Tailored health education messages increase attention

Tailored, i.e. personalized and individualized,  health education messages are generally found to be more effective in promoting health behavior change than generic health education messages. The evidence is most convincing for nutrition education messages. It has been argued that a higher attention for personalized messages causes such better effects. A recent study by Kessels et al.  published in the journal 'Appetite' used objective  assessments of attention to test if attention was indeed higher for tailored as compared to generic nutrition education messages. The amount of attention allocation was measured by recording event-related potentials, i.e. 'brain waves', and reaction times. Results revealed a main effect of tailoring, indicating that more attention resources were allocated to tailored vs. non-tailored messages. The study also tested the effects of low threat vs. high threat messages, and the results indicate that high threat messages, i.e. messages that may initiate more fear, get less attention. The findings confirm that tailoring is an effective means to draw attention to health messages, whereas high threat information seems to result in a loss in message attention. Nutrition education should thus be preferably personally tailored but should not present fear arousing messages.

Preparing a special series on epidemiological modelling to progress obesity research and inform obesity policy.

On Monday and Tuesday, November 15 and 16 a group of scientists got together in London at the Welcome Trust conference center, guided by the editors of the Lancet, and supported by the National Heart Forum, to prepare a special series in the Lancet journal on the progress in obesity epidemic and policy research enables by the development and use of epidemiological modelling. This special series will be similar to the one on chronic disease that was recently published in the journal.

The authors of the draft papers were there as well as invited reviewers, to present and comment upon the draft papers and discuss the further development of the special series. I was invited to review on of the four papers. Of course, because the papers are still in a preliminary state, no details on the content of the papers can be shared here. But the series will probably make an important contribution to informing clinicians, public health professionals, policy makers, as well as the general public about epidemiological modelling contributing to better evidence-based obesity policies.

Experiencing the new Nordic Diet at Noma restaurant

A few years ago, Dr. Elling Bere of Agder University in Kristiansand, Norway and myself published a paper in Public Health Nutrition, arguing in favour of regionally appropriate and sustainable health promoting diets ‘diets’.

We argued that because most of the key determinants of the world’s burden of disease are diet-related, the promotion of healthful diets is important for population health worldwide. Furthermore, we argued that changes in health promoting eating habits may also contribute to preservation of the environment. For that purpose, we believed that the translation of health-promoting dietary recommendations into practical recommendations for healthful eating should be more tailored to regional circumstances. This will promote population health as well as help preserve cultural diversity in eating habits and contribute to more environmentally friendly eating. We described a possible regional ‘Nordic’ diet, mimicking the Mediterranean diet to some extent, as an example of such regionally appropriate health promoting diets based on food stuffs readily available and culturally embedded in the Nordic countries of Europe.

The ‘Nordic Diet’ has received quite some attention in recent years and a Danish research project was started. Arguably the best advocate of Nordic eating is the famous Noma restaurant. Noma is a two Michelin star restaurant run by chef René Redzepi in Copenhagen, Denmark. The name is an acronym of the two Danish words "nordisk" (Nordic) and "mad" (food), and the restaurant is known for its reinvention and interpretation of the Nordic Cuisine. In 2010, it was ranked as the Best Restaurant in the World.

Yesterday I was finally able to enjoy the Nordic diet in the very best possible way. With foods like fried reindeer moss, live shrimp (see picture!), goat butter, pine needle desert, wild duck, steamed oyster and much more, I had the best eating experience ever.

EMGO+ Midwifery researchers respond in BMJ to a paper in that journal questionning the Dutch maternity care system

Click here for the full rapid response

Dr. Ank de Jonge from the EMGO Institute for Health and Care Research and colleagues wrote a rapid response in the British Medical Journal to the paper by Evers et al. in the BMJ on perinatal mortality and morbidity in the Utrecht region. Evers et al.’s study is the first study in the Netherlands ever to show a higher mortality rate among births that started in primary care compared with secondary care. Ank de Jonge et al., argue that given the limitations of the study, the conclusion that labour starting in primary care carries a higher risk of delivery related perinatal death compared to labour starting in secondary care is premature from a scientific point of view.

A writing workshop to report the first results of the ENERGY project.

From 3 to 5 November, representatives of the EuropeaN Energy balance Research to prevent excessive weight Gain among Youth (ENERGY) project meet in Amsterdam for a ‘writing workshop’. A group of researchers from Belgium, Norway and the Netherlands meet in a meeting room in the Amsterdam Library to write the first scientific papers to report the first results of the ENERGY project. Two review papers, secondary analyses papers based on earlier studies, but also the first papers based on the ENERGY cross sectional study in 7 countries across Europe are prepared and pursued. The ENERGY cross sectional data set has become ready for analyses just a few days ago. The first analyses indicate that overweight prevalence among schoolchildren differs considerably between countries, with exceptionally high prevalence rates in Greece, and much lower rates in Norway, Belgium and the Netherlands. Also very large differences in behaviors that may contribute to risk for overweight and obesity, such as intakes of sugared drinks, breakfast habits, active commuting to school, are observed.

What social networks promote the spread of behavior change?

In the September 3 issue of Science Magazine a very interesting study by Demon Sentola provides supportive experimental evidence for why behavior change may be more likely in community-based approaches than in more linear health education settings. The paper reports on 6 experiments that show that  behavior change spreads more quickly, more thoroughly and is adopted more strongly in social networks with more clustering, i.e. with many interlinking ties between individuals, than in more random social networks with few casual ties between individuals. The latter social network is associated with quicker spread of infections and is regarded as more effective for spreading knowledge across societies. But these studies indicate that for behavior change, many interlinked direct social contacts may be needed to reinforce behavior changes.

The cost-effectiveness of health education and health promotion interventions

True evidence-based behavioral nutrition and physical activity interventions are hard to ac

complish. The health effects of such interventions are often only seen in the long run; increasing physical activity or healthful dietary changes will not immediately reduce the risks for heart disease or diabetes. It maye take years before such healthful behavior changes show in morbidity or mortality statistics. Evaluation of behavioral nutrition and physical activity is therefore mostly beased on analyses of changes in these behaviors, not on changes in actual health or disease. Economic evaluations, i.e. assessing the cost-effectiveness of behavior change interventions is therefore hardly ever done.

However, in recent years, evaluation of health effects and of the cost-effectiveness of behavior change interventions is more often attempted, by using epidemiological modelling. In such model-based evaluations the behavior change effects, e.g. the effects of the intervention in terms of minutes of extra physical activity per week, or extra servings of fruit and vegetables per day, is translated into expected health effects by means of epidemiological models that are based on the best available evidence on how such changes in behavior predict changes in health and disease in the (sometimes many) years to come.

In recent weeks two papers appeared that attempted to assess the cost-effectiveness of behavioral nutrition and physical activity interventions. The first study, by Dr. Saskia te Velde et al, published in Economics and Human Biology presents the assessements of long-term health effects and cost-effectivess of the Pro Children intervention. Pro Children was a European Commission funded project aiming to increase fruit and vegetable intakes among school children in Europe. Te Velde et al presented the positive effect on behavior change in an earlier paper in the British Journal of Nutrition, and now present clear indications of the cost-effectivenes of this fruit and vegetable promotion scheme based on an established epidemiological model. The second paper by Dr. Van der Keulen et al. (Hilde vander Keulen defended her doctoral thesis succesfully and thus got her PhD last Friday)

, published in the International Journal of Behavioral Nutrition and Physical Activity assessed the cost-effectiveness of the Vitalum interventions, a computer-tailored health education intervention, a motivational interviewing intervention, and a combination of both, to promote physical activity and fruit and vegetable intakes among older adults. This study also provides clear indications that these interventions are cost-effective, with the best economic evidence for the computer-tailored intervention.

These studies contribute to better evidence-based health education and health promotion and do indicate that such interventions can be cost-effective.

A special issue on studies from project HOPE

The Health-promotion through Obesity Prevention across Europe (HOPE) project started in 2007, was recently completed and aimed to bring the European scientific knowledge on overweight, obesity and their determinants together and use the expertise of researchers across Europe to contribute to tackling the obesity epidemic. A special issue of Public Health Nutrition now appeared that presents important results from one of the work packages of the HOPE project that aims at gaining and integrating knowledge on the determinants of nutrition, physical activity and obesity among schoolchildren and adolescents (aged 10-18 years) in different European regions. It includes contributions from Northern Europe (Norway), Central and Eastern Europe (Germany, Poland and the Czech Republic), Southern Europe (Greece) and Western Europe (Belgium and The Netherlands), as well as an overview of the availability of good-quality data on prevalence rates and trends in overweight (including obesity) among adolescents in European Union (EU) countries. The studies that are included report prevalence differences, data on relevant nutrition and physical activity behaviours, as well as potential physical and environmental behavioural determinants. These papers provide further evidence on differences in obesity and overweight prevalence among different EU regions and countries, and contribute to the further exploration of risk factors that may or should be addressed in obesity prevention efforts for school-aged children and adolescents in EU countries.
I co authored three of the papers in the issue: an editorial introducing the other papers and the HOPE project at large, a paper on direct and indirect association between environmental factors and fruit intake, and a paper on whether individual cognitions mediate the association of socio-cultural and physical environmental factors with adolescent sports participation.

Grand opening meeting of the Food & Nutrition Delta

Food & Nutrition Delta is part of the innovation program Food & Nutrition. This program is carried out in dialogue with the Ministry of Economic Affairs, more specific the Agency NL Innovation.

On the initiative of the Dutch business community and knowledge providers, together with the Ministries of Economic Affairs, Agriculture, Nature and Food Quality, and Health, Welfare and Sport, the innovation programme Food & Nutrition was created. This programme is focused at making the Netherlands a leading Food Innovation region in Europe.

Today, the 'grand opening' was at Fort Voordorp near Utrecht with a program of presentations on different relevant topics. Prof. Jaap Seidell and myself gave a workshop in the 'consumer behavior' track of the program. Prof. Seidell presented the rationale and some evaluation results related to the choices logo ('ik kies bewust logo'), i.e. a front of pack logo aiming to encourage consumers to make healthier choices within product categories and food producers to change their products to lower saturated fat, sugar and salt contents so that their produce meets the logo criteria. I presented on motivational and environmental determinants of fruit and vegetable consumption. A handout of my presentation can be accessed here.

Towards evidence-based, quality-controlled health promotion: the Dutch recognition system for health promotion interventions

Registration or recognition systems for best-practice health promotion interventions may contribute to better quality assurance and control in health promotion practice. In the Netherlands, such a system has been developed and is being implemented aiming to provide policy makers and professionals with more information on the quality and effectiveness of available health promotion interventions and to promote use of good-practice and evidence-based interventions by health promotion organizations. The quality assessments are supervised by the Netherlands Organization for Public Health and the Environment and the Netherlands Youth Institute and conducted by two committees, one for interventions aimed at youth and one for adults. These committees consist of experts in the fields of research, policy and practice. Four levels of recognition are distinguished inspired by the UK Medical Research Council's evaluation framework for complex interventions to improve health: (i) theoretically sound, (ii) probable effectiveness, (iii) established effectiveness, and (iv) established cost effectiveness. Specific criteria have been set for each level of recognition, except for Level 4 which will be included from 2011. The rationale, organization and criteria of this Dutch recognition system and the first experiences with the system are now described in a 'Point of View' article in Health Education Research.

Move more, sit less! A Think Tank meeting to encourage individuals and communities to increase physical activity and decrease sedentary behaviors

This week I participaed in an international 'Think Tank' meeting in NewCastle, UK. On Sunday the Great North Run will take place there, and attached to that 1/2 marathin event, in which some 50,000 people will participate, a Think Tank symposium was organised to brainstorm on how to promote healthy eating & physical activity, and discourage sedentray behaviours across the life course. I participated as a discussant in the meeting on physical activity and sedentary behaviours. In that meeting short introductions on the evidence regarding physical activity and sedentary behaviours for different target groups (i.e. pre-schoolers, school-age children, elderly etc) were provided by, for example, professors Fiona Bull, John Reilly, Gareth Stratton, Tom McKenzie, Wendy Brown, Jo Salmon and Simon Marschall. These introductions were followed by round table discussions.
Key Issues for the Think Tank were:

1. We are now realising that sedentary behaviour is often excessive and we need to seek ways to reduce too much sitting
2. Often physical activity has been seen as something for children and young adults. More emphasis needs to be placed on all ages across the lifespan
3. We need a dual approach to increasing physical activity and decreasing sedentary behaviour
4. We need to know more about successful ways to change behaviour.

The Think Tank aim was to:

• Tackle the important issues of physical activity and sedentary behaviour across the lifespan (pre-school children, young people and older adults), consider how guidelines and policies can work to encourage behaviour change, and evaluate the role of new technologies in behaviour change
• Synthesise state-of-the-art evidence
• State clear conclusions about what is known, not known, and what needs to be known in the future
• Arrive at practical suggestions for behaviour change in the context being addressed.

The chair of the Think Tank, professor Stuart Biddle of Loughborough University, wit some support staff will now try to synthesize the conclusions from the intensive discussions in a recommendations document.

Front-of-pack nutrition label appears to stimulate 'healthier' product development

In addition to helping consumers make healthier food choices, front-of-pack nutrition labels, such as the 'choices' label or 'trafiic light' logos that are in fashion today, could encourage companies to reformulate existing food products and/or develop new ones with a product composition more in line with dietary recommendations. In the International Journal of Behavioral Nutrition and Physical Activity the largest study to date on this topic was published recently. The study by Ellis Vyth and colleagues investigated the effect of a nutrition logo on the development of healthier products by food manufacturers in the Netherlands.

A total of 47 food manufacturers joining the Choices Foundation in the Netherlands indicated whether their Choices products were newly developed, reformulated or already complied with the Choices criteria and provided nutrient composition data for their products.

Most products carrying the logo as a result of reformulation and new product development were soups and snacks. Sodium (salt) reduction was the most common change found in processed meats, sandwiches, soups and sandwich fillings. Dietary fiber was significantly increased in most newly developed Choices product groups; for example, in fruit juices, processed meats, dairy products, sandwiches and soups. Saturated fatty acids and added sugar were significantly decreased both in reformulated and newly developed dairy products. Caloric content was significantly decreased only in reformulated dairy products, sandwich fillings and in some newly developed snacks.

The results indicate that the Choices logo has motivated food manufacturers to reformulate existing products and develop new products with a healthier product composition, especially where sodium and dietary fiber are concerned.

A new edition of 'Obesity Epidemiology'

Yesterday I received my firts copy of the new edition of''Obesity Epidemiology', published by Oxford University Press, that I edited with professors David Crawford, Bob Jeffery and Kylie Ball. The full title of the book is 'Obesity epidemiology: From aetiology to public health'. The 26 chapters in the book, with authors from Australia, North America, Europe and East Asia describes the epidemiology of obesity, the drivers of the obesity epidemic, and prevention approaches.

Two new professors held their inaugural addresses

On Thursday September 9, professors Tineke Abma and Guy Widdershoven held their inaugural addresses. Both professors are with the department of Medical Humanities and the EMGO Institute for Health and Care Research at the VU University Medical Center.

Professor Abma accepted her chair with an impressive and powerful presentation on the importance participation of patients –or the word clients is better if participation is indeed realized – in health care, and elderly care more in particular. Her address was based on her research in homes for the elderly. The grant finale of her speech was showing a clip of the Zimmers performing the Who’s ‘My Generation’. The Zimmers are a band of 50 elderly, “consisting of around 50 people with a cumulative age of around 3700, the band are here to challenge a whole host of misconceptions about the elderly by taking them on a true rock 'n' roll journey. The band celebrate all that old age should be.”

Professor Widdershoven used the work of second century men of arms and philosopher Marcus Aurelius to build a case for true empirical medical ethics research. The larger part of his address was on presented the aims and process of and research on moral deliberation projects.

Evaluating evaluations of health promotion campaigns in the Netherlands

Nationwide health promotion campaigns are an important part of government-funded health promotion efforts. Valid evaluations of these campaigns are important, but difficult because gold standard research designs are not applicable and budget, personnel, and time for evaluation is often very tight. In the Netherlands, Health Promotion Institutes (HPIs) are responsible for these campaigns. We conducted an exploratory study among the HPIs to gain a better insight into the goals, practices, conditions, and perceived barriers regarding evaluation of these campaigns. A paper reporting this exploration was recently published in Health Promotion International.

We conducted  personal interviews with representatives of six different HPIs who had direct responsibility for the management of the evaluation of their national campaigns. Based on these interviews it became clear that the HPIs typically made use of a pre-test–post-test design with single measurements before and after the campaign without a control group. In campaign preparations, HPIs used qualitative research to pre- and pilot-test some campaign materials or activities, but true formative evaluation was rare. Accountability to their sponsors, peers, and the population at large, was an important reason for evaluation, but the most important intrinsic motivation to evaluate was to inform future campaigns. In terms of the RE-AIM (Reach Efficacy Adoption Implementation Maintenance) framework, evaluation was mostly restricted to reach and effects; hardly any evaluation of adoption, implementation, or maintenance was reported. Budget restrictions and time restraints were reported as the main barriers for more extensive formative and more elaborate interrupted time series design effect evaluation. In conclusion, our exploration indicates that evaluation of nationwide campaigns is standard procedure, but the research designs applied are weak, due to lack of time, budget and research methodology expertise. Next to additional budget and opportunities for longer-term planning, input from external experts regarding evaluation research designs and data management are needed for evaluation improvement.

The ENERGY project is halfway

From August 29-31 we had the 'midterm' meeting of the EuropeaN Energy balance Research to prevent excessive weight Gain among Youth (ENERGY) project a Framework 7 European Commission funded project coordinated by the EMGO Institute for Health and Care Research. The midterm meeting was organised by and held at the University of Oslo, department of Nutrition. Halfway through the project we have conducted a series of systematic reviews that have or will soon be submitted for publication on family environmental determinants of obesity related behavioral nutrition and physical activity, on mediators and moderators of obesity prevention intervention effects, and of economic incentives in such interventions. Secondary analyses and focus group interviews have been conducted to gain more insight in the above mentioned determinants. But maybe most importantly, in the firts 18 months a cross European school-based, family involved survey study has been conducted among more than 7000 children in 7 countries across Europe. In this survey study, school children were measured for weight, height and waist circumference, they completed questionnaires on a range of dietary , physical activity and sedentary behaviors, and a sub sample wore accelerometers to assess their physical activity more objectively and gave blood samples for further biomarker evaluation. The data set is now being checked and cleaned and will soon be ready for first analyses. A copy of the design paper van be accessed here. A protocol paper for the survey study will soon be submitted for publication. We celebrated this accomplishment with a nice Norwegian see food dinner that was further enriched with a great musical performance by a Norwegian four female vocal group.

In the second half of the project an intervention to contribute to evidence-based obesity prevention among schoolchildren in Europe will be developed and tested in five countries. The meeting was largely dedicated to the first steps of mapping this intervention.

Voor Dik en Dun ('For thick and thin'): Health Council of the Netherlands report on obesity prevention and eating disorders

Many interventions and initiatives are being undertaken, also on behalf of the Dutch Ministry of Health, Welfare and Sport, to contribute to the prevention of overweight and obesity in the Netherlands. These government initiated or supported interventions are mainly aiming to promote healthier eating and  physical activity behaviors. In the context of these prevention and health promotion projects, the Minister of Health, Welfare and Sport has asked the Health Council of the Netherlands to advise on whether this increased attention that is being paid to overweight and obesity in the public arena may be a risk factor for the development of eating disorders. In the advice, that was published today, a specially appointed Committee, chaired by Professor Inez de Beaufort, and I had the pleasure to be a committee member, concludes that only very limited research has been conducted on this specific topic, but what is known to date suggests that the present day official campaigns and interventions for prevention of overweight are unlikely to cause eating disorders. Therefore, the committee concludes that there is no need to modify the current prevention policy focusing on a healthy diet and sufficient physical activity.
Different articles were published in Dutch news papers today on the publication of this report, for example in 'De Telegraaf', and on 'Nu.NL'. Interestingly, these media put most emphasis on the fact that campaigns may have negative side effects related to eating disorders instead of on the main conclusions described above.

The FoBoNet network for PhD students from the Nordic countries interested in food and nutrition

The FoBoNet seminar series is a podium for PhD students and their advisors from the Nordic countries with an interest in Nutrition research, especially from a social sciences perspective. Dr. Gun Roos, from the National Institute for Consumer Research in Oslo, Norway, is the actual coordinator, and takes care of this series in close collaboration with her sister Dr. Eva Roos from Folkhälsean Research Center, Helsinki, Finland, from.., Professor Margareta Wandel, from the University of Oslo and Professor Lotte Holm from Kopenhagen University. This year the event took place from August 23-25 in Tuusula, near Helsinki, Finland. I was invited to give a keynote lecture. A pdf handout of the presentation can be accessed here.

It is a three day event, but I could unfortunately only be there for the first and part of the second day. Gun Roos did the introductions at the start of the seminar. Then the actual program started with two ‘keynote lectures’. The larger part of the rest of the program was what the network is really about: PhD students presenting part of their work.
Professor Dale Southerton, director of the Sustainable Practices Research Group at Manchester University gave the first keynote in which he presented a theory on determinants of food choice and habits. He posited that we should take a much more practice-based approach, i.e. looking at what people actually do, instead of a more attitude/motivational (i.e. in line with for example the Theory of Planned Behavior)-based approach.

I provided a keynote on environmental influences on behavioral nutrition and physical activity. Both Professor Southerton and myself build a case for the importance of contextual factors, i.e. the physical, social cultural, political and economical environments in explaining food habits.

On the Tuesday morning Carola Ray from the Folkhälsan Research Center in Finland, Kristiina Kainulainen of the University of Helsinki, Hillevi Preli and Stina Olafsdottir, both from the University of Gothenburg presented their work all related to determinants of food and health among children. Eva Roos of the Folkhälsan Center chaired the session. Presentations covered school-based intervention studies to promote healthier lifestyles, social, cultural and personal factors related to easting habits, an analysis of food TV adds in Sweden, and the relation between watching TV and intake of sugar-sweetened drinks among youngsters.


Today I provided a lecture at the FoBoNet network meeting. The FoBoNet seminar series is a podium for PhD students and their advisors from the Nordic countries with an interest in Nutrition research, especially from a social sciences perspective. I talked about personal and environmental determinants of behavioral nutrition & physical activity.

A study to inform interventions to prevent unintentional poisoning of toddlers

A study by Beirens and colleagues published in the International Journal of Pediatrics reports on an explorative study on determinants of safely storing medication and cleaning products by parents to avoid poisoning in their kids. Unintentional poisoning is a major cause of nonfatal injuries in children aged 0-24 months. Associations of self-reported habits regarding 'child safe storage' of medication and cleaning products by parents with a range of family factors and motivations and attitudes were assessed. Data were gathered from a cross-sectional survey using self-administered questionnaires, mailed to a population sample of 2470 parents with toddlers. The study was based on the Protection Motivation Theory. 

The results suggests that health promotion activities promoting safe storage habits should particularly focus on parents' self-efficacy of storing poisonous products in a child safe manner and on the vulnerability of their child in their home concerning an unintentional poisoning incident.

being a participant in the PROOF study

In the Netherlands, approximately half of the working population works regularly with a computer. This concerns over 3 million people. Pain in the neck, shoulders, arms and/or hands, referred to as musculoskeletal disorders (MSDs), are still very common in this group and the size of this group is not decreasing. Previous research has shown that psychosocial work environment and computer use play a role in the development of MSDs. However, through what mechanisms is not known. The purpose of the so-called PROOF study (INTERACTIONS OF BIOMECHANICS AND PSYCHOSOCIAL STRESSORS IN RELATION TO THE DEVELOPMENT OF MSDs IN THE MODERN OFFICE)  is to get better insight in the development of MSDs by exploring the role of psychosocial work environment and computer use. We hope that the results will contribute to the prevention of MSDs in the future. The PROOF study is conducted by Linda Eijckelhof, MSc at the EMGO Institute for Health and Care research. The study is a collaboration with the Harvard School of Public Health in Boston, and is supervised by Professor Allard van der Beek here at EMGO+.

In this study, 120 office workers will be categorized in one of four defined profiles of psychosocial work environment, based on the amount of “reward” one receives at work and their reported level of “overcommitment” (both collected through a questionnaire). Biomechanical exposures (i.e. forces on keyboard and mouse, postural dynamics, and EMG of neck-shoulder muscles and wrist extensors) and computer usage will be measured for two hours during a workday at participants’ own work stations. These biomechanical factors will be compared across the four psychosocial profiles.


With these data a task-based exposure model will be developed to estimate the biomechanical exposures within different psychosocial work environments adjusted for individual factors. This model will be applied to a cohort of about 1000 office workers, of whom computer usage was assessed objectively and health outcome was self-reported in a two-year longitudinal study (PROMO). In this way, we will be able to relate biomechanical exposure to the development of MSDs measured in a large epidemiological study.
Yesterday I participated as one of the research subjects. Being researched instead of being a researcher for a change...

The 2009 annual report of EMGO+ is out

Two weeks ago we send out the 2009 annual report of the EMGO Institute for Health and Care Research (EMGO+). A pdf of the annual report can be accessed via this link. This 2009 report is the first annual evaluation after EMGO became EMGO+. On January 1 the old EMGO Institute of the VU University Medical Center, merged with strong research groups of the VU University faculties of Psychology & Education and of Earth & Life Sciences to conduct excellent research in public and occupational health, primary care, rehabilitation and long-term care.More specifically, by fulfilling its mission EMGO+ is aiming to contribute to improving evidence based:

• public and occupational health;
• primary health care;
• mental health care;
• rehabilitation practice;
• long-term health and health care.

The 2009 annual report shows that the institutes 2009 output in terms of publications, doctorol theses and acquired research funding is stronger than the sum of the 2008 outputs of the groups that merged to form EMGO+.

School-based fruit and vegetable promotion may have beneficial effects on unhealthy snacking

A study recently published in the Journal of Human Nutrition & Dietetics suggests that a Dutch school-based program to promote fruits and vegetable intakes among primary schoolchildren may have beneficial effects on top of an increased intake of fruits and vegetables.

Ample fruit and vegetable (F&V) intake has been associated with a decreased risk of chronic disease. If  increased F&V consumption would also lead to a lower intake of unhealthy, high calorie snacks, the positive effects of F&V promotion would even be better. Therefore, this study aimed to investigate whether a primary school-based intervention (the Dutch Schoolgruiten Project) that promoted F&V intake could additionally reduce the intake of unhealthy, high calorie snacks during school breaks.

The study applied a longitudinal design with baseline and two follow-up measurements. Children were aged 9–10 years; 705 children participated in the study. The main strategy to promote F&V's was a 'school fruit scheme, i.e. free provision of FYV in the school classes to improve the availability, accessibility and exposure to F&V at school. The effects of the intervention on F&V intakes was reported in an earlier publication in Public Health Nutrition. The children in the intervention schools brought F&V from home to school at follow-up significantly more often than children in comparison schools where no F&V scheme was implemented. The kids in the intervention schools also brought fewer unhealthy snacks to school for conusmption during school breaks. This study provides therefore some evidence that the Schoolgruiten intervention effect on F&V intake also reduced unhealthy snacking during school breaks.

A systematic review of studies on the association between food envrionments and obesogenic dietary behaviors

Earlier this months a new systematic review study was published that I co-authored. Dr. Katrina Giskes of  the School of Public Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia was first authors. The review was conducted as part of the Health promotion through Obesity Prevention in Europe (HOPE) project, a European Commission supported study in its 6th framework program.

The review examined whether physical, social, cultural and economical environmental factors (see the ANGELO model for a framework in which these different environmental factors are described) are associated with obesogenic dietary behaviours and overweight/obesity among adults. Literature searches of the most relevant databases of scientific literature identified original studies examining the different environmental factors and their associations with consumption of energy, fat, fibre, fruit, vegetables, sugar-sweetened drinks, meal patterns and weight status. Twenty-eight studies were selected;  the majority (16) of these studies were conducted in the USA. Being overweight or obese was consistently associated with the food environment; greater accessibility to supermarkets or less access to takeaway outlets were associated with a lower BMI or lower prevalence of overweight/obesity. However, obesogenic dietary behaviours did not mirror these associations; mixed associations were found between the environment and obesogenic dietary behaviours. Living in a socioeconomically-deprived area was the only environmental factor consistently associated with a number of obesogenic dietary behaviours. Associations between the environment and weight status appear to be more consistent than that seen between the environment and dietary behaviours. The environment may play an important role in the development of overweight/obesity, however the dietary mechanisms that contribute to this remain unclear and the physical activity environment is also likely to play an important role in weight gain, overweight and obesity.

Energy Symposium at ICO conference

Last week we show cased our ENERGY project (ENERGY stands for EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) at the International Confernece on Obesity in Stockholm Sweden. Amika Singh, the ENERGY coordinator organised the symposium. I chaired the symposium in which Energy principal investigators Carolyn Summerbell, Lea Maes, Mai Chin A Paw, Jurgen Jensen and Yannis Manios gave short presentations on energy balance behaviors, on mediators and moderators of these dietary, physical activity and sedentary behaviors, of possible economic strategies to influence these behaviors, and about the design and proceedings of a large cross sectional survey we are conducting across Europe, involving almost 10,000 children and one of their parents, to gain more insight into these issues, to inform the development and formative evaluation of a school-based, family involved intervention scheme aiming to contribute to obesity prevention in school-aged children in Europe. The presentations were discussed and reacted upon by two of the leading obesity prevention researchers, Boyd Swinburn from Deakin University, Melbourne, Australia, and Jane Wardle form University College, London.

Ruhr 2010: Cycling on a major freeway.

The ‘Ruhrgebiet’, i.e. the Ruhr metropolis, the area between Duisburg and Dortmund in Germany is one of the cultural capitals of Europe in 2010. The area show cases its industrial cultural heritage, with Essen and its former coal industry complex Zollverein as one of the highlights. Yesterday, July 18, one of the main attractions of Ruhr 2010 was ‘Still-Leben Ruhrschnellweg A-40’ or still life with Freeway a-40. The A-40 is one of the major freeways in the Ruhr metropolis. But last Sunday all motorized traffic was banned over a 60 km stretch, and the freeway was turned into a 60 k picnic table on one side, and a 60 k cycling freeway on the other. Millions of cyclist came to experience the ‘still life’, with major bicycle traffic jams as a result. Click here for some pictures.

Cycling the Alps with great friends

Last week was 6 days of intensive cycling through the Schwarzwald and the Swiss, Italian and French Alps. Hereafter are links to the routes and event details.

Alpen fietsen 2010 Dag 1 by hansbrug at Garmin Connect - Details

Alpen fietsen 2010 Dag 2 by hansbrug at Garmin Connect - Details

Alpen fietsen 2010 Dag 3 by hansbrug at Garmin Connect - Details

Alpen fietsen 2010 Dag 4 by hansbrug at Garmin Connect - Details

Dag 5 Alpen fietsen 2010 by hansbrug at Garmin Connect - Details

Alpen fietsen 2010 Dag 6 by hansbrug at Garmin Connect - Details

Pictures of the trip can be accessed here

A short video of Day 3 can be accessed here

Joint Programming Initiative “a healthy diet for a healthy life”

The importance of diet and health is now a key priority for most EU Member States seeking to deal with an increase in obesity and diet-related chronic diseases in their ageing populations. The increased prevalence of obesity, especially in vulnerable and disadvantaged population groups, may be indicative of a worsening trend of poor diet (choice) and physical activity across the EU population. No doubt, the prevalence of lifestyle-related diseases will increase and in the long term, this may have a negative impact on life expectancy and reduce the quality of life and will lead to increased health costs. European governments are struggling with the growing social and economic consequences of the alarming increase in obesity and food-related diseases.

The food and nutrition research community in Europe develops knowledge to enable production of safe, varied and nutritious foods and dietary patterns. Research is undertaken in university faculties and research institutes, and in agro-food companies. While excellent research has been carried out throughout Europe, this has not always been transferred to relevant stakeholders, i.e. the public, health promotion institutes, retail, or industry in a way to maximally benefit from the results. There is, therefore, a true need to avoid duplication of research activities and improve communication in effective knowledge transfer among research communities, health promotion organisations and food sector.

Making advances in the food, nutrition and health research will require close interactions between physical and bio-medical sciences, and social sciences. Research in sectors across the food and health care chains will require support from funding sources both national and international, and from the European Commission. Close cooperation is needed to ensure resources are targeted effectively and efficiently to scientific challenges, without duplication of effort or leaving gaps that would reduce opportunities for innovation.
Europe is now working towards joint programming in the field of diet & health research. Today a group of scientist met at Schiphol airport to work on a vision document to further shape the joint programming initiative that will lead to more coordinated nutrition & health research across Europe and may also influence the European Commission 8th framework research priorities. Two main research areas were brought forward in two groups. One of diet and chronic disease, and one on determinants of dietary patterns, I chaired the second group consisting of public health nutrition experts from Italy, the Netherlands, Norway and Spain.

An analysis of the VU University Medical Center’s focus areas

The VU University Medical Center (VUmc) has five specific focus areas on which we wish to excel: Cancer and Immunology, ‘Vital Functions’ (i.e. mostly cardiovascular disease oriented), Neurosciences, Movement Sciences, and Extramural and ‘Trans’ mural health care (i.e. mostly focussed on public and occupational health, primary care, rehabilitation, and long-term care). The board of the VUmc has asked for an evaluation and future analysis of each of these focus areas. I chair the committee for the analysis of Extra and Trans Mural health care. Yesterday was the first committee meeting in which the analysis plan was discussed, as well as the timeline and the criteria. The committee consists of experts in primary care, elderly care, internal medicine, psychiatry, rehabilitation medicine, public and occupation health, oncology, diabetes care etc. The analysis is meant to help us realise our specific strengths within these broad focus areas in order to make further choices where and when necessary.

A Dutch admission system for health promotion interventions

Registration or recognition systems for best-practice health promotion interventions may contribute to better quality assurance and control in health promotion practice. In the Netherlands such a system has been developed and is being implemented aiming to provide policy makers and professionals with more information on the quality and effectiveness of available health promotion interventions and to promote use of good-practice and evidence-based interventions by health promotion organisations. The quality assessments are supervised by the Netherlands Organisation for Public Health and the Environment and the Netherlands Youth Institute and conducted by two sub-committees, one for interventions aimed at youth and one for adults. I chair the sub-committee for admission of interventions aimed at adults. These committees consist of experts in the fields of research, policy and practice. Four levels of recognition are distinguished inspired by the UK Medical Research Council’s evaluation framework for complex interventions to improve health: (I) theoretically sound; (II) probable effectiveness; (III) established effectiveness; (IV) established cost-effectiveness. Specific criteria have been set for each level of recognition, except for level 4 which will be included from 2011. Yesterday a meeting was held between representatives of the supervising organisations, the two sub-committee chairs, and representatives of the main stakeholders, i.e. the organisations responsible for the development and implementation of health promotion interventions in the Netherlands (such as the Netherlands Nutrition Center, the Netherlands Institute for Sport and Physical Activity, the national organisation for Municipal Health Services, and the Netherlands Institute for Homosexuality, Health and Wellbeing). This meeting was pasrt of a first evaluation of the admission system, i.e. to discuss the mutual experiences with the system and to explore further developments.

Cycling to work and cycling to school

The Norwegian Medical Journal published an article on the merits of cycling to work. The authors report  positive effects of cycling to work on fitness (VO2max) and health indicators (total cholesterol, HDL cholesterol and body mass index). Earlies studies, including research conducted in the Netherlands and Norway, indicate that cycling to school is also associated with evident health benefits.

For my home to work cycling route...click here.

A symposium to honour Prof. Andre Knottnerus

Yesterday, Prof. Andre Knottnerus was honoured with a special symposium because he stepped down as chair of the Netherlands Health Council. The minister of health -Ab Klink-, the chair of the Social and Economic Council of the Netherlands -Dr. Alexander Rinnooy-Kan-, the inspector general of the national Health Care Inspectorate –Prof. Gerrit van der Wal, and others gave brief presentations to illustrate the importance of Andre Knottnerus work for the Health Council. The symposium was led by Prof. Daan Kromhout, the vice chair of the Health Council.

Prof. Knottnerus will continue his work for the public good as chair of the Scientific Council for Government Policy.

Andre Knottnerus is a member of the external advisory board of the EMGO Institute for Health and Care Research.

First research seminar of the newly established department of Midwifery Science

About two years ago the college for Midwifery of Amsterdam and Groningen together with the VU University Medical Center, expressed the ambition to further develop the discipline of Midwifery in the Netherlands into a university-based, academic field. Such a development is already in a more developed state in countries like the UK, Canada and the Scandinavian countries.

In this development it was decided to work towards an academic bachelor and master program to be established at the VU University Medical Center, and to start a research program. This establishment of this research program was the first concrete step in this academic development process, and the EMGO Institute for Health and Care Research at VUmc took the responsibility for this step in close collaboration with the Midwifery college.

Two post doctoral researchers were recruited, Drs Ank de Jonge and Judith Manien, in close collaboration with the Netherlands Institute for Health Services Research, a national study of midwifery practice was conducted (the ‘Deliver’ study), a number of Midwifes and Midwifery college teachers started their PhD research projects, and a chair in Midwifery Science was founded.

Early this year these developments led to the establishment of the first university department of Midwifery Science in the Netherlands. Yesterday, June 15, this department held its first research seminar. The research presentation was given by Dr. Eileen Hutton, associate professor at the department of Obstetrics and Gynaecology and assistant dean at the faculty of Health Sciences at McMaster University in Hamilton, Canada. Dr. Hutton will be appointed as the part time professor of Midwifery Science at the VUmc department later this year. We are very proud that such an authority in the field is willing and able to lead the further development of the research program and to further develop the scientific talent in Midwifery Science in the Netherlands. She will combine this chair with her work in Canada.

ISBNPA 2010 will start tonight

This evening the 9th annual conference of the International Society of Behavioral Nutrition & Physical Activity (ISBNPA) will start. Today the preconference workshops were held, one on computer-tailored nutrition & physical activity education. With keynotes by Knut-Inge Klepp, Pascal Sheeran, Robert Jeffrey, Deborah Tate, and David Ludwig, symposia, oral presentations and posters on all cutting edge behavioral nutrition and physical activity research topics, the local organisasing committee, led by Simone French of the University of Minnesota, together with the scientific committee, led by the upcoming ISBNPA president, Knut-Inge Klepp, have come up with a great program.

Alpe D'Huez has been concurred by the VUmc team for Alpe D'HuZes

Last thursday a team of VU University Medical Center professors, Post doctoral students and PhD students cycled up and down Alpe D'Huez mountain in behalf of the Alpe D'HuZes foundation to raise money for research to support cancer patients and survivors. Our combined team did more than 40 climbs to Alpe D'Huez (...all participants combined did over 10,000 climbs...I was lucky to be the 10,000th at the finish line when I completed my 7th...), and we raised more than 60,000 Euros.

Click here for my personal video impression of the event day.

Money raised by Alpe D'HuZes supports the A-Care program (Alpe D'HuZes Cancer Rehabilitation research program) coordinated at the EMGO Institute for Health and Care Research, and chairs in 'Living with Cancer' and 'Nutrition and Cancer' both embedded in the EMGO Institute.

8 days until alpe d'huzes

Eight days to go until the Alpe D'Huzes fund raiser. On June 3 almost 3000 cyclist will climb Alpe D'Huez mountain for one or more times. A substantial number of those 3000 will go for six climbs on that one day. This effort is undertaken by these cycling crazies in order to raise as much money as possible for research aiming to inform and improve 'living with cancer'.

The Alpe D'Huzes foundation organises this event. Alpe D'Huzes means something like 'Alpe Six Times' in Dutch. In 2006 the event was organised for the first time on the 6th of June, when the founding fathers of Alpe D'Huzes, Peter Kapitein and Coen van Veenendaal cycled the Alpe six times with a small group of other people dedicated to do some cycling for a great cause. The money raised from 2006 on goes to the Netherlands Cancer Society, to a specific fund for research that fits the Alpe D'Huzes. The money raised so far goes, among other things, to the Alpe D'Huzes Cancer Rehabilitation Project (A-CaRe), to the endowed chair in 'Living with Cancer' , i.e. Professor Irma Verdonck, at the department of Clinical Psychology, and very soon to an endowed chair in nutrition and cancer at the department of Health Sciences at the VU University and the EMGO Institute for Health and Care Research, VU University/VU University Medical Center.

As the director of the EMGO Institute, I participated in the event last year, indeed completing the six climbs; click here for a video impression of my experiences in 2009.

This year the VU University Medical Center participates with 3 teams in the event. Led by our dean, professor Wim Stalman, the VU University Medical Center has formed three teams of cancer researchers. One of the teams is the so-called 'Pro(f)' team, consisting of professors; I am one of their riders, please see my personal participant page. Another is the 'talent team' consisting of PhD students.
Yester day the Pro and Talent teams had a joined training ride, right through the center of the Netherlands, from Overveen in the west, to Papendal, near Arnhem in the east. Coffee and cake were served in Rhenen, in our dean’s back yard, where some team photos were made. Please click here for a short video impression and here for some photos.

The training session showed that we are ready for the event next week.