Long-Term Effects of Traffic-Related Air Pollution on Mortality in a Dutch Cohort (NLCS-AIR Study)

BACKGROUND: Several studies have found an effect on mortality of between-city contrasts in long-term exposure to air pollution. The effect of within-city contrasts is still poorly understood. OBJECTIVES: We studied the association between long-term exposure to traffic-related air pollution and mortality in a Dutch cohort. METHODS: We used data from an ongoing cohort study on diet and cancer with 120,852 subjects who were followed from 1987 to 1996. Exposure to black smoke (BS), nitrogen dioxide, sulfur dioxide, and particulate matter < or = 2.5 microm (PM(2.5)), as well as various exposure variables related to traffic, were estimated at the home address. We conducted Cox analyses in the full cohort adjusting for age, sex, smoking, and area-level socioeconomic status. RESULTS: Traffic intensity on the nearest road was independently associated with mortality. Relative risks (95% confidence intervals) for a 10-microg/m(3) increase in BS concentrations (difference between 5th and 95th percentile) were 1.05 (1.00-1.11) for natural cause, 1.04 (0.95-1.13) for cardiovascular, 1.22 (0.99-1.50) for respiratory, 1.03 (0.88-1.20) for lung cancer, and 1.04 (0.97-1.12) for mortality other than cardiovascular, respiratory, or lung cancer. Results were similar for NO(2) and PM(2.5), but no associations were found for SO(2). CONCLUSIONS: Traffic-related air pollution and several traffic exposure variables were associated with mortality in the full cohort. Relative risks were generally small. Associations between natural-cause and respiratory mortality were statistically significant for NO(2) and BS. These results add to the evidence that long-term exposure to ambient air pollution is associated with increased mortality

Effectiveness of a parenting programme in a public health setting: a randomised controlled trial of the positive parenting programme (Triple P) level 3 versus care as usual provided by the preventive child healthcare (PCH)

BACKGROUND: Considering the high burden of disease of psychosocial problems in children and adolescents, early intervention regarding problem behaviour of young children is very important. The Preventive Child Healthcare (PCH) offers a good setting to detect such problem behaviour and to provide parenting support to the parents concerned. This paper aims to describe the design of an effectiveness study of a parenting programme for parents of children with mild psychosocial problems after an initial, evidence based screening in routine PCH. METHODS/DESIGN: The effects of the intervention will be studied in a randomised controlled trial. Prior to a routine PCH health examination, parents complete a screening questionnaire on psychosocial problems. Parents of children with increased but still subclinical levels of psychosocial problems will be assigned at random to the experimental group (Triple P, level 3) or to the control group (care as usual). Outcome measures, such as problem behaviour in the child and parenting behaviour, will be assessed before, directly after and 6 and 12 months after the intervention. DISCUSSION: Parenting support may be an effective intervention to reduce psychosocial problems in children but evidence-based parenting programmes that fit the needs of the PCH are not available as yet. Although the Triple P programme seems promising and suitable for a universal population approach, evidence on its effectiveness in routine PCH still lacks. TRIAL REGISTRATION: NTR1338

The effectiveness of "Exercise on Prescription" in stimulating physical activity among women in ethnic minority groups in the Netherlands: protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Lack of physical activity is an important risk factor for overweight, diabetes, cardiovascular disease and other chronic conditions. In the Netherlands, ethnic minority groups are generally less physically active and rate their own health poorer compared to ethnic Dutch. This applies in particular to women. For this reason women from ethnic minority groups are an important target group for interventions to promote physical activity.</p> <p>In the Netherlands, an exercise referral program ("Exercise on Prescription") seems successful in reaching women from ethnic minority groups, in particular because of referral by the general practitioner and because the program fits well with the needs of these women. However, the effect of the intervention on the level of physical activity and related health outcomes has not been formally evaluated within this population. This paper describes the study design for the evaluation of the effect of "Exercise on Prescription" on level of physical activity and related health outcomes.</p> <p>Methods</p> <p>The randomized controlled trial will include 360 inactive women from ethnic minority groups, with the majority having a non-Western background, aged between 18 and 65 years old, with regular visits to their general practitioner. Participants will be recruited at healthcare centres within a deprived neighbourhood in the city of The Hague, the Netherlands.</p> <p>An intervention group of 180 women will participate in an exercise program with weekly exercise sessions during 20 weeks. The control group (n = 180) will be offered care as usual. Measurements will take place at baseline, and after 6 and 12 months. Main outcome measure is minutes of self reported physical activity per week. Secondary outcomes are the mediating motivational factors regarding physical activity, subjective and objective health outcomes (including wellbeing, perceived health, fitness and body size) and use of (primary) health care. Attendance and attrition during the program will be determined.</p> <p>Conclusion</p> <p>This trial will provide information on the effectiveness of an exercise referral scheme on the short and long term among women from ethnic minority groups, mainly non-Western, in the Netherlands. The results of this study will contribute to the evidence base for interventions in ethnic minority populations.</p> <p>Trial registration</p> <p>Dutch Trial register: NTR1294</p

The influence of population characteristics on variation in general practice based morbidity estimations

Contains fulltext : 96442.pdf (publisher's version ) (Open Access

Cost-Effectiveness of an Opportunistic Screening Programme and Brief Intervention for Excessive Alcohol Use in Primary Care

Effective prevention of excessive alcohol use has the potential to reduce the public burden of disease considerably. We investigated the cost-effectiveness of Screening and Brief Intervention (SBI) for excessive alcohol use in primary care in the Netherlands, which is targeted at early detection and treatment of ‘at-risk’ drinkers.We compared a SBI scenario (opportunistic screening and brief intervention for ‘at-risk’ drinkers) in general practices with the current practice scenario (no SBI) in the Netherlands. We used the RIVM Chronic Disease Model (CDM) to extrapolate from decreased alcohol consumption to effects on health care costs and Quality Adjusted Life Years (QALYs) gained. Probabilistic sensitivity analysis was employed to study the effect of uncertainty in the model parameters. In total, 56,000 QALYs were gained at an additional cost of €298,000,000 due to providing alcohol SBI in the target population, resulting in a cost-effectiveness ratio of €5,400 per QALY gained.Prevention of excessive alcohol use by implementing SBI for excessive alcohol use in primary care settings appears to be cost-effective

Towards a comprehensive estimate of national spending on prevention

Background Comprehensive information about national spending on prevention is crucial for health policy development and evaluation. This study provides a comprehensive overview of prevention spending in the Netherlands, including those activities beyond the national health accounts. Methods National spending on health-related primary and secondary preventive activities was examined by funding source with the use of national statistics, government reports, sector reports, and data from individual health associations and corporations, public services, occupational health services, and personal prevention. Costs were broken down by diseases, age groups and gender using population-attributable risks and other key variables. Results Total expenditures on prevention were €12.5 billion or €769 per capita in the Netherlands in 2003, of which 20% was included in the national health accounts. 82% was spent on health protection, 16% on disease prevention, and 2% on health promotion activities. Most of the spending was aimed at the prevention of infectious diseases (34%) and acute physical injuries (29%). Per capita spending on prevention increased steeply by age. Conclusion Total expenditure on health-related prevention is much higher than normally reported due to the inclusion of health protection activities beyond the national health accounts. The allocative efficiency of prevention spending, particularly the high costs of health protection and the low costs of health promotion activities, should be addressed with information on their relative cost effectiveness

Cost-effectiveness of opportunistic screening and minimal contact psychotherapy to prevent depression in primary care patients

Background: Depression causes a large burden of disease worldwide. Effective prevention has the potential to reduce that burden considerably. This study aimed to investigate the cost-effectiveness of minimal contact psychotherapy, based on Lewinsohn's 'Coping with depression' course, targeted at opportunistically screened individuals with sub-threshold depression. Methods and Results: Using a Markov model, future health effects and costs of an intervention scenario and a current practice scenario were estimated. The time horizon was five years. Incremental cost-effectiveness ratios were expressed in euro per Disability Adjusted Life Year (DALY) averted. Probabilistic sensitivity analysis was employed to study the effect of uncertainty in the model parameters. From the health care perspective the incremental cost-effectiveness ratio was € 1,400 per DALY, and from the societal perspective the intervention was cost-saving. Although the estimated incremental costs and effects were surrounded with large uncertainty, given a willingness to pay of € 20,000 per DALY, the probability that the intervention is cost-effective was around 80%. Conclusion: This modelling study showed that opportunistic screening in primary care for sub-threshold depression in combination with minimal contact psychotherapy may be cost-effective in the prevention of major depression

Towards a general framework for including noise impacts in LCA

Industrial Ecolog

Milieu en gezondheid in de OESO-regio: verlies van gezondheid en van geld

Dit rapport schat het effect van blootstelling aan milieufactoren op de gezondheid in de OESO-regio, in termen van verloren gezondheid en geld. Geschat werd dat 2-5% van de totale ziektelast gerelateerd is aan milieuverontreiniging. Voor de rijkste OESO landen werd dit gezondheidsverlies economisch gewaardeerd op 45-140 miljard US$(of 53-160 US$ per capita; centrale schatting). Eerst is voor 16 ziekten met hoge ziektelast geschat welke fractie daarvan toe te schrijven is aan mileufactoren: OESO 2-5%, niet-OESO 8-12%, wereld 7.5-11%. Vervolgens is deze milieugerelateerde ziektelast geldelijk gewaardeerd. Het toepassen van deze percentages op de totale gezondheidsuitgaven resulteerde in een schatting van milieugerelateerde gezondheids-kosten van 45-110 miljard $(40-100$/capita). Omdat gezondheids-uitgaven echter vrijwel alleen morbiditeit betreffen, zijn de kosten van milieu-gerelateerde morbiditeit en mortaliteit ook apart geschat: morbiditeit met behulp van ziekte-specifieke directe ziektekosten, mortaliteit door verloren levensjaren te waarderen als BNP per capita en door 'willingness-to-pay' waarden voor sterfte gedeeld door de bijbehorende verloren levensverwachting. Tesamen resulteerde dit in de volgende schattingen van milieu-gerelateerde gezondheidskosten voor de rijkste OESO-landen: een lage schatting van 30-95 miljard $(35-105$/capita), een middenschatting van 45-140 miljard $(53-160$/capita), en een hoge schatting van 215-680 miljard $(240-775$/capita).This study assessed the environmental health impact within the OECD region, both in terms of lost health and lost money. 2-5% of the total Burden of Disease (BoD) was attributed to environmental factors. Environmental health loss in the OECD high income subregion was monetary valued at US$45-140 billion (or US$53-160 per capita, central estimate). First, environment attributable fractions of the BoD of 16 diseases with high disease burdens were assessed and total environmental BoD was estimated at: OECD region 2-5%, non-OECD 8-12%, world 7.5-11%. Second, an economic valuation of the environmental health impact was performed. Applying the above percentages to the total health expenditure resulted in OECD environmental health costs of 45-110 billion US$(40-100$/capita). However, since health expenditures only apply to morbidity, morbidity and mortality costs were also estimated separately. Environmental morbidity costs were obtained using disease-specific direct costs of illness, environmental mortality costs were based on a monetary valuation of the years of life lost, first as GDP per capita and second by using willingness-to-pay values for death divided by lost life expectancy. This finally lead to three different estimates of environmental health costs in the OECD high income region: a lower estimate of US$30-95 billion (US$35-105 per capita), a central estimate of US$45-140 billion (US$53-160 per capita), and an upper estimate of US$215-680 billion (US$240-775 per capita).Enviroment Directorate of Organization for Economic Co-operation and Development ED-OEC