Risks and Ultraviolet Budgets using Earth Observation (RUBEO): Including a nonstandard atmosphere and geographic ozone trend differences in risk assessments

No RIVM report number in publicationUV-budget maps (the geographical distribution of effective UV at ground level) can be derived from satellite data. These UV-budget maps visualise changes in effective UV caused by ozone depletion and changes in cloud cover and aerosol content. Alterations in UV-budget maps over time give - in combination with dose-effect models for UV-induced effects - insight in the associated risks for human health and the environment. This report describes the results of the RUBEO-project: calculating Risks and Ultraviolet Budgets using Earth Observation (RUBEO). RUBEO aims at a better cloud parameterisation and incorporating temporal and spatial resolution for surface albedo, aerosol content and tropospheric ozone content. The geographical distribution of ozone and UV climatology and trends over Europe are analysed, and a cost-benefit analysis of satellite based UV budget mapping is provided. The UV-budget mapping can be applied using TOMS and GOME ozone data. A large scale statistical analysis of cloud effects is given comparing ISCCP and TOMS based remote sensing methods with cloud effects derived from ground measurements. Both satellite derived methods correlate well (r 0.93) with the ground based analysis. Correction for non-zero albedo, under clear sky conditions, adds maximal 8% to the yearly effective UV-budget. Temporal and spatial differences in aerosol optical thickness and tropospheric ozone content, result in a decrease in effective UV of 3% for every 0.1 increase in aerosol optical thickness, and in a decrease in effective UV of 4% for every 10 DU increase in tropospheric ozone. Stratospheric ozone trends of -1 to -4% per decade observed over Europe correspond to a 0.5 to 4% increase in skin cancer weighted effective UV. The largest trends are seen in the central part of Western Europe. At present satellite based UV-budget maps form a functional basis for trend analysis and risk assessment. However, satellite data and ground-based observations are both indispensable. Maps for changing UV-budgets and associated skin cancer risks have been used in 'state of the environment', reports. Such overviews, regularly published by the Dutch National Institute of Public Health and the Environment (RIVM) and the European Environmental Agency (EPA), support the evaluation and formulation of adequate environmental policies. This report describes a project carried out in the framework of the Users Support Programme (USP-2), under responsibility of the Netherlands Remote Sensing Board (BCRS).Beleidscommissie Remote Sensing (BCRS

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes.

Abstract BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo. (Funded by Amylin Pharmaceuticals; EXSCEL ClinicalTrials.gov number, NCT01144338 .)

Magnetic fields near high-voltage substations and termination towers

Er zijn aanwijzingen dat kinderen die dicht bij bovengrondse hoogspanningslijnen wonen mogelijk een hogere kans hebben om leukemie te krijgen. Daarom is er in Nederland sinds 2005 uit voorzorg beleid op dit gebied. De overheid wil daarmee zo veel mogelijk voorkomen dat kinderen in nieuwe situaties lange tijd in de magneetveldzone van bovengrondse hoogspanningslijnen verblijven. De minister voor Klimaat en Energie wil met de minister voor Volkshuisvesting en Ruimtelijke Ordening dit beleid nu aanpassen. Het huidige beleid voor hoogspanningslijnen wordt uitgebreid naar andere onderdelen van het elektriciteitsnetwerk: ondergrondse kabels, hoogspanningsstations, zogeheten opstijgpunten en transformatorhuisjes. De ministers overwegen om voor de grootte van de magneetveldzone rond deze onderdelen vaste afstanden te kiezen. Dan hoeft het magneetveld niet steeds voor elk onderdeel apart te worden berekend. Het RIVM heeft daarom de magneetveldcontouren bij zes hoogspanningsstations en zes opstijgpunten laten berekenen en geanalyseerd. Hieruit blijkt dat de omtrek van de magneetveldzone rond een hoogspanningsstation grillig verloopt. Die magneetveldzone kan zich uitstrekken tot 65 meter buiten het hek van het station. Deze afstanden geven slechts een indruk, omdat maar een klein aantal locaties is onderzocht. Het is daarom niet makkelijk om op basis van deze inzichten één vaste afstand te kiezen. Meer berekeningen zouden deze beperking kunnen oplossen. Het kan zijn dat de ministeries met de huidige gegevens voor een vaste afstand willen kiezen. In dat geval stelt het RIVM voor om daar een extra veiligheidsmarge aan toe te voegen. Ze kunnen er ook voor kiezen om de magneetveldcontour bij de stations, net als bij bovengrondse hoogspanningslijnen, te laten uitrekenen en geen vaste afstand te gebruiken.There are indications that children who live near overhead high-voltage power lines may be at higher risk of developing leukaemia. These findings led to the introduction of a precautionary policy in the Netherlands in 2005. With this policy, the government aims to prevent new situations in which children spend long periods of time in the magnetic field zone of overhead high-voltage power lines as much as possible. The Minister for Climate and Energy Policy now wants to amend this policy along with the Minister for Housing and Spatial Planning. The current policy on high-voltage power lines is to be expanded to include other components of the electricity network: underground cables, highvoltage substations, termination towers and transformer boxes. The ministers are considering choosing fixed distances for the size of the magnetic field zone around these components. This would eliminate the need to always calculate the magnetic field separately for each component. RIVM has therefore commissioned the calculation of magnetic field contours at six high-voltage substations and six termination towers, and has analysed the contours. The findings show that the circumference of the magnetic field zone around high-voltage substations is irregular. This magnetic field zone can extend up to 65 meters beyond the substation fence. These distances only give an impression, since only a few sites were examined. As a result, it is not easy to choose a single fixed distance based on these insights. Further calculations could resolve this limitation. The Ministries may want to choose a fixed distance based on the current data. In that case, RIVM proposes that an additional safety margin be added. They may also choose to have the magnetic field contour at the substations calculated, as in the case of overhead high-voltage power lines, and not to use a fixed distance

Calculating magnetic field zone near overhead power lines in close proximity

Het RIVM stelt voor om de Handreiking waarmee de magneetveldzone bij bovengrondse hoogspanningslijnen wordt berekend, te actualiseren. De huidige Handreiking is in 2009 opgesteld om ervoor te zorgen dat de magneetveldzone steeds op dezelfde manier berekend wordt. De Handreiking beschrijft de berekening voor een afzonderlijke bovengrondse hoogspanningslijn. In andere situaties, bijvoorbeeld bij hoogspanningsverbindingen die zo dicht bij elkaar liggen dat ze elkaars magneetveld beïnvloeden, konden adviesbureaus het RIVM per geval om verduidelijking vragen. Het voorstel is om de Handreiking uit te breiden met rekenvoorschriften voor die situaties waarin twee of meer bovengrondse hoogspanningsverbindingen zich in elkaars nabijheid bevinden. De voorgestelde wijzigingen zijn het resultaat van verkennende berekeningen voor situaties waarin deze beïnvloeding aan de orde is. De uitbreiding is van belang omdat het aantal locaties waar hoogspanningsverbindingen zich dicht bij elkaar bevinden toeneemt. Dat komt omdat nieuwe hoogspanningslijnen met het oog op een goede ruimtelijke ordening zo veel mogelijk met bestaande lijnen worden gebundeld, waardoor twee rijen masten naast elkaar ontstaan. Ook kan het zijn dat de draden van een nieuwe verbinding met de draden van een bestaande lijn op één rij masten worden gecombineerd. Als gevolg van de voorgestelde aanpassingen zullen de adviesbureaus die in staat zijn om een magneetveldzone volgens de huidige Handreiking te berekenen, opnieuw moeten worden beoordeeld. Er zal dan worden getest of zij ook in staat zijn om berekeningen uit te voeren voor de situaties waar sprake is van beïnvloeding. De Handreiking is voortgekomen uit het voorzorgsbeleid voor bovengrondse hoogspanningslijnen uit 2005. Hierin is een magneetveldzone gedefinieerd waarbinnen in nieuwe situaties zo weinig mogelijk woningen, scholen, crèches en kinderopvangplaatsen terecht mogen komen. Aanleiding hiervoor was wetenschappelijk onderzoek dat aangeeft dat kinderen die in de buurt van bovengrondse hoogspanningslijnen wonen een grotere kans hebben om leukemie te krijgen.RIVM proposes to update the Dutch Guideline used to calculate the magnetic field zone near overhead power lines. The present Guideline has been prepared in 2009 to ensure that the magnetic field zones are always calculated in the same way. The Guideline describes the calculation for one separate overhead power line. In other situations, such as power connectors that are so close together that they influence each other's magnetic field, consultants could ask RIVM per case for clarification. The proposal is to expand the Guideline with calculation instructions for those situations where two or more overhead power connectors are in close proximity. The proposed amendments are the result of exploratory calculations for situations in which this influence is relevant. The expansion is important because the number of locations is increasing where overhead power connectors are close to each other. This is because - to ensure good spatial planning - new power connectors are bundled, resulting in two rows of masts close together. It is also possible that the cables of a new connector are combined with the cables of an existing line resulting in one row of masts. Due to the proposed changes, the consultants who are able to calculate a magnetic field zone according to the present Guideline should be reassessed. There will then be tested whether they are also able to perform calculations for the situations where mutual influence is relevant. The Guideline emerged from the precautionary policy to overhead power lines issued in 2005. This policy defines a magnetic field zone within which, in new situations, as few as possible dwellings, schools and crèches are to be situated. The reason for the policy was that scientific research indicates that children who live in the vicinity of overhead power lines are more likely to develop leukaemia.Ministerie van Infrastructuur en Milie

Background of the Dutch overhead power line policy

Magnetische velden afkomstig van bovengrondse hoogspanningslijnen mogen in nieuwe woningen, scholen en kinderdagverblijven niet sterker zijn dan 0,4 microtesla. De overheid adviseert daarom gemeenten, provincies en netbeheerders om rond die hoogspanningslijnen preventief een zone in te stellen die vrij blijft van dergelijke bebouwing. Dit geldt voor situaties waarin nieuwe woningen in de buurt van een bovengrondse hoogspanningslijn worden gebouwd of nieuwe hoogspanningslijnen die bij bestaande woonwijken worden gerealiseerd. Het Rijksinstituut voor Volksgezondheid en Milieu (RIVM) heeft het ministerie van Volkshuisvesting, Ruimtelijke Ordening en Milieubeheer (VROM) ondersteund bij het ontwikkelen van dit beleid. Het beleid is ontwikkeld omdat kinderen die in de buurt van bovengrondse hoogspanningslijnen wonen mogelijk een hogere kans op leukemie hebben. Het magnetische veld zou daarvoor verantwoordelijk kunnen zijn, al is een oorzakelijk verband niet bewezen. Met het voorzorgsbeleid wil de overheid voorkomen dat het potentiele risico toeneemt. De magneetveldzone rond de hoogspanningslijnen markeert een gebied waarin het magnetische veld, gemiddeld over een jaar genomen, sterker is dan 0,4 microtesla. De breedte van de zone wordt afgeleid uit de nominale stroom waarvoor de hoogspanningslijn is ontworpen. De keuze voor deze magneetveldzone sluit goed aan bij internationale epidemiologische onderzoeken. Het RIVM heeft de overheid bijgestaan door de beleidsmakers van actuele wetenschappelijke kennis te voorzien. Daarnaast heeft het instituut hulpmiddelen ontwikkeld om het beleid naar de praktijk te kunnen vertalen. De twee belangrijkste hulpmiddelen zijn: een methode om de magneetveldzone te berekenen en een digitale kaart van de Nederlandse bovengrondse hoogspanningslijnen met bijbehorende magneetveldzones. Deze hulpmiddelen zijn te vinden op een website die het RIVM voor gemeenten, provincies en netbeheerders heeft ontwikkeld, http://www.rivm.nl/hoogspanningslijnen.Magnetic fields due to overhead power lines in new dwellings, schools and daycare centres should not exceed 0.4 microtesla. The Dutch government advises municipalities, provinces and grid companies in achieving this standard by establishing, as preventive measure, zones that are kept free from these type of buildings. This applies to new developments in the vicinity of existing power lines and to new power lines being developed close to existing residential areas. RIVM supported the Ministry of Environment in developing this overhead power line policy. The policy has been developed because children living near overhead power lines may run an increased leukaemia risk due to magnetic fields from the power lines, although a causal connection has not been proven. The goal of this precautionary policy is to prevent a future increase in this potential risk. The magnetic field zone marks an area in the vicinity of the power lines where the magnetic field averaged over a year exceeds 0.4 microtesla. Its width is derived from the nominal current for which the power line has been designed. This choice for the magnetic field zone is in line with international epidemiological surveys. RIVM supported the government in providing policy makers with the best available scientific knowledge and also developed tools for implementing the policy. A guideline for calculating the magnetic field zone and a digital map of the overhead power lines with the corresponding magnetic field zones form the two most important tools. These tools are available in Dutch via the website http://www.rivm.nl/hoogspanningslijnen developed by RIVM for municipalities, provinces and grid companies.VROM-DGM-SA

Power line policy in practice : A pilot study

Uit een quick scan van het RIVM onder twaalf gemeenten met hoogspanningslijnen in de provincie Utrecht blijkt dat de helft van deze gemeenten niet op de hoogte is van het VROM-advies voor hoogspanningslijnen. Gemeenten waar de hoogspanningslijnenproblematiek speelt, zijn over het algemeen wil van het beleid op de hoogte. Onder druk van verontruste burgers nemen zij vaak strengere maatregelen dan wordt geadviseerd, bijvoorbeeld door maatregelen voor bestaande situaties te treffen of door een vastgesteld woningbouwplan uit te stellen. Geen van de geonterviewde gemeenten heeft een duidelijk aanspreekpunt om hun inwoners over hoogspanningslijnen te informeren. Internationaal epidemiologisch onderzoek wijst op een mogelijk verhoogd risico op leukemie bij kinderen die in de buurt van bovengrondse hoogspanningslijnen wonen. Eind 2005 heeft VROM een beleidsadvies hierover naar gemeenten, provincies en netbeheerders gestuurd. Het ministerie wil voorkomen dat kinderen in nieuwe situaties langdurig aan magnetische velden van bovengrondse hoogspanningslijnen worden blootgesteld. VROM adviseert daarom in nieuwe situaties een zone bij de hoogspanningslijnen vrij te houden van woningen, scholen en kinderdagverblijven. Het advies richt zich op het opstellen of wijzigen van bestemmingsplannen. Omdat een dergelijke procedure jaren duurt, kan nu, ruim twee jaar nadat het advies is ingevoerd, nog niet worden beoordeeld of het succesvol is. De quick scan vond plaats in opdracht van de VROM-Inspectie Regio Noord-West, die wil achterhalen welke rol het VROM-advies binnen gemeenten speelt en welke invloed burgers op het hoogspanningslijnenbeleid uitoefenen.A Quick Scan performed by RIVM among twelve municipalities with an overhead power line revealed that half of these municipalities were not aware of the power line policy recommended by the Netherlands Ministry of Housing, Spatial Planning and the Environment (VROM). Those municipalities where power lines are an (openly) debated public issue are generally well-informed on the recommended policy. Due to public pressure, these latter municipalities often take more stringent measures than those advised by the VROM; these include implementing specific measures for existing neighbourhoods and/or postponing construction plans for new neighbourhoods that have already received council approval. None of the municipalities interviewed had an information service specifically aimed at providing their residents with information on power lines. Results from international epidemiological investigations point to the possibility that children living in the vicinity of overhead power lines may have an enhanced risk of developing childhood leukaemia. At the end of 2005 the VROM issued a policy advice for municipalities, provinces and grid companies. The aim of this policy advice is to prevent situations from developing where children can be subjected to long-term exposure to magnetic fields due to overhead power lines. In such new situations, the Ministry advises local governments to reserve a buffer zone near the power line that is to be kept empty of home residences, schools and day-care centres. As the policy advice focuses on the framing or changing of zoning plans - procedures which may take several years - it is currently impossible to evaluate if this policy advice issued in 2005 has been successful. The Quick Scan was performed by order of the Inspectorate of the Ministry of Housing, Spatial Planning and the Environment of the Northwest Region of the Netherlands. The aim of the Inspectorate was to evaluate the role of the policy advice at the municipal level and the degree to which individuals can influence a municipality's decision on power line placement.VROM-Inspectie Regio Noord-WestAfdeling Veiligheid en Risico'