• Head skeleton malformations in zebrafish (Danio rerio) to assess adverse effects of mixtures of compounds.

      Staal, Yvonne C M; Meijer, Jeroen; van der Kris, Remco J C; de Bruijn, Annamaria C; Boersma, Anke Y; Gremmer, Eric R; Zwart, Edwin P; Beekhof, Piet K; Slob, Wout; van der Ven, Leo T M (2018-10-04)
      The EU-EuroMix project adopted the strategy of the European Food Safety Authority (EFSA) for cumulative risk assessment, which limits the number of chemicals to consider in a mixture to those that induce a specific toxicological phenotype. These so-called cumulative assessment groups (CAGs) are refined at several levels, including the target organ and specific phenotype. Here, we explore the zebrafish embryo as a test model for quantitative evaluation in one such CAG, skeletal malformations, through exposure to test compounds 0-120 hpf and alcian blue cartilage staining at 120 hpf, focusing on the head skeleton. Reference compounds cyproconazole, flusilazole, metam, and thiram induced distinctive phenotypes in the head skeleton between the triazoles and dithiocarbamates. Of many evaluated parameters, the Meckel's-palatoquadrate (M-PQ) angle was selected for further assessment, based on the best combination of a small confidence interval, an intermediate maximal effect size and a gentle slope of the dose-response curve with cyproconazole and metam. Additional test compounds included in the CAG skeletal malformations database were tested for M-PQ effects, and this set was supplemented with compounds associated with craniofacial malformations or cleft palate to accommodate otherwise organized databases. This additional set included hexaconazole, all-trans-retinoic acid, AM580, CD3254, maneb, pyrimethanil, imidacloprid, pirimiphos-methyl, 2,4-dinitrophenol, 5-fluorouracil, 17alpha-ethynylestradiol (EE2), ethanol, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), PCB 126, methylmercury, boric acid, and MEHP. Most of these compounds produced a dose-response for M-PQ effects. Application of the assay in mixture testing was provided by combined exposure to cyproconazole and TCDD through the isobole method, supporting that in this case the combined effect can be modeled through concentration addition.
    • Headache in girls and boys growing up from age 11 to 20 years: the PIAMA birth cohort study.

      Wijga, Alet H; Gehring, Ulrike; van de Putte, Elise M; Koppelman, Gerard; Vader, Sarah; Schmits, Ruben J H; Wouden, J Hans C van der; Picavet, H Susan J (2020-11-18)
    • Health and Economic Impact of a Tender-Based, Sex-Neutral Human Papillomavirus 16/18 Vaccination Program in the Netherlands.

      Qendri, Venetia; Bogaards, Johannes A; Berkhof, Johannes (2017-07-15)
      Uptake of human papillomavirus (HPV) vaccine among girls in the Dutch immunization program has plateaued at around 60%. Vaccinating boys may be an appealing complementary strategy for the prevention of HPV-related diseases, especially since tender negotiations and reduced dosing schemes have driven down the cost of vaccination.
    • Health assessments for health governance—concepts and methodologies

      Fehr, Rainer; Alexanderson, Kristina; Favaretti, Carlo; de Jong, Judith; La Torre, Giuseppe; Lim, Tek-Ang; Martin-Olmedo, Piedad; Mekel, Odile C L; Michelsen, Kai; Rosenkötter, Nicole; et al. (2017-08)
    • Health care costs in the last year of life--the Dutch experience.

      Polder, Johan J; Barendregt, Jan J; Oers, Hans van (2006-10-01)
      Health expenditure depends heavily on age. Common wisdom is that the age pattern is dominated by costs in the last year of life. Knowledge about these costs is important for the debate on the future development of health expenditure. According to the 'red herring' argument traditional projection methods overestimate the influence of ageing because improvements in life expectancy will postpone rather than raise health expenditure. This paper has four objectives: (1) to estimate health care costs in the last year of life in the Netherlands; (2) to describe age patterns and differences between causes of death for men and women; (3) to compare cost profiles of decedents and survivors; and (4) to use these figures in projections of future health expenditure. We used health insurance data of 2.1 million persons (13% of the Dutch population), linked at the individual level with data on the use of home care and nursing homes and causes of death in 1999. On average, health care costs amounted to 1100 Euro per person. Costs per decedent were 13.5 times higher and approximated 14,906 Euro in the last year of life. Most costs related to hospital care (54%) and nursing home care (19%). Among the major causes of death, costs were highest for cancer (19,000 Euro) and lowest for myocardial infarctions (8068 Euro). Between the other causes of death, however, cost differences were rather limited. On average costs for the younger decedents were higher than for people who died at higher ages. Ten per cent of total health expenditure was associated with the health care use of people in their last year of life. Increasing longevity will result in higher costs because people live longer. The decline of costs in the last year of life with increasing age will have a moderate lowering effect. Our projection demonstrated a 10% decline in the growth rate of future health expenditure compared to conventional projection methods.
    • Health effects of vibrations due to trains.

      van Kamp, I; van Kempen, E; van Wijnen, H; Verheijen, E; Istamto, T; Ferreira, J; Breugelmans, O; Dirven, L; Koopman, A
    • Health Effects Related to Wind Turbine Sound: An Update.

      van Kamp, Irene; van den Berg, Frits (2021-08-30)
    • Health expenditure of employees versus self-employed individuals; a 5 year study.

      Herber, Gerrie-Cor; Schipper, Maarten; Koopmanschap, Marc; Proper, Karin; van der Lucht, Fons; Boshuizen, Hendriek; Polder, Johan; Uiters, Ellen (2020-08-27)
    • Health impact assessment of a skin sensitizer: Analysis of potential policy measures aimed at reducing geraniol concentrations in personal care products and household cleaning products.

      Jongeneel, W P; Delmaar, J E; Bokkers, B G H (2018-09)
      A methodology to assess the health impact of skin sensitizers is introduced, which consists of the comparison of the probabilistic aggregated exposure with a probabilistic (individual) human sensitization or elicitation induction dose. The health impact of potential policy measures aimed at reducing the concentration of a fragrance allergen, geraniol, in consumer products is analysed in a simulated population derived from multiple product use surveys. Our analysis shows that current dermal exposure to geraniol from personal care and household cleaning products lead to new cases of contact allergy and induce clinical symptoms for those already sensitized. We estimate that this exposure results yearly in 34 new cases of geraniol contact allergy per million consumers in Western and Northern Europe, mainly due to exposure to household cleaning products. About twice as many consumers (60 per million) are projected to suffer from clinical symptoms due to re-exposure to geraniol. Policy measures restricting geraniol concentrations to <0.01% will noticeably reduce new cases of sensitization and decrease the number of people with clinical symptoms as well as the frequency of occurrence of these clinical symptoms. The estimated numbers should be interpreted with caution and provide only a rough indication of the health impact.
    • Health literacy among older adults is associated with their 10-years' cognitive functioning and decline - the Doetinchem Cohort Study.

      Geboers, Bas; Uiters, Ellen; Reijneveld, Sijmen A; Jansen, Carel J M; Almansa, Josué; Nooyens, Astrid C J; Verschuren, W M Monique; de Winter, Andrea F; Picavet, H Susan J (2018-03-20)
      Many older adults have low levels of health literacy which affects their ability to participate optimally in healthcare. It is unclear how cognitive decline contributes to health literacy. To study this, longitudinal data are needed. The aim of this study was therefore to assess the associations of cognitive functioning and 10-years' cognitive decline with health literacy in older adults.
    • Health literacy skills for informed decision making in colorectal cancer screening: Perceptions of screening invitees and experts.

      Woudstra, Anke J; Timmermans, Daniëlle R M; Uiters, Ellen; Dekker, Evelien; Smets, Ellen M A; Fransen, Mirjam P (2017-12-20)
      The process of informed decision making (IDM) requires an adequate level of health literacy. To ensure that all individuals have equal opportunity to make an informed decision in colorectal cancer (CRC) screening, it is essential to gain more insight into which health literacy skills are needed for IDM. Our aims were (i) to explore how individuals make a decision about CRC screening and (ii) to explore which skills are needed for IDM in CRC screening and (iii) to integrate these findings within a conceptual framework.
    • The health of Antillean migrants in the Netherlands: a comparison with the health of non-migrants in both the countries of origin and destination.

      Verstraeten, Soraya P A; van den Brink, Carolien L; Mackenbach, Johan P; van Oers, Hans A M (2018-04-09)
      This article examines risk factor and health differences between Antillean migrants in the Netherlands and Antillean and Dutch non-migrants, and relates these findings to four commonly used explanations for migrant health disparities.
    • Health Policy Performance in 16 Caribbean States, 2010-2015.

      Verstraeten, Soraya P A; van Oers, Hans A M; Mackenbach, Johan P (2019-04-01)
      To determine whether Caribbean states vary in health policy performance in 11 different areas; to explore the association with sociodemographic, economical, and governance determinants; and to estimate the potential health gains of "best-practice" health policies. We selected 50 indicators that included data on mortality (latest available, 2010-2015), intermediate outcomes, and policy implementation to calculate a state's health policy performance score. We related this score to country characteristics and calculated the potential number of avoidable deaths if the age-specific mortality rates of best-performer Martinique applied in all states. We found large differences in health policy performance among Caribbean states. Martinique, Cuba, and Guadeloupe had the highest performance scores, and Guyana, Belize, and Suriname the lowest. Political affiliation, religious fractionalization, corruption, national income, and population density were associated with health policy performance. If the mortality rates of Martinique applied to all Caribbean states, an overall mortality reduction of 12% would be achieved. Differences in health outcomes between Caribbean states are partly attributable to variations in health policy implementation. Our results suggest that many deaths can be prevented if Caribbean governments adopt best-practice policies.
    • Health Risks Awareness of Electronic Waste Workers in the Informal Sector in Nigeria.

      Ohajinwa, Chimere M; Van Bodegom, Peter M; Vijver, Martina G; Peijnenburg, Willie J G M (2017-08-13)
      Insight into the health risk awareness levels of e-waste workers is important as it may offer opportunities for better e-waste recycling management strategies to reduce the health effects of informal e-waste recycling. Therefore, this study assessed the knowledge, attitude, and practices associated with occupational health risk awareness of e-waste workers compared with a control group (butchers) in the informal sector in Nigeria. A cross-sectional study was used to assess health risk awareness of 279 e-waste workers (repairers and dismantlers) and 221 butchers from the informal sector in three locations in Nigeria in 2015. A questionnaire was used to obtain information on socio-demographic backgrounds, occupational history, knowledge, attitude, and work practices. The data was analysed using Analysis of Variance. The three job designations had significantly different knowledge, attitude, and practice mean scores (p = 0.000), with butchers consistently having the highest mean scores. Only 43% of e-waste workers could mention one or more Personal Protective Equipment needed for their job compared with 70% of the butchers. The health risk awareness level of the e-waste workers was significantly lower compared with their counterparts in the same informal sector. A positive correlation existed between the workers' knowledge and their attitude and practice. Therefore, increasing the workers' knowledge may decrease risky practices.
    • The Health Risks of Electronic Cigarette Use to Bystanders.

      Visser, Wouter F; Klerx, Walther N; Cremers, Hans W J M; Ramlal, Ramon; Schwillens, Paul L; Talhout, Reinskje (2019-04-30)
    • Health Risks of Polybrominated Diphenyl Ethers (PBDEs) and Metals at Informal Electronic Waste Recycling Sites.

      Ohajinwa, Chimere May; Van Bodegom, Peter M; Osibanjo, Oladele; Xie, Qing; Chen, Jingwen; Vijver, Martina G; Peijnenburg, Willie J G M (2019-03-13)
      Concerns about the adverse public health consequences of informal electronic waste (
    • Health status in Europe: comparison of 24 urban areas to the corresponding 10 countries (EURO-URHIS 2).

      Koster, E M; de Gelder, R; Di Nardo, F; Williams, G; Harrison, A; van Buren, L P; Lyshol, H; Patterson, L; Birt, C A; Higgerson, J; et al. (2017-05-01)
      : In Europe, over 70% of the population live in urban areas (UAs). Most international comparative health research is done using national level data, as reliable and comparable urban data are often unavailable or difficult to access. This study aims to investigate whether population health is different in UAs compared with their corresponding countries. : Routinely available health-related data were collected by the EURO-URHIS 2 project, for 10 European countries and for 24 UAs within those countries. National and UA level data for 11 health indicators were compared through the calculation of relative difference, and geographical patterns within Europe were investigated using the Mann Whitney U test. Linear regression modelling was used to adjust for population density, gross domestic product and urbanicity. : In general, the urban population in Eastern Europe is less healthy than the Western European urban population. However, people in Eastern Europe have significantly better broad health outcomes in UAs as compared with the corresponding country as a whole, whereas people in Western Europe have generally worse broader health outcomes in UAs. : For most European countries and UAs that were investigated, the national level health status data does not correspond with the health status at UA level. In order to identify health problems in UAs and to provide information for local health policy, health monitoring and international benchmarking should also be conducted at the local level.
    • Health technology assessment applied to emergency preparedness: a new perspective.

      Miglietta, Alessandro; de Waure, Chiara; Chronaki, Catherine; Wild, Claudia; Favaretti, Carlo; Timen, Aura; Edelstein, Michael; Petelos, Elena (2021-07-16)