The Hague, Netherlands
The Hague, Netherlands

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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.


Langendijk J.A.,University of Groningen | Lambin P.,Maastricht University | De Ruysscher D.,Catholic University of Leuven | Widder J.,University of Groningen | And 2 more authors.
Radiotherapy and Oncology | Year: 2013

Most new radiation techniques, have been introduced primarily to reduce the dose to normal tissues in order to prevent radiation-induced side effects. Radiotherapy with protons is such a radiation technique that due to its superior beam properties compared to photons enables better sparing of normal tissues. This paper describes a stepwise methodology to select patients for proton therapy when the primary aim is to reduce side effects. This method has been accepted by the Dutch health authorities to select patients for proton therapy. In addition, an alternative method is described in case randomised controlled trials are considered not appropriate. © 2013 Elsevier Ltd. All rights reserved.


Grant
Agency: European Commission | Branch: FP7 | Program: CSA-CA | Phase: SiS-2008-1.3.3.1 | Award Amount: 1.05M | Year: 2009

The general objective of this project is to improve the quality, effectiveness and efficiency of science advice for health across Europe. Science advice is any recommendation for policy action based on scientific knowledge, considering also expert judgment, ethical and societal values, and experience from relevant stakeholders. Many EU Member States have national science advisory bodies. However, many health issues have transnational dimensions. Moreover, the rapid increase of scientific knowledge and health issues to be addressed exceed what can be dealt with by national bodies. Accordingly, international collaboration between national bodies will lead to more effective and efficient science advice, in support of decision-making at national and EU level. This objective narrowly fits in FP7-SIS-2008-1.3.3.1. The general objective has been translated into the following specific objectives: Describe the functions and structure of existing national science advisory bodies for health in 12 European countries; and carry out a thematic analysis of reports from each country Establish a common best practice methodology for science advice Develop a plan for communication and cooperation in the expanding network of science advisory bodies, taking advantage of the SINAPSE system Illustrate the common methodology and the functioning of the network by developing a pilot case study for a European science advisory report A common methodology with improved transnational cooperation promotes open governance, as more evidence-based policy making in Europe will be more transparent to the public. The recently established European Science Advisory Network for Health coordinates activities among science advisory bodies within the EU, and is eminently suited to provide the infrastructure for these tasks. As improvement of science advice is a long-term goal, the Coordinating Action will also aim at strengthening the network beyond the time frame of the project.


Rubin G.J.,King's College London | Hillert L.,Karolinska Institutet | Nieto-Hernandez R.,King's College London | van Rongen E.,Health Council of the Netherlands | Oftedal G.,Norwegian University of Science and Technology
Bioelectromagnetics | Year: 2011

Idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) is a controversial illness in which people report symptoms that they believe are triggered by exposure to EMF. Double-blind experiments have found no association between the presence of EMF and self-reported outcomes in people with IEI-EMF. No systematic review has assessed whether EMF exposure triggers physiological or cognitive changes in this group. Using a systematic literature search, we identified 29 single or double-blind experiments in which participants with IEI-EMF were exposed to different EMF levels and in which objectively measured outcomes were assessed. Five studies identified significant effects of exposure such as reduced heart rate and blood pressure, altered pupillary light reflex, reduced visual attention and perception, improved spatial memory, movement away from an EMF source during sleep and altered EEG during sleep. In most cases, these were isolated results that other studies failed to replicate. For the sleep EEG findings, the results reflected similar changes in the IEI-EMF participants and a non-IEI-EMF control group. At present, there is no reliable evidence to suggest that people with IEI-EMF experience unusual physiological reactions as a result of exposure to EMF. This supports suggestions that EMF is not the main cause of their ill health. © 2011 Wiley Periodicals, Inc.


Verschaeve L.,University of Antwerp | Juutilainen J.,University of Eastern Finland | Lagroye I.,French National Center for Scientific Research | Miyakoshi J.,Hirosaki University | And 6 more authors.
Mutation Research - Reviews in Mutation Research | Year: 2010

There has been growing concern about the possibility of adverse health effects resulting from exposure to radiofrequency radiations (RFR), such as those emitted by wireless communication devices. Since the introduction of mobile phones many studies have been conducted regarding alleged health effects but there is still some uncertainty and no definitive conclusions have been reached so far. Although thermal effects are well understood they are not of great concern as they are unlikely to result from the typical low-level RFR exposures. Concern rests essentially with the possibility that RFR-exposure may induce non-thermal and/or long-term health effects such as an increased cancer risk. Consequently, possible genetic effects have often been studied but with mixed results. In this paper we review the data on alleged RFR-induced genetic effects from in vitro and in vivo investigations as well as from human cytogenetic biomonitoring surveys. Attention is also paid to combined exposures of RFR with chemical or physical agents. Again, however, no entirely consistent picture emerges. Many of the positive studies may well be due to thermal exposures, but a few studies suggest that biological effects can be seen at low levels of exposure. Overall, however, the evidence for low-level genotoxic effects is very weak. © 2010 Elsevier B.V.


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.


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.


Houweling H.,Health Council of the Netherlands | Verweij M.,Health Council of the Netherlands | Verweij M.,University Utrecht | Ruitenberg E.J.,Health Council of the Netherlands | Ruitenberg E.J.,VU University Amsterdam
Vaccine | Year: 2010

As more and more new vaccines are developed and brought to the market, governments have to make decisions about which vaccinations to include in public programmes. This paper describes the experience in the Netherlands in developing a framework for assessing whether a vaccination should be included in the National Immunization Programme (NIP). Bearing in mind the public nature, the factors that determine a vaccine's suitability for inclusion in a communal vaccination programme have been translated into seven selection criteria, grouped under five thematic headings: seriousness and extent of the disease burden, effectiveness and safety of the vaccination, acceptability of the vaccination, efficiency of the vaccination, and priority of the vaccination. The seven criteria and the explanation of them provide a framework for the systematic examination of arguments for and against the inclusion and prioritisation of particular vaccinations. As an illustration, the vaccinations currently provided in the Netherlands through public programmes as well as 23 'candidate' vaccinations are assessed against the seven criteria. The proposed assessment framework including the selection criteria can take full account of the values and specificities as they may differ between situations and countries; the transparency of the approach may help to clarify which elements of the assessment are pivotal in specific situations. Using the criteria furthers a trustworthy, transparent and accountable process of decision-making about inclusion of new vaccinations in public vaccination programmes and may help to retain public confidence. © 2010 Elsevier Ltd. All rights reserved.


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.


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.

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