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The Hague, Netherlands

Gefenaite G.,University of Groningen | Munster J.M.,University of Groningen | van Houdt R.,Health Council of the Netherlands | Hak E.,University of Groningen
Vaccine | Year: 2011

In the Netherlands, the number of notified human Q fever cases showed a steep increase over the last three years and is not expected to disappear in the next few years. Since vaccination might be an option to prevent Q fever cases in the general population, evidence is needed about its effectiveness. We therefore conducted a meta-analysis to determine the evidence base for effectiveness for Q fever vaccination in human populations. We calculated Mantel-Haenszel risk ratios and we used the following formula to calculate the vaccines effectiveness: (1 - mhRR)×100%. Although individual and the pooled estimates showed a high effectiveness of Q fever vaccine, conclusions for the general population cannot be confidently drawn about vaccine effectiveness due to potential flaws in the design of the studies and the selected group of study participants. © 2010 Elsevier Ltd.

Verweij M.F.,Wageningen University | Houweling H.,Health Council of the Netherlands
Vaccine | Year: 2014

Given the ethical aspects of vaccination policies and current threats to public trust in vaccination, it is important that governments follow clear criteria for including new vaccines in a national programme. The Health Council of the Netherlands developed such a framework of criteria in 2007, and has been using this as basis for advisory reports about several vaccinations. However, general criteria alone offer insufficient ground and direction for thinking about what the state ought to do. In this paper, we present and defend two basic ethical principles that explain why certain vaccinations are the state's moral-political responsibility, and that may further guide decision-making about the content and character of immunisation programmes. First and foremost, the state is responsible for protecting the basic conditions for public health and societal life. Secondly, states are responsible for promoting and securing equal access to basic health care, which may also include certain vaccinations. We argue how these principles can find reasonable support from a broad variety of ethical and political views, and discuss several implications for vaccination policies. © 2014 Elsevier Ltd.

Van Deventer E.,World Health Organization | Van Rongen E.,Health Council of the Netherlands | Saunders R.,Public Health England
Bioelectromagnetics | Year: 2011

The World Health Organization (WHO) has recently published a new research agenda for radiofrequency fields. The document lists high priority and other research needs for health effects research, subdivided into epidemiology, human studies, animal studies, cellular studies and mechanisms, and for social science research. © 2011 Wiley-Liss, Inc.

Stegeman J.H.,Erasmus University Rotterdam | Schoten E.J.,Health Council of the Netherlands | Terpstra O.T.,Leiden University
Advances in Health Sciences Education | Year: 2013

In this article we discuss clinical workplace learning using a dual approach: a theoretical one and an empirical one. Drawing on the philosophical work of Aristotle, Polanyi and Schön we posit that the 'knowing and acting' underpinning day-to-day medical practice is personal and embraces by nature a tacit dimension. Consequently, imparting and acquiring this knowledge type necessitates personal interaction between trainer and trainee. The tacit dimension particularly influences modelling and feedback. In our empirical exploration we explore these educational routes in two disparate disciplines: surgery and paediatrics. We use a longitudinal design with in-depth interviewing. Our conclusion on modelling is: modelling is a dynamic and fragmented process reflecting discipline bound characteristics and working styles. On feedback it is: 'feedback' serves as vehicle for three distinctive forms of commenting on performance, each holding a specific power of expression for learning. We propose to view clinical workplace learning as: an interactive master-apprenticeship model encompassing modelling and feedback as natural educational routes. We conceptualise modelling and feedback as 'function' of interaction (developing grounded theory). Modelling function and feedback function may serve to study these routes as didactical components of ongoing interaction between trainer and trainee rather than an educator-driven series of unrelated events. © 2012 Springer Science+Business Media B.V.

Lenters V.,University Utrecht | Vermeulen R.,University Utrecht | Dogger S.,Health Council of the Netherlands | Stayner L.,University of Chicago | And 3 more authors.
Environmental Health Perspectives | Year: 2011

Background: Asbestos is a well-recognized cause of lung cancer, but there is considerable between-study heterogeneity in the slope of the exposure-response relationship. Objective: We considered the role of quality of the exposure assessment to potentially explain heterogeneity in exposure-response slope estimates. Data sources: We searched PubMed MEDLINE (1950-2009) for studies with quantitative estimates of cumulative asbestos exposure and lung cancer mortality and identified 19 original epidemiological studies. One was a population-based case-control study, and the others were industry-based cohort studies. Data extraction: Cumulative exposure categories and corresponding risks were abstracted. Exposure-response slopes [K L (lung cancer potency factor of asbestos)] were calculated using linear relative risk regression models. Data synthesis: We assessed the quality of five exposure assessment aspects of each study and conducted random effects univariate and multivariate meta-regressions. Heterogeneity in exposure-response relationships was greater than expected by chance (I 2 = 64%). Stratification by exposure assessment characteristics revealed that studies with well-documented exposure assessment, larger contrast in exposure, greater coverage of the exposure history by exposure measurement data, and more complete job histories had higher meta-K L values than did studies without these characteristics. The latter two covariates were most strongly associated with the K L value. Meta-KL values increased when we incrementally restricted analyses to higher-quality studies. Conclusions: This meta-analysis indicates that studies with higher-quality asbestos exposure assessment yield higher meta-estimates of the lung cancer risk per unit of exposure. Potency differences for predominantly chrysotile versus amphibole asbestos-exposed cohorts become difficult to ascertain when meta-analyses are restricted to studies with fewer exposure assessment limitations.

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