Time filter

Source Type

Ladbury G.A.F.,Centers for Disease Control and Prevention | Ladbury G.A.F.,Dutch National Institute for Public Health and the Environment RIVM | Gavana M.,Aristotle University of Thessaloniki | Danis K.,Centers for Disease Control and Prevention | And 6 more authors.
PLoS ONE | Year: 2013

Introduction: During summer 2010, 262 human cases including 35 deaths from West Nile virus (WNV) infection were reported from Central Macedonia, Greece. Evidence from mosquitoes, birds and blood donors demonstrated that the epidemic was caused by WNV lineage 2, which until recently was considered of low virulence. We conducted a household seroprevalence study to estimate the spread of infection in the population during the epidemic, ascertain the relationship of infection to clinical disease, and identify risk factors for infection. Methods: We used a two-stage cluster design to select a random sample of residents aged ?18 years in the outbreak epicentre. We collected demographic, medical, and risk factor data using standard questionnaires and environmental checklists, and tested serum samples for presence of WNV IgG and IgM antibodies using ELISA. Results: Overall, 723 individuals participated in the study, and 644 blood samples were available. Weighted seropositivity for IgG antibodies was 5.8% (95% CI: 3.8-8.6; n=41). We estimated that about 1 in 130 (1:141 to 1:124) infected individuals developed WNV neuroinvasive disease, and approximately 18% had clinical manifestations attributable to their infection. Risk factors for infection reflected high exposure to mosquitoes; rural residents were particularly at risk (prevalence ratio: 8.2, 95% CI: 1.1-58.7). Discussion: This study adds to the evidence that WNV lineage 2 strains can cause significant illness, demonstrating ratios of infection to clinical disease similar to those found previously for WNV lineage 1. © 2013 Ladbury et al.


Van Berkel J.J.,Dutch National Institute for Public Health and the Environment RIVM | Lambooij M.S.,Dutch National Institute for Public Health and the Environment RIVM | Hegger I.,Dutch National Institute for Public Health and the Environment RIVM
BMC Medical Informatics and Decision Making | Year: 2015

Background: Patient empowerment is crucial in the successful self-management of people with chronic diseases. In this study, we investigated whether discussions about medicine use taking place on online message boards contribute to patient empowerment and could subsequently result in the more effective use of medicines. We discuss the extent to which patient empowerment processes occur in discussions on online message boards, focusing on patients with three disorders with different characteristics: diabetes, Amyotrophic Lateral Sclerosis (ALS) and Attention Deficit / Hyperactivity Disorder (ADHD). Because information is an important factor in both patient empowerment and self-management, we also evaluate the quality of the information being exchanged. Methods: We used a deductive thematic analysis method based on pre-existing categories. We gathered and analysed 5532 posts related to the conditions ADHD, ALS and diabetes from seven message boards (three for ADHD, three for diabetes, and one for ALS). We coded the posts for empowerment processes and the quality of the information exchanged. Results: We identified patient empowerment processes in posts related to all three disorders. There is some variation in the frequency of these processes, but they show a similar order in the results: patients used the online message boards to exchange information, share personal experiences and for empathy or support. The type of information shared in these processes could contribute to the patient's self-efficacy when it comes to medicine use. The exchanged information was either correct or largely harmless. We also observed a tendency whereby participants correct previously posted incorrect information, and refer people to a healthcare professional following a request for medical advice, e.g. concerning the choice of medicines or dosage. Conclusions: Our findings show that patient empowerment processes occur in posts related to all three disorders. The type of information shared in these processes can contribute to the patient's self-efficacy when it comes to medicine use. The tendency to refer people to a healthcare professional shows that patients still reserve an important role for healthcare professionals in the care process, despite the development towards more self-management. © 2015 van Berkel et al.; licensee BioMed Central.


Bellamy L.J.,White Queen Safety Strategies | Mud M.,RPS | Manuel H.J.,Dutch National Institute for Public Health and the Environment RIVM | Oh J.I.H.,Ministry of Social Affairs and Employment SZW
Journal of Loss Prevention in the Process Industries | Year: 2013

In the Netherlands there are around 400 "Seveso" sites that fall under the Dutch Major Hazards Decree (BRZO) 1999. Between 2006 and 2010 the Dutch Labour Inspectorate's Directorate for Major Hazard Control completed investigations of 118 loss of containment incidents involving hazardous substances from this group. On the basis of investigation reports the incidents were entered in a tailor-made tool called Storybuilder developed for the Dutch Ministry of Social Affairs and Employment for identifying the dominant patterns of technical safety barrier failures, barrier task failures and underlying management causes associated with the resulting loss of control events. The model is a bow-tie structure with six lines of defence, three on either side of the central loss of containment event. In the first line of defence, failures in the safety barriers leading to loss of control events were primarily equipment condition failures, pre start-up and safeguarding failures and process deviations such as pressure and flow failures. These deviations, which should have been recovered while still within the safe envelope of operation, were missed primarily because of inadequate indication signals that the deviations have occurred. Through failures of subsequent lines of defence they are developing into serious incidents. Overall, task failures are principally failures to provide adequate technical safety barriers and failures to operate provided barriers appropriately. Underlying management delivery failures were mainly found in equipment specifications and provisions, procedures and competence. The competence delivery system is especially important for identifying equipment condition, equipment isolation for maintenance, pre-start-up status and process deviations. Human errors associated with operating barriers were identified in fifty per cent of cases, were mostly mistakes and feature primarily in failure to prevent deviations and subsequently recover them. Loss of control associated with loss of containment was primarily due to the containment being bypassed (72% of incidents) and less to material strength failures (28%). Transfer pipework, connections in process plant and relief valves are the most frequent release points and the dominant release material is extremely flammable. It is concluded that the analysis of a large number of incidents in Storybuilder can support the quantification of underlying causes and provide evidence of where the weak points exist in major hazard control in the prevention of major accidents. © 2013 Elsevier Ltd.


Wolting A.G.,Dutch National Institute for Public Health and the Environment RIVM | Vijgen L.J.,DCMR Environmental Protection Agency
AIChE Annual Meeting, Conference Proceedings | Year: 2013

This paper describes a method to calculate risks generated by liquefied natural gas (LNG) filling stations for road trucks. An increasing number of these stations are operational in the Netherlands and they require activities such as transfer, storage, saturation and supply of LNG. Under the Dutch legislative context, facilities that handle or store large amounts of hazardous substances must carry out a quantitative risk analysis (QRA) for land-use planning purposes. The outcomes of the QRA determine the kinds of activities that are acceptable in the surroundings of the facility. The method defines which release scenarios and frequencies to use and how consequences of release scenarios must be calculated. Outcomes are presented for a generic station and some alternative designs for which calculated safety distances are in the range of 66 - 140 meter.


Kapo K.E.,Waterborne Environmental Inc | Holmes C.M.,Waterborne Environmental Inc | Dyer S.D.,Procter and Gamble | De Zwart D.,Dutch National Institute for Public Health and the Environment RIVM | Posthuma L.,Dutch National Institute for Public Health and the Environment RIVM
Environmental Toxicology and Chemistry | Year: 2014

Eco-epidemiological studies utilizing existing monitoring program data provide a cost-effective means to bridge the gap between the ecological status and chemical status of watersheds and to develop hypotheses of stressor attribution that can influence the design of higher-tier assessments and subsequent management. The present study describes the process of combining existing data and models to develop a robust starting point for eco-epidemiological analyses of watersheds over large geographic scales. Data resources from multiple federal and local agencies representing a range of biological, chemical, physical, toxicological, and other landscape factors across the state of Ohio, USA (2000-2007), were integrated with the National Hydrography Dataset Plus hydrologic model (US Environmental Protection Agency and US Geological Survey). A variety of variable reduction, selection, and optimization strategies were applied to develop eco-epidemiological data sets for fish and macroinvertebrate communities. The relative importance of landscape variables was compared across spatial scales (local catchment, watershed, near-stream) using conditional inference forests to determine the scales most relevant to variation in biological community condition. Conditional inference forest analysis applied to a holistic set of environmental variables yielded stressor-response hypotheses at the statewide and eco-regional levels. The analysis confirmed the dominant influence of state-level stressors such as physical habitat condition, while highlighting differences in predictive strength of other stressors based on ecoregional and land-use characteristics. This exercise lays the groundwork for subsequent work designed to move closer to causal inference. © 2014 SETAC.


Hoek G.,University Utrecht | Boogaard H.,University Utrecht | Knol A.,Dutch National Institute for Public Health and the Environment RIVM | De Hartog J.,University Utrecht | And 17 more authors.
Environmental Science and Technology | Year: 2010

Toxicological studies have provided evidence of the toxicity of ultrafine particles (UFP), but epidemiological evidence for health effects of ultrafines is limited. No quantitative summary currently exists of concentration - response functions for ultrafine particles that can be used in health impact assessment. The goal was to specify concentration - response functions for ultrafine particles in urban air including their uncertainty through an expert panel elicitation. Eleven European experts from the disciplines of epidemiology, toxicology, and clinical medicine selected using a systematic peer-nomination procedure participated. Using individual ratings supplemented with group discussion, probability distributions of effect estimates were obtained for all-cause mortality and cardiovascular and respiratory hospital admissions. Experts judged the small database of epidemiological studies supplemented with experimental studies sufficient to quantify effects of UFP on all-cause mortality and to a lesser extent hospital admissions. Substantial differences in the estimated UFP health effect and its uncertainty were found between experts. The lack of studies on longterm exposure to UFP was rated as the most important source of uncertainty. Effects on hospital admissions were considered more uncertain. This expert elicitation provides the first quantitative evaluation of estimates of concentration response functions between urban air ultrafine particles and all-cause mortality and hospital admissions. © 2010 American Chemical Society.


Ladbury G.,Dutch National Institute for Public Health and the Environment RIVM | Ostendorf S.,Municipal Health Service Gelderland Midden | Waegemaekers T.,Municipal Health Service Gelderland Midden | van Binnendijk R.,Dutch National Institute for Public Health and the Environment RIVM | And 2 more authors.
Eurosurveillance | Year: 2014

We describe a mumps outbreak in a highly-vaccinated population attending a party at a youth club. In a retrospective cohort study with 60 of approximately 100 participants responding, vaccination status was verified for 58/59 respondents, of whom 54 were vaccinated twice and four once. The attack rate was 22% (13 cases, all vaccinated), with smoking at the party (risk ratio (RR) 3.1; 95% confidence interval (CI): 1.6-6.0, p=0.001) and age ≥21 years (RR 4.7; 95% CI: 2.1-10.2, p<0.0001) as risk factors for disease in the binominal regression analysis. Mild upper respiratory illness was also highly prevalent in those who did not meet the mumps case definition (n=46) after the party, suggesting that mumps virus infection may cause mild disease in vaccinated individuals. Our investigation adds to evidence that crowded social events and smoking may facilitate spread of mumps virus among vaccinated populations, with waning immunity playing a role. The suggestion that mumps virus infection in vaccinated individuals may manifest as mild upper respiratory illness could have implications for transmission and warrants further investigation.


Ossebaard H.C.,Dutch National Institute for Public Health and the Environment RIVM | Van Gemert-Pijnen L.,University of Twente | Seydel E.R.,University of Twente
Policy and Internet | Year: 2012

Against a backdrop of New Public Management and healthcare system reform the Dutch Ministry of Health commissioned the National Institute for Public Health and the Environment (RIVM) to develop, host and manage an online public national health and care portal. The portal aims to facilitate consumer decision-making behavior in health and healthcare and to contribute to transparency in order to improve the quality of care and the general functioning of the health markets. This article describes the policy context and uses a multi-methods approach to evaluate the extent to which the portal, as an instrument of health policy, is meeting its original objectives. Four qualitative and quantitative methods of user data collection - online survey, market monitoring, web analytics, and direct user feedback - are used to estimate the impact of the portal with regard to user behavior and online health information needs over time. We find that the portal reaches a fair share of the Dutch health information market in quantitative and qualitative terms. However, while its exact contribution to the functioning of the health markets in terms of transparency remains undecided, it seems plausible that the portal's impact on choice behavior, choice awareness and empowerment is rather small. © 2012 Policy Studies Organization.


Ladbury G.,Dutch National Institute for Public Health and the Environment RIVM
Euro surveillance : bulletin Européen sur les maladies transmissibles = European communicable disease bulletin | Year: 2014

We describe a mumps outbreak in a highly-vaccinated population attending a party at a youth club. In a retrospective cohort study with 60 of approximately 100 participants responding, vaccination status was verified for 58/59 respondents, of whom 54 were vaccinated twice and four once. The attack rate was 22% (13 cases, all vaccinated), with smoking at the party (risk ratio (RR) 3.1; 95% confidence interval (CI): 1.6-6.0, p=0.001) and age ≥21 years (RR 4.7; 95% CI: 2.1-10.2, p<0.0001) as risk factors for disease in the binominal regression analysis. Mild upper respiratory illness was also highly prevalent in those who did not meet the mumps case definition (n=46) after the party, suggesting that mumps virus infection may cause mild disease in vaccinated individuals. Our investigation adds toevidence that crowded social events and smoking may facilitate spread of mumps virus among vaccinated populations, with waning immunity playing a role. The suggestion that mumps virus infection in vaccinated individuals may manifest as mild upper respiratory illness could have implications for transmission and warrants further investigation.


PubMed | Dutch National Institute for Public Health and the Environment RIVM
Type: | Journal: BMC medical informatics and decision making | Year: 2015

Patient empowerment is crucial in the successful self-management of people with chronic diseases. In this study, we investigated whether discussions about medicine use taking place on online message boards contribute to patient empowerment and could subsequently result in the more effective use of medicines. We discuss the extent to which patient empowerment processes occur in discussions on online message boards, focusing on patients with three disorders with different characteristics: diabetes, Amyotrophic Lateral Sclerosis (ALS) and Attention Deficit / Hyperactivity Disorder (ADHD). Because information is an important factor in both patient empowerment and self-management, we also evaluate the quality of the information being exchanged.We used a deductive thematic analysis method based on pre-existing categories. We gathered and analysed 5532 posts related to the conditions ADHD, ALS and diabetes from seven message boards (three for ADHD, three for diabetes, and one for ALS). We coded the posts for empowerment processes and the quality of the information exchanged.We identified patient empowerment processes in posts related to all three disorders. There is some variation in the frequency of these processes, but they show a similar order in the results: patients used the online message boards to exchange information, share personal experiences and for empathy or support. The type of information shared in these processes could contribute to the patients self-efficacy when it comes to medicine use. The exchanged information was either correct or largely harmless. We also observed a tendency whereby participants correct previously posted incorrect information, and refer people to a healthcare professional following a request for medical advice, e.g. concerning the choice of medicines or dosage.Our findings show that patient empowerment processes occur in posts related to all three disorders. The type of information shared in these processes can contribute to the patients self-efficacy when it comes to medicine use. The tendency to refer people to a healthcare professional shows that patients still reserve an important role for healthcare professionals in the care process, despite the development towards more self-management.

Loading Dutch National Institute for Public Health and the Environment RIVM collaborators
Loading Dutch National Institute for Public Health and the Environment RIVM collaborators