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Een demonstratie tegen zinloos straatgeweld was het begin van een landelijke mediagolf, die meer dan een kwartaal duurde. In deze periode werd geweld op straat een issue van hoge maatschappelijke prioriteit, die in korte tijd een plaats op de politieke agenda bereikte. In dit artikel wordt de vraag onderzocht of deze mediagolf invloed heeft gehad op de mate waarin de bevolking geweld op straat als risico voor de gezondheid percipieert. De gegevens van dit onderzoek zijn afkomstig uit zeven landelijk representatieve steekproeven, in grootte varierend van 727 tot 1.152 personen in de leeftijd van 18 tot 90 jaar. De gegevens werden verzameld door middel van interviews bij de respondenten thuis. De surveys vonden plaats v00r (jaarlijks van 1992 tot en met 1996), tijdens (oktober 1997) en na de mediagolf (februari 1998). Door middel van multipele logistische regressies werd gecontroleerd voor de confounders geslacht, leeftijd, opleiding, urbanisatie en vijftien overige percepties van gezondheidsrisico's. De belangrijkste uitkomst is, dat de bevolking na de mediagolf over straatgeweld aanzienlijk banger is dat de eigen gezondheid wordt aangetast door geweld op straat dan daarvoor. Vanuit een breder 'public health' perspectief wordt ter discussie gesteld in hoeverre de nieuwsmedia zouden moeten proberen te voorkomen dat misplaatste angstgevoelens buitenproportioneel worden aangewakkerd.

In the 1980s epidemiology was rediscovered by health policy makers and health target setting was introduced. Although it brought back the populations' health as the central goal in health policy, some problems were also identified with the use of targets. First, of course, the political risk of being so explicit in a field where one does not control all the relevant determinants. Secondly, problems were encountered in terms of epidemiological methodology and data availability. However, the fact that in some countries targets could be sustained over several cabinets shows that they may also help to keep health policy on a steady course. In addition, public health epidemiology and public health models have since provided many of the tools necessary to set realistic targets and to translate the results of epidemiological research adequately into estimates of the potential health benefits of alternative interventions. Not long ago the World Health Organisation (WHO) presented its new generation of targets, in its policy 'Health for All in the 21st Century'. With these targets the WHO has once again chosen to put social justice and the public's health high on the health policy agenda. It is to be hoped that the progress which has been made with the methodology of public health epidemiology and the necessary data for the member states in the next Global Burden of Disease project will allow for the use of these targets in the core of policy making, the priority setting of resource allocation.

This paper addresses major developments in the safety evaluation of chemical mixtures during the past 15 years, reviews today's state of the art of mixture toxicology, and discusses challenges ahead. Well-thought-out tailor-made mechanistic and empirical designs for studying the toxicity of mixtures have gradually substituted trial-and-error approaches, improving the insight into the testability of joint action and interaction of constituents of mixtures. The acquired knowledge has successfully been used to evaluate the safety of combined exposures and complex mixtures such as, for example, the atmosphere at hazardous waste sites, drinking water disinfection by-products, natural flavouring complexes, and the combined intake of food additives. To consolidate the scientific foundation of mixture toxicology, studies are in progress to revisit the biological concepts and mathematics underlying formulas for low-dose extrapolation and risk assessment of chemical mixtures. Conspicuous developments include the production of new computer programs applicable to mixture research (CombiTool, BioMol, Reaction Network Modelling), the application of functional genomics and proteomics to mixture studies, the use of nano-optochemical sensors for in vivo imaging of physiological processes in cells, and the application of optical sensor micro- and nano-arrays for complex sample analysis. Clearly, the input of theoretical biologists, biomathematicians and bioengineers in mixture toxicology is essential for the development of this challenging branch of toxicology into a scientific subdiscipline of full value. © 2002 Elsevier Science Ltd. All rights reserved. Chemicals/CAS: Air Pollutants; Xenobiotics

Objective - It is generally accepted that a wide range of factors determine the health of a population, many of which are beyond the remit of the Ministry of Health. The aim of intersectoral health policy is to influence these factors. Success depends on a multi-stage process. This paper aims to provide support for the first stage of this process in the form of a quick scan for appraising the feasibility of intersectoral health policy. Design - The content of the quick scan for intersectoral health policy was derived from a literature review. To determine the usefulness of this quick scan, the study looked at two examples in the policy sectors of education and safety. Main results - The quick scan distinguishes between three factors: (1) the availability of evidence, (2) the degree of support, and (3) the availability of tools for implementation. The quick scan made it possible to review the two policy sectors systematically in a relatively short time and to obtain sufficient information for priority setting in intersectoral health policy. The examples in this paper suggest that intersectoral health policy for community safety is more feasible than intersectoral policy for psychosocial problems in secondary education. However, specific information is required for a more precise assessment of feasibility. Conclusions - There are many ways of improving health through intersectoral health policy. The proposed quick scan may provide systematic support for setting priorities before developing policies of this kind.

This thesis focuses on asthma symptoms in early childhood. From a public health perspective, we aim to improve health and health-related quality of life through the prevention of asthma symptoms and by signaling, counselling or management of children who are at a high risk of developing asthma. The public health approach that we used in this thesis provides a useful framework to study the association between social indicators and asthma symptoms in early childhood and the underlying pathways. This thesis also studies the impact of asthma on the child’s health-related quality of life and evaluates the systematic assessment of asthma symptoms and environmental tobacco smoke exposure at preventive youth healthcare centers. Finally, we developed an asthma risk appraisal tool to assess the risk on asthma at school age in preschool children who present with asthma symptoms at well-child care.

Zoonoses can be defined as infectious diseases that are transmitted from vertebrate animals to man under natural conditions. Applying this definition, a review is presented of zoonoses, occurring in the Netherlands. Data about this group of infectious diseases were collected from public health and veterinary data sources. From the results of the inventory it can be concluded that the major part of the zoonoses is caused by foodborne infections. It has been estimated that yearly a total number of 420,000 persons suffer from Salmonella and Campylobacter infections. The remaining zoonoses under study were found to be of limited importance for the general population; because of their concentration in some professional groups and because of the availability of preventive measures, these infections are important in certain subgroups of the population.

The aim of this cross-sectional study was to assess differences in caries experience according to socio-economic status (SES) in a health-care system with full coverage of dental costs for children up to the age of 18 yr. In 2011 and 2014, by performing hurdle negative binomial models, we obtained data on 3,022 children and young adults aged 5, 8, 11, 14, 17, 20, and 23 yr, living in four cities in the Netherlands. At all ages between 5 and 23 yr, the percentages of children with caries-free dentitions were lower and mean caries experience were higher in low-SES than in high-SES participants. In 5-yr-old children with dmft > 0, mean caries experience was 3.6 in those with low SES and 2.3 in those with high SES. In 23-yr-old participants, these estimates were 6.8 and 4.4, respectively (P < 0.05). Low-SES children have a greater risk of more caries experience than high-SES children. Thus, in a system with full free paediatric dental coverage, socio-economic inequality in caries experience still exists. Dental health professionals, well-child care doctors and nurses, general practitioners, and elementary school teachers should collaborate to promote oral health at the community level, with specific targeting of low-SES families. We further need policy measures to curtail, at community level, the increasing availability and consumption of highly processed, carbohydrate-rich foods, with particular attention for low-SES families.

Objective: In November 1993, Dutch health authorities advised that women planning a pregnancy should take folic acid in the periconceptional period to reduce the risk of fetal neural tube defects. In the autumn of 1995 a national campaign was organized to inform women and health care professionals in a systematic way. Methods: We assessed the awareness and behaviour of women at their first or second antenatal visit in two surveys in the spring of 1994 and the autumn of 1995, in order to evaluate the impact of non-systematic information during that period, and to collect baseline data to evaluate the effect of the national folic acid campaign. The two surveys were carried out in the north and the west of The Netherlands. Results: The proportion of women who had heard of folic acid increased from 28% to 78%. The proportion that used folic acid during any period in pregnancy increased from 7.8% to 26%. The proportion that took folic acid tablets during the whole of the recommended period increased from 0.8 to 4.4%. In the group of women wits did not take folic acid, the proportion who did 'not like to use anything during pregnancy' decreased, as did the proportion who did 'not think it is useful'. Conclusion: In The Netherlands, non-systematic information about periconceptional folic acid use has already led to significant changes in awareness and behaviour before the start of the national folic acid campaign.

Objective. To establish the prevalence of chronic diseases reported by parents among a random population of Dutch children. Furthermore, to establish how often these children visited a physician because of a chronic disease, and used drugs for its treatment. Setting. Dordrecht and environs. Design. Descriptive. Method. In the school year 1990-1991, all 8689 parents of school children summoned for a periodical health check by the school doctor or school nurse were sent a questionnaire together with the notification. With the aid of a list of criteria it was determined for every child during the periodical health check if the diseases, if any, were serious, if the children were being treated for them and if they used medication. Results. The response to the questionnaire amounted to 98.3%. Of the children examined, 21.3% according to the parents suffered from one or more chronic diseases, 3.7% to a major extent. Of the group with one or more chronic diseases, 25.2% were monitored by the family doctor, 10.5% by the paediatrician, 18.6% by various other specialists and 4.5% by a homeopathist. Of the population as a whole, 10.1% used medication because of one or several of the chronic diseases; this accounted for 47.4% of the group with one or several chronic diseases. Conclusion. The prevalence of chronic diseases in school children reported by the parents is so high that it should be given attention in post-graduate education and public health information.

In Japan there is growing concern about the possible adverse effects of consumption of food from styrene containers (mainly those made from polystyrene paper) due to the alleged oestrogenic activity of styrene oligomers (dimers and trimers), which may migrate into the food. To examine the possible oestrogenic activity of styrene dimers and trimers, extracts were made from 'general purpose polystyrene (GPPS)' and administered orally to immature female rats over a 4 day period. Increase of uterus weight (wet and blotted) was used for assessment of possible oestrogenic activity. To establish the sensitivity of the test method, immature rats were treated with diethylstilboestrol (DES), a well-known oestrogenic compound. It was found that treatment of rats with levels of up to 60 μg of styrene dimers and 930 μg of styrene trimers per kilogram body weight per day did not give any statistically significant increase of the uterus weight (wet or blotted), whereas DES caused statistically significant, dose-related increases in uterus weight at levels as low as 0.89 μg kg-1 body weight day-1. It was concluded that, compared with the estimated maximum human daily intake of styrene trimers of 1 μg kg-1 body weight day-1 from polystyrene food containers, the risk of adverse human health effects with respect to oestrogenicity may be considered negligible. Copyright © 2001 John Wiley & Sons, Ltd. Chemicals/CAS: Estrogens; Polystyrenes

Advancing our knowledge on the toxicology of combined exposures to chemicals and implementation of this knowledge in guidelines for health risk assessment of such combined exposures are necessities dictated by the simple fact that humans are continuously exposed to a multitude of chemicals. A prerequisite for successful research and fruitful discussions on the toxicology of combined exposures (mixtures of chemicals) is the use of defined terminology implemented by an authoritative international body such as, for example, the International Union of Pure and Applied Chemistry (IUPAC) Toxicology Committee. The extreme complexity of mixture toxicology calls for new research methodologies to study interactive effects, taking into account limited resources. Of these methodologies, statistical designs and mathematical modelling of toxicokinetics and toxicodynamics seem to be most promising. Emphasis should be placed on low-dose modelling end experimental validation. The scientifically sound so-called bottom-up approach should be supplemented with more pragmatic approaches, focusing on selection of the most hazardous chemicals in a mixture and careful consideration of the mode of action and possible interactive effects of these chemicals. Pragmatic approaches may be of particular importance to study and evaluate complex mixtures; after identification of the 'top ten' (most risky) chemicals in the mixture they can be examined and evaluated as a defined (simple) chemical mixture. In setting exposure limits for individual chemicals, the use of an additional safety factor to compensate for potential increased risk due to simultaneous exposure to other chemicals, has no clear scientific justification. The use of such an additional factor is a political rather than a scientific choice.

Priority setting for the evaluation of health technologies in the Netherlands is exclusively based on the scientific merits of individual research proposals. This process has not resulted in satisfactory allocation of resources. Therefore, societal criteria for setting priorities for health technology assessment have been proposed as an adjunct to scientific criteria. These societal criteria include the burden of disease, uncertainty about the (cost-)effectiveness of the intervention at issue, the potential benefits of the research project, and its potential impact on health care. To realize the full potential of this model for priority setting, a number of methodological issues need to be addressed. Joint efforts of researchers and policy makers in this field are necessary for future progress.

Objective: To describe the rationale and methods for a European project (EFCOSUM) to develop a method for a European food consumption survey that delivers internationally comparable data on a set of policy-relevant nutritional indicators. Rationale and methods: Currently Member States are collecting data and information for use at national level. At an international level, such data are often of limited comparability and of varying quality. To promote the development and exchange of adequate, reliable and comparable indicators of public health, and the structures needed to exchange the relevant data, a programme of Community action on health monitoring was set up for the EU. The objective of the action programme is to contribute to the establishment of a Community Health Monitoring System. Data will be made available to all Member States via a telematic network, which is currently being developed for the Health Monitoring Programme. With regard to nutrition, there is a need for a limited set of policy-relevant dietary indicators that are comparable among EU Member States. In the field of nutrition, however, there is a regrettable lack of internationally comparable data. The project 'European Food Consumption Survey Method' (EFCOSUM) therefore aimed to define a (minimum) set of dietary components which are relevant determinants of health and to define a method for the monitoring of food consumption in nationally representative samples of all age-sex categories in Europe in a comparable way. The project was carried out by 14 Member States as well as nine other European countries. Activities of the project included plenary sessions, desk research, and working group activities, building on existing experience from such projects as DAFNE, EPIC, FLAIR Eurofoods-Enfant project, COST Action 99 and others. The proposed method may be used alone, or as a calibration method to accompany existing ongoing studies. Sponsorship: European Commission, DG SANCO F/3, Health Monitoring Programme. © 2002 Nature Publishing Group All rights reserved.

Valid estimates of caries experience are needed to monitor oral population health. Obtaining such estimates in practice is often complicated by nonresponse and missing data. The goal of this study was to estimate caries experiences in a population of children aged 5 and 11 years, in the presence of nonresponse and missing data. Four estimation methods are compared. Each method makes implicit assumptions about the processes that caused the nonresponse and the missing data. Three of the four methods are based on unrealistic assumptions about the missing data and underestimate caries experience. Under the missing at random assumption, multiple imputation in combination with direct standardization corrects for the deficiencies of current methodology. In the presence of missing data and nonresponse, we recommend a combination of multiple imputation and direct standardization to obtain correct estimates of caries experience. © 2013 S. Karger AG, Basel.

OBJECTIVES: From 1 January 2006, the distinction between the health insurance fund and private insurance was abolished and a basic insurance package was agreed for everyone in the Netherlands. Dental treatment for young people below the age of 18 is reimbursed under the terms of this basic package. Dental treatment for adults is not covered in this basic insurance package. Basic principles for nonreimbursing dental care for adults were that any health and financial risks for individual citizens in the future should be acceptable for them with the corollary that the oral health of young adults when they make the switch - from collectively financed care to care to be paid for individually - should be at such a level that the needed oral health care is affordable. To meet this requirement, it is important to have knowledge of the prevalence of oral diseases and trends in oral health in young people from a public health perspective. The aim of this article is to describe trends in caries experience in young people in the Netherlands from 1990 to 2009, taking into account the challenge in methodology concerning this changing social context. METHODS: To describe caries experience in young people, a repeated cross-sectional study design was used. The study consisted of a clinical oral examination and a questionnaire survey. Data were sampled from 8, 14 and 20-year-olds in 1990 and 1996, and 9, 15 and 21-year-olds in 2003 and 2009, living in Alphen a/d Rijn, Gouda, Breda and 's-Hertogenbosch. The DMF index was used for describing caries experience. The trends were studied separately in high and low socioeconomic status (SES) groups. SES was operationalized as the dichotomous variable of educational level of the mother or the adolescent. Multiple imputation was applied to predict the DMFS for missing ages for certain years, which made it possible to test the trends. Linear and logistic regression analyses were used to study the trends through the years. RESULTS: This study showed, according to different age- and SES groups, either declines or no statistically significant changes in caries experience over the last two decades. CONCLUSIONS: No deterioration was shown. However, there is still room for further improvement in oral health in children. Dental professionals and politicians should develop a vision on to what extent caries experience is acceptable in a public health perspective in young people.

Background: Present study aimed to identify socio-demographic, medical and social-cognitive correlates of physical activity among Dutch older individuals. Methods. A systematic random sample of 2,568 Dutch participants aged 45-70 years filled out the validated modified Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire on physical activity. Socio-demographic and social-cognitive correlates were measured with validated instruments; medical correlates were checked by a general practitioner. The study had a cross-sectional design and the data collection ran from March 2005 until August 2006. Linear regression analyses were conducted to identify correlates of PA. We separated the findings for men from those for women to explore potential gender-specific associations. Results: Being female, living in North Limburg or North-Brabant, having a higher educational level, a higher perceived behavioral control, more knowledge about PA advantages, a stronger habitual PA behavior, having more action plans and a stronger intention to engage in PA were significantly associated with higher PA levels. Being older, being a smoker, having a higher body mass index (BMI), having a paid job, observing others being physically active and overestimating one's PA level were associated with being less physically active. Socio-demographic and medical correlates significantly explained 20% of the variance of PA behavior while social-cognitive correlates as attitude explained an additional 4% and intention together with actual control explained another 1% of the variance of PA behavior. Conclusion: There may be stable individual differences that influence PA in view of the fact that several socio-demographic and medical factors were not completely mediated by the socio-cognitive factors. The current study may help to focus PA interventions for individuals aged 45-70 years on influential socio-demographic, medical and social-cognitive correlates. Physical activity was significantly associated with age, gender, education, BMI, work situation, region of residence, smoking, awareness, advantages, descriptive norm, perceived behavioral control, habit, action plans and intention. © 2014 Mesters et al.; licensee BioMed Central Ltd.