Johannes Brug, PhD

Screen time predicts weight gain but body fatness did not predict more screen time in boys

2012-01-27T22:13:00.001+01:00

Screen time, i.e. TV viewing and computer time, has been found to be associated with overweight in children and adolescents. However, it is unclear if kids who are overweight start watching more TV or if kids who watch more TV are more likley to become overweight. The aim of a study just published in the International Journal of Behavioral Nutrition & Physical Activity examined the direction of the association between screen time and body fatness in Dutch adolescents. Dr. Teatske Altenburg was first author.

Longitudinal data of 465 Dutch adolescents (mean age at baseline 13 years, 53% boys) was used. Body fatness (objectively measured Body Mass Index (BMI), four skin folds and waist- and hip circumference), self-reported time spent watching TV and computer use, and aerobic fitness (shuttle run test) were assessed in all participants at three time points during 12 months. State of the art statistical analyses were conducted to see if screen time predicted body fatness in the following time period and/or whether body fatness predicted more screen time.

Time spent TV viewing did indeed predict changes in BMI and hip circumference in boys, but not in girls, in the subsequent period. Computer time significantly predicted increases in skinfolds in boys and girls and increases in BMI in girls. Body fatness did not predict any changes in screen time.
Our study thus only partly supports the widely posited hypothesis that more screen time cause increases in body fatness. In addition, this study demonstrates that high levels of body fatness did not predict increases in screen time.

A review of worksite physical activity promotion interventions in Europe

2012-01-22T19:51:00.001+01:00

In a paper just published in e-pub in Obesity Facts, we reviewed the effectiveness of physical activity promotion interventions in the worksite setting in Europe. Studies included (n = 33) were divided in 6 intervention categories. Moderate evidence of effectiveness was found for physical fitness outcomes with exercise training interventions and for physical activity outcomes with active commuting interventions. Although our review suggested that worksite interventions did result in more physical activity, our review showed no or inconclusive evidence for obesity-related outcomes for all intervention categories. We concluded that active commuting and exercise training appear as promising approaches to promote physical activity or fitness in the workplace. The effect of interventions on obesity-related outcomes remains to be further investigated.

Differences in fruit and vegetable intake among Dutch schoolchildren between 2003 and 2009

2012-01-10T17:53:00.001+01:00

Fruit and vegetable (FV) intake in children in the Netherlands is much lower than recommended. Recurrent appraisal of intake levels is important for detecting changes in intake over time and to inform future interventions and policies. The aim of a study recently published in the International Journal of Behavioral Nutrition & Physical Activity was to investigate differences in fruit and vegetable intake, and whether these could be explained by differences in potential determinants of FV intake in 11-year-old Dutch schoolchildren, by comparing two school samples assessed in 2003 and 2009 in tow European Commission funded projects, i.e. the Pro Children and Pro Greens projects. In 2009, more children complied with the World Health Organization recommendation of 400g fruit and vegetables per day (17.0%) than in 2003 (11.8%). This difference was mainly explained by a difference in the parental demand regarding their child's intake, by differences in children's knowledge of recommended fruit intake levels and by whether parents faciliated their child's fruit intake. Vegetable intake was lower in the 2009 sample than in the 2003 sample but this difference could not be explained by the assessed mediators. The findings indicate that fruit intake among 11-year-olds improved somewhat between 2003 and 2009. Vegetable intake, however, appears to have declined somewhat between 2003 and 2009. Since a better knowledge of the recommendation, parental demand and facilitation explained most of the observed fruit consumption difference, future interventions may specifically address these potential mediators.

In memoriam: Prof. Marci Campbell

2011-12-21T21:00:00.000+01:00

Early this week I received notification of the terrible news that Prof. Marci Campbell, professor at the department of nutrition at the UNC School of Global Public Health of the University of North Carolina at Chapell hill died of cancer.

Dr. Campbell’s research focused on nutrition behavior change for health promotion and disease prevention. Her research focused on investigating health communication strategies aimed at reducing risk factors for cancer and chronic diseases in minority and under-served communities. Approaches include testing effectiveness and cost-effectiveness of computer-generated, individually tailored interventions on diet, physical activity, and cancer screening behaviors for health promotion and disease prevention in diverse populations; impact of multi-level interventions including individual, social, organization and environmental approaches to address social and economic determinants and encourage healthy behaviors; and dissemination research using evidence-based interventions for obesity prevention and health promotion on a population-wide level.

I worked closely with Marci when I took my first steps in research. I was fortunate enough to spend a few months at the University of North Carolina in the early 1990’s when Marci and I were both working on our PhD theses in which we studied the development, implementation and effects of computer-tailored nutrition education. Marci published the first paper on this topic in the American Journal of Public Health. Since then Marci and I kept collaborating on a number of studies, including a reviews in the American Journal of Clinical Nutrition and in Patient Education and Counceling, and as co-advisors for the PhD research of Dr. Willemieke Kroeze, who went on to further explore and improve computer-tailored health education.

Marci was a great friend and colleague and I am grateful that I could work and spent time with her.

New book on writing health communications

2011-12-21T20:36:00.000+01:00

This week a new book on writing health communication is out. The book, edited by prof. Charles Abraham of the University of Sussex and Dr. Marieke Kools of Maastricht University. The book provides a systematic and detailled description with lots of practical information regarding how people process information and how such insights can be used to improve health education materials. The book has chapters on message framing, the use of fear appeals, tailoring messages, using graphics, and behaviour change. Each chapter is illustrated with examples - including both good and bad practice and covering a range of health topics. Together with Anke Oenema of Maastricht University, I wrote the chapter on computer-tailored health education.

Study on reliability and validity of the ENERGY questionnaire published

2011-12-14T15:29:00.000+01:00

The ENERGY-project is a European Commission funded cross-European project to gain more insight

in Energy Balance Related Behaviors (EBRB, i.e. specific eating, physical activity and sedentary behaviors that contribute to risk for overweight and obesity) and their potential behavioural determinants, and to inform and test a school-based and family-involved obesity prevention intervention scheme. As part of the ENERGY-project a crosssectional survey among more than 7000 children, their parents, and schools was conducted in seven countries representing different regions of Europe. This survey used questionnaires among children, parents, and school staff, as well as observations in the school and school environments. However, for the survey no established valid and reliable measures that could be administered in large populations of schoolchildren in different countries across Europe were available. Therefore, we developed a child and parent questionnaire to assess a range of EBRBs and potential individual and environmental behavioural determinants, and examined the test-retest reliability and construct validity of these two main questionnaires used in the ENERGY cross-sectional survey. The reliability study among children is now published in the International Journal of Behavioral Nutrition and Physical Activity, with Dr. Amika Singh as the first author.

2011-12-11T21:01:00.000+01:00

Self-care is an important aspect of heart failure (HF) management. Information on possible determinants of selfcare is needed for the development of self-care promotion interventions. HF self-care includes self-care management, self-care maintenance, sodium, fluid and alcohol intake restriction, physical activity, smoking cessation, monitoring signs and symptoms and keeping follow-up appointments. To assess the evidence regarding presumed determinants of HF self-care in order to make recommendations for interventions to promote self-care behavior among HF patients, a systematic literature review was conducted. This review is now published in the journal Heart Failure Reviews, with Rony Oosterum-Calo as first author. Twenty-six original scientific articles were included in the review. Results showed that patients’ who were diagnosis with HF longer agi, i.e. with more experience with the disease, were more likley to performe self-care maintenance. Moreover, it was found that HF patients’ perceived benefits and barriers are related to their restriction of sodium intake, and that patients with type-D personality are less likely to consult medical professionals. All other evidence was inconsistent, mainly due to insufficient evidence or lack of studies. Interventions that aim to increase the performance of self-care maintenance can teach newly diagnosed patients the skills that are usually attained with experience acquired as a result of living with HF for a longer time. Perceived benefits and barriers of restricting sodium intake could be targeted in interventions for sodium intake reduction among HF patients. Finally, interventions for the promotion of adequate consulting of medical professionals can specifically target HF patients with a type-D personality.

Trying to explain educational differences in consumption of sugary drinks

2011-12-08T16:22:00.000+01:00

One of the possibly most important correlates and determinants of nutrition behaviour is socio-economic background. Again and again it is found that people from lower socio-economic status, as indicated by level of education, income, job status or other factors, are, for example, more likely to be overweight and eat poorer diets. Such differences are already found among children and adolescents. In a recent paper published in Public Health Nutrition, we explored mediators of gender and educational differences in sugarsweetened soft drinks consumption (SDC) and we investigated whether gender and level of future education moderate the associations of accessibility, modelling, attitudes and preferences with SDC. We were able to use data from 2870 children in 9th and 10th grade from more than thirty secondary schools in Norway.

As expected, girls and pupils planning higher education reported to drink SDC less often than boys and pupils going to higher levels of education. The differences according to future education plans were mediated by accessibility and modelling: thus children who were planning to go to higher education had lower accesibility to sugary drinks and were less likely to be exposed to peer models that drank lots of sugary drinks.

The joint Australian-New Zealand Nutrion Societies meeting

2011-12-08T15:50:00.001+01:00

Last week I presented the results of the ENERGY study on childhood overweight and obesity and prevention of childhood overweight and obesity across Europe, at the annual meeting of the Australian and New Zealand nutrition societies. The meeting's theme was 'Lean and Green' with a focus on obesity as well as on sustainable food and nutrition. My keynote presentation was linked to the 'Lean' theme, while Prof. Tim Lang talked about the link with sustainability - via a web-video presentation. The meeting was much like similar meetings in the Netherlands or elsewhere in Europe, with similar presentations, studies and discussions, and even sponsors (e.g. similar to such events in the Netherlands, the Dairy industry was the main sponsor of the meeting).

Visiting the School of Population Health, University of Auckland

2011-11-28T05:38:00.000+01:00

On my way to the joint annual meeting of the Australian and New Zealand Nutrition Societies in Quesnstown, New Zealand, together with Professor Kylie Ball from Deakin University, I visited the clinical trial research unit of the School of Population Health of the University of Auckland. We had meetings with the behavioral nutrition and physical activity research leaders of the unit, i.e. Cliona Ni Mhurchu and Ralph Madison, as well as a number of research fellows and PhD students. Kylie and I provided a joint symposium at lunch time.

Visiting C-PAN at Deakin University, Melbourne

2011-11-21T00:39:00.000+01:00

This week I am visiting the Center for Phyiscal Activity and Nutrition Research (C-PAN) at Deaking University, Melbourne, Australia. C-PAN is one of the internationally leading groups in (behavioral) nutrition and physical activity research. Their focus is very similar to parts of the EMGO Institute for Health and Care Research (EMGO+), our Lifestyle, Overweight & Diabetes and Musculoskeletal Health programs in particular. The close collaboration with C-PAN has resulted in a number of joined projects, including involvement of C-PAN staff in the EMGO+ European Commission funded ENERGY project on obesity prevention in school-age children across Europe, and involvement of EMGO+ staff in C-PAN's READY project on resilience to obesity among women from lower socio-economic backgrounds, and a growing number of joint scientific publications. The accompanying photo shows (except for myself and C-PAN's director David Crawford's son Alex) the C-PAN staff that visited EMGO+ in the last couple of years, as well as another regular visitor of C-PAN, Prof. Bob Jeffery from the epidemiology unit of the University of Minnesota, USA. (Notice C-PAN in chocolate letters, in anticipation of the Dutch Sinterklaas festivities....)http://en.wikipedia.org/wiki/Sinterklaas

Health education is not enough to promote healthy diets and physical activity

2011-11-11T16:32:00.000+01:00

Today two PhD candidates from the EMGO Institute for Health and Care Research defended there theses at the VU University here in Amsterdam. In his thesis 'Efforts to prevent diabetes and cardiovascular disease in primary care' Jeroen Lakerveld explored the effects of a health education program based on motivational interviewing and problem solving treatment to motivate and enable people with high risk to adopt health behaviors that contribute to diabetes prevention (e.g. healthy eating and physical activity). The effect study showed generally no effects of this health education approach. Dr. Lakerveld states that the approach taken may have been too limited, and that for interventions to be effective changes in the environment, i.e. the availablity of and social support for health choices may be needed.

Willemijn Vermeer studied the role of portion sizes of foods and the development and evaluation of interventions to motivate or enable people to take smaller portion sizes. Earlier research shows that portion sizes have increase quite abit over the years, e.g. coke, candy bars, fast food entrees are sold in much bigger portion sizes nowadays than a few decades ago. Additional research strongly suggests that these increases contribute to overeating and to overweight and obesity. Dr. Vermeer research shows that policies to actually reduce portion sizes are not acceptable for the general public or for food catering organisation, while interventions that are regarded as acceptable, i.e. better labels to explain portion sizes or more choice between different portion sizes, appear to be ineffective.

Both studies suggest that health education is not enough and that people need to be nudged toward healthier behavior - that the healthy choice should be made the easy and default choice. The present Dutch government disregards this and earlier (and even stronger) evidence. Theb Dutch policy is that people are ablle and will make informed choices about their health behavior and that freedom of choice and autonomy should be promoted. In an environment that promotes supersizing and lack of physical activity, that freedom of choice appears to be quite relative.

A review on economic incentives and nutritional behavior among children in the school setting

2011-10-27T18:19:00.000+02:00

Health behaviour may be promoted by different incentives. Economic incentives, i.e. monetary rewards or price incentives, e.g. making healthy foods less expensive and unhealthy foods more expensive, may be applied. However, the true possibilities and effects of such interventions are debated, and their applicability among children may be doubtful. The aim of a review, just published online in the journal Nutrition Reviews, was to examine the existing literature on the effectiveness of economic incentives for producing sound nutritional behavior in schools Altogether, 3,472 research publications were identified in the systematic search, of which 50 papers were retrieved. Of these, 30 publications representing 28 studies were regarded as of highe enough quality and relevant. The review indicates that price incentives are effective for altering consumption in the school setting. Other types of economic incentives have been included in combined intervention schemes, but the inclusion of other intervention elements makes it difficult to draw conclusions about their effectiveness.

A second writing workshop to publish further results of the ENERGY project

2011-10-13T16:06:00.001+02:00

The ENERGY project stands for the "EuropeaN Energy balance Research to prevent excessive weight Gain

among Youth : Theory and evidence-based development and validation of an intervention scheme to promote healthy nutrition and physical activity". ENERGY consists of a series of systematic reviews, secondary data analyses, a school-based and family involved cross sectional and intervention study among 7000 and 2500 children and one of their parents respectively. Seven countries across Europe are involved. The project description and study design papers regarding the cross sectional study in general and the accelerometer study (i.e. a study to monitor schoolchildren physical activity objectively) have been published, and a number of scientific papers have been submitted for publications. These concern papers on prevalence - and differences in prevalence between the seven countries - of overweight and obesity, as well as engagement in a range of behaviors (i.e. physical activity, sedentary behaviors, dietary behaviors) associated with risk for being or becoming overweight; differences in prevalence according to ethnic background of the children. Further papers that have been submitted focus on, for example, the reliability and validity of the measures used in the ENERGY study, the relation between weather circumstances and physical activity, the association between sedentary behavior and blood markers for metabolic health, et cetera.
These days another writing workshop is ongoing in a bed-and-breakfast facility in Amsterdam to write and prepare the next series of scientific papers from the project. Scientists from the UK, Norway, Spain, Belgium and the Netherlands meet here for 3 days to write and provide feedback on a series of papers regarding for example mediators of socio-economic differences in childhood overweight, the clustering of physical activity and sedentary behavior patterns, the contribution of TV watsching to total sedentary behavior and a range of other topics. All these papers use data from the cross sectional survey of ENERGY. Data for the ENERGY intervention study targetting sedentray behavior among school children in five of the partcipating countries are now being collected and will be available later this year.

A workshop in Stockholm on grading evidence regarding public health interventions

2011-10-07T13:38:00.000+02:00

Last Wednesday, the Swedish National Institute of Public Health organised a meeting in Stockholm to explore the do's and don't's of grading evidence regarding public health interventions to help policy makers to identify the best and most effective interventions to promote population health. In public health and health promotion the cry for better evidence-based practice is strong and obvious. However, grading the evidence in public health is more complicated as compared to medical interventions. In public health, interventions are, for example, often group or population based rather than aimed at individuals, effects are often only to be observed in the long run, and interventions are mostly complex, multi-component and context dependent. These characteristics make it more difficult to study public health interventions in research designs that are regarded as the most internally valid, i.e. randomised controlled trials (RCT). In existing systems to grade evidence for medical interventions, such as the GRADE system, evidence not based on RCT designed studies can never be strong, thus favouring individual medical interventions above population-based public health interventions. Therefore, maybe new or other systems need to be developed, or the GRADE system may need to be adapted to better accomodate public health and health promotion interventions. At the workshop I presented the Dutch acknowledgement system for health promotion interventions, led by the the Centres for Healthy Living and Youth Health of the Netherlands National Institute for Public Health and the Environment and the Netherlands Youth Institute. This system was specifically designed and 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. 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, taking into account the specific evaluation researhc challenges for public health and health promotion evaluation research. The way the Ducth system works and the first experiences and results were published in a paper in Health Education Research.

Nicole Ezendam successfully defends her PhD thesis

2011-09-29T18:12:00.000+02:00

Today Nicole Ezendam received her doctorate degree after a successful public defence of her thesis entitled “Vet is niet Vet (Fat aint Phat): studies on the prevention of excessive weight gain among adolescents.” Her thesis encompasses three studies exploring determinants of unnecessary weight gain among adolescents and four studies on the development, effects and the process of the FATaintPHAT intervention. This is a computer-tailored program to motivate and enable adolescents to adopt more healthy dietary and physical activity habits.

Her research shows that the intervention appeared to help the participants to adopt healthier dietary habits, but failed to encourage them to become more physically active

The third Alpe D'Huzes cancer rehabilitation program annual meeting

2011-09-27T12:24:00.002+02:00

Today the third annual meeting of the Alpe D'Huzes Cancer Rehabilitation (A-Care) program was held in Amsterdam. A-Care is a comprehensive program of eight PhD studies organised in two subprograms to further our knowledge on the effects of exercise in cancer rehabilitation and survival. The first subprogram focusses on clinical research to study the effects and mechanisms of effect of different exercise regimes in different groups of cancer patients. The second subprogram focusses on ways to implement and disseminate succesful exercise interventions. Dr. Laurien Buffart, the acting coordinator of A-CaRe 1 and a recent 'Bas Mulder award laureat, organised the day.

Prof. Rob Newton (see picture), and Drs. Lee Jones and Renate Winkels provided state of the art overviews of the roles of exercise and diet in cancer rehabilitation and survival, and Prof Wim van Harten and Dr. Mai Chinapaw provided overviews of ghe progress of the two subprograms.

Prof. Christianne de Groot is inaugurated as professor of obstetrics

2011-09-27T10:52:00.000+02:00

Yesterday, Prof. Christianne de Groot gave her inaugural address as professor and head of department of obstetrics at the VU University Medical Center. She first presented the well known facts that perinatal mortality is higher in the Netherlands than in surrounding countries. She argued that for a better perinatal care true and close collaboration between extramural and intramural care, between midwifes and obstetricians, in a true women and child care center is of crucial importance. Such close collaborations are now being developed and researched within VUmc and the EMGO Institute for Health and Care Research.

The Journal of Nutrition Education and Behavior podcast on our study on computer-tailored nutrition education

2011-09-11T17:33:00.000+02:00

In the upcomming issues of the Journal of Nutrition Education and Behavior, a paper by Dr. Kroeze et al is published on an evaluation of computer-tailored nutrition education on saturated fat intake among adults. This evaluation was not based on self-reported intakes, but on biomarkers, i.e. blood lipids. In more detail: a group of more than 400 adults receved either computer-tailored nutrition education about their fat intake levels or not, and cholesterol levels were measured in blood samples to assess if exposure to the nutrition education resulted in better blood lipid levels. However, despite clear favorable changes in self-reported fat intake levels, no effects on blood lipids were found. If you want to learn more about this study, and how these conflicting results should ne interpreted, please listen to a podcast interview with the firts author of our paper (look for 9/8/11).

Dr Anna Timperio gives a seminar on home and family determinants of overweight in children

2011-09-02T08:06:00.001+02:00

Yesterday, Dr. Anna Timperio, of the Center for Physical Activity and Nutrition Research of Deakin University gave a seminar on her work on home and family environment determinants of physical activity, eating behaviors, sedentary activities and overweight in children. In her seminar she presented an overview of results of the CLAN and HEAPS studies, two longitudinal studies aiming to unravel why children become overweight or not. Her work shows that family environmental factors, such as example behavior of parents, doing physical acyivities together, and the availability of physical activity equipement in the home, appear to be more important than neighbourhood factors, for children's physical activity.

Home and neighbourhood correlates of weight status among children in low socio-economic neighbourhoods in Australia

2011-08-31T12:05:00.000+02:00

Understanding the underlying drivers of obesity-risk behaviours is needed to inform prevention initiatives. People, including children, of lower socioeconomic position groups are more likley to be overweight and obese, and understanding of the drivers of such socio-economic differences in weight status are of special importance. It is very likely that factors in the home and local neighbourhood environments are of importance. However little research has examined such possible determinants among children from low socioeconomic backgrounds. A study conducted in Victoria, Australia, on this topic was recently published by Prof. David Crawford from the Center for Physical Activity and Nutrition of Deakin University. The study examined home, social and neighbourhood correlates of body mass index in children living in disadvantaged neighbourhoods. Data were collected from 491 women with children aged 5-12 years living in forty urban and forty rural socioeconomically disadvantaged areas (suburbs) of Victoria. Mothers completed questionnaires about the home environment, social norms and neighbourhood environment in relation to physical activity, healthy eating and sedentary behaviour. Children's height and weight were measured at school or home. The results showed that children who had a television in their bedroom and whose mothers made greater use of food as a reward for good behaviour had higher body mass index. Increasing efficacy among mothers to promote physical activity, limiting use of food as a reward and not placing TV in children's bedrooms may be important targets for future obesity prevention initiatives in disadvantaged communities.

A new grant to further enrich computer-tailored health education

2011-08-30T17:51:00.000+02:00

Computer-tailored health education, i.e. using ICT to provide people with individually tailored feedback and advice to motivate and enable more healthy lifestyles, is a very promising health education technique (see Brug et al for an early overview of the evidence, Oenema et al for a firts study on web-based computer-tailoring, or Kroeze et al for a more recent systematic review). One of the critiques on this form of on-line health education is that it does not include the necessary social interaction to better realise lasting behavior changes. With the development and very fast dissemination of web-based social networks, the distribution of mobile internet, and ever faster and more powerful mobile devices, the possibilities to provide computer-tailored health education where and when it matters, based on objective measures of behavioral patterns, and linking this to social network features become apparant. We have just received notice that we will receive an important research grant, with Dr. Saskia te Velde as the main applicant, in the Partnership programma STW-NIHC-Philips Research“Healthy Lifestyle Solutions” to develop and test such further innovations in computer-tailored health education promoting physical activity among young adults.

Effectiveness of workplace interventions in Europe promoting healthy eating: a systematic review

2011-07-29T10:57:00.000+02:00

The worksite is a promising setting for health promotion. A review recently published online in the European Journal of Public Health by professor Lea Maes et al. summarizes the evidence of effect of intervention studies in European countries promoting a healthy diet solely and in combination with increasing physical activity at the workplace. The review included studies published from 1 January 1990 to 1 October 2010; worksite-based interventions promoting a healthy diet solely or in combination with physical activity aiming at primary prevention and measuring anthropometrical or behavioural change among adults (≥18 years old) were included.

Seventeen studies solely focusing on promotion of a healthy diet were identified. Eight of these studies investigated health education intervention, one studie explored the effects of changes in the worksite environment, and eight used a combination of both (i.e. multi-component interventions). None of the interventions was rated as very 'strong'. The reviewed studies showed moderately strong evidence for effects on dietary change.

In conclusion only moderate evidence was found for positive effects of nutrition interventions implemented at the workplace. Effects of workplace health promotion interventions may be improved if stronger adherence to established quality criteria for such interventions is realized.

FUSE (the centre for translational research in public health) strategy meeting

2011-07-28T11:03:00.000+02:00

Last Tuesday I attended - as an external member of the FUSE strategy board- a strategy meeting to explore and inform the centre's policy, strategy and tactics for the years to come. The meeting was led by the centre's director, Professor Martin White, and was held after the centre's third anniversary, and two yeard before its firts term ends. FUSE is an inter-university centre for translational research in public health. It is a collaboration between five universities in the north-east of England - Durham, Newcastle, Northumbria, Sunderland and Teesside - and works in partnership with the public and in collaboration with the National Health Service, local and regional government and other public, private and voluntary organisations in North East England. FUSE focusses on the translation from research into public health policy and practice, it aims to do practice-based research to improve evidence-based practice, and its main goal is to develop a scalable model for such translation. Such translation of research into policy and practice, and translation of policy and practice issues in research is of of great importance in the field of public health. A lot of research is being conducted but the results certainly do not always find their way into true practice, and much of policy and practice in public health is not evidence-based. In the Netherlands this translation issue is being tackled by so-called academic collaborative centre's. The EMGO Institute for Health and Care Research leads and participates in anumber of such centre's, for example for public health, for youth health care, for occupational health, and mental health.

Impact Factor of the International Journal of Behavioral Nutrition and Physical Activity

2011-06-29T12:25:00.000+02:00

This week the new impact factor (IF) of the International Journal of Behavioral Nutrition and Physical Activity was announced: 3.17. This is a significant increase from last year's 2.63. This means that on average the papers published in IJBNPA are now cited 3.2 times. This is an impressive IF for such a young journal. The journal was established as part of the International Society of Behavioral Nutrition and Physical Activity (ISBNPA) about 10 years ago. The society and the journal have grown into a leading society and journal in the field. Given the fact that nutrition and physical activity are important in the prevention and management of the most important chronic diseases, including diabetes, cardiovascular disease and some cancers, the ISBNPA and IJBNPA scientific platforms are timely and important.

ISBNPA 2011

2011-06-18T09:36:00.001+02:00

Just a bit more than an hour ago the 10th annual meeting of the International Society of Behavioral Nutrition and Physical Activity, held in Melbourne Australia, ended. The conference was three days of energizing and inspiring presentations and discussions of cuting edge research on nutrition, physical activity and sedentary behaviors. The focus of the society is on the associations of these behaviors with a variety of health outcomes, the determinants of engagement is these behaviors and ways to motivate, enable and facilitate people across the life course to engage in healthful eating and physical activity.

The conference ended today with a very funny as well as very serious debate on where the in most countries relatively tiny budget available for promotion of healthful eating and physical activity should be invested: in the young only, or not (and thus also in the old(er)). Three experts argued for each side, and in different forms, including a rap act, a home movie on one of the experts young and old dog's, preaching and plain old argumentation. Professors Jim Sallis, Louis Barr and Dr. Karen Campbell argued in favour of the proposition by binging forward that health behaviors track from childhood into adulthood, that epigenetic influences at a very young age may make people more liable for chronic disease across their life span and many arguments more. The opposition consisted of Profs. Tony Worsely, Adrian Bauman and Abby King, and they argued that the largest burden of chronic disease is in midlife and the elderly, that lifestyle behavior changes in adults and elderly have a much faster return on investment, that adults and the elderly provide role models for the young and meny arguments more. It was very lively debate, and at the end the team arguing against the propostion were declared the winners, based on the strength of theur argumentation as well as the show they performed to bring their arguments across.

The debate waa follwoed by the announcement of the prices for the best presentations from young investigators, farewell words of the outgoing president of the society (Prof Knut Inge Klepp), some words of thanks from the chair of the local organising committee and the incoming president (Prof. David Crawford), and a great performance by the chair of the local organising committee for next year's conference (in Austin, Texas), Prof. Deanna Hoelscher.

A joint EMGO+ - C-PAN pre-ISBNPA meeting

2011-06-15T06:03:00.002+02:00

Two days before the actual kick-off of the tenth annual meeting of the International Society for Behavioral Nutrition and Physical Activity (ISBNPA) in Melbourne, we organised a pre-conference meeting to celebrate and confirm the very fruitful collaboration between the behavioral nutrition & physical activity research groups of EMGO+ (VU University and VU Medical Center) and of the Center for Physical Activity and Nutrition Research (C-PAN) (Deakin University).

After introductions and words of welcome from the two directors of EMGO+ and C-PAN, i.e. myself and Prof. David Crawford, researchers from both institutes presented overviews of different research lines, e.g. on pricing and labeling strategies to influence nutrition behaviors, on studies on disparities in behavioral nutrition and physical activity according to socio-economic status, on determinants and intervantions on sedentary behaviors, on genetic and environmental determinants of nutrition and physical activity behaviors, et cetara. Thereafter, three guests, (associate) Profs. Annie Anderson, Frank van Lenthe and Stuart Biddle, provided overviews on where they think the field of behavioral nutrition and physical activity is especially in need of further research. At the end of the day, researchers from broke out in small group sessions to develop innovative research ideas for joint projects.

The success of the collaboration between the two centers so far is illustrated by the fact that we have an intensive exchange program, with 9 researchers having visited C-PAn from EMGO+ or vice versa for a few weeks up to a couple of months, and by five joint externally funded research projects, sponsored by for example the European Commission and the World Cancer Research fund, as well as more than 10 joint international publications (the link provides some examples) and more than others 10 under review.

For whom and under what circumstances do school-based interventions to promote energy balance behaviors work?

2011-06-09T11:19:00.000+02:00

The aim of a review recently published on-line by Mine Yildirim et al. in the International Journal of Pediatric Obesity was to systematically review the results and quality of studies investigating the so-called moderators of schoolbased interventions aimed at energy balance-related behaviors (diet, phsyical activity and sedentary behaviors). Such moderators tell us for whom and under what circumstances these interventions are effective or not. In total 61 original studies were included in our review. Gender, ethnicity, age, baseline values the different behaviors, weight status and socioeconomic status were the most frequently studied potential moderators of intervention effects. Gender was found to be a consistent moderator of intervention effects, i.e. school-based interventions appear to work differently for boys and gilrs, and our review evidence suggests that such interventions generally work better among girls. For the other potential moderators, there were just not enough studies of good enough quality to draw further conclusions. Consequently, our review revealed that there is still lack of insight into what interventions work for whom and that future studies should do better jobs to explore if and how intervention effects differ among different target group segments.

Keep cycling!

2011-06-08T14:21:00.000+02:00

The objective of the study recently published by Dr. Elling Bere et al. in the International Journal of Pediatric Obesity was to assess the longitudinal association between cycling to school and weight status in two cities where cycling to school is common - Kristiansand (Norway) and Rotterdam (The Netherlands). Data from the ENDORSE (Rotterdam) and YOUTH IN BALANCE (Kristiansand) studies were used. Both studies were longitudinal studies with two years between the two measurements and both studies were among students in early adolesence (13.2 and 13.4 years at the start of the study). We categorized the students according to their mode of commuting to school at the two measurements: NO cycling at both measurements, STARTED cycling to school, STOPPED cycling and CONTINUED cycling. Measured weight and height were obtained at both time points, and weight status (overweight vs. not overweight) was calculated using international classification criteria for BMI from the International Obesity Task Force. The two datasets were analyzed separately and together. The results showed that those who stopped cycling had a three times greater odds of being overweight at the end of the study while those continued cycling had more than half the odds of being overweight, as compared to the other three groups together. The same trend was observed in both study samples. This study thus indicates that kids should continue to cycle to school; it is not only a fun, fit and environmentally friendly means of transportation, it may also help to avoid becoming overweight.

Dr. Laurien Buffart is granted a ‘Bas Mulder Award’

2011-06-08T09:01:00.000+02:00

This year for the first time the prestigious Bas Mulder Awards were granted by the Netherlands Cancer Society on behalf of the Alpe D’Huzes Foundation. This Bas Mulder Award – named after and in remembrance of Bas Mulder; who was a living example of the Alpe D’Huzes mission but who died of cancer in 2009 at the age of 24- is a personal grant aimed at “grooming talent” in the field of research that contributes to longer and better lifes for cancer patients. Laurien Buffart will receive her approximately 650,000 Euro grant on the mountain where next Thursday for the sixth year in a row thousands of cyclists will pedal up and down Alpe D'Huez to raise money for cancer research. Last year, Laurien participated in this Alpe D'Huzes event herself with two teams of VU University Medical Center researchers to contribute to the fund raiser. Laurien, who already co-leads the A-CaRe research program to improve cancer rehabilitation at the EMGO Institute for Health and Care Research, will use her award to further organise an international consortium, hire two PhD students and together build an international database of data from randomized controlled trials testing exercise and psychosocial support interventions aiming to improve quality of life of cancer patients and survivors. This database will then be used for a series of meta analyses to better understand why, for whom and under what circumstances these interventions work in order to develop better tailored quality of life improving interventions in the years to come.

Effectiveness of a primary school-based intervention to reduce overweight

2011-06-01T12:16:00.000+02:00

'Lekker Fit! ('enjoy beging fit') is a school-based program to contribute to the prevention of overweight and obesity among schoolchildren. Recently a study to evaluate the effectiveness of this program was published in the International Journal of Pediatric Obesity by Dr. Wilma Jansen et al. The purpose of this study was to evaluate the effect on weight status indicators as well as physical fitness. In total 20 schools and 2,622 children aged 6-12 years (grades 3-8) from multi-ethnic, low income inner-city neighbourhoods in Rotterdam, the Netherlands, participated. The intervention was informed by behavioural and ecological models of health behaviors that contribute to or may help to prevent unnecessary weight gain in children. The main components of the intervention were the implementation of three physical education (PE) sessions a week by a professional PE teacher, additional sport and play activities outside school hours and an educational program. Weight status, body mass index, waist circumference and fitness (20 m shuttle run) were measured to assess effects. Children who participated in Lekker Fit! were found to be less likley to be overweight, had a smaller mean waist circumference, and performed significantly better in the shuttle run test than kids in the 'control schools', but vthese favourable results were only found among the younger children, i.e. the 6-9 year olds.

The EMGO+ 2010 annual report is online

2011-05-20T08:42:00.000+02:00

The annual report for 2010 of the EMGO Institute for Health & Care Research is online. The report is electronic-only this year, which makes it readily available, easy to browse through and easy to disseminate in the wider local, national and international scientific community (and it helped us to save some trees and money).

Please take some time to browse through the report. This will inform you about the very interesting range of programs, projects and research topics our institute covers, and about our infrastructure that supports our research. When reading the report you will notice that our efforts in 2010 have resulted in output and impact that is (again!) substantially better than in the year before. We have published substantially more, without a reduction in quality of the papers, our citation index remained at its constant high level, we were able to acquire another record high amount of Euros in external grant money, and we were again able to show that our work is regarded as highly relevant by our external stakeholders.

The fact that our 2010 results show better performance than the 2004-2009 period, i.e. the period that was evaluated as excellent on all counts in the report of the external international evaluation committee, is very good news for the institute.

The EMGO+ annual meeting is underway

2011-05-19T08:54:00.002+02:00

Today we have our annual meeting of the EMGO Institute for Health and Care Research. The entire day is focussed on measurement, which is, of course, one of the cores of scientific research and progress. As Baron Kelvin said: "if you cannot measure it, then it is not science". But measurement comes in many different ways, and to quote another icon of science -Einstein-: "not everything that can be counted counts, and not everything that counts can be conted. Our program today is about computer adaptive testing, on using smart phones in measurement, on applying registrations, etc. This program was designed by Dr. Caroline Terwee, the coordinator of the Knowledge Center for Measurement of the EMGO Institute for Health and Care Research.

At the end of the meeting the societal impact and science awards were granted and celebrated, and the EMGO+ junior fellows, i.e. the mid-career researchers within the institute that are supported by EMGO+ with personal post-doctoral grants to boost their research careers - were interviewed (see photo), as well as the junior researchers who received travel grants to establish international collaborations.
Ludeke Lambeek recieved the science award for her paper in the British Medical Journal on the economic evaluation of integrated care for low back pain patients.
Hanneke Wijnhoven received the societal impact award for her work in developing, testing and disseminating the SNAQ questionnaire to detect undernutrition in the elderly.

Wendy Brouwer defends her doctoral thesis on exposure to internet health promotion interventions

2011-05-18T13:40:00.000+02:00

Today, Dr. wendy Brouwer defended her doctoral thesis on exposure to internet-delivered interventions aiming to promote health behaviors, such as healthy eating, non smoking and physical activity. Her thesis research shows that characteristics of the users predict whether they will go to a health promotion website, but that characteristics of the intervention are crucial predictors of really using the web-based intervention and staying long enough to get exposed to the health promotion information and feedback. Major parts of her research are published in scientific journals such as the Journal of Medical Internet Research and Health Education Research.

Dr. Patti-Jean Naylor presents research on Action Schools BC

2011-05-11T09:36:00.000+02:00

This week Dr. Patti-Jean Naylor from the University of Victoria, Canada, visited the Youth & Health research group of the EMGO Institute for Health and Care Research, led by Dr. Mai Chinapaw.

Dr. Naylor presented results on the evaluation of the Action Schools BC program, a best-practice project to provide school children in British Colombia, Canada with more options to make healthy choices regarding physical activity and healthy eating. The health outcome evaluation she presented strongly indicates that the model was effective at increasing the physical activity level of students, and contributed to improvements in their bone health, heart health, dietary requirement awareness, and academic performance. Pilot research regarding the healthy eating part of the model suggested that the initiative was effective at changing the pattern of vegetable and fruit consumption of school children in Grades 4 to 7.

This program has strong similarities with projects conducted at EMGO, such as the DoIT, Go4it and Jump-in projects.

Mediators of effective energy-balance interventions in youth

2011-04-20T18:30:00.000+02:00

Obesity prevention in youth requires effective interventions targeting the so-called energy balance-related behaviours (that is, physical activity, sedentary and dietary behaviours). To improve (cost-)effectiveness of these interventions, we need to know the working mechanisms underlying behavioural change. Mediation analyses is a technique that helps to explore an analyse via what pathways interventions have their effects (...or not). Identifying such mediators of intervention effects can help professionals in developing new interventions or adapting existing interventions so that these are targetted at these succesful mediators as good as possible. Dr. Maartje van Stralen and colleagues just published a systematic review of studies on identification of psychosocial and environmental mediators of school-based interventions for youth, aiming to change physical activity, dietary and/or sedentary behaviours. The review paper was published in the International Journal of Obesity and was conducted as part of the ENERGY project, a cross-European and European Commission funded project to inform effective prevention of overweight and obesity in schoolchildren across Europe. Twenty-four studies were identified in the scientific literature. Based on the review of these 24 studies, strong evidence for self-efficacy and moderate evidence for intention as mediators of physical activity interventions was found, i.e. improvements in physical activity were brought about via positive changes in self-efficacy and intentions. Some evidence was found that attitudes, knowledge and habit strength were mediators of dietary behaviour interventions. Too few studies were avialbale on interventions aiming to reduce sedentary time to draw any conclusions regarding potential mediators.

KLV 125 years

2011-04-13T09:06:00.000+02:00

The Wageningen University and Research Center Alumni network (KLV) celebrates its 125 year anniversary this year. Part of the celebrations is a series of presentations and debates on emerging topics regarding food, nutrition and agriculture, with ‘How to feed the World’ as the over-arching theme. Yesterday afternoon I presented at one of these debate sessions in Nieuwspoort in the Hague.

The topic of the afternoon was how healthy and sustainable food and nutrition can and should go together. The debate focussed on whether promotion of healthy and sustainable food should be primarily be pursued via health education to encourage well-informed healthy choices, or more via health protection measures, i.e. by changes in the availability and accessibility of foods in order to make the healthy and sustainable choice more or less the ‘default’ choice.

The great public health promotion accomplishments (the US Centers of Disease Control (CDC) as well as for example the department of Public Health of Erasmus University Medical Center have made overviews succeses of prevention as well as of the past were mostly the result of health protection measures. Two well-known examples are the building of drinking water and sewage systems that has resulted in the almost disappearance of some major infectious diseases; and traffic safety measures have resulted in an impressive reduction in (fatal) traffic accidents.

Recent research shows that our dietary choices are strongly influences by environmental cues, i.e. by what is easily available and accessible. And in our fast food nations, some of the most readily available and almost unavoidable foods are high calorie-low nutrient foods like sweet and savoury snacks, sugar-sweetened drinks.

the impact of too much sitting...

2011-03-30T21:20:00.000+02:00

A recent systematic review conducted by Dr. Mai Chinapaw and colleagues, published in the journal Obesity Reviews, focusses on the possible health consequences of sedentary behavior. Recent research indicates that sedentary behavior, often operationalized as TV-time and other screen viewing behaviors, is associated with higher risk for being overweight and obese, as well as (other) metabolic health problems. the effects of sedentary behavior appear to be rather independent of physical activity, i.e. even when people do exercise a lot, sitting for prolonged periods of time may still increase their risk. The aim of this systematic review was to describe the prospective relationship between childhood sedentary behaviour and health indicators. 31 studies were indentified in data bases of scientific publications. In these studies 27 different cohorts were investigated. The systematic review of these studies confirmed that more 'sedentary time'- mainly TV viewing - predicts a higher body mass index (BMI) and other indicators of body fat. Evidence was also found that more sedentary time is associated with lower fitness levels, but no convincing evidence was found that sedentary time is associated with higher blood pressure, blood lipids or lower bone mass.

The successes of prevention in the Netherlands.

2011-03-20T18:19:00.000+01:00

On March 11, the department of Public Health of Erasmus University Medical Center celebrated its 40 anniversary with a symposium on the success of prevention in the Netherlands, in the period of 1970-2010. The symposium was well attended by almost all experts in the field, as well as representatives of policy and practice organisations.

The head of the department, Prof Johan Mackenbach provided an overview of the success of prevention. This overview is more extensively documented and described in the book that he edited on the topic (see the picture), and illustrated in a short documentary.

Mackenbach argued in his presentation that the successes of prevention are often rather unnoticed, because, indeed successful prevention prevents ill health or mortality, i.e. it prevents an event from happening. This relative invisibility of the success of prevention may be one of the important reasons why policy makers have less attention for prevention and are often less willing to invest in prevention (only a few percent of the national health care budget is invested in prevention).

The successes presented by Mackenbach were identified based on the following criteria:

1. The effectiveness of the preventive action, policy or intervention should be scientifically well-documented

2. The effect of the preventive intervention should have clearly caused a reduction in mortality or morbidity because of the disease that the intervention was aiming to prevent

The team that did the analyses came up with 5 fields of prevention, i.e. prevention regarding pregnancy and youth care, prevention regarding work & health, prevention of accidents and injuries, promoting health lifestyles, and medical preventative interventions.

In terms of prevention of deaths, the antismoking efforts were by far the most successful prevention intervention in the last 40 years, with more than 6900 deaths prevented per year. Other important successes are the removal of trans fatty acids from foodstuffs (1500 deaths per year avoided), the screening on and treatment of high blood pressure (3000 per year), and traffic safety measures (2000).

Writing papers for the energy project

2011-03-11T21:14:00.000+01:00

The last few days I spend in Ghent. Part of the team of the Energy project met there to write a series of scientific papers on overweight, obesity and energy balance behaviors in European schoolchildren. Papers were prepared on the validity of the questionnaires used for data collection in the project, on sedentary behaviors among the children and the relation with metabolic function, and on mediators and moderators of dietary, physical activity and sedentary behaviors. All these papers are prepared to further inform obesity prevention efforts in this important target group.

Bregje Onwuteaka Philipsen inaugurated

2011-03-04T15:25:00.000+01:00

Today prof. Bregje Onwuteaka Philipsen accepted her chair in End of Life Research. In the Netherlands about 135,000 people die annually. For about 90,000 of these people, their end of life is something they foresee and something they and their important others can prepare for in this phase of end of life care. Bregje Onwuteaka Philipsen, a recent 'Vici laureat', i.e. she received one of the most prestigious personal research grants available in the Netherlands, has conducted and will conduct and lead important research to inform and improve end of life care. In her inaugural address she provided an overview of work accomplished and work to be done.

2011-02-09T10:50:00.000+01:00

Active transportation, e.g. walking or cycling to school or work, may contribute to energy balance, i.e. preventing unwanted weight gain, and prevent becoming overweight. Some studies have been conducted looking at the association between active commuting to school and weight status among youth, but no clear conlusion can be drawn. Some recent studies suggest that cycling to school may make a bigger difference than walking to school. The purpose of our study, recently published in the Scandinavian Journal of Medicine and Science in Sport, (with Dr. Elling Bere as first author) was to assess the association between cycling to school and weight status in two cities, Rotterdam and Kristiansand, i.e. in the Netherlands and Norway, two countries where cycling to school remains common. Data from two studies, ENDORSE (Rotterdam) and Youth in Balance (Kristiansand), were used including, respectively, 1361 and 1197 adolescents around 14 years old. The adolescents were categorized as cyclist or non-cyclist based on questionnaires asking them about their usual mode of transportation to school. Twenty-five and 18% were categorized as overweight, and 35% and 31% were categorized as cyclists, in Rotterdam and Kristiansand, respectively. Further analyses showed that youth who cycled to school were about half as likely to be overweight than their peers who did not, after adjusting for a range of other possible 'reasons' for being overweight. These results thus suggest that cycling to school may 'protect' against overweight, but more rigorous research is necessary.

The protocol of the ENERGY cross sectional study now published

2011-02-04T16:55:00.000+01:00

ENERGY stands for European Energy balance Research to prevent excessive weight gain among youth, and is a European Commission funded project aiming to study important dietary, physical activity and sedentary behaviors among youth aged 10-12 across Europe. ENERGY also investigates determinants of engaging in such behaviors and develops and tests an intervention scheme to promote more healthful energy-balance behavior in schoolchildren. The protocol paper of the cross-sectional ENERGY study, describing the methods, procedures and measures of the study, and with Dr. Maartje van Stralen as first author, has now been published in BMC Public Health.

Research concerning elderly populations at EMGO+

2011-02-04T14:54:00.000+01:00

Last Tuesday we show cased our research concerning elderly populations. The focus was especially on research conducted by the departments of General Practice, Nursing Home Medicine, Public & Occupational Health and Medical Humanities, i.e. the 'extramural' departments of the VU University Medical Center. Professor Guy Widdershoven chaired the afternoon symposium. Professor Dorly Deeg provided an overview of the history and scope of research among the elderly at the VU University and its medical center; Professor Henriette van der Horst shared her thoughts on the future of such research. A panel of project leaders provided their reactions to these introductions, which gave input for a general discussion with the audiende. Finally, more than 50 posters on relevant recent research were presented and discussed.

Farewell address by Prof. Martijn Katan

2011-01-30T13:03:00.000+01:00

Yesterday Professor Martijn Katan gave his farewell address as professor of nutrition at the department of health sciences and the EMGO Institute for health and care research. Before Martijn Katan's lecture there was a short symposium with two distinghuised invited speakers: Professors Jan Vandenbroucke and Marion Nestle. Marion Nestle presented her work on food politics and the relation between nutrition researcher, nutrtion researchers and food policies of governments and food industry. Vandenboucke and Katan himself spoke about the problems nutrition researchers face in establishing evidence-based practice. Martijn Katan used examples from his own research career - his world famous research on transfats and cafestol- to urge the future generation of nutrition researchers to go back to the reductionist approach, focussing in nutrients rather than foods or food patterns. I myself have argued that a focus on food patterns may be more fruitful; see for example the paper I wrote with Elling Bere on the Nordic Diet. However, Katan certainly has a point that internally valid research on the potential health promoting effects of food patterns is very difficult (Katan would claim it to be impossible, I think...).

Home environment variables and adolescent soft drink consumption

2011-01-19T17:53:00.000+01:00

Soft-drink consumption is regarded as one of the important target behaviours for the prevention of excessive weight gain among adolescents. To be able to modify these behaviours in obesity prevention interventions, further understanding of the underlying factors and mediational pathways is required: why do adolescents drink soft drinks and what may help or motivate them to drink less? A study recently published online in Appetite journal aimed to explore associations between home environment variables and adolescent soft drink consumption. The ENDORSE study data were used for this purpose and the study was a collaboration between researchers from the EMGO institute for Health and Care Research, the department of Public Health of Erasmus Medical Center and the Center for Physical Activity and Nutrition Research at Deakin University. We explored if home environment variables such as home availability and accessibility of soft drinks, parental modeling, and parental rules regarding soft drink consumption of their adolescent children), as well as the adolescents' intentions, attitudes, perceived behavior control, and perceived parental norm and habit strength regarding soft drinks were associated with their intake levels. We found significant associations between the home environment variables and soft drink consumption and our results indicated that habit strength and intention were the strongest mediators. Intention and habit strength partly mediate the associations between home environment factors and soft drink consumption, suggesting that home environment variables influence soft drink consumption both indirectly and directly.

Two review studies provide systematic insights in what may promote exposure to internet delivered health promotion interventions

2011-01-08T20:50:00.000+01:00

The Internet is considered to be a promising delivery channel of interventions aimed at promoting healthful behaviors. Exposure to these interventions, however, is generally low. A more extensive exploration of methods, strategies, and their effectiveness with regard to facilitating exposure is therefore important to improve the use of such interventions and promote healthful behavior changes. Two systematic reviews were conducted that I was involved in a s a co-author, one on studies among adolsecents, one among adults. The first study, with Dr. Rik Crutzen as firts author, is now e-published in the journal Health Education and Behavior. The review of studies among adults is available on-line, with Wendy Brouwer as first author, at the Journal of Medical Internet Research.

cycling in Patagnonia

2011-01-08T20:21:00.000+01:00

The last four weeks + a few days my wife and I cycled part of the route 40 and the Carretera Austral in southern Patagonia. We peddaled through one of the most beautiful parts of the world. Please click here for some pictures.

Tailored health education messages increase attention

2010-11-30T11:53:00.000+01:00

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.

2010-11-16T14:18:00.000+01:00

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

2010-11-11T15:39:00.001+01:00

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

2010-11-04T08:09:00.001+01:00

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.

2010-11-03T15:42:00.001+01:00

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?

2010-10-18T22:21:00.000+02:00

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

2010-10-17T14:38:00.001+02:00

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

2010-10-08T17:12:00.001+02:00

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

2010-09-29T18:54:00.000+02:00

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

2010-09-17T15:22:00.000+02:00

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

2010-09-17T15:02:00.001+02:00

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:

We are now realising that sedentary behaviour is often excessive and we need to seek ways to reduce too much sitting
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
We need a dual approach to increasing physical activity and decreasing sedentary behaviour
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

2010-09-15T12:49:00.000+02:00

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'

2010-09-14T08:44:00.001+02:00

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

2010-09-11T19:11:00.000+02:00

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

2010-09-03T15:23:00.001+02:00

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

2010-09-01T21:10:00.003+02:00

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

2010-08-25T14:21:00.002+02:00

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

2010-08-23T14:30:00.003+02:00

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

2010-08-20T11:33:00.001+02:00

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

2010-08-06T15:06:00.000+02:00

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

2010-08-01T20:30:00.000+02:00

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

2010-08-01T20:15:00.000+02:00

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

2010-07-21T17:36:00.000+02:00

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

2010-07-19T09:04:00.001+02:00

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.

2010-07-19T08:47:00.000+02:00

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

2010-07-03T21:44:00.003+02:00

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”

2010-06-25T16:58:00.000+02:00

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

2010-06-23T09:08:00.001+02:00

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

2010-06-23T08:52:00.000+02:00

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

2010-06-18T12:01:00.002+02:00

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

2010-06-18T11:51:00.000+02:00

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

2010-06-16T09:26:00.003+02:00

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

2010-06-09T19:11:00.003+02:00

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

2010-06-06T12:12:00.007+02:00

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

2010-05-25T20:51:00.005+02:00

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.

Rosemarie Dröes inaugurated as Professor of Psychosocial care for people with dementia

2010-05-25T12:53:00.001+02:00

Last Friday, Rosemarie Dröes held her inaugural address to accept her chair in Psychosocial care for people with dementia. Professor Dröes’ chair is at the department of Nursing home Medicine of the VU University medical center. She is the head of the research program on care and support in dementia’ of the department of Psychiatry of the VU University medical center and the Regional Institute for Mental Health Services GGZ-inGeest in Amsterdam. Her research is embedded in the Quality of Care program of the EMGO Institute for Health and Care Research. Professor Dröes’ presentation clearly illustrated her past performance and future ambitions in conducting excellent research in order to develop, implement and disseminate improved dementia care practice.

A seminar by colleagues from the Center for Physical Activity and Nutrtion Research (C-Pan), Deakin University

2010-05-20T14:54:00.001+02:00

On Friday May 21 Prof. Jo Salmon and Dr. Lukar Thornton give a seminar at the EMGO Institute for Health and Care Research. Prof. Salmon will spend her sabbatical at the institute, and Dr. Thornton was over for just a few days. EMGO+ has a successful ongoing collaboration with C-PAN. We collaborate on different The director of C-PAN, Prof. David Crawford is a visiting professor at EMGO+.
Prof. Salmon’s presentation is on ‘Standing up for children's health: reducing children's sedentary time at school and home’, while Lukar Thornton will speak about ‘Current approaches to measurements of food environments and some approaches for the future’.

A course on mediation analysis within the ENERGY project

2010-05-20T14:25:00.003+02:00

In behaviour nutrition and physical activity research the focus is more and more on indentifying the interplay between different behavioral determinants, i.e. on indentifying the causal pathways from more distal to more proximal determinants to health behaviors and health outcomes. In health behaviour change intervention research, the focus is more and more on why, i.e. through what causal pathways interventions work or not.

To answer such research questions, mediation analysis is key. Within the “EuropeaN Energy balance Research to prevent excessive weight Gain among Youth” (ENERGY)-project, such analyses are a main focus to indeed identify the mediating pathways of determinants of energy balance-related eating and physical activity behaviors, and the mediating path ways through which energy-balance interventions have their effects. Today, Drs. Maartje van Stralen and Saskia te Velde and Mine Yildrim, MSc led a workshop to introduce the ENERGY researchers in mediation analyses. The introductory course was attended by colleagues from the Netherlands, Norway, Belgium and Australia.

EGEA conference: A conference on promotion of fruits and vegetables

2010-05-07T09:27:00.003+02:00

From Wednesday to this Friday a conference was held in Brussels on the role of fruits and vegetables in pursuing the social and health benefits of a balanced diet. This is the 6th so-called EGEA conference on this topic, supported by the European Commission. I had the honour and pleasure to give the opening key note on the role of socio-economic determinants in promoting fruits and vegetables. I especially used results of the Pro Children, Schoolgruiten, and Pro Greens studies to illustrate the socio-economic disparities and the potential to address these with school-based fruit and vegetable promotion programs.

During the rest of the conference evidence was presented on the associations of fruit and vegetable intakes with morbidity and mortality, on different health promotion schemes to encourage fruits and vegetables, on physical, social and economical influences on fruit and vegetable intakes, and on European Commission research an policy projects on fruit and vegetable promotion.

More than 100 university professors plead in favour of sustainable agriculture in the Netherlands

2010-04-28T16:32:00.003+02:00

In 2001 a Dutch governmental advisory committee led by Herman Wijffels, recommended to initiate and implement drastic changes in Dutch agriculture and livestock raising. Their report was a strong advise to move to a more sustainable system, also taking animal welfare much more into account. A movement towards a true sustainable system, with a stronger focus on quality instead of further growth in production was recommended. The minister at the time, Laurens-Jan Brinkhorst, accepted announced he would take the advice at heart, calling the advise and recommended changes “clear, hard, and inevitable”. Brinkhorst stated that the Netherlands would take an international lead in developing a more animal friendly and societal acceptable farming system, and many of the changes were supposed to be implemented or at least ongoing in 2010.

Now it is 2010, governments and ministers of agriculture have changed, we have had, amongst others, the threat of a H1N1 flu epidemic, we have a Q-fever epidemic in part of the Netherlands, recently very alarming findings have been communicated regarding antibiotic resistant bacteria among people exposed to antibiotic overloaded live stock.

And agriculture and farming have not made the changes recommended in 2001 and embraced by the minister at the time.

A group of more than 100 university professors from a variety of disciplines now ask for action. In a letter in the national news paper NRC Handelsblad of April 28 the plead for a true change towards sustainable agriculture, raising of livestock and farming methods for reasons of (1) environmental protection, climate change prevention, and food security; and (2) public health.

The full letter with argumentation is published on line which included the list of 'authors', and the NRC article, which is a shorter version, can be accessed via the NRC website.

Dr. Irma Verdonck accepts her chair in Cancer Research with a specific focus on ‘living with cancer’

2010-04-22T13:04:00.001+02:00

Yesterday Dr. Irma Verdonck gave her inaugural address on ‘Living with Cancer’ to accept her endowed chair on behalf of the Alpe D’Huzes foundation, a charity that organizes cycling events to raise money for cancer research, especially to improve long-term perspectives for cancer patients.
Dr. Verdonck presented her plans to build a large cohort study of cancer patients to get better insights in the associations between living with cancer and mental health, as well as to build and research an e-health system to better promote psychosocial health among cancer survivors. Her chair is embedded in the EMGO Institute for Health and Care Research, and she will work closely, in a joint research program, with the CCA-V/Ici cancer research institute of the VU University Medical Center.

The annual meeting of the EMGO Institute for Health and Care Research

2010-04-19T20:37:00.003+02:00

Last Thursday we had the annual meeting of the EMGO Institute for Health and Care Research at 'Pakhuis de Zwijger'. Our guest Prof. Ronald Stolk of the Groningen University Medical Center, was the first speaker. He introduced the LifeLines project to the EMGO community. LifeLines is a cohort study in a large representative sample of the population of the northern provinces of the Netherlands, covering three generations. The main objective is to unravel the interaction between genetic and environmental factors in the development of multifactorial diseases, their concurrent development in individuals and their complications as a complex trait. The rest of the morning program was devoted to our own cohort studies, i.e. the Twin Registry, Nesda & Nesdo, Lasa, CheckIt, ABCD, Hoorn and AGGO; studies covering the whole life course from newly born infants to the very old. These cohort studies were presented, each in 5 minutes, and afterwards we worked on new research plans on further exploiting these cohorts, preferably combining more than one of the EMGO cohort studies.
In the afternoon the four research programs of the institute met in separate parallel sessions. At the end of the day, the junior researchers who had received a travel grant in the past year, and the researchers who received an EMGO fellowship in the past year presented their research. Finally the EMGO science award and Societal Impact award were announced. Drs. Wilma Waterlander and Ingrid Steenhuis of the Department of Health Sciences received the Societal Impact Award for their studies and ministerial advice on pricing strategies to promote healthier diet. Marijn Distel received the Science Award for her paper 'The five factor model of personality and borderline personality disorder: A genetic anlaysis of comorbidity', published in Biological Psychology.

Care for your health

2010-04-14T15:53:00.004+02:00

This week the Dutch Council for Public Health and Health Care published its report called Care for your Health: Behaviour and health; the new regulation. The report starts with a quote from a Bob Dylan song: "you don't need a weatherman to know which way the wind blows"; the Council thus claims that they just report the obvious. In this report the council argues that the health care in the Netherlands should really shift its focus and organisation from 'care and disease' (in Dutch 'Zorg en ziekte', zz) to 'behaviour and health' (in Dutch 'gedrag en gezondheid', gg). The council states that important trends, such as:
1. Health care consumers who seek optimal health instead of care for disease
2. These consumers are not passive care consumers as such but are actors, taking responsibility for their own health and (preventive) health care.
3. Chronic diseases and multi-morbidity will more and more shape the health care arena, asking for a stringer focus on primary, secondary and tertiary prevention
4. Health behaviour, including lifestyle behaviours are of utmost importance in prevention, treatment as well as in rehabilitation and disease management.
These trends have not yet been incorporated in the way health care is organised, financed and insured in the Netherlands. The Council states that the whole health care system should be much more focussed on forward thinking aimed at prevention, early detection, and pro-action instead of treatment when disease is apparent, with a much stronger and more important role for preventive and primary health care.

What is a Mediterranean Diet?

2010-04-01T09:36:00.001+02:00

Eating according to what has been labelled the Mediterranean diet is associated with a significant improvement in health. However, it is unclear what this diet really contains. In a recent paper published in Public Health Nutrition, Elling Bere of the University of Agder in Kristiansand, Norway, and myself discuss the contents of the ‘scientific’ Mediterranean diet, i.e. the contents as we found in studies that claim to have found supporting evidence for the health enhancing properties of the Med diet. Based on this analysis we show and argue that the evidence of the health-enhancing properties of the Mediterranean diet is not necessarily based on Mediterranean foods. The results indicate that we do not have to eat Mediterranean foods to enjoy the health-promoting properties of the diet it represents. To maintain dietary variety, cultural diversity and heritage, as well as for environmental reasons, it seems more appropriate to promote regionally appropriate diets throughout the world – rather than a global Mediterranean diet. In an earlier paper that we published we provided some evidence that a ‘Nordic Diet’, i.e. a diet based on foods originating in the Nordic countries, may have similar health promoting properties as a Med diet.

A review of reviews on Early-life determinants of overweight and obesity

2010-03-22T21:34:00.003+01:00

The aim of a recently published review of earlier review studies in the journal Obesity Reviews was to review the evidence for early-life (from conception
to 5 years of age) determinants of obesity. Twenty-tow eligible reviews were identified. Although all included review studies were below high quality, the study was able to indetfy a range of potential determinants. Factors associated with later
overweight and obesity were: maternal diabetes, maternal smoking, rapid infant
growth, no or short breastfeeding, obesity in infancy, short sleep duration,
<30 min of daily physical activity, consumption of sugar-sweetened beverages.
Maternal smoking, breastfeeding, infant size and
growth, short sleep duration and television viewing were supported by the better quality reviews. Most evidence is based on cross sectional research and it is therefore difficult to establish a causal association between possible
determinants and obesity, and the relative importance of each determinant. Future
research should focus on early-life interventions to confirm the role of protective
and risk factors and to tackle the high burden obesity represents for present and
future generations. This review was conducted within the Health Promotion through Obesity Prevention in Europe (HOPE) study.

Seminar on computer-tailored health education

2010-03-22T21:32:00.001+01:00

On March 9 the EMGO Institute for Health and Care Research organised a morning symposium on new developments in computer-tailored health education. Dr. Seth Noar, associate professor in the department of communication at the University of Kentucky. He is the first author of the first meta-analysis on effects of computer-tailoring in health education. Apart from Dr. Noar’s keynote, researchers from Philips Research, University of Maatricht, Erasmus University Medical Centre, and the EMGO Institute for Health and Care Research provided short presentations on ongoing innovation of computer-tailoring research.

Joint Programming Initiative for A healthy diet for a healthy life

2010-03-08T21:16:00.000+01:00

Last Thursday I chaired a meeting of delegates from 20 European countries to discuss a joint programming initiative on Diet, Nutrition & Health. The meeting was organised by the Netherlands Organisation of Health Research and Development and the Netherlands Agency on behalf of four Ministries.

Joint Programming Initiatives are European efforts to coordinate research efforts among member states. Joint Programming offers a voluntary process for a revitalised partnership between the Member States based on clear principles and transparent high-level governance. By enhancing cooperation among those that develop and manage research programmes, it aims to increase the efficiency and impact of national public research funding in strategic areas.

One such Joint Programme Initiative (JPI) that is now being prepared is ‘A Healthy Diet for a Healthy Life’. This initiative that we focussed on last Thursday should provide a basis for a scientific research agenda, sup-ported by a common vision and a management structure concerning the global challenges ahead: to shift from a defensive policy combating the global approach promoting health by improving the quality of our diet and nutrition. The JPI has been brought forward by the joined efforts and support of 19 countries and remains open to additional participating countries. The JPI will focus on three broad research themes: lifestyle and social determinants; Within the next months the vision document and a governance structure for this initiative will be further prepared and proposed.

Short research seminar to kick off collaboration between EMGO+ and Philips Research

2010-03-02T15:40:00.000+01:00

On March 2 2010, Rob Udink and Wim Stut from Philips research in Eindhoven visited the EMGO Institute for health and Care Research. They provided a short symposium on Philips’ activities in the rationale for and the development of IT-supported tailored Behavioral change interventions to assist and facilitate patients’ self management. This meeting marked the start of a collaborative research project of Philips Research and the EMGO+ Institute in which such behaviour change interventions will be tested and evaluated. The EMGO+ Institute has much expertise on the development, evaluation and implementation of computer-tailored health education.
The collaboration will be materialized in a joint research project that will result in a PhD thesis to be defended at the EMGO+ institute by a research fellow employed by Philips Research.

Seminar at Deakin

2010-02-17T06:42:00.002+01:00

Monday night I was kindly invited to give a seminar on behalf of Deakin University's Center for Physical Activity & Nutrition research (C-PAN) at the Cancer Council Victoria in Melbourne, Australia. The title of my talk was "Evidence-based promotion of healthful eating and physical activity in Europe". My talk was mostly on the results derived from the European Commission funded projects HOPE (Health promotion through Obesity Prevention across Europe), Pro Children (promoting fruit and vegetable intakes among children across Europe) and ENERGY (EuropeaN Energy balance Research to prevent excess weight Gain among Youth). I provided an overview of evidence on prevalence and trends in overweight and obesity across Europe as well as of prevalence and trends in behaviors that may increase or reduce the risk of excess weight gain. The larger part of my presentation was on potential determinants of such behaviors and how insight in such determinants may help us to design interventions that can contribute to promotion of more healthful behavioral nutrition and physical activity patterns. It was indeed a pleasure and an honor to give the talk and to be able to discuss some of the findings with Australian colleagues.

A recent systematic review on school-based behavioural nutrition and physical activity interventions.

2010-02-11T03:49:00.002+01:00

A recent systematic review on school-based behavioural nutrition and physical activity interventions was published in Obesity Reviews. This review paper was conducted within the Health Promotion through Obesity Prevention across Europe (HOPE) project. Prof. Ilse de Bourdeaudhuij was first author on this paper. The review confirms what has been suggested earlier, i.e. that combining school-based health education with meaningful changes in the school and/or school neighbourhood physical activity and food environments, and that a focus on both sides of the energy balance, i.e. on nutrition and physical activity, give better and more relevant effects. The evidence was strongest for changes in relevant energy balance behaviours and suggestive for changes in weight and weight status. Their was a lack of studies that included good measurements of BMI or other weight status indicators (e.g. waist circumference, skin folds).
The review further suggests that computer-tailored personalized education in the classroom showed better results than a generic classroom curriculum. Environmental interventions might include organized physical activities during breaks, or before and after school; improved availability of physical activity opportunities in and around the school environment; increased physical education lesson time; improved availability or accessibility of healthy food options; and restricted availability and accessibility of unhealthy food options.

12 steps to improve public health?

2010-02-03T09:04:00.002+01:00

The UK Faculty of Public Health has proposed 12 "practical steps to tackle serious public health concerns from obesity and heart disease to alcohol and sexually transmitted infections". These steps were proposed to call upon all political parties to introduce robust public health policies to improve the nation's health. The 12 steps are:
1. A minimum price of 50p per unit of alcohol sold
2. No junk food advertising in pre-watershed television
3. Ban smoking in cars with children
4. Chlamydia screening for university and college freshers
5. 20 mph limit in built up areas
6. A dedicated school nurse for every secondary school
7. 25% increase in cycle lanes and cycle racks by 2015
8. Compulsory and standardised front-of-pack labelling for all pre-packaged food
9. Olympic legacy to include commitment to expand and upgrade school sports facilities and playing fields across the UK
10. Introduce presumed consent for organ donation
11. Free school meals for all children under 16
12. Stop the use of transfats

In its manifesto, the Faculty of Public Health claims that endorsing these steps will significantly improve the health of the UK population.

Professor Paul van der Maas gives his farewell lecture

2010-01-31T11:54:00.002+01:00

On Friday January 29 professor Paul van der Maas gave his final lecture in the main auditorium of the Erasmus University. Prof. van der Maas was professor of Public Health since 1983. He was dean of the Erasmus University Medical Center and chair or member of many key advisory board and committees for public health and public health research in the Netherlands. He has conducted and led cutting edge research projects on cancer screening, aging, and end-of-life care.
Eight of his PhD students are now professors in different areas of public health research, and they have produced a ‘liber amicorum’ for prof. van der Maas.
His final lecture as professor of Public Health stated that public health can be shaped and influenced, but that public health is also fragile; based on the last century one may think that our public health can only go up, given the impressive increases in for example life expectancies in most countries around the world. But great threats to public health such as the growing food shortages, ecological downfall, and emerging infectious diseases will be enormous challenges that public health researchers, policy makers and practitioners will have to face.
Prof. van der Maas ‘retirement’ does not mean that he will not remain active in the field. For one thing, he will chair the grant application committee for the assessment and evaluation of grant applications submitted to the Dutch Cancer Society grant schemes funded by the Alpe D’Huzes foundation.