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Background: Prehabilitation is a novel clinical strategy to optimize patients’ health in the waiting period before surgery. Objectives: This article aims to gather the evidence for the effectiveness of unimodal, non-pharmacological psychological prehabilitation interventions on preoperative anxiety and stress before surgery. Design: This is a PRISMA-guided systematic review and narrative synthesis of randomized controlled trials. Methods: The online databases Medline, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, PsycINFO and Google Scholar were searched on March 20th 2023. The search strategy led to 13,667 records screened and five records of randomized controlled trials included for full-text analysis. A risk-of-bias assessment was performed using the Revised Cochrane Risk of Bias 2 tool. Results: Significant reduction in preoperative anxiety was seen in three studies comprising 337 participants. Two studies did not find that unimodal psychological prehabilitation reduces preoperative anxiety. Only one study assessed preoperative stress and reported a significant reduction. Intervention types used included guided imagery, stress management training, virtual reality experience and computer cognitive behavioral therapy. Conclusions: There is contradictory evidence whether unimodal, non-pharmacological psychological prehabilitation can reduce preoperative anxiety. There is little evidence that non-pharmacological prehabilitation can reduce preoperative stress. Suggestions to improve the research in this field are discussed.

Contains fulltext : 300240.pdf (Publisher’s version ) (Open Access), Dravet syndrome is a severe epileptic encephalopathy, characterized by (febrile) seizures, behavioural problems and developmental delay. Eighty per cent of patients with Dravet syndrome have a mutation in SCN1A, encoding Nav1.1. Milder clinical phenotypes, such as GEFS+ (generalized epilepsy with febrile seizures plus), can also arise from SCN1A mutations. Predicting the clinical phenotypic outcome based on the type of mutation remains challenging, even when the same mutation is inherited within one family. This clinical and genetic heterogeneity adds to the difficulties of predicting disease progression and tailoring the prescription of anti-seizure medication. Understanding the neuropathology of different SCN1A mutations may help to predict the expected clinical phenotypes and inform the selection of best-fit treatments. Initially, the loss of Na+-current in inhibitory neurons was recognized specifically to result in disinhibition and consequently seizure generation. However, the extent to which excitatory neurons contribute to the pathophysiology is currently debated and might depend on the patient clinical phenotype or the specific SCN1A mutation. To examine the genotype-phenotype correlations of SCN1A mutations in relation to excitatory neurons, we investigated a panel of patient-derived excitatory neuronal networks differentiated on multi-electrode arrays. We included patients with different clinical phenotypes, harbouring various SCN1A mutations, along with a family in which the same mutation led to febrile seizures, GEFS+ or Dravet syndrome. We hitherto describe a previously unidentified functional excitatory neuronal network phenotype in the context of epilepsy, which corresponds to seizurogenic network prediction patterns elicited by proconvulsive compounds. We found that excitatory neuronal networks were affected differently, depending on the type of SCN1A mutation, but did not segregate according to clinical severity. Specifically, loss-of-function mutat

RIVM rapport:As part of efforts to combat the harmful environmental impact of plastic litter, the European Union has been rolling out a series of measures. Among them is a ban – introduced in 2021 – on a range of single-use plastics (SUP). These are plastics that are designed to be used once and then thrown away. Many of these products are used to pack, serve and consume food and beverages. They include drinking straws, stirrers and disposable plates. Following the ban on using plastic for the manufacture of these products, they are now being made from alternative materials such as paper, wheat straw and bamboo. RIVM investigated for which products these materials are being used and which chemical substances they might contain. It then assessed whether any of these substances might be harmful to health and whether they could migrate into food. The investigation shows that the materials currently in use potentially contain a wide range of substances. To enable targeted research into their potential risks, RIVM has identified which substances and materials would have to be further investigated first. RIVM conducted this survey on behalf of the Netherlands Food and Consumer Product Safety Authority (NVWA)., De Europese Unie wil de schadelijke effecten voor het milieu van plastic zwerfafval tegengaan. Sinds de zomer van 2021 worden daarvoor stap voor stap maatregelen ingevoerd. Zo zijn sinds 2021 verschillende soorten plastic producten verboden die gemaakt zijn om één keer te gebruiken en daarna weg te gooien - de zogeheten Single Use Plastics (SUP). Veel van deze producten worden gebruikt om eten en drinken te verpakken, te serveren of te consumeren. Dat zijn bijvoorbeeld rietjes, roerstaafjes of wegwerpbordjes. Vanwege het verbod op het gebruik van plastic voor deze producten worden ze nu van andere materialen gemaakt, zoals papier, tarwemeel of bamboe. Het RIVM heeft geïnventariseerd welke materialen worden gebruikt en welke stoffen in die materialen zouden kunnen zitten. Daarna is gekeken welke van deze stoffen mogelijk schadelijk zijn voor de gezondheid en of deze stoffen in voedsel kunnen terechtkomen. De inventarisatie laat zien dat er in de gebruikte materialen heel veel stoffen zouden kunnen zitten. Om gerichter onderzoek te kunnen doen naar mogelijke risico’s heeft het RIVM aangegeven naar welke stoffen en materialen het eerst onderzoek zou moeten worden gedaan. Het RIVM heeft dit onderzoek in opdracht van de Nederlandse Voedsel en Waren Autoriteit (NVWA(Nederlandse Voedsel- en Warenautoriteit)) gedaan.

RIVM rapport:Enzymes are increasingly being added to consumer products such as cleaning products and personal care products. This is done to dissolve dirt or stains, for example. The Netherlands Food and Consumer Product Safety Authority (NVWA) wants to know whether the use of enzymes is safe, especially in new types of products. RIVM has therefore made an overview of the products containing them and which regulatory frameworks apply to them. It was also examined whether it is possible to assess whether the use is safe. The overview makes it clear that there is insufficient information available about the amount of enzymes in certain products and about the amount that is safe for specific enzymes. It is also not clear to what extent consumers are exposed to enzymes. As a result, there is not enough information to assess whether the use of products containing enzymes is safe. This research helps to make recommendations for future evaluation of enzymes in consumer products. The inventory identified 184 cleaning products, 46 personal care products, 12 veterinary hygiene products and 2 pet care products containing enzymes. The products are subject to various regulatory frameworks, such as for personal care products or for cleaning products. The type of enzymes used and the amount were usually not stated on the packaging. In addition, a survey among manufacturers showed that most would not share their product enzyme concentrations. They do expect to use more enzymes in the future. The main health effect that enzymes can cause is respiratory sensitisation. This effect can arise, for example, if consumers are exposed to enzymes through air when using sprays. RIVM conducted this study on behalf of the Netherlands Food and Consumer Product Safety Authority (NVWA). It is a follow-up to the earlier study into microbial cleaning products., Enzymen worden steeds vaker toegevoegd aan producten voor consumenten, zoals schoonmaakmiddelen en persoonlijke verzorgingsproducten. Dit wordt gedaan om bijvoorbeeld vuil of vlekken op te lossen. De Nederlandse Voedsel- en Warenautoriteit (NVWA(Nederlandse Voedsel- en Warenautoriteit)) wil weten of het gebruik van enzymen veilig is, vooral in nieuwe soorten producten. Het RIVM heeft daarom een overzicht gemaakt van de producten waar ze in zitten en welke wetten daarvoor gelden. Ook is gekeken of het mogelijk is om te bepalen of het gebruik veilig is. Het overzicht maakt duidelijk dat er onvoldoende informatie beschikbaar is over de hoeveelheid enzymen in bepaalde producten en welke hoeveelheid voor specifieke enzymen veilig is. Ook is niet duidelijk in welke mate consumenten aan enzymen blootstaan. Daardoor is er ook niet genoeg informatie om te kunnen beoordelen of het gebruik van producten met enzymen veilig is. Dit onderzoek helpt om aanbevelingen te doen voor een toekomstige evaluatie van enzymen in producten voor consumenten. In ons marktonderzoek zijn er 184 schoonmaakproducten met enzymen gevonden, 46 producten voor persoonlijke verzorging, 12 veterinaire hygieneproducten en 2 huisdierverzorgingsproducten. De producten vallen onder verschillende wetten, zoals voor persoonlijke verzorgingsproducten of voor schoonmaakmiddelen. Het gebruikte type enzymen en de hoeveelheid stonden meestal niet op de verpakking vermeld. Ook bleek uit een enquete onder producenten dat de meeste hun enzymenconcentraties niet konden delen. Wel verwachten ze in de toekomst meer enzymen te gaan gebruiken. Het belangrijkste effect op de gezondheid dat enzymen kunnen veroorzaken is sensibilisatie van de luchtwegen. Dit effect kan bijvoorbeeld ontstaan als consumenten bij het gebruik van sprays via de lucht aan enzymen worden blootgesteld. Het RIVM heeft dit onderzoek gedaan in opdracht van de NVWA. Het is een vervolg op de eerdere studie naar microbiele reinigingsmiddelen.