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Erik Lebret
National Institute of Public Health and the Environment Bilthoven The Netherlands

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Original research article
Published: 22 July 2021 in Risk Analysis
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Risk assessment of chemicals can be based on toxicology and/or epidemiology. The choice of toxicological or epidemiological data can result in different health-based guidance values (HBGVs). Communicating the underlying argumentation is important to explain these differences to the public and policymakers. In this article, we explore the argumentation used to justify the use of toxicological or epidemiological data in the derivation of HBGVs in four different risk assessments for the chemical Perfluorooctanoic acid (PFOA). The pragma-dialectical argumentation theory (PDAT) is hereby applied. The argumentations to select relevant health endpoints or certain studies to infer causality appeared mainly based on “symptomatic relations,” that is, study results are used as characteristic of what was claimed to be a causal relation without delving into the actual causal argumentation that preceded it. Starting points that are at the basis of the chain of arguments remained implicit. Argumentation to use epidemiological and/or toxicological data was only briefly mentioned and the underlying argumentative foundation that led to the conclusion was seldom found or not addressed at all. The decision to include/exclude information was made based on the availability of data, or the motives for the choice remained largely unclear. We conclude that more depth in argumentation and a subordinative chain of arguments is needed to better disclose the underlying reasoning leading to a certain health-based guidance value (HBGV). More explicit identification and discussion of starting points could be a valuable addition to general risk assessment frameworks for maximum use of toxicological and epidemiological data and shared conclusions of the assessment.

ACS Style

W.P. Jongeneel; H. van Klaveren; R.P. Bogers; J. Dévilee; K.R. Rijs; A. Piersma; T. Vermeire; E. Lebret. Argumentation Analysis of Risk Assessments: The Case of Perfluorooctanoic Acid. Risk Analysis 2021, 1 .

AMA Style

W.P. Jongeneel, H. van Klaveren, R.P. Bogers, J. Dévilee, K.R. Rijs, A. Piersma, T. Vermeire, E. Lebret. Argumentation Analysis of Risk Assessments: The Case of Perfluorooctanoic Acid. Risk Analysis. 2021; ():1.

Chicago/Turabian Style

W.P. Jongeneel; H. van Klaveren; R.P. Bogers; J. Dévilee; K.R. Rijs; A. Piersma; T. Vermeire; E. Lebret. 2021. "Argumentation Analysis of Risk Assessments: The Case of Perfluorooctanoic Acid." Risk Analysis , no. : 1.

Journal article
Published: 26 November 2019 in Environment International
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Most previous studies that investigated associations of surrounding green, air pollution or traffic noise with mortality focused on single exposures. The aim of this study was to evaluate combined associations of long-term residential exposure to surrounding green, air pollution and traffic noise with total non-accidental and cause-specific mortality. We linked a national health survey (Public Health Monitor, PHM) conducted in 2012 to the Dutch longitudinal mortality database. Subjects of the survey who were 30 years or older on 1 January 2013 (n = 339,633) were followed from 1 January 2013 till 31 December 2017. We used Cox proportional hazard models to evaluate associations of residential surrounding green (including the average Normalized Difference Vegetation Index (NDVI) in buffers of 300 m and 1000 m), annual average air pollutant concentrations (including particulate matter (PM10, PM2.5), nitrogen dioxide (NO2)) and traffic noise with non-accidental, circulatory disease, respiratory disease, lung cancer and neurodegenerative disease mortality. We observed 26,886 non-accidental deaths over 1.627.365 person-years of follow-up. Surrounding green, air pollution and traffic noise exposure were not significantly associated with non-accidental or cause-specific mortality. For non-accidental mortality, we found a hazard ratio (HR) of 0.99 (0.98, 1.01) per IQR increase in NDVI 300 m, a HR of 0.99 (95% CI: 0.97, 1.01) per IQR increase in NO2, a HR of 0.98 (0.97, 1.00) per IQR increase in PM2.5 and a HR of 0.99 (95% CI: 0.97, 1.01) per IQR increase in road-traffic noise. Analyses restricted to non-movers or excluding subjects aged 85+ years did not change the findings. We found no evidence for associations of long-term residential exposures to surrounding green, air pollution and traffic noise with non-accidental or cause-specific mortality in a large population based survey in the Netherlands, possibly related to the relatively short follow-up period.

ACS Style

Jochem O. Klompmaker; Gerard Hoek; Lizan D. Bloemsma; Marten Marra; Alet H. Wijga; Carolien Van Den Brink; Bert Brunekreef; Erik Lebret; Ulrike Gehring; Nicole A.H. Janssen. Surrounding green, air pollution, traffic noise exposure and non-accidental and cause-specific mortality. Environment International 2019, 134, 105341 .

AMA Style

Jochem O. Klompmaker, Gerard Hoek, Lizan D. Bloemsma, Marten Marra, Alet H. Wijga, Carolien Van Den Brink, Bert Brunekreef, Erik Lebret, Ulrike Gehring, Nicole A.H. Janssen. Surrounding green, air pollution, traffic noise exposure and non-accidental and cause-specific mortality. Environment International. 2019; 134 ():105341.

Chicago/Turabian Style

Jochem O. Klompmaker; Gerard Hoek; Lizan D. Bloemsma; Marten Marra; Alet H. Wijga; Carolien Van Den Brink; Bert Brunekreef; Erik Lebret; Ulrike Gehring; Nicole A.H. Janssen. 2019. "Surrounding green, air pollution, traffic noise exposure and non-accidental and cause-specific mortality." Environment International 134, no. : 105341.

Correspondence
Published: 06 November 2019 in Environment International
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The number of anthropogenic chemicals, manufactured, by-products, metabolites and abiotically formed transformation products, counts to hundreds of thousands, at present. Thus, humans and wildlife are exposed to complex mixtures, never one chemical at a time and rarely with only one dominating effect. Hence there is an urgent need to develop strategies on how exposure to multiple hazardous chemicals and the combination of their effects can be assessed. A workshop, “Advancing the Assessment of Chemical Mixtures and their Risks for Human Health and the Environment” was organized in May 2018 together with Joint Research Center in Ispra, EU-funded research projects and Commission Services and relevant EU agencies. This forum for researchers and policy-makers was created to discuss and identify gaps in risk assessment and governance of chemical mixtures as well as to discuss state of the art science and future research needs. Based on the presentations and discussions at this workshop we want to bring forward the following Key Messages:

ACS Style

Elina Drakvik; Rolf Altenburger; Yasunobu Aoki; Thomas Backhaus; Tina Bahadori; Robert Barouki; Werner Brack; Mark Cronin; Barbara Demeneix; Susanne Hougaard Bennekou; Jacob van Klaveren; Carsten Kneuer; Marike Kolossa-Gehring; Erik Lebret; Leo Posthuma; Lena Reiber; Cynthia Rider; Joëlle Rüegg; Giuseppe Testa; Bart van der Burg; Hilko van der Voet; A. Michael Warhurst; Bob van de Water; Kunihiko Yamazaki; Mattias Öberg; Åke Bergman. Statement on advancing the assessment of chemical mixtures and their risks for human health and the environment. Environment International 2019, 134, 105267 -105267.

AMA Style

Elina Drakvik, Rolf Altenburger, Yasunobu Aoki, Thomas Backhaus, Tina Bahadori, Robert Barouki, Werner Brack, Mark Cronin, Barbara Demeneix, Susanne Hougaard Bennekou, Jacob van Klaveren, Carsten Kneuer, Marike Kolossa-Gehring, Erik Lebret, Leo Posthuma, Lena Reiber, Cynthia Rider, Joëlle Rüegg, Giuseppe Testa, Bart van der Burg, Hilko van der Voet, A. Michael Warhurst, Bob van de Water, Kunihiko Yamazaki, Mattias Öberg, Åke Bergman. Statement on advancing the assessment of chemical mixtures and their risks for human health and the environment. Environment International. 2019; 134 ():105267-105267.

Chicago/Turabian Style

Elina Drakvik; Rolf Altenburger; Yasunobu Aoki; Thomas Backhaus; Tina Bahadori; Robert Barouki; Werner Brack; Mark Cronin; Barbara Demeneix; Susanne Hougaard Bennekou; Jacob van Klaveren; Carsten Kneuer; Marike Kolossa-Gehring; Erik Lebret; Leo Posthuma; Lena Reiber; Cynthia Rider; Joëlle Rüegg; Giuseppe Testa; Bart van der Burg; Hilko van der Voet; A. Michael Warhurst; Bob van de Water; Kunihiko Yamazaki; Mattias Öberg; Åke Bergman. 2019. "Statement on advancing the assessment of chemical mixtures and their risks for human health and the environment." Environment International 134, no. : 105267-105267.

Historical article
Published: 14 October 2019 in PLOS ONE
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In the Netherlands, an association was found between the prevalence of pneumonia and living near goat and poultry farms in 2007-2013. This association then led to regulatory decisions to restrict the building of new goat farms and to reduce emissions of poultry farms. Confirmation of these results, however, is required because the period of previous analyses overlapped a Q-fever epidemic in 2007-2010. To confirm the association, we performed a population-based study during 2014-2016 based on general practitioner (GP) data. Electronic medical records of 90,183 persons were used to analyze the association between pneumonia and the population living in the proximity (within 500-2000 m distance) of goat and poultry farms. Data were analyzed with three types of logistic regression (with and without GP practice as a random intercept and with stratified analyses per GP practice) and a kernel model to discern the influence of different statistical methods on the outcomes. In all regression analyses involving adults, a statistically significant association between pneumonia and residence within 500 meters of goat farms was found (odds ratio [OR] range over all analyses types: 1.33-1.60), with a decreasing OR for increasing distances. In kernel analyses (including all ages), a population-attributable risk between 6.0 and 7.8% was found for a distance of 2000 meters in 2014-2016. The associations were consistent across all years and robust for mutual adjustment for proximity to other animals and for several other sensitivity analyses. However, associations with proximity to poultry farms are not supported by the present study. As the causes of the elevated pneumonia incidence in persons living close to goat farms remain unknown, further research into potential mechanisms is required for adequate prevention.

ACS Style

Pim M. Post; Lenny Hogerwerf; Anke Huss; Ronald Petie; Gert Jan Boender; Christos Baliatsas; Erik Lebret; Dick Heederik; Thomas J. Hagenaars; C. Joris Ijzermans; Lidwien A. M. Smit. Risk of pneumonia among residents living near goat and poultry farms during 2014-2016. PLOS ONE 2019, 14, e0223601 .

AMA Style

Pim M. Post, Lenny Hogerwerf, Anke Huss, Ronald Petie, Gert Jan Boender, Christos Baliatsas, Erik Lebret, Dick Heederik, Thomas J. Hagenaars, C. Joris Ijzermans, Lidwien A. M. Smit. Risk of pneumonia among residents living near goat and poultry farms during 2014-2016. PLOS ONE. 2019; 14 (10):e0223601.

Chicago/Turabian Style

Pim M. Post; Lenny Hogerwerf; Anke Huss; Ronald Petie; Gert Jan Boender; Christos Baliatsas; Erik Lebret; Dick Heederik; Thomas J. Hagenaars; C. Joris Ijzermans; Lidwien A. M. Smit. 2019. "Risk of pneumonia among residents living near goat and poultry farms during 2014-2016." PLOS ONE 14, no. 10: e0223601.

Journal article
Published: 01 October 2019 in Environment International
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Green space has been hypothesized to improve cardiometabolic health of adolescents, whereas air pollution and traffic noise may negatively impact cardiometabolic health. To examine the associations of green space, air pollution and traffic noise with cardiometabolic health in adolescents aged 12 and 16 years. Waist circumference, blood pressure, cholesterol and glycated hemoglobin (HbA1c) were measured in subsets of participants of the Dutch PIAMA birth cohort, who participated in medical examinations at ages 12 (n = 1505) and/or 16 years (n = 797). We calculated a combined cardiometabolic risk score for each participant, with a higher score indicating a higher cardiometabolic risk. We estimated exposure to green space (i.e. the average Normalized Difference Vegetation Index (NDVI) and percentages of green space in circular buffers of 300 m and 3000 m), air pollution (by land-use regression models) and traffic noise (using the Standard Model Instrumentation for Noise Assessments (STAMINA) model) at the adolescents' home addresses at the time of the medical examinations. We assessed associations of these exposures with cardiometabolic health outcomes at ages 12 and 16 by multiple linear regression, adjusting for potential confounders. We did not observe consistent patterns of associations of green space, air pollution and traffic noise with the cardiometabolic risk score, blood pressure, total cholesterol levels, the total/HDL cholesterol ratio and HbA1c. We found inverse associations of air pollution with waist circumference at both age 12 and 16. These associations weakened after adjustment for region, except for particulate matter with a diameter of <2.5 μm (PM2.5) at age 12. The association of PM2.5 with waist circumference at age 12 remained after adjustment for green space and road traffic noise (adjusted difference - 1.42 cm [95% CI -2.50, -0.35 cm] per 1.16 μg/m3 increase in PM2.5). This study does not provide evidence for beneficial effects of green space or adverse effects of air pollution and traffic noise on cardiometabolic health in adolescents.

ACS Style

Lizan D. Bloemsma; Ulrike Gehring; Jochem O. Klompmaker; Gerard Hoek; Nicole A.H. Janssen; Erik Lebret; Bert Brunekreef; Alet H. Wijga. Green space, air pollution, traffic noise and cardiometabolic health in adolescents: The PIAMA birth cohort. Environment International 2019, 131, 104991 .

AMA Style

Lizan D. Bloemsma, Ulrike Gehring, Jochem O. Klompmaker, Gerard Hoek, Nicole A.H. Janssen, Erik Lebret, Bert Brunekreef, Alet H. Wijga. Green space, air pollution, traffic noise and cardiometabolic health in adolescents: The PIAMA birth cohort. Environment International. 2019; 131 ():104991.

Chicago/Turabian Style

Lizan D. Bloemsma; Ulrike Gehring; Jochem O. Klompmaker; Gerard Hoek; Nicole A.H. Janssen; Erik Lebret; Bert Brunekreef; Alet H. Wijga. 2019. "Green space, air pollution, traffic noise and cardiometabolic health in adolescents: The PIAMA birth cohort." Environment International 131, no. : 104991.

Journal article
Published: 17 September 2019 in Environmental Research
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Self-perceived general health (SGH) is one of the most inclusive and widely used measures of health status and a powerful predictor of mortality. However, only a limited number of studies evaluated associations of combined environmental exposures on SGH. Our aim was to evaluate associations of combined residential exposure to surrounding green, air pollution and traffic noise with poor SGH in the Netherlands. We linked data on long-term residential exposure to surrounding green based on the Normalized Difference Vegetation Index (NDVI) and a land-use database (TOP10NL), air pollutant concentrations (including particulate matter (PM10, PM2.5), and nitrogen dioxide (NO2)) and road- and rail-traffic noise with a Dutch national health survey, resulting in a study population of 354,827 adults. We analyzed associations of single and combined exposures with poor SGH. In single-exposure models, NDVI within 300 m was inversely associated with poor SGH [odds ratio (OR) = 0.91, 95% CI: 0.89, 0.94 per IQR increase], while NO2 was positively associated with poor SGH (OR = 1.07, 95% CI: 1.04, 1.11 per IQR increase). In multi-exposure models, associations with surrounding green and air pollution generally remained, but attenuated. Joint odds ratios (JOR) of combined exposure to air pollution, rail-traffic noise and decreased surrounding green were higher than the odds ratios of single-exposure models. Studies including only one of these correlated exposures may overestimate the risk of poor SGH attributed to the studied exposure, while underestimating the risk of combined exposures.

ACS Style

Jochem O. Klompmaker; Nicole A.H. Janssen; Lizan D. Bloemsma; Ulrike Gehring; Alet H. Wijga; Carolien Van Den Brink; Erik Lebret; Bert Brunekreef; Gerard Hoek. Residential surrounding green, air pollution, traffic noise and self-perceived general health. Environmental Research 2019, 179, 108751 .

AMA Style

Jochem O. Klompmaker, Nicole A.H. Janssen, Lizan D. Bloemsma, Ulrike Gehring, Alet H. Wijga, Carolien Van Den Brink, Erik Lebret, Bert Brunekreef, Gerard Hoek. Residential surrounding green, air pollution, traffic noise and self-perceived general health. Environmental Research. 2019; 179 ():108751.

Chicago/Turabian Style

Jochem O. Klompmaker; Nicole A.H. Janssen; Lizan D. Bloemsma; Ulrike Gehring; Alet H. Wijga; Carolien Van Den Brink; Erik Lebret; Bert Brunekreef; Gerard Hoek. 2019. "Residential surrounding green, air pollution, traffic noise and self-perceived general health." Environmental Research 179, no. : 108751.

Journal article
Published: 01 August 2019 in Environmental Health Perspectives
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Surrounding green, air pollution, and noise have been associated with cardiometabolic diseases, but most studies have assessed only one of these correlated exposures. We aimed to evaluate associations of combined exposures to green, air pollution, and road traffic noise with cardiometabolic diseases. In this cross-sectional study, we studied associations between self-reported physician-diagnosed diabetes, hypertension, heart attack, and stroke from a Dutch national health survey of 387,195 adults and residential surrounding green, annual average air pollutant concentrations [including particulate matter with aerodynamic diameter [Formula: see text] ([Formula: see text]), PM with aerodynamic diameter [Formula: see text] ([Formula: see text]), nitrogen dioxide ([Formula: see text]), and oxidative potential (OP) with the dithiothreitol (DTT) assay ([Formula: see text])] and road traffic noise. Logistic regression models were used to analyze confounding and interaction of surrounding green, air pollution, and noise exposure. In single-exposure models, surrounding green was inversely associated with diabetes, while air pollutants ([Formula: see text], [Formula: see text]) and road traffic noise were positively associated with diabetes. In two-exposure analyses, associations with green and air pollution were attenuated but remained. The association between road traffic noise and diabetes was reduced to unity when adjusted for surrounding green or air pollution. Air pollution and surrounding green, but not road traffic noise, were associated with hypertension in single-exposure models. The weak inverse association of surrounding green with hypertension attenuated and lost significance when adjusted for air pollution. Only [Formula: see text] was associated with stroke and heart attack. Studies including only one of the correlated exposures surrounding green, air pollution, and road traffic noise may overestimate the association of diabetes and hypertension attributed to the studied exposure. https://doi.org/10.1289/EHP3857.

ACS Style

Jochem O. Klompmaker; Nicole A. H. Janssen; Lizan D. Bloemsma; Ulrike Gehring; Alet H. Wijga; Carolien Van Den Brink; Erik Lebret; Bert Brunekreef; Gerard Hoek. Associations of Combined Exposures to Surrounding Green, Air Pollution, and Road Traffic Noise with Cardiometabolic Diseases. Environmental Health Perspectives 2019, 127, 087003 .

AMA Style

Jochem O. Klompmaker, Nicole A. H. Janssen, Lizan D. Bloemsma, Ulrike Gehring, Alet H. Wijga, Carolien Van Den Brink, Erik Lebret, Bert Brunekreef, Gerard Hoek. Associations of Combined Exposures to Surrounding Green, Air Pollution, and Road Traffic Noise with Cardiometabolic Diseases. Environmental Health Perspectives. 2019; 127 (8):087003.

Chicago/Turabian Style

Jochem O. Klompmaker; Nicole A. H. Janssen; Lizan D. Bloemsma; Ulrike Gehring; Alet H. Wijga; Carolien Van Den Brink; Erik Lebret; Bert Brunekreef; Gerard Hoek. 2019. "Associations of Combined Exposures to Surrounding Green, Air Pollution, and Road Traffic Noise with Cardiometabolic Diseases." Environmental Health Perspectives 127, no. 8: 087003.

Journal article
Published: 31 May 2019 in Environment International
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Evidence is emerging that poor mental health is associated with the environmental exposures of surrounding green, air pollution and traffic noise. Most studies have evaluated only associations of single exposures with poor mental health. To evaluate associations of combined exposure to surrounding green, air pollution and traffic noise with poor mental health. In this cross-sectional study, we linked data from a Dutch national health survey among 387,195 adults including questions about psychological distress, based on the Kessler 10 scale, to an external database on registered prescriptions of anxiolytics, hypnotics & sedatives and antidepressants. We added data on residential surrounding green in a 300 m and a 1000 m buffer based on the Normalized Difference Vegetation Index (NDVI) and a land-use database (TOP10NL), modeled annual average air pollutant concentrations (including particulate matter (PM10, PM2.5), and nitrogen dioxide (NO2)) and modeled road- and rail-traffic noise (Lden and Lnight) to the survey. We used logistic regression to analyze associations of surrounding green, air pollution and traffic noise exposure with poor mental health. In single exposure models, surrounding green was inversely associated with poor mental health. Air pollution was positively associated with poor mental health. Road-traffic noise was only positively associated with prescription of anxiolytics, while rail-traffic noise was only positively associated with psychological distress. For prescription of anxiolytics, we found an odds ratio [OR] of 0.88 (95% CI: 0.85, 0.92) per interquartile range [IQR] increase in NDVI within 300 m, an OR of 1.14 (95% CI: 1.10, 1.19) per IQR increase in NO2 and an OR of 1.07 (95% CI: 1.03, 1.11) per IQR increase in road-traffic noise. In multi exposure analyses, associations with surrounding green and air pollution generally remained but attenuated. Joint odds ratios [JOR], based on the Cumulative Risk Index (CRI) method, of combined exposure to air pollution, traffic noise and decreased surrounding green were higher than the ORs of single exposure models. Associations of environmental exposures with poor mental health differed somewhat by age. Studies including only one of these three correlated exposures may overestimate the influence of poor mental health attributed to the studied exposure, while underestimating the influence of combined environmental exposures.

ACS Style

Jochem O. Klompmaker; Gerard Hoek; Lizan D. Bloemsma; Alet H. Wijga; Carolien Van Den Brink; Bert Brunekreef; Erik Lebret; Ulrike Gehring; Nicole A.H. Janssen. Associations of combined exposures to surrounding green, air pollution and traffic noise on mental health. Environment International 2019, 129, 525 -537.

AMA Style

Jochem O. Klompmaker, Gerard Hoek, Lizan D. Bloemsma, Alet H. Wijga, Carolien Van Den Brink, Bert Brunekreef, Erik Lebret, Ulrike Gehring, Nicole A.H. Janssen. Associations of combined exposures to surrounding green, air pollution and traffic noise on mental health. Environment International. 2019; 129 ():525-537.

Chicago/Turabian Style

Jochem O. Klompmaker; Gerard Hoek; Lizan D. Bloemsma; Alet H. Wijga; Carolien Van Den Brink; Bert Brunekreef; Erik Lebret; Ulrike Gehring; Nicole A.H. Janssen. 2019. "Associations of combined exposures to surrounding green, air pollution and traffic noise on mental health." Environment International 129, no. : 525-537.

Journal article
Published: 02 January 2019 in Journal of Risk Research
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ACS Style

Sander C.S. Clahsen; Holly S. Van Klaveren; Theo G. Vermeire; Irene Van Kamp; Bart Garssen; Aldert H Piersma; Erik Lebret. Understanding conflicting views of endocrine disruptor experts: a pilot study using argumentation analysis. Journal of Risk Research 2019, 23, 62 -80.

AMA Style

Sander C.S. Clahsen, Holly S. Van Klaveren, Theo G. Vermeire, Irene Van Kamp, Bart Garssen, Aldert H Piersma, Erik Lebret. Understanding conflicting views of endocrine disruptor experts: a pilot study using argumentation analysis. Journal of Risk Research. 2019; 23 (1):62-80.

Chicago/Turabian Style

Sander C.S. Clahsen; Holly S. Van Klaveren; Theo G. Vermeire; Irene Van Kamp; Bart Garssen; Aldert H Piersma; Erik Lebret. 2019. "Understanding conflicting views of endocrine disruptor experts: a pilot study using argumentation analysis." Journal of Risk Research 23, no. 1: 62-80.

Journal article
Published: 20 November 2018 in Environmental Research
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Air pollution, traffic noise and absence of green space may contribute to the development of overweight in children. To investigate the combined associations of air pollution, traffic noise and green space with overweight throughout childhood. We used data for 3680 participants of the Dutch PIAMA birth cohort. We estimated exposure to air pollution, traffic noise and green space (i.e. the average Normalized Difference Vegetation Index (NDVI) and percentages of green space in circular buffers of 300 m and 3000 m) at the children's home addresses at the time of parental reported weight and height measurements. Associations of these exposures with overweight from age 3 to 17 years were analyzed by generalized linear mixed models, adjusting for potential confounders. Odds ratios (OR's) are presented for an interquartile range increase in exposure. odds of being overweight increased with increasing exposure to NO2 (adjusted OR 1.40 [95% confidence interval (CI) 1.12 − 1.74] per 8.90 µg/m3) and tended to decrease with increasing exposure to green space in a 3000 m buffer (adjusted OR 0.86 [95% CI 0.71 − 1.04] per 0.13 increase in the NDVI; adjusted OR 0.86 [95% CI 0.71 − 1.03] per 29.5% increase in the total percentage of green space). After adjustment for NO2, the associations with green space in a 3000 m buffer weakened. No associations of traffic noise with overweight throughout childhood were found. In children living in an urban area, living further away from a park was associated with a lower odds of being overweight (adjusted OR 0.67 [95% CI 0.52 − 0.85] per 359.6 m). Exposure to traffic-related air pollution, but not traffic noise or green space, may contribute to childhood overweight. Future studies examining the associations of green space with childhood overweight should account for air pollution exposure.

ACS Style

Lizan D. Bloemsma; Alet H. Wijga; Jochem O. Klompmaker; Nicole A.H. Janssen; Henriëtte A. Smit; Gerard Koppelman; Bert Brunekreef; Erik Lebret; Gerard Hoek; Ulrike Gehring. The associations of air pollution, traffic noise and green space with overweight throughout childhood: The PIAMA birth cohort study. Environmental Research 2018, 169, 348 -356.

AMA Style

Lizan D. Bloemsma, Alet H. Wijga, Jochem O. Klompmaker, Nicole A.H. Janssen, Henriëtte A. Smit, Gerard Koppelman, Bert Brunekreef, Erik Lebret, Gerard Hoek, Ulrike Gehring. The associations of air pollution, traffic noise and green space with overweight throughout childhood: The PIAMA birth cohort study. Environmental Research. 2018; 169 ():348-356.

Chicago/Turabian Style

Lizan D. Bloemsma; Alet H. Wijga; Jochem O. Klompmaker; Nicole A.H. Janssen; Henriëtte A. Smit; Gerard Koppelman; Bert Brunekreef; Erik Lebret; Gerard Hoek; Ulrike Gehring. 2018. "The associations of air pollution, traffic noise and green space with overweight throughout childhood: The PIAMA birth cohort study." Environmental Research 169, no. : 348-356.

Perspective
Published: 31 October 2018 in Risk Analysis
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This perspective presents empirical data to demonstrate the existence of different expert views on scientific policy advice on complex environmental health issues. These views are partly research‐field specific. According to scientific literature, experts differ in the way they provide policy advice on complex issues such as electromagnetic fields (EMF), particulate matter (PM), and antimicrobial resistance (AMR). Where some experts feel their primary task is to carry out fundamental research, others actively engage in the policy dialogue. Although the literature provides ideas about expert roles, there exists little empirical underpinning. Our aim is to gather empirical evidence about expert roles. The results of an international study indicated that experts on EMF, PM, and AMR differ in the way they view their role in the policy dialogue. For example, experts differed in their views on the need for precaution and their motivation to initiate stakeholder cooperation. Besides, most experts thought that their views on the risks of EMF/PM/AMR did not differ from those of colleagues. Great dissensus was found in views on the best ways of managing risks and uncertainties. In conclusion, the theoretical ideal–typical roles from the literature can be identified to a certain extent.

ACS Style

Pita Spruijt; Anne B. Knol; Arthur C. Petersen; Erik Lebret. Expert Views on Their Role as Policy Advisor: Pilot Study for the Cases of Electromagnetic Fields, Particulate Matter, and Antimicrobial Resistance. Risk Analysis 2018, 39, 968 -974.

AMA Style

Pita Spruijt, Anne B. Knol, Arthur C. Petersen, Erik Lebret. Expert Views on Their Role as Policy Advisor: Pilot Study for the Cases of Electromagnetic Fields, Particulate Matter, and Antimicrobial Resistance. Risk Analysis. 2018; 39 (5):968-974.

Chicago/Turabian Style

Pita Spruijt; Anne B. Knol; Arthur C. Petersen; Erik Lebret. 2018. "Expert Views on Their Role as Policy Advisor: Pilot Study for the Cases of Electromagnetic Fields, Particulate Matter, and Antimicrobial Resistance." Risk Analysis 39, no. 5: 968-974.

Consensus development conference
Published: 21 September 2018 in International Journal of Environmental Research and Public Health
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The European Union’s 7th Environmental Action Programme (EAP) aims to assess and minimize environmental health risks from the use of hazardous chemicals by 2020. From this angle, policy questions like whether an implemented policy to reduce chemical exposure has had an effect over time, whether the health of people in specific regions or subpopulations is at risk, or whether the body burden of chemical substances (the internal exposure) varies with, for example, time, country, sex, age, or socio-economic status, need to be answered. Indicators can help to synthesize complex scientific information into a few key descriptors with the purpose of providing an answer to a non-expert audience. Human biomonitoring (HBM) indicators at the European Union (EU) level are unfortunately lacking. Within the Horizon2020 European Human Biomonitoring project HBM4EU, an approach to develop European HBM indicators was worked out. To learn from and ensure interoperability with other European indicators, 15 experts from the HBM4EU project (German Umweltbundesamt (UBA), Flemish research institute VITO, University of Antwerp, European Environment Agency (EEA)), and the World Health Organization (WHO), European Core Health Indicator initiative (ECHI), Eurostat, Swiss ETH Zurich and the Czech environmental institute CENIA, and contributed to a workshop, held in June 2017 at the EEA in Copenhagen. First, selection criteria were defined to evaluate when and if results of internal chemical exposure measured by HBM, need to be translated into a European HBM-based indicator. Two main aspects are the HBM indicator’s relevance for policy, society, health, and the quality of the biomarker data (availability, comparability, ease of interpretation). Secondly, an approach for the calculation of the indicators was designed. Two types of indicators were proposed: ‘sum indicators of internal exposure’ derived directly from HBM biomarker concentrations and ‘indicators for health risk’, comparing HBM concentrations to HBM health-based guidance values (HBM HBGVs). In the latter case, both the percentage of the studied population exceeding the HBM HBGVs (PE) and the extent of exceedance (EE), calculated as the population’s exposure level divided by the HBM HBGV, can be calculated. These indicators were applied to two examples of hazardous chemicals: bisphenol A (BPA) and per- and polyfluoroalkyl substances (PFASs), which both have high policy and societal relevance and for which high quality published data were available (DEMOCOPHES, Swedish monitoring campaign). European HBM indicators help to summarize internal exposure to chemical substances among the European population and communicate to what degree environmental policies are successful in keeping internal exposures sufficiently low. The main aim of HBM indicators is to allow follow-up of chemical safety in Europe.

ACS Style

Jurgen Buekers; Madlen David; Gudrun Koppen; Jos Bessems; Martin Scheringer; Erik Lebret; Dimosthenis Sarigiannis; Marike Kolossa-Gehring; Marika Berglund; Greta Schoeters; Xenia Trier. Development of Policy Relevant Human Biomonitoring Indicators for Chemical Exposure in the European Population. International Journal of Environmental Research and Public Health 2018, 15, 2085 .

AMA Style

Jurgen Buekers, Madlen David, Gudrun Koppen, Jos Bessems, Martin Scheringer, Erik Lebret, Dimosthenis Sarigiannis, Marike Kolossa-Gehring, Marika Berglund, Greta Schoeters, Xenia Trier. Development of Policy Relevant Human Biomonitoring Indicators for Chemical Exposure in the European Population. International Journal of Environmental Research and Public Health. 2018; 15 (10):2085.

Chicago/Turabian Style

Jurgen Buekers; Madlen David; Gudrun Koppen; Jos Bessems; Martin Scheringer; Erik Lebret; Dimosthenis Sarigiannis; Marike Kolossa-Gehring; Marika Berglund; Greta Schoeters; Xenia Trier. 2018. "Development of Policy Relevant Human Biomonitoring Indicators for Chemical Exposure in the European Population." International Journal of Environmental Research and Public Health 15, no. 10: 2085.

Review article
Published: 28 August 2018 in Environment International
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Humans and wildlife are exposed to an intractably large number of different combinations of chemicals via food, water, air, consumer products, and other media and sources. This raises concerns about their impact on public and environmental health. The risk assessment of chemicals for regulatory purposes mainly relies on the assessment of individual chemicals. If exposure to multiple chemicals is considered in a legislative framework, it is usually limited to chemicals falling within this framework and co-exposure to chemicals that are covered by a different regulatory framework is often neglected. Methodologies and guidance for assessing risks from combined exposure to multiple chemicals have been developed for different regulatory sectors, however, a harmonised, consistent approach for performing mixture risk assessments and management across different regulatory sectors is lacking. At the time of this publication, several EU research projects are running, funded by the current European Research and Innovation Programme Horizon 2020 or the Seventh Framework Programme. They aim at addressing knowledge gaps and developing methodologies to better assess chemical mixtures, by generating and making available internal and external exposure data, developing models for exposure assessment, developing tools for in silico and in vitro effect assessment to be applied in a tiered framework and for grouping of chemicals, as well as developing joint epidemiological-toxicological approaches for mixture risk assessment and for prioritising mixtures of concern. The projects EDC-MixRisk, EuroMix, EUToxRisk, HBM4EU and SOLUTIONS have started an exchange between the consortia, European Commission Services and EU Agencies, in order to identify where new methodologies have become available and where remaining gaps need to be further addressed. This paper maps how the different projects contribute to the data needs and assessment methodologies and identifies remaining challenges to be further addressed for the assessment of chemical mixtures.

ACS Style

Stephanie K. Bopp; Robert Barouki; Werner Brack; Silvia Dalla Costa; Jean-Lou C.M. Dorne; Paula E. Drakvik; Michael Faust; Tuomo K. Karjalainen; Stylianos Kephalopoulos; Jacob van Klaveren; Marike Kolossa-Gehring; Andreas Kortenkamp; Erik Lebret; Teresa Lettieri; Sofie Nørager; Joëlle Rüegg; Jose V. Tarazona; Xenia Trier; Bob van de Water; Jos van Gils; Åke Bergman. Current EU research activities on combined exposure to multiple chemicals. Environment International 2018, 120, 544 -562.

AMA Style

Stephanie K. Bopp, Robert Barouki, Werner Brack, Silvia Dalla Costa, Jean-Lou C.M. Dorne, Paula E. Drakvik, Michael Faust, Tuomo K. Karjalainen, Stylianos Kephalopoulos, Jacob van Klaveren, Marike Kolossa-Gehring, Andreas Kortenkamp, Erik Lebret, Teresa Lettieri, Sofie Nørager, Joëlle Rüegg, Jose V. Tarazona, Xenia Trier, Bob van de Water, Jos van Gils, Åke Bergman. Current EU research activities on combined exposure to multiple chemicals. Environment International. 2018; 120 ():544-562.

Chicago/Turabian Style

Stephanie K. Bopp; Robert Barouki; Werner Brack; Silvia Dalla Costa; Jean-Lou C.M. Dorne; Paula E. Drakvik; Michael Faust; Tuomo K. Karjalainen; Stylianos Kephalopoulos; Jacob van Klaveren; Marike Kolossa-Gehring; Andreas Kortenkamp; Erik Lebret; Teresa Lettieri; Sofie Nørager; Joëlle Rüegg; Jose V. Tarazona; Xenia Trier; Bob van de Water; Jos van Gils; Åke Bergman. 2018. "Current EU research activities on combined exposure to multiple chemicals." Environment International 120, no. : 544-562.

Original research article
Published: 15 August 2018 in Risk Analysis
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Why do countries regulate, or prefer to regulate, environmental health risks such as radiofrequency electromagnetic fields and endocrine disruptors differently? A wide variety of theories, models, and frameworks can be used to help answer this question, though the resulting answer will strongly depend on the theoretical perspective that is applied. In this theoretical review, we will explore eight conceptual frameworks, from different areas of science, which will offer eight different potential explanations as to why international differences occur in environmental health risk management. We are particularly interested in frameworks that could shed light on the role of scientific expertise within risk management processes. The frameworks included in this review are the Risk Assessment Paradigm, research into the roles of experts as policy advisors, the Psychometric Paradigm, the Cultural Theory of Risk, participatory approaches to risk assessment and risk management, the Advocacy Coalition Framework, the Social Amplification of Risk Framework, and Hofstede's Model of National Cultures. We drew from our knowledge and experiences regarding a diverse set of academic disciplines to pragmatically assemble a multidisciplinary set of frameworks. From the ideas and concepts offered by the eight frameworks, we derive pertinent questions to be used in further empirical work and we present an overarching framework to depict the various links that could be drawn between the frameworks.

ACS Style

Sander C. S. Clahsen; Irene Van Kamp; Betty C. Hakkert; Theo G. Vermeire; Aldert H. Piersma; Erik Lebret. Why Do Countries Regulate Environmental Health Risks Differently? A Theoretical Perspective. Risk Analysis 2018, 39, 439 -461.

AMA Style

Sander C. S. Clahsen, Irene Van Kamp, Betty C. Hakkert, Theo G. Vermeire, Aldert H. Piersma, Erik Lebret. Why Do Countries Regulate Environmental Health Risks Differently? A Theoretical Perspective. Risk Analysis. 2018; 39 (2):439-461.

Chicago/Turabian Style

Sander C. S. Clahsen; Irene Van Kamp; Betty C. Hakkert; Theo G. Vermeire; Aldert H. Piersma; Erik Lebret. 2018. "Why Do Countries Regulate Environmental Health Risks Differently? A Theoretical Perspective." Risk Analysis 39, no. 2: 439-461.

Journal article
Published: 05 April 2018 in Environmental Health Perspectives
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Green space may influence health through several pathways, for example, increased physical activity, enhanced social cohesion, reduced stress, and improved air quality. For green space to increase physical activity and social cohesion, spending time in green spaces is likely to be important. We examined whether adolescents visit green spaces and for what purposes. Furthermore, we assessed the predictors of green space visits. In this cross-sectional study, data for 1911 participants of the Dutch PIAMA (Prevention and Incidence of Asthma and Mite Allergy) birth cohort were analyzed. At age 17, adolescents reported how often they visited green spaces for physical activities, social activities, relaxation, and to experience nature and quietness. We assessed the predictors of green space visits altogether and for different purposes by log-binomial regression. Fifty-three percent of the adolescents visited green spaces at least once a week in summer, mostly for physical and social activities. Adolescents reporting that a green environment was (very) important to them visited green spaces most frequently {adjusted prevalence ratio (PR) [95% confidence interval (CI)] very vs. not important: 6.84 (5.10, 9.17) for physical activities and 4.76 (3.72, 6.09) for social activities}. Boys and adolescents with highly educated fathers visited green spaces more often for physical and social activities. Adolescents who own a dog visited green spaces more often to experience nature and quietness. Green space visits were not associated with the objectively measured quantity of residential green space, i.e., the average normalized difference vegetation index (NDVI) and percentages of urban, agricultural, and natural green space in circular buffers around the adolescents’ homes. Subjective variables are stronger predictors of green space visits in adolescents than the objectively measured quantity of residential green space. https://doi.org/10.1289/EHP2429

ACS Style

Lizan D. Bloemsma; Ulrike Gehring; Jochem O. Klompmaker; Gerard Hoek; Nicole A.H. Janssen; Henriette A. Smit; Judith M. Vonk; Bert Brunekreef; Erik Lebret; Alet H. Wijga. Green Space Visits among Adolescents: Frequency and Predictors in the PIAMA Birth Cohort Study. Environmental Health Perspectives 2018, 126, 1 .

AMA Style

Lizan D. Bloemsma, Ulrike Gehring, Jochem O. Klompmaker, Gerard Hoek, Nicole A.H. Janssen, Henriette A. Smit, Judith M. Vonk, Bert Brunekreef, Erik Lebret, Alet H. Wijga. Green Space Visits among Adolescents: Frequency and Predictors in the PIAMA Birth Cohort Study. Environmental Health Perspectives. 2018; 126 (4):1.

Chicago/Turabian Style

Lizan D. Bloemsma; Ulrike Gehring; Jochem O. Klompmaker; Gerard Hoek; Nicole A.H. Janssen; Henriette A. Smit; Judith M. Vonk; Bert Brunekreef; Erik Lebret; Alet H. Wijga. 2018. "Green Space Visits among Adolescents: Frequency and Predictors in the PIAMA Birth Cohort Study." Environmental Health Perspectives 126, no. 4: 1.

Conference paper
Published: 18 March 2018 in Noise
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Background/aim Exposure to air pollution, noise and green space may be associated with children’s body mass index. However, no studies have examined the combined effects of these environmental exposures on markers of adiposity in children. We investigated the individual and combined associations of air pollution, road traffic noise and green space with overweight in children aged 12 years. Methods Weight and height were measured at age 12 years in 1508 participants of the Dutch PIAMA birth cohort study. Annual average air pollution levels (NO2, PM2.5, PM10, PMcoarse, and PM2.5 absorbance) at the children’s homes were estimated by land-use regression models. Road traffic noise exposure was assessed by linking children’s home addresses to modelled road traffic noise levels. We used different indicators to assess exposure to green space: the average Normalised Difference Vegetation Index (NDVI) and percentages of urban, agricultural and natural green space in buffers of 300 m and 3000 m around the children’s homes, and the distance from the homes to the nearest park. We analysed the associations between the exposures and overweight by logistic regression. Results Twelve percent of the children were overweight. Neither in single- nor in multi-exposure models we found significant associations of air pollution, road traffic noise, and green space with overweight. For example, we found an OR per interquartile range increase in exposure of 1.12 [95% CI: 0.90 to 1.39] for NO2, OR 1.03 [95% CI: 0.84 to 1.26] for PM2.5 absorbance, OR 1.15 [95% CI: 0.94 to 1.40] for road traffic noise and OR 0.85 [95% CI: 0.68 to 1.05] and OR 0.87 [95% CI: 0.71 to 1.06] for the average NDVI in the 300 m and 3000 m buffer, respectively, in single-exposure models. The associations changed only slightly when the other environmental exposures were added in multi-exposure models. Conclusion Our results do not provide support for adverse effects of air pollution and road traffic noise or beneficial effects of green space exposure on overweight in children aged 12 years. We will perform longitudinal analyses to examine the associations of air pollution, road traffic noise and green space with overweight throughout childhood.

ACS Style

Lizan Bloemsma; Ulrike Gehring; Jochem Klompmaker; Henriëtte Smit; Johan De Jongste; Judith Vonk; Gerard Hoek; Nicole Janssen; Bert Brunekreef; Erik Lebret; Alet Wijga. OP XI – 3 Air pollution, noise, green space and overweight in children aged 12 years: the piama birth cohort study. Noise 2018, 75, A21 -A21.

AMA Style

Lizan Bloemsma, Ulrike Gehring, Jochem Klompmaker, Henriëtte Smit, Johan De Jongste, Judith Vonk, Gerard Hoek, Nicole Janssen, Bert Brunekreef, Erik Lebret, Alet Wijga. OP XI – 3 Air pollution, noise, green space and overweight in children aged 12 years: the piama birth cohort study. Noise. 2018; 75 ():A21-A21.

Chicago/Turabian Style

Lizan Bloemsma; Ulrike Gehring; Jochem Klompmaker; Henriëtte Smit; Johan De Jongste; Judith Vonk; Gerard Hoek; Nicole Janssen; Bert Brunekreef; Erik Lebret; Alet Wijga. 2018. "OP XI – 3 Air pollution, noise, green space and overweight in children aged 12 years: the piama birth cohort study." Noise 75, no. : A21-A21.

Journal article
Published: 01 January 2018 in Environmental Research
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In epidemiological studies, exposure to green space is inconsistently associated with being overweight and physical activity, possibly because studies differ widely in their definition of green space exposure, inclusion of important confounders, study population and data analysis.We evaluated whether the association of green space with being overweight and physical activity depended upon definition of greenspace.We conducted a cross-sectional study using data from a Dutch national health survey of 387,195 adults. Distance to the nearest park entrance and surrounding green space, based on the Normalized Difference Vegetation Index (NDVI) or a detailed Dutch land-use database (TOP10NL), was calculated for each residential address. We used logistic regression analyses to study the association of green space exposure with being overweight and being moderately or vigorously physically active outdoors at least 150min/week (self-reported). To study the shape of the association, we specified natural splines and quintiles.The distance to the nearest park entrance was not associated with being overweight or outdoor physical activity. Associations of surrounding green space with being overweight or outdoor physical activity were highly non-linear. For NDVI surrounding greenness, we observed significantly decreased odds of being overweight [300m buffer, odds ratio (OR) = 0.88; 95% CI: 0.86, 0.91] and increased odds for outdoor physical activity [300m buffer, OR = 1.14; 95% CI: 1.10, 1.17] in the highest quintile compared to the lowest quintile. For TOP10NL surrounding green space, associations were mostly non-significant. Associations were generally stronger for subjects living in less urban areas and for the smaller buffers.Associations of green space with being overweight and outdoor physical activity differed considerably between different green space definitions. Associations were strongest for NDVI surrounding greenness.

ACS Style

Jochem O. Klompmaker; Gerard Hoek; Lizan D. Bloemsma; Ulrike Gehring; Maciej Strak; Alet H. Wijga; Carolien Van Den Brink; Bert Brunekreef; Erik Lebret; Nicole A.H. Janssen. Green space definition affects associations of green space with overweight and physical activity. Environmental Research 2018, 160, 531 -540.

AMA Style

Jochem O. Klompmaker, Gerard Hoek, Lizan D. Bloemsma, Ulrike Gehring, Maciej Strak, Alet H. Wijga, Carolien Van Den Brink, Bert Brunekreef, Erik Lebret, Nicole A.H. Janssen. Green space definition affects associations of green space with overweight and physical activity. Environmental Research. 2018; 160 ():531-540.

Chicago/Turabian Style

Jochem O. Klompmaker; Gerard Hoek; Lizan D. Bloemsma; Ulrike Gehring; Maciej Strak; Alet H. Wijga; Carolien Van Den Brink; Bert Brunekreef; Erik Lebret; Nicole A.H. Janssen. 2018. "Green space definition affects associations of green space with overweight and physical activity." Environmental Research 160, no. : 531-540.

Journal article
Published: 11 December 2017 in International Journal of Environmental Research and Public Health
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To effectively manage environmental health risks, stakeholders often need to act collectively. Stakeholders vary in their desire to act due to many factors, such as knowledge, risk perception, interests, and worldviews. Understanding their perceptions of the issues at stake is crucial to support the risk governance process. Even though concern assessment is a pivotal element of risk governance, few tools for rapid assessment are reported in the literature. We tested a rapid and relatively cheap approach, taking the Dutch debate on Intensive Animal Production Systems (IAPS) and health as an example. Dutch policy-oriented publications on IAPS and health and ten semi-structured in-depth interviews with a variety of stakeholders were analyzed to identify stakeholders and concerns involved in the Dutch debate about IAPS and health. Concerns were mapped and a stakeholder network was derived. Three classes of concerns were recognized in the discussions about IAPS and health: concerns related to health risks, concerns regarding the activity causing the risks (IAPS), and concerns about the process to control the risks. The notions of ‘trust’ and ‘scientific uncertainty’ appeared as important themes in the discussions. Argumentation based on concerns directly related to health risks, the activity causing the risk (IAPS), and its risk management can easily become muddled up in a societal debate, limiting the development of effective action perspectives. Acknowledging these multiple stakeholder concerns can clarify the positions taken by stakeholders and allow for more and other action perspectives to develop.

ACS Style

Marleen Kraaij-Dirkzwager; Joost Van Der Ree; Erik Lebret. Rapid Assessment of Stakeholder Concerns about Public Health. An Introduction to a Fast and Inexpensive Approach Applied on Health Concerns about Intensive Animal Production Systems. International Journal of Environmental Research and Public Health 2017, 14, 1534 .

AMA Style

Marleen Kraaij-Dirkzwager, Joost Van Der Ree, Erik Lebret. Rapid Assessment of Stakeholder Concerns about Public Health. An Introduction to a Fast and Inexpensive Approach Applied on Health Concerns about Intensive Animal Production Systems. International Journal of Environmental Research and Public Health. 2017; 14 (12):1534.

Chicago/Turabian Style

Marleen Kraaij-Dirkzwager; Joost Van Der Ree; Erik Lebret. 2017. "Rapid Assessment of Stakeholder Concerns about Public Health. An Introduction to a Fast and Inexpensive Approach Applied on Health Concerns about Intensive Animal Production Systems." International Journal of Environmental Research and Public Health 14, no. 12: 1534.

Journal article
Published: 01 March 2017 in International Journal of Hygiene and Environmental Health
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Human biomonitoring as a tool to support chemicals regulation in the European Union Discussio

ACS Style

Catherine Ganzleben; Jean-Philippe Antignac; Robert Barouki; Argelia Castaño; Ulrike Fiddicke; Jana Klanova; Erik Lebret; Nicolas Olea; Dimosthenis Sarigiannis; Greta Schoeters; Ovnair Sepai; Hanna Tolonen; Marike Kolossa-Gehring. Human biomonitoring as a tool to support chemicals regulation in the European Union. International Journal of Hygiene and Environmental Health 2017, 220, 94 -97.

AMA Style

Catherine Ganzleben, Jean-Philippe Antignac, Robert Barouki, Argelia Castaño, Ulrike Fiddicke, Jana Klanova, Erik Lebret, Nicolas Olea, Dimosthenis Sarigiannis, Greta Schoeters, Ovnair Sepai, Hanna Tolonen, Marike Kolossa-Gehring. Human biomonitoring as a tool to support chemicals regulation in the European Union. International Journal of Hygiene and Environmental Health. 2017; 220 (2):94-97.

Chicago/Turabian Style

Catherine Ganzleben; Jean-Philippe Antignac; Robert Barouki; Argelia Castaño; Ulrike Fiddicke; Jana Klanova; Erik Lebret; Nicolas Olea; Dimosthenis Sarigiannis; Greta Schoeters; Ovnair Sepai; Hanna Tolonen; Marike Kolossa-Gehring. 2017. "Human biomonitoring as a tool to support chemicals regulation in the European Union." International Journal of Hygiene and Environmental Health 220, no. 2: 94-97.

Comparative study
Published: 01 January 2017 in Journal of Public Health Management and Practice
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Epidemiological preparedness is vital in providing relevant, transparent, and timely intelligence for the management, mitigation, and prevention of public health impacts following major environmental health incidents. A register is a set of records containing systematically collected, standardized data about individual people. Planning for a register of people affected by or exposed to an incident is one of the evolving tools in the public health preparedness and response arsenal. We compared and contrasted the instigation and design of health registers in the epidemiological response to major environmental health incidents in England, France, Italy, the Netherlands, and the United States. Consultation with experts from the 5 nations, supplemented with a review of gray and peer-reviewed scientific literature to identify examples where registers have been used. Populations affected by or at risk from major environmental health incidents in England, France, Italy, the Netherlands, and the United States. Nations were compared with respect to the (1) types of major incidents in their remit for considering a register; (2) arrangements for triggering a register; (3) approaches to design of register; (4) arrangements for register implementation; (5) uses of registers; and (6) examples of follow-up studies. Health registers have played a key role in the effective public health response to major environmental incidents, including sudden chemical, biological, radiological, or nuclear, as well as natural, more prolonged incidents. Value has been demonstrated in the early and rapid deployment of health registers, enabling the capture of a representative population. The decision to establish a health register must ideally be confirmed immediately or soon after the incident using a set of agreed criteria. The establishment of protocols for the instigation, design, and implementation of health registers is recommended as part of preparedness activities. Key stakeholders must be aware of the importance of, and protocols for, establishing a register. Agencies will find value in preparing and implementing registers as part of an effective public health response to major environmental incidents, including sudden chemical, biological, radiological, or nuclear incidents, as well as natural, more prolonged incidents.

ACS Style

Behrooz Behbod; Giovanni Leonardi; Yvon Motreff; Charles R. Beck; Joris Yzermans; Erik Lebret; Oleg I. Muravov; Tesfaye Bayleyegn; Amy Funk Wolkin; Paolo Lauriola; Rebecca Close; Helen Crabbe; Philippe Pirard. An International Comparison of the Instigation and Design of Health Registers in the Epidemiological Response to Major Environmental Health Incidents. Journal of Public Health Management and Practice 2017, 23, 20 -28.

AMA Style

Behrooz Behbod, Giovanni Leonardi, Yvon Motreff, Charles R. Beck, Joris Yzermans, Erik Lebret, Oleg I. Muravov, Tesfaye Bayleyegn, Amy Funk Wolkin, Paolo Lauriola, Rebecca Close, Helen Crabbe, Philippe Pirard. An International Comparison of the Instigation and Design of Health Registers in the Epidemiological Response to Major Environmental Health Incidents. Journal of Public Health Management and Practice. 2017; 23 (1):20-28.

Chicago/Turabian Style

Behrooz Behbod; Giovanni Leonardi; Yvon Motreff; Charles R. Beck; Joris Yzermans; Erik Lebret; Oleg I. Muravov; Tesfaye Bayleyegn; Amy Funk Wolkin; Paolo Lauriola; Rebecca Close; Helen Crabbe; Philippe Pirard. 2017. "An International Comparison of the Instigation and Design of Health Registers in the Epidemiological Response to Major Environmental Health Incidents." Journal of Public Health Management and Practice 23, no. 1: 20-28.