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Background: Frailty in newly-diagnosed multiple myeloma (NDMM) patients is associated with treatment-related toxicity, which negatively affects health-related quality of life (HRQoL). Currently, data on changes in HRQoL of frail and intermediate-fit MM patients during active treatment and post-treatment follow-up are absent. Methods: The HOVON123 study (NTR4244) was a phase II trial in which NDMM patients ≥ 75 years were treated with nine dose-adjusted cycles of Melphalan-Prednisone-Bortezomib (MPV). Two HRQoL instruments (EORTC QLQ-C30 and -MY20) were obtained before start of treatment, after 3 and 9 months of treatment and 6 and 12 months after treatment for patients who did not yet start second-line treatment. HRQoL changes and/or differences in frail and intermediate-fit patients (IMWG frailty score) were reported only when both statistically significant (p < 0.005) and clinically relevant (>MID). Results: 137 frail and 71 intermediate-fit patients were included in the analysis. Compliance was high and comparable in both groups. At baseline, frail patients reported lower global health status, lower physical functioning scores and more fatigue and pain compared to intermediate-fit patients. Both groups improved in global health status and future perspective; polyneuropathy complaints worsened over time. Frail patients improved over time in physical functioning, fatigue and pain. Improvement in global health status occurred earlier than in intermediate-fit patients. Conclusion: HRQoL improved during anti-myeloma treatment in both intermediate-fit and frail MM patients. In frail patients, improvement occurred faster and, in more domains, which was retained during follow-up. This implies that physicians should not withhold safe and effective therapies from frail patients in fear of HRQoL deterioration.

RIVM rapport:Luchtverontreiniging is schadelijk voor de gezondheid. Het RIVM heeft onderzocht of blootstelling aan luchtvervuiling door fijnstof en stikstofdioxide invloed heeft op de kans om besmet te raken met het coronavirus en op de kans om daar ernstig ziek van te worden. Onder ernstig ziek verstaan we dat iemand in het ziekenhuis moet worden opgenomen of aan de ziekte overlijdt. Mensen die aan hoge concentraties luchtverontreiniging blootstonden, blijken een grotere kans te hebben om besmet te raken. Ook was hierdoor de kans groter dat mensen door corona in het ziekenhuis moesten worden opgenomen omdat ze erg ziek werden. Ten slotte was de kans dat ze aan corona stierven groter. Deze effecten zijn te zien kort (een tot twee weken) na een periode van meer luchtverontreiniging. Dat is ook zo wanneer mensen jaren wonen op een plek met meer luchtverontreiniging. Deze resultaten bevestigen eerdere conclusies uit internationaal onderzoek. Ook blijkt dat bij een langdurige blootstelling aan luchtverontreiniging de kans op een corona-infectie hetzelfde is als die op andere luchtwegaandoeningen. Denk aan andere luchtweginfecties met klachten die lijken op corona. Dat luchtverontreiniging in het algemeen een grotere kans geeft op luchtwegaandoeningen was al bekend. In het onderzoek is gekeken naar drie belangrijke bronnen van fijnstof in Nederland: landbouw, wegverkeer en industrie. Deze bronnen hebben invloed op de luchtkwaliteit. Ook verschilt per bron de samenstelling van fijnstof, en daarmee de schadelijkheid. Fijnstof van de veehouderij draagt bij aan zowel de kans op besmetting als de ernst van de ziekte. Fijnstof van wegverkeer lijkt meer invloed te hebben op de ernst van de ziekte en minder op de kans om met het virus besmet te raken. Fijnstof van industrie lijkt niet bij te dragen. De resultaten van het onderzoek ondersteunen het beleid van de Nederlandse overheid om de luchtkwaliteit te verbeteren. Het RIVM heeft dit onderzoek gedaan met de Universiteit Utrecht, Wageningen, Air pollution is harmful to health. RIVM has examined whether exposure to air pollution from particulate matter and nitrogen dioxide increases the risks of getting infected with SARS-CoV-2 and falling severely ill. Severe illness was defined as a person requiring hospitalisation or dying as a result of COVID-19. This study found that people who were exposed to high concentrations of air pollution had an increased risk of getting infected with SARS-CoV-2. This exposure also increased the risk of hospital admission or death due to COVID-19. These effects were observed shortly (within one to two weeks) after exposure to elevated concentrations of air pollution. This was also the case for people who had been living for years in locations with elevated concentrations of air pollution. These results confirm the findings of previous international studies. It was also found that, among people under long-term exposure to air pollution, the risk of getting infected with SARS-CoV-2 was not different from that of developing other respiratory diseases, such as those causing symptoms similar to those of SARS-CoV-2 infection. It was already known that exposure to air pollution increases the risk of developing respiratory diseases in general. This study also looked at three major sources of particulate matter emissions in the Netherlands: agriculture, road traffic and industry. These sources have an impact on air quality. In addition, the composition of particle matter emissions and therefore their harmfulness differ per source. Exposure to particular matter emissions from agriculture increases both the risk of getting infected and the severity of the illness. It was found that particular matter emissions from road traffic have a larger effect on the severity of COVID-19 but less of an effect on the risk of getting infected with SARS-CoV-2. Particular matter emissions from industry did not appear to contribute significantly to either. The results of this study support the policy of

RIVM rapport:In 2021 concludeerde de Gezondheidsraad dat er nog weinig bekend is over de risico’s voor de gezondheid van de kleinste deeltjes fijnstof (ultrafijnstof, UFP(ultrafine particles (ultrafijne deeltjes))) in de buitenlucht. De raad adviseerde ultrafijnstof structureel te gaan meten en modelleren. Daarmee kan worden bepaald hoeveel ultrafijnstof de Nederlandse bevolking via de lucht inademt. Het ministerie van Infrastructuur en Waterstaat (IenW(Infrastructuur en Waterstaat)) heeft het RIVM gevraagd of het mogelijk is om metingen van ultrafijnstof in het landelijk meetnet voor luchtkwaliteit op te nemen. Het RIVM denkt dat het kan en gaat meetstations inrichten om er ervaring mee op te doen. Het is nog wel te vroeg om een groot meetnet met veel meetpunten op te zetten. Dat komt omdat er nog veel kennis over UFP ontbreekt. Ultrafijnstof is een mengsel van extreem kleine deeltjes (kleiner dan 0,1 micrometer) die verschillen in grootte, van verschillende bronnen komen en verschillende stoffen bevat. Daardoor kan de concentratie niet zoals fijnstof worden gemeten, maar moeten de deeltjes worden geteld. Het RIVM stelt voor om op (minimaal) zeven vaste stations de aantallen ultrafijne deeltjes te meten en op enkele stations ook de grootte van de deeltjes. Kennis over de grootte van de deeltjes is nodig om meer inzicht in gezondheidseffecten te krijgen. Daar is nog weinig over bekend. Om een beeld van de blootstelling aan UFP in heel Nederland te krijgen, wordt deze naast de metingen berekend met rekenmodellen. Het is namelijk te duur om veel meetpunten te plaatsen. Met genoeg meetgegevens is het mogelijk om in Nederland verschillen in de concentraties te berekenen en op kaarten aan te geven. Voor dit onderzoek heeft het RIVM gesproken met experts in België en Groot-Brittannië en deskundigen van de regionale meetnetten over instrumenten en toekomstige plannen. Daarnaast is gezondheidsdeskundigen in Nederland gevraagd wat hun wensen zijn over het meten en modelleren van UFP. Op, In 2021, the Health Council of the Netherlands found that much remains unknown about the health risks associated with airborne ultrafine particles (UFP). The Health Council recommended the systematic measuring and modelling of ultrafine particles. This will make it possible to determine the amount of airborne ultrafine particles inhaled by the Dutch population. The Ministry of Infrastructure and Water Management has asked RIVM whether it is possible to have these ultrafine particle measurements conducted by the National Air Quality Monitoring Network. RIVM believes this can be done and will set up monitoring stations in order to gain the necessary experience. Because of the scant knowledge regarding UFP, it is too early to set up a large-scale monitoring network with a high number of monitoring stations. The term ‘ultrafine particles’ refers to a mixture of extremely small particles (smaller than 0.1 micrometre) that vary in size, origin and composition. This makes it impossible to measure their concentration in the air, as can be done for fine particles. Instead, the number of ultrafine particles must be measured. RIVM proposes to set up (at least) seven fixed monitoring stations to measure the number of ultrafine particles and a few mobile stations to measure their size. Knowledge about the size of the particles is required to gain further insight into their health effects. That knowledge is currently largely absent. The mobile monitoring stations will also detect the provenance of UFP emissions. To get a clear picture of the exposure of the Dutch population to UFP, the measurements will be supplemented with calculations derived from computer modelling. The reason for using this approach is that it is too expensive to set up a large number of monitoring stations. Given sufficient measurement data, it will be possible to estimate the number of ultrafine particles over the Netherlands and indicate these on a map. To prepare for this investigation, RIVM held discussi

Tropospheric ozone is a species whose concentration partially depends on meteorology, and partially on a complex non-linear chemistry. It is also hazardous to human health, and high ozone spikes in particular can be damaging to the respiratory and cardiovascular systems. Investigating the effect of climate change on ozone is a necessary aspect of any assessment of any future health impacts. This study aims to use two Representative Con- centration Pathways (2.6 and 8.5) to quantify what changes in climate mean for ozone air quality and associated health effects in North-Western Europe. The WRF-Chem model is used, with a high resolution (6.6 x 6.6 km) domain nested in larger, lower-resolution pan-European parent domains. Firstly, the methods of speciation for Non-Methane Volatile Organic Compounds, emis- sions & forcing input, boundary & initial conditions for the different scenarios are intro- duced. The model is then shown to have a general negative bias when considering ozone levels, most likely due to inconsistencies between the emissions dataset and fluctuations in local emissions on short timescales. This results in likely very conservative estimates Relative Risk to health as a result of ozone pollution in the model, but the risk can be shown to be increasing from 2010 to 2050. Shown also is that general ozone levels are less sensitive to climate changes directly but more so to Nitrogen Oxides (NO x = NO + NO 2 ) concentrations, which themselves are influenced to a degree by meteorology.

At present, anthropogenic halogens and oceanic emissions of Very Short-Lived Substances (VSLS) are responsible for stratospheric ozone destruction. Emissions of the, mostly long-lived, anthropogenic halogens have been reduced, and as a consequence, their atmospheric abundance has started to decline since the beginning of the 21st century. Emissions of VSLS are, on the other hand, expected to increase in the future. VSLS are known to have large natural sources; however increasing evidence arises that their oceanic production and emission is enhanced by anthropogenic activities. Here, we introduce a new approach of assessing the overall impact of all oceanic halogen emissions on stratospheric ozone by calculating Ozone Depletion Potential (ODP)-weighted emissions of VSLS. Seasonally and spatially dependent, global distributions are derived exemplary for CHBr3 for the period 1999–2006. At present, ODP-weighted emissions of CHBr3 amount up to 50% of ODP-weighted anthropogenic emissions of CFC-11 and to 9% of all long-lived ozone depleting substances. The ODP-weighted emissions are large where strong oceanic emissions coincide with high-reaching convective activity and show pronounced peaks at the equator and the coasts with largest contributions from the Maritime Continent and West Pacific. Variations of tropical convective activity lead to seasonal shifts in the spatial distribution of the ODP with the updraught mass flux explaining 71% of the variance of the ODP distribution. Future climate projections based on RCP8.5 scenario suggest a 31% increase of the ODP-weighted CHBr3 emissions until 2100 compared to present values. This increase is related to larger convective activity and increasing emissions in a future climate; however, is reduced at the same time by less effective bromine-related ozone depletion. The comparison of the ODP-weighted emissions of short and long-lived halocarbons provides a new concept for assessing the overall impact of oceanic bromine emissi

At present, anthropogenic halogens and oceanic emissions of Very Short-Lived Substances (VSLS) are responsible for stratospheric ozone destruction. Emissions of the, mostly long-lived, anthropogenic halogens have been reduced, and as a consequence, their atmospheric abundance has started to decline since the beginning of the 21st century. Emissions of VSLS are, on the other hand, expected to increase in the future. VSLS are known to have large natural sources; however increasing evidence arises that their oceanic production and emission is enhanced by anthropogenic activities. Here, we introduce a new approach of assessing the overall impact of all oceanic halogen emissions on stratospheric ozone by calculating Ozone Depletion Potential (ODP)-weighted emissions of VSLS. Seasonally and spatially dependent, global distributions are derived exemplary for CHBr3 for the period 1999–2006. At present, ODP-weighted emissions of CHBr3 amount up to 50% of ODP-weighted anthropogenic emissions of CFC-11 and to 9% of all long-lived ozone depleting substances. The ODP-weighted emissions are large where strong oceanic emissions coincide with high-reaching convective activity and show pronounced peaks at the equator and the coasts with largest contributions from the Maritime Continent and West Pacific. Variations of tropical convective activity lead to seasonal shifts in the spatial distribution of the ODP with the updraught mass flux explaining 71% of the variance of the ODP distribution. Future climate projections based on RCP8.5 scenario suggest a 31% increase of the ODP-weighted CHBr3 emissions until 2100 compared to present values. This increase is related to larger convective activity and increasing emissions in a future climate; however, is reduced at the same time by less effective bromine-related ozone depletion. The comparison of the ODP-weighted emissions of short and long-lived halocarbons provides a new concept for assessing the overall impact of oceanic bromine emissi

Chlorofluorocarbons (CFCs) are the primary cause of ozone depletion, and they also contribute to global climate change. With the global phaseout of CFCs and the coming phaseout of hydrochlorofluorocarbons (HCFCs), the substitute hydrofluorocarbons (HFCs) are increasingly used. While CFCs were originally used mainly in applications such as spray cans and were released within a year after production, concern about the ozone layer led to reductions in rapid-release applications, and the relative importance of slower-release applications grew. HFCs are now mainly used in refrigerators and air conditioners (AC) and are released over years to a decade after production. Their containment in such equipment represents banks, which are building up as production grows. A key finding of our work is that the increases of HFC banks represent a substantial unseen commitment to further radiative forcing of climate change also after production of the chemicals ceases. We show that earlier phaseouts of HFCs would provide greater benefits for climate protection than previously recognized, due to the avoided buildup of the banks. If, for example, HFC production were to be phased out in 2020 instead of 2050, not only could about 91–146 GtCO2-eq of cumulative emission be avoided from 2020 to 2050, but an additional bank of about 39–64 GtCO2-eq could also be avoided in 2050. Choices of later phaseout dates lead to larger commitments to climate change unless growing banks of HFCs from millions of dispersed locations are collected and destroyed.

RIVM rapport:This annual report comprises an overview of the air quality and the load placed on soils and surface water by atmospheric deposition in the Netherlands on the basis of measurements and model calculations. Special attention has been paid to the smog regulation of 2001, with chapters on global, photochemical, acidifying, particulate and local air pollution. New standards issuing from Dutch and European (EU) directives are also introduced here., Op basis van metingen en modelberekeningen wordt een samenvattend beeld gegeven van de luchtkwaliteit en de belasting van bodem en oppervlaktewater door atmosferische depositie in Nederland in 2000. Het rapport bestaat uit een speciaal onderwerp, Smogregeling 2002, en uit de volgende hoofdstukken: mondiale-, fotochemische-, verzurende-, deeltjesvormige- en lokale luchtverontreiniging. In dit jaaroverzicht worden ook nieuwe normen ge6ntroduceerd die voortvloeien uit het nieuwe Besluit luchtkwaliteit en uit Europese (EU) richtlijnen.

RIVM rapport:The air quality for 2001 is found to strongly resemble that for 2000. The decreasing trend in concentrations seen in the nineties, is still valid on the whole. Concerning the meteorological influences, 2001 can be considered as a normal year. Widespread exceedances occurred for ozone and PM10, and in the deposition of potential acid and total nitrogen. In the urban environment, exceedances of the annual mean limit value for NO2 occurred along road length of about 2000 km. Calculations for benzene and benzo[a]pyrene showed that exceedances were incidental. This annual air quality survey provides an overview of the air quality and the load placed on soils and surface water by atmospheric deposition in the Netherlands, on the basis of measurements and model calculations. The report describes global, photochemical, acidifying, particulate and local air pollution. Special attention has been paid to the Dutch air quality in relation to the new European legislation on air quality., Als we de luchtkwaliteit over 2001 vergelijken met die van 2000 blijken deze in grote lijnen met elkaar overeen te komen. De trendmatige daling van concentraties heeft zich in grote lijnen doorgezet. 2001 was wat meteorologische invloed betreft een normaal jaar. Normoverschrijdingen op landelijke schaal hebben zich voorgedaan van ozon, zwevende deeltjes (PM10), depositie van potentieel zuur en stikstof. In de stedelijke omgeving is de jaargemiddelde norm NO2 overschreden langs een weglengte van circa 2000 km. Voor benzeen en benzo[a]pyreen geven berekeningen aan dat incidenteel overschrijdingen van grenswaarden kunnen zijn voorgekomen. In het jaaroverzicht luchtkwaliteit 2001 wordt op basis van metingen en modelberekeningen een samenvattend beeld gegeven van de luchtkwaliteit en de belasting van bodem en oppervlaktewater door atmosferische depositie in Nederland over 2001. Het rapport beschrijft de onderwerpen: mondiale, fotochemische, verzurende, deeltjesvormige en lokale luchtverontreiniging. Als extra onderwerp is een hoofdstuk opgenomen over de Nederlandse luchtkwaliteit in relatie tot de nieuwe Europese wetgeving voor luchtkwaliteit.

RIVM rapport:This annual survey presents a view based on measurements and model calculations of air quality and the burden on soils and surface water, caused by atmospheric depostition, in the Netherlands in 1998 and 1999. The report consists of one special topic, 'Background to air-quality monitoring', and the folowing chapters on global, photochemical, acidifying, particulate and local air pollution. New standards issueing from the European directives are als introduced here., Op basis van metingen en modelberekeningen wordt een samenvattend beeld gegeven van de luchtkwaliteit en de belasting van bodem en oppervlaktewater door atmosferische depostie in Nederland in 1998 en 1999. Het speciale onderwerp in dit rapport is Achtergronden bij de luchtkwaliteitsmonitoring. Het rapport bestaat verder uit de hoofdstukken: mondiale-, fotochemische-, verzurende-, deeltjesvormige- en lokale luchtverontreiniging. In dit jaaroverzicht worden ook nieuwe normen geintroduceerd die voortvloeien uit Europese richtlijnen.