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RIVM rapport:De Nederlandse overheid wil dat er minder mensen roken, overgewicht hebben of te veel alcohol drinken. Om dat te bereiken is in 2018 het Nationaal Preventieakkoord afgesloten met doelen voor 2040. Hiervoor heeft de overheid met meer dan zeventig partijen afspraken gemaakt. Het RIVM heeft berekend of de doelen in 2040 worden gehaald met de afspraken zoals ze nu worden uitgevoerd. Het RIVM heeft daarvoor berekend hoe de situatie in 2040 zal zijn met én zonder afspraken. Uit de berekening blijkt dat de doelen voor problematisch drinken met de afspraken niet worden gehaald. Het aantal problematische drinkers zal nauwelijks dalen. Van veel van de afspraken in het NPA zoals ze nu worden uitgevoerd, is weinig effect te verwachten. Het doel is dat het aantal volwassenen dat problematisch drinkt vijf procent is in 2040. Het aantal jongeren dat zegt de afgelopen maand gedronken te hebben moet naar 15 procent. Extra en stevigere maatregelen zijn nodig om deze doelen te bereiken. Dit zijn bijvoorbeeld maatregelen om alcoholhoudende dranken duurder te maken, alcoholhoudende dranken minder beschikbaar te maken en reclame voor alcoholhoudende dranken te beperken., The Dutch government wants to reduce the number of people who smoke, are overweight or consume excessive amounts of alcohol. To this end, the National Prevention Agreement was drawn up in 2018, with goals for 2040. In this context, the government made agreements with over 70 different parties. RIVM has calculated whether the agreements, as they are currently being implemented, will be enough to reach the goals for 2040. It has calculated what the situation will look like in 2040 both with and without agreements. The calculations show that the agreements will not result in the goals on problematic drinking being met. There will hardly be any decrease in the number of people who drink problematically. Many of the agreements in the NPA, as they are currently being implemented, are expected to have little effect. The goal for 2040 is to reduce the percentage of adults who drink problematically to 5 per cent and to reduce the percentage of young people who say they drank alcohol in the past month to 15 per cent. More and stricter measures will be necessary to meet these goals. Examples of such measures include making alcoholic drinks more expensive and less easily available and limiting advertising for alcoholic drinks.

De Nederlandse overheid wil dat er minder mensen roken, overgewicht hebben of te veel alcohol drinken. Om dat te bereiken, is in 2018 het Nationaal Preventieakkoord afgesloten met doelen voor 2040. Hiervoor heeft de overheid met meer dan zeventig partijen afspraken gemaakt. Het RIVM heeft berekend of de doelen in 2040 worden gehaald met de afspraken zoals ze nu worden uitgevoerd. Het RIVM heeft daarvoor berekend hoe de situatie in 2040 zal zijn met én zonder afspraken. Uit de berekening blijkt dat de doelen niet worden gehaald met de afspraken. Ondanks de afspraken zal het aantal mensen met overgewicht blijven stijgen. Door de afspraken neemt het aantal mensen met overgewicht wel iets minder sterk toe dan zonder de afspraken. Extra en stevigere maatregelen zijn nodig om de doelen te bereiken. Dit zijn bijvoorbeeld: gezond voedsel goedkoper maken, ongezond voedsel duurder maken, of reclame voor ongezond voedsel verder beperken. Het doel is dat in 2040 maximaal 38 procent van de volwassenen en 9,1 procent van de kinderen (4 t/m 17 jaar) overgewicht heeft. Volgens de berekeningen zal met de huidige afspraken ongeveer 56 procent van de volwassenen overgewicht hebben. Zonder afspraken zou dat 58 procent zijn. Het aantal kinderen met overgewicht zal ongeveer 14 procent zijn in plaats van 15 procent.

The concept of the bioeconomy and the growing demand for biomass have raised concerns about the sustainability of an increased biomass use. To address this issue, various certification systems and labels have been developed to verify compliance with sustainability requirements in bioenergy and bio-based value chains. However, various market requirements and political frameworks make certification complex and difficult to understand. An IEA Bioenergy Task 45 project has analyzed existing certification schemes to better understand methodological differences and compliance factors. This article summarises the main project outcomes regarding relevant compliance and verification parameters such as risk assessments, transparency, auditor competencies and others. Sustainability certification supports sustainable biomass production, but it alone cannot guarantee sustainability. Certification should be part of a broader sustainability governance framework, including national policies and legislation. The complexity and competition of markets and political frameworks can lead to a race to the bottom that jeopardizes trust and reputation. Policy makers and industry need to streamline certification as a driver of change within a functional governance framework.

We present the paleomagnetic dating of the upper Miocene red alluvial to palustrine sequences of the area north of Teruel. The magnetostratigraphy of the Masada del Valle and Masada Ruea sections indicates a minimum age of about 11 Ma to the lowermost sediments post-dating the unconformity over the Mesozoic basement. The overall Miocene sequence represents a retrogradation of the alluvial system, grading upwards into palustrinellacustrine sedimentation. The onset of palustrine deposition is dated in Masada Ruea at about 9.7 Ma. The late Vallesian faunas of Masía del Barbo, of which leve1 2B is the reference locality of biochronozone MNlO, are dated to 9.3 Ma. The anisotropy of magnetic susceptibility (AMS) in the tenigenous sediments suggests that the orientation of the magnetic ellipsoids represents the paleocurrent direction. Paleocurrent interpretations based on AMS data can be used for a better comprehension of the facies arrangement in the Neogene sediments of the Teruel basin., Se ha realizado un estudio magnetostratigráfico de las sucesiones aluviales que afloran al norte de Teruel (sector de Masada del Valle- Masada Ruea) con objeto de precisar la edad de los sedimentos y de los yacimientos de vertebrados fósiles. La correlación de las sucesiones con la escala de tiempo de polaridad geomagnética indica una edad de 11 Ma para los sedimentos mas antiguos estudiados y que yacen en discordancia sobre el substrato Mesozoico. La iniciación de la expansión de la sedimentación palustre/lacustre ha sido datada en Masada Ruea en cerca de 9.7 Ma. La edad de las faunas de Masía del Barbo 2B, localidad de referencia para la biocronozona MN10, es de 9.3 Ma. La anisotropia de la susceptibilidad magnética (AMS) en las facies siliciclásticas indica que la orientación de la fábrica magnética esta controlada por la dirección de paleocorrientes. Los datos de AMS pueden ser útiles para determinar la evolución de las paleocorrientes y contribuir al estudio de la distribución de facies y la evolución del relleno sedimentario de la cuenca, Comisión Interministerial de Ciencia y Tecnología, Diputación General de Aragón, Comissionat per Universitats i Recerca de la Generalitat de Catalunya, Depto. de Mineralogía y Petrología, Fac. de Ciencias Geológicas, TRUE, pub

BACKGROUND: Surgical resection followed by adjuvant mFOLFIRINOX (5-fluorouracil with leucovorin, irinotecan, and oxaliplatin) is currently the standard of care for patients with resectable pancreatic cancer. The main concern regarding adjuvant chemotherapy is that only half of patients actually receive adjuvant treatment. Neoadjuvant chemotherapy, on the other hand, guarantees early systemic treatment and may increase chemotherapy use and thereby improve overall survival. Furthermore, it may prevent futile surgery in patients with rapidly progressive disease. However, some argue that neoadjuvant therapy delays surgery, which could lead to progression towards unresectable disease and thus offset the potential benefits. Comparison of perioperative (i.e., neoadjuvant and adjuvant) with (only) adjuvant administration of mFOLFIRINOX in a randomized controlled trial (RCT) is needed to determine the optimal approach. METHODS: This multicenter, phase 3, RCT will include 378 patients with resectable pancreatic ductal adenocarcinoma with a WHO performance status of 0 or 1. Patients are recruited from 20 Dutch centers and three centers in Norway and Sweden. Resectable pancreatic cancer is defined as no arterial contact and ≤ 90 degrees venous contact. Patients in the intervention arm are scheduled for 8 cycles of neoadjuvant mFOLFIRINOX followed by surgery and 4 cycles of adjuvant mFOLFIRINOX (2-week cycle of oxaliplatin 85 mg/m2, leucovorin 400 mg/m2, irinotecan 150 mg/m2 at day 1, followed by 46 h continuous infusion of 5-fluorouracil 2400 g/m2). Patients in the comparator arm start with surgery followed by 12 cycles of adjuvant mFOLFIRINOX. The primary outcome is overall survival by intention-to-treat. Secondary outcomes include progression-free survival, resection rate, quality of life, adverse events, and surgical complications. To detect a hazard ratio of 0.70 with 80% power, 252 events are needed. The number of events is expected to be reached after the inclusion of

Background: Hepaticojejunostomy anastomotic stricture (HJAS) is an adverse event after pancreatoduodenectomy (PD) which can result in jaundice and/or cholangitis. With endoscopy, HJAS can be managed. However, few studies report the specific success and adverse event rates of endoscopic therapy after PD. Methods: Patients with symptomatic HJAS, who underwent an endoscopic retrograde cholangiopancreatography at the Erasmus MC between 2004-2020, were retrospectively included. Primary outcomes were short-term clinical success defined as no need for re-intervention <3 months and long-term <12 months. Secondary outcome measures were cannulation success and adverse events. Recurrence was defined as symptoms with radiological/endoscopic confirmation. Results: A total of 62 patients were included. The hepaticojejunostomy was reached in 49/62 (79%) of the patients, subsequently cannulated in 42/49 (86%) and in 35/42 patients (83%) an intervention was performed. Recurrence of symptomatic HJAS after technically successful intervention occurred in 20 (57%) patients after median time to recurrence of 7.5 months [95%CI, 7.2–NA]. Adverse events were reported in 4% of the procedures (8% of patients), mostly concerning cholangitis. Discussion: Endoscopic treatment for symptomatic HJAS after PD has a moderate technical success rate and a high recurrence rate. Future studies should optimize endoscopic treatment protocols and compare percutaneous versus endoscopic treatment.

Background: In general, migrant women have a lower breast cancer (BC) incidence rate and higher BC mortality than autochthonous women. Further, migrant women show lower participation in the national BC screening program. To further investigate those aspects, we aimed to determine differences in incidence and tumor characteristics between autochthonous and migrant BC patients in Rotterdam, the Netherlands. Methods: We selected women diagnosed with BC in Rotterdam during 2012–2015 from the Netherlands Cancer Registry. Incidence rates were calculated by migrant status (i.e., women with or without migration background). Multivariable analyses revealed adjusted odds ratios (OR) and 95% confidence intervals (CI) on the association between migration status and patient and tumor characteristics, additionally stratified by screening attendance (yes/no). Results: In total 1372 autochthonous and 450 migrant BC patients were included for analysis. BC incidence was lower among migrants than among autochthonous women. Overall, migrant women were younger at BC diagnosis (53 vs. 64 years, p < 0.001), and had higher risks of positive lymph nodes (OR 1.76, 95% CI 1.33–2.33) and high grade tumors (OR 1.35, 95% CI 1.04–1.75). Especially non-screened migrant women had higher risk of positive nodes (OR 2.73, 95% CI 1.43–5.21). Among the subgroup of screened women, we observed no significant differences between migrant and autochthonous patients. Conclusion: Migrant women have lower BC incidence than autochthonous women, but diagnosis was more often at younger age and with unfavorable tumor characteristics. Attending the screening program strongly reduces the latter. Therefore, promotion of participation in the screening program is recommended.

Contains fulltext : 251392.pdf (Publisher’s version ) (Open Access), Patients with coronary artery disease (CAD) are more sedentary compared with the general population, but contemporary cardiac rehabilitation (CR) programmes do not specifically target sedentary behaviour (SB). We developed a 12-week, hybrid (centre-based+home-based) Sedentary behaviour IntervenTion as a personaLisEd Secondary prevention Strategy (SIT LESS). The SIT LESS programme is tailored to the needs of patients with CAD, using evidence-based behavioural change methods and an activity tracker connected to an online dashboard to enable self-monitoring and remote coaching. Following the intervention mapping principles, we first identified determinants of SB from literature to adapt theory-based methods and practical applications to target SB and then evaluated the intervention in advisory board meetings with patients and nurse specialists. This resulted in four core components of SIT LESS: (1) patient education, (2) goal setting, (3) motivational interviewing with coping planning, and (4) (tele)monitoring using a pocket-worn activity tracker connected to a smartphone application and providing vibrotactile feedback after prolonged sedentary bouts. We hypothesise that adding SIT LESS to contemporary CR will reduce SB in patients with CAD to a greater extent compared with usual care. Therefore, 212 patients with CAD will be recruited from two Dutch hospitals and randomised to CR (control) or CR+SIT LESS (intervention). Patients will be assessed prior to, immediately after and 3 months after CR. The primary comparison relates to the pre-CR versus post-CR difference in SB (objectively assessed in min/day) between the control and intervention groups. Secondary outcomes include between-group differences in SB characteristics (eg, number of sedentary bouts); change in SB 3 months after CR; changes in light-intensity and moderate-to-vigorous-intensity physical activity; quality of life; and patients' competencies for self-management. Outcomes of the SIT LESS randomised cli

Item does not contain fulltext, OBJECTIVE: Non-adherence to adjuvant endocrine therapy (AET) for breast cancer leads to increased recurrence and mortality risk and healthcare costs. Evidence on feasible, effective AET adherence interventions is scarce. This paper describes the systematic adaptation of the cost-effective adherence improving self-management strategy (AIMS) for patients with HIV to AET for women after breast cancer treatment. METHODS: We followed the intervention mapping protocol for adapting interventions by conducting a needs assessment, reviewing target behaviours and determinants, reassessing behaviour change methods and adapting programme content. Therefore, we performed a literature review, consulted behavioural theory and organised nine advisory board meetings with patients and healthcare professionals. RESULTS: Non-adherence occurs frequently among AET users. Compared to HIV treatment, AET is less effective, and AET side effects are more burdensome. This drives AET treatment discontinuation. However, the key determinants of non-adherence are largely similar to HIV treatment (e.g. motivation, self-regulation and patient-provider relationship); therefore, most strategies in AIMS-HIV also seem suitable for AIMS-AET. Modifications were required, however, regarding supporting patients with coping with side effects and sustaining treatment motivation. CONCLUSION: AIMS seems to be a suitable framework for adherence self-management across conditions and treatments. Intervention mapping offered a transparent, systematic approach to adapting AIMS-HIV to AET.

Voldoende zoet water is noodzakelijk voor waterafhankelijke sectoren als landbouw, natuur, drinkwaterbedrijven en industrie. Zelfs in laaggelegen gebieden als Nederland wordt de disbalans tussen watervraag en wateraanbod steeds groter, naarmate waterbeheer, watergebruik en klimaat verder veranderen. Dit artikel is een samenvatting van een peer-reviewed artikel waarin een overzicht is gegeven van de veranderde drainagepraktijk in Nederland, met name van ontwikkelingen in gebruik en ontwerp van buisdrainage tussen 1950-2020: van water afvoeren, naar afvoeren én vasthouden en afvoeren én vasthouden én aanvullen. Op basis van Nederlandse veldproeven met regelbare drainage met subirrigatie en internationale literatuur, geven we inzicht in de componenten van de waterbalans die beïnvloed worden door drainage en subirrigatie. Op basis hiervan geven we een doorkijk naar of en hoe regelbare drainage met subirrigatie ingepast kan worden in het regionale watersysteem., Sufficient freshwater is needed for water-dependent sectors such as agriculture, nature, drinking water production, and industry. However, even in low-lying, flood-prone countries like The Netherlands, climate change, weather extremes, economic growth, urbanization, land subsidence, and increased food production makes it more complex to guarantee sufficient freshwater for all sectors at the same time. Furthermore, the frequency and amplitude of extremely dry and wet weather conditions is expected to increase. The current Dutch water management system is not designed to anticipate on these extremes. Over the last decades, (subsurface) drainage of agricultural fields, land consolidation, and urbanization resulted in declining groundwater tables. Additionally, the fresh water demand of different sectors as mentioned increased, causing an increased pressure on the regional groundwater system. As a consequence, the annual groundwater table in sandy soil areas dropped over time with the effect that, nowadays, fresh water is becoming scarce in dry periods. Agricultural drainage could be decreased, resulting in larger groundwater recharge rates and higher groundwater tables. In this article we provide insight in the shifting drainage systems and management in the Netherlands (1950-2020), with the corresponding drainage systems, developing from conventional drainage (approx. 1950 - 1990), to controlled drainage (1990's onwards), climate adaptive drainage (2010 onwards), and systems combination with subirrigation (2018 56 Stromingen 2022 (28), nr 3 onwards). Furthermore, we provide insight in the effect of subirrigation on groundwater levels and crop yields, based on both international literature and measurements of Dutch field pilots.