Public health indicators for the EU: the joint action for ECHIM (European Community Health Indicators & Monitoring).

Background: Public health policies aim to improve and maintain the health of citizens. Relevant data and indicators are needed for a health policy that is based on factual information. After 14 years of work (1998-2012), the multi-phase action on European Community Health Indicators (ECHI) has created a health monitoring and reporting system.

Health indicators in Europe: availability and data needs.

Background: The European Union (EU) lacks adequate capacity for public health monitoring. The creation of a stable European Health Information System would help Member States to carry out evidence-based health policy. Such a system would also benefit EU health priorities by providing European wide comparable information.

European community health monitoring: the EUPHIX-model.

Aims: On 20 June 2008, the EUPHIX website (www.euphix.org) was officially launched.

The ECHI project: health indicators for the European Community.

Background: Within the EU Health Monitoring Programme (HMP), the ECHI project has proposed a comprehensive list of 'European Community Health Indicators'.

Methods: In the design of the indicator set, a set of explicit criteria was applied. These included: i) be comprehensive and coherent, i.

[Performance of the Dutch health care from an international perspective: background and implications for policy].

The 'World Health Report 2000' has stimulated discussions on the Netherlands' performance in health and healthcare from an international perspective. The only concrete result it provided was a world ranking in which the Netherlands stood in 17th place. The comparative data which have appeared in several other recent reports, are more useful to policy makers, a notable example being those from the Organization for Economic Cooperation and Development (OECD).

A national burden of disease calculation: Dutch disability-adjusted life-years. Dutch Burden of Disease Group.

Objectives: This study estimated the burden of disease due to 48 major causes in the Netherlands in 1994 in disability-adjusted life-years (DALYs), using national epidemiologic data and disability weights, and explored associated problems and uncertainties.

Methods: We combined data from Dutch vital statistics, registrations, and surveys with Dutch disability weights to calculate disease-specific health loss in DALYs, which are the sum of years of life lost (YLLs) and years lived with disability (YLDs) weighted for severity.

Results: YLLs were primarily lost by cardiovascular diseases and cancers, while YLDs were mostly lost by mental disorders and a range of chronic somatic disorders (such as chronic nonspecific lung disease and diabetes).

An aggregate public health indicator to represent the impact of multiple environmental exposures.

We present a framework to aggregate divergent health impacts associated with different types of environmental exposures, such as air pollution, residential noise, and large technologic risks. From the policy maker's point of view, there are at least three good reasons for this type of aggregation: comparative risk evaluation (for example, setting priorities), evaluation of the efficiency of environmental policies in terms of health gain, and characterizing health risk associated with geographical accumulation of multiple environmental exposures. The proposed impact measure integrates three important dimensions of public health: life expectancy, quality of life, and number of people affected.

['Public health status and perspectives' 1997. IV. Health status and life expectancy weighted].

The construction of composite measures of population health status meets the need to combine data on mortality and morbidity into one single population health index. Such indices can serve in principle to monitor population health status over time, or as support for the allocation of resources. In the framework of the 'Dutch public health status and forecasts report' for 1997 several calculations, new for the Netherlands, are made along the lines of both the 'health expectancy and the 'disability-adjusted life years' (DALY) concepts.

Classification of chemicals for carcinogenic and mutagenic properties.

In the framework of the EC labelling guide, three categories were devised for carcinogenic as well as for mutagenic chemicals. In short, category 1 is for compounds shown to produce these effects in man, whereas category 2 is meant to contain substances that should be regarded as such, generally on the basis of sufficient experimental data. Category 3 is for compounds that cause concern but for which the evidence is not sufficient for 1 or 2.

Environmental effects of genotoxins (eco-genotoxicology).

Genotoxic chemicals can damage the genetic material of humans as well as that of organisms living in the environment. With respect to adverse effects, alterations induced in the germ line, leading to alterations in the genetic make-up of populations, are of primary concern in ecosystems, because somatic changes, even if they lead to a loss of individuals, will not be critical in populations with a large reproductive surplus. This is different in human toxicology where genetic alterations in germ cells as well as in somatic cells of any individual are of concern.

Role of genotoxicity assays in the regulation of chemicals in The Netherlands: considerations and experiences.

This paper discusses genotoxicity testing and data interpretation as applied in The Netherlands in the context of the regulation of chemicals. Guidelines were first formulated in 1981 and their use evolved in practice, on the basis of increasing experience at the national and international levels. The distinction between in vitro assays to detect intrinsic genotoxic properties and in vivo assays as a subsequent phase to show the realization of this potential in an intact organism has always been a cornerstone of the Dutch approach.

A paradigm of delayed union and nonunion in the lumbosacral joint. A study of motion and bone grafting of the lumbosacral spine in sheep.

In a group of nine sheep (Group A), it was noted that when small, interlocking cancellous and cortical cancellous bone grafts are placed posteriorly on the lumbosacral spine, union always occurred in the interlumbar motion segments and almost never occurred at the lumbosacral joint. One of the main differences in these two areas is the amount of motion that occurs at each level with flexion and extension. Because nonunion following bone grafting for arthrodesis of the spine is a serious clinical problem, we have studied the amount of motion seen at the interlumbar and lumbosacral joints in sheep to ascertain how much motion is compatible with union and how much is associated with nonunion.

[Environment, chemicals and public health].

It is obvious that, to the general public, environmental pollution determines the state of public health to a considerable extent. Scientifically, however, this relationship is less readily detectable, particularly when the environment polluted by chemicals is the polluted human environment. It is more correct to define 'environment' to include both the 'external' and the 'local' environment.

Inhalation exposure in Drosophila mutagenesis assays: experiments with aliphatic halogenated hydrocarbons, with emphasis on the genetic activity profile of 1,2-dichloroethane.

A series of mutation experiments was carried out with Drosophila melanogaster using inhalation exposure. 1,2-Dichloroethane (DCE) and 1,2-dibromoethane (DBE) were active in the sex-linked recessive lethal assay (SLRLT), whereas dichloromethane, dibromomethane, 1,2-dichloropropane and 1,3-dichloropropane were not. Compared to DBE, DCE is a less potent mutagen in the SLRL system.

International Commission for Protection Against Environmental Mutagens and Carcinogens. ICPEMC publication No. 18. Review of the genotoxicity and carcinogenicity of antischistosomal drugs; is there a case for a study of mutation epidemiology? Report of a task group on mutagenic antischistosomals.

One of the interests of ICPEMC is to identify situations in which the possible induction of inherited defects in man by mutagen exposure could actually be studied. The large-scale use of mutagenic drugs in field programmes against schistosomiasis, mainly during the 1970's, was considered a possible case. An ICPEMC task group approached the problem by (1) updating the genetic toxicology data base for antischistosomal drugs, and (2) reviewing possible study areas.

Mutagenic activity of acrylamide in eukaryotic systems but not in bacteria.

The vinyl monomer acrylamide (AA) was studied for its activity in a range of genotoxicity tests, including the Salmonella/microsome test, the fluctuation test using Klebsiella pneumoniae, the test for gene mutations at the TK and HPRT loci in L5178Y mouse lymphoma cells, tests for chromosomal aberrations and SCEs in V79 Chinese hamster cells, the sex-linked recessive lethal (SLRL) and somatic mutation and recombination (SMART) assays in Drosophila melanogaster and the mouse bone marrow micronucleus assay. AA showed genotoxic activity in most systems. The bacterial tests did not respond, in compliance with literature data; also in the Drosophila SLRL test, no significant increase in mutation rate was observed.

In vitro formation of a triazene compound by reaction of sulphadimidine and nitrite.

The interaction between the veterinary drug sodium sulphadimidine and nitrite has been studied under acid conditions and the formation of 1,3-di-(4-[N-(4,6-dimethyl-2-pyrimidinyl)sulphamoylphenyl)triazene (DDPSPT) was demonstrated. This compound was not mutagenic when tested on Salmonella typhimurium and Drosophila melanogaster. In addition to the formation of DDPSPT, desaminosulphadimidine was identified as a minor reaction product.

Trenimon-induced sex chromosome loss in Drosophila: different dose-responses for ring-X loss as compared to rod-X loss and Y-marker loss.

Drosophila melanogaster males carrying either a ring- or a rod-shaped X-chromosome were injected or fed with Trenimon (triaziquone) at concentrations ranging from 5 X 10(-5) to 2 X 10(-2) mM. The F1 generation was assayed for the occurrence of total sex chromosome loss and of Y-chromosome markers. Sex-linked recessive lethal tests were carried out simultaneously.

Mutagenicity of methyl bromide in a series of short-term tests.

Methyl bromide is commonly used as a soil fumigant in greenhouses. In the framework of a toxicological evaluation, it was tested for possible genotoxic properties in two bacterial test systems (the fluctuation test using Klebsiella pneumoniae and the plate test using Salmonella typhimurium TA100 and TA98), two systems using mammalian cells in vitro (forward mutations at the TK and HPRT loci in L5178Y mouse lymphoma cells and unscheduled DNA synthesis in primary rat-liver cells) and in the sex-linked recessive lethal test using Drosophila melanogaster. Methyl bromide was active in all tests except the DNA-repair assay.

High proportion of multi-locus deletions among hycanthone-induced X-linked recessive lethals in Drosophila melanogaster.

328 X-linked recessive lethal mutations induced in late spermatids by hycanthone methanesulfonate were tested for coverage by duplications that comprised, in total, about 24% of the euchromatic X chromosome; 78 lethals appeared to be covered. Crossover localization tests of a random sample of 38 non-covered lethals revealed 4 chromosomes carrying a lethal within a duplicated segment. Lethals localized to a particular region were crossed to reference deficiencies and single-locus mutations, and inter se, to ascertain their genetic extent.

Studies on the induction of sex-linked recessive lethal mutations in Drosophila melanogaster by nitroheterocyclic compounds.

24 nitroheterocyclic compounds were investigated for their capacity to induce sex-linked recessive lethals in Drosophila, by the adult feeding technique, and in some cases injection or larval-feeding methods. Out of 9 5-nitroimidazoles, ZK 26.173 and ZK 25.