safety is and vice versa. The degree to which people have confidence that government bodies and companies can prevent an accident from happening also relates to the feeling of safety. The more confidence there is, the greater the feeling of safety and vice versa. The same applies to the degree of confidence that emergency assistance services will be able to mitigate the consequences of an accident with hazardous substances. Finally, people also feel safer if they are confident that they can limit the consequences of a possible accident themselves. <br>
    • 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.
    • Kwaliteitscontrole parameters van de Nederlandse Downsyndroom screening laboratoria met de combinatietest, 2017

      Carbo E; EVG; V&amp;Z (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-11-13)
      The first trimester combined test for Down syndrome executed by seven Dutch screening laboratories was in line with the quality requirements in 2017. These are the findings of an assessment by RIVM, meeting the directive of the Dutch Ministry of Health, Welfare and Sport to ensure the quality of the combined test. <br> <br>Since 1 January 2007, screening for Down syndrome with the first trimester combined test has been available to all pregnant women, as part of a nationwide screening programme. Screening for Edwards' syndrome and Patau syndrome was added to the programme later. Starting in April 2017, a new prenatal test, known as the Non-Invasive Prenatal Test (NIPT) has been introduced as another prenatal test in the Netherlands in the TRIDENT-2 study. Due to this new development, many women chose the NIPT over the first trimester combined test. Since December 2017, all laboratories except the Star-SHL laboratory in Rotterdam have stopped analyzing the combined test, due to the reduction of number of participating women. <br> <br>A total of 21,307 screening tests were carried out in 2017, which means that 12.3 per cent of pregnant women opted for the test in 2017. This percentage is an average based on the entire year of 2017, and it should be noted that the NIPT was introduced in April. The percentage of participating pregnant women was 38.9 per cent in the first three months in 2017, while 4.1 per cent of pregnant women participated in December 2017. <br> <br>The laboratories performed all the blood analyses of the first trimester combined test. The complete risk calculation based on the blood analysis and nuchal translucency was carried out by either the laboratories or by some of the ultrasound scanning centres in the Netherlands. The risk calculations for 61 per cent of the total number of combined tests performed in 2017 were made in the laboratories. Part of this evaluation is based only on the probability calculations provided by the laboratories, supplemented by the complete risk calculations supplied by one regional centre (SPSNN). <br> <br>The maternal age at which the test was most frequently conducted in 2017 varied between the laboratories, with median ages ranging from 31.0 to 32.4. The number of pregnant women who had an increased risk of having a child with Down syndrome varied slightly per laboratory (between 3.4 and 6.8 per cent). These differences are a result of, among other things, the average age of the participating pregnant women, which differed slightly from one region to another.<br>
    • Verkenning werkwijze controle en beoordeling grondwaterkwaliteitsdata in LMG, KMG, PMG

      Baumann RA; Claessens JW; Prins HF; LGW; M&amp;V (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-11-13)
      Exploratory study on the quality control and assessment methods used for groundwater quality data in the National Groundwater Quality Monitoring Network (LMG), the Water Framework Directive Groundwater Quality Monitoring Programme (KMG) and the Provincial Groundwater Quality Monitoring Programme (PMG)<br>Three monitoring programmes are used in the Netherlands to collect data on the quality of the groundwater. RIVM operates the National Groundwater Quality Monitoring Network (LMG), while the WFD Groundwater Quality Monitoring Programme (KMG) and the Provincial Groundwater Quality Monitoring Programme (PMG) are operated by the provinces. The groundwater quality data of these programmes are currently being integrated into a single system, the Key Register of the Subsurface (Basisregistratie ondergrond, BRO). It is important that the data are comparable. RIVM has therefore analysed how these data are validated. The validation protocol used by the different organisations, allows some freedom in this respect. <br> .<br>The exploratory study shows that various types of software are used to control and assess the data. Furthermore, the quality control and assessment are carried out by different parties (RIVM, the provinces or a hired party). The way in which the data are ultimately documented also varies. These observations have led to an agreement to develop an automated standard for data control and assessment. It is important that this takes place under the responsibility of the parties delivering the data, that is, the so called source owners. <br> <br>Despite the above differences, it is expected that at least 90% of the data in the three monitoring programmes can be included in the BRO with sufficient quality assurance. Between 5 - 10% of the data need adjustment that can be underpinned by facts. Around 2% of the data will still need some discussion. A panel of experts will have to decide which of these data should be included in the BRO and, if so, how this should be done. It is also crucial that a uniform method is developed for handling of this data.<br>
    • Kwaliteitscontrole parameters van de Nederlandse Downsyndroom screening laboratoria met de combinatietest, 2017

      Carbo E; EVG; GZB (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-11-13)
      The first trimester combined test for Down syndrome executed by seven Dutch screening laboratories was in line with the quality requirements in 2017. These are the findings of an assessment by RIVM, meeting the directive of the Dutch Ministry of Health, Welfare and Sport to ensure the quality of the combined test. Since 1 January 2007, screening for Down syndrome with the first trimester combined test has been available to all pregnant women, as part of a nationwide screening programme. Screening for Edwards' syndrome and Patau syndrome was added to the programme later. Starting in April 2017, a new prenatal test, known as the Non-Invasive Prenatal Test (NIPT) has been introduced as another prenatal test in the Netherlands in the TRIDENT-2 study. Due to this new development, many women chose the NIPT over the first trimester combined test. Since December 2017, all laboratories except the Star-SHL laboratory in Rotterdam have stopped analyzing the combined test, due to the reduction of number of participating women. A total of 21,307 screening tests were carried out in 2017, which means that 12.3 per cent of pregnant women opted for the test in 2017. This percentage is an average based on the entire year of 2017, and it should be noted that the NIPT was introduced in April. The percentage of participating pregnant women was 38.9 per cent in the first three months in 2017, while 4.1 per cent of pregnant women participated in December 2017. The laboratories performed all the blood analyses of the first trimester combined test. The complete risk calculation based on the blood analysis and nuchal translucency was carried out by either the laboratories or by some of the ultrasound scanning centres in the Netherlands. The risk calculations for 61 per cent of the total number of combined tests performed in 2017 were made in the laboratories. Part of this evaluation is based only on the probability calculations provided by the laboratories, supplemented by the complete risk calculations supplied by one regional centre (SPSNN). The maternal age at which the test was most frequently conducted in 2017 varied between the laboratories, with median ages ranging from 31.0 to 32.4. The number of pregnant women who had an increased risk of having a child with Down syndrome varied slightly per laboratory (between 3.4 and 6.8 per cent). These differences are a result of, among other things, the average age of the participating pregnant women, which differed slightly from one region to another.
    • Verkenning werkwijze controle en beoordeling grondwaterkwaliteitsdata in LMG, KMG, PMG

      Baumann RA; Claessens JW; Prins HF; LGW; MIL (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-11-13)
      Three monitoring programmes are used in the Netherlands to collect data on the quality of the groundwater. RIVM operates the National Groundwater Quality Monitoring Network (LMG), while the WFD Groundwater Quality Monitoring Programme (KMG) and the Provincial Groundwater Quality Monitoring Programme (PMG) are operated by the provinces. The groundwater quality data of these programmes are currently being integrated into a single system, the Key Register of the Subsurface (Basisregistratie ondergrond, BRO). It is important that the data are comparable. RIVM has therefore analysed how these data are validated. The validation protocol used by the different organisations, allows some freedom in this respect. . The exploratory study shows that various types of software are used to control and assess the data. Furthermore, the quality control and assessment are carried out by different parties (RIVM, the provinces or a hired party). The way in which the data are ultimately documented also varies. These observations have led to an agreement to develop an automated standard for data control and assessment. It is important that this takes place under the responsibility of the parties delivering the data, that is, the so called source owners. Despite the above differences, it is expected that at least 90% of the data in the three monitoring programmes can be included in the BRO with sufficient quality assurance. Between 5 - 10% of the data need adjustment that can be underpinned by facts. Around 2% of the data will still need some discussion. A panel of experts will have to decide which of these data should be included in the BRO and, if so, how this should be done. It is also crucial that a uniform method is developed for handling of this data.