Wednesday, December 17, 2008
The Deliver study
• What is the quality of the care provided by midwives (professional quality of pre-conceptional, antenatal, natal and postnatal care, communication, client safety, client perceptions)?
• How is primary midwifery organized (gatekeeper function, role division, harmonization, responsibilities, cooperation, continuity of care, ICT, student supervision)?
• How accessible is midwifery care (proximity, care consumption, midwifery problems at GP service point)?
The study will however, form the basis for investigations of a wider range of important research questions. For this purpose, ‘add-on’ studies can be submitted to use and further help to build the Deliver data base .
Saturday, December 13, 2008
A prestigious grant for an outstanding EMGO researcher.
On Friday December 12 it was announced by the Netherlands Organization for Health Research and Development that Dr. Bregje Onwuteaka-Philipsen was awarded a Vici grant. This Vici grant is one of the most prestigious personal research grants for senior researchers in order to encourage and enable innovative health research. Bregje Onwuteaka-Philipsen is associate professor. She is the program leader of the research programme ‘quality of care’, one of the 4 research programs of the EMGO institute. Furthermore she leads the research line ‘public health at the end of life’ at the department of public and occupational health. She will use her Vici grant for further research within this research line.
Saturday, December 6, 2008
Five days in Minneapolis
Drs. Simone French and Robert Jeffery invited me to give two lectures, to discuss mutual research interests, and to visit with a number of colleagues from the division as well as from the departments of psychology, kinesiology and of food science and nutrition, i.e. departments with which the division of epidemiology has close collaborations in inter- and trans-disciplinary research.
The division has a strong focus on behavioural nutrition and physical activity research, especially related to obesity prevention. The division has managed to get a number of key players in this field together in one centre, which creates the right focus and mass to do the meaningful, necessary interdisciplinary studies. The research is organised in different research centres, e.g. on nutrition, physical activity, obesity research, social epidemiology and cardiovascular research. I believe there are great similarities between the division and the EMGO Institute for Health and Care Research, and especially with its Lifestyle, Obesity and Diabetes program.
It was cold in Minneapolis, but I managed to get some outdoor physical activity by running at minus 14 Celsius along the Mississippi river. I was also treated to very good food and nutrition while here. Minneapolis restaurants serve very nice food, although I was a bbit shocked when I noticed pieces of bacon in an ice cream desert that one of my dinner companions had chosen. I was quickly informed that this was a rather innocent use of pork fat. I was told that at the Minnesota State Fair, held each year right in between the Twin Cities of Minneapolis and Saint Paul, they serve bacon lollies covered in maple syrup, and chocolate bars with pieces of bacon have even been introduced. Well, as my colleague noticed, most things taste better with chocolate while most other things taste better with bacon, so why not combine the two.
Saturday, November 29, 2008
The deliverables of the HOPE project are underway
Our preliminary results indicate that across Europe there is indeed evidence that obesity prevalence is still growing among school-aged children and adolescents, with a few countries that are exceptions to this rule. For younger children there is no evidence that obesity rates are growing. This should not be interpreted as evidence that obesity is no problem among younger children; the right monitoring data are just not available to explore trends in obesity prevalence in this age group in Europe.
For school-aged children it appears that school-based intervention that combine nutrition education, and that provide the right infrastructure and support for physical activity and health eating can make a difference. Such interventions are associated with more healthy behaviours as well as leaner body composition among children.
In the next few months we will finalise our finding, prepare these for publication in scientific journals, and translate these into concrete policy recommendations.
Wednesday, November 19, 2008
Injury prevention for toddlers
Hoe related unintentional injuries remain one of the main health threats for children in established market economy countries. In the Netherlands each year about 44,000 children need medical care because of such injuries, and this goes with high medical costs.
Today Tinneke Beirens defended her thesis called ‘Home-related injury prevention and safety promotion in the setting of preventive Youth Health Care (see http://www.erasmusmc.nl/overerasmusmc/newsarticles/Peuters.lager.opgeleiden.veilig and http://www.euroipn.org/cerepri/pre_event/files/presentations/Oral/Exposure%20of%20toddlers%20to%20fall%20Tinneke%20Beirens%20ORAL%20I.pdf).
Her thesis explored the possibilities of injury prevention by investigating parental safety behaviours (such as placing safety gates at the stairs in their home, and storing poisonous products, for example cleaning products or prescription drugs, in a child-safe manner), correlates of these behaviours, and the effectiveness of the so-called safety cards. These cards are the main education tool used by Child Health Clinics and developed by the Dutch Consumer Safety Institute (http://www.veiligheid.nl/), to educate parents about why and how to protect their children from accidents in and around the home.
Tinneke’s research showed that many parents do engage in child protection behaviours, but there is still much room for improvement. Two interesting findings were that lower educated people on average take better precautions than the higher educated, and that parents have high intentions to take safety measures when they have their first child, but often only act on these intentions when they have their second.
Tuesday, November 4, 2008
Hand hygiene in Dutch hospitals: compliance and determinants.
In this age of high tech medicine, simply adhering to basic hand hygiene instructions to prevent ill health seems so obvious. But the compliance rates indicate that washing your hands when this is necessary and according to the instructions may not be that simple and straightforward.
The study that was presented included observations in Dutch hospitals to get objective assessments of hand hygiene compliance (since most compliance data are based on self reports, which may obviously be biased), and a Delphi study and a cross-sectional survey among doctors, nurses, and trainees to explore potential determinants of hand hygiene compliance and possibilities to promote better compliance.
The study was led by Dr. Ed van Beeck of the Department of Public Health, Erasmus University Medical Center (http://www.erasmusmc.nl/MAGE/), and Vicky Erasmus of the same department (http://survey.erasmusmc.nl/intern/pwp/front.php).
The study showed that observed hand hygiene compliance was even worse than expected based on self-reports. Compliance rates were below 30% overall. Especially worrying was the extremely low hand hygiene compliance before patient contacts, with hospital workers showing good hand hygiene in only a few % of the events when hand washing was needed. Somewhat better hand hygiene was observed after patient contacts, especially when the health care worker had been in contact with bodily fluid. Differences in compliance were found according to the kind of hospital investigated (small peripheral hospitals > university hospitals) and the hospital unit (surgical ward > IC unit). The observations also showed the frequency of events that require hand hygiene behavior. Basically, if appropriate hand hygiene indeed performed before or after each event that officially requires hand washing or hand alcohol, health care workers would spend a substantial part of their day ‘cleaning’ their hands. Such a time investment may just not be possible.
The exploration of potential determinants indicated that lack of knowledge of the importance of hand hygiene (among doctors only), low perceived control (i.e. most probably related to the time restraints) regarding hand hygiene practices, lack of positive descriptive norms regarding hand hygiene (among nurses only) were associated with low compliance. Furthermore, doctors were more likely to show higher compliance if they thought lack of hand hygiene could have severe health consequences for themselves, while nurses were more likely to be compliant if they perceived the potential consequences for their patients as severe.
Interventions to improve hand hygiene may include educational activities to further improve knowledge of hand hygiene recommendations, and to further stress the importance of hand hygiene practices, but should also include changes in the physical and social environments that will make compliance easier and normative.
The study was financially supported by the Netherlands Organisation for Health Research and Development, ZonMW (http://www.zonmw.nl/).
Monday, October 27, 2008
TIGO: a new national inter-institutional institute for research on aging.
Such an aging population faces us with many challenges, often related to health. Maybe the most striking and relevant examples are to do with the work force and health care costs. In order to maintain and ensure a large enough work force to maintain economic prosperity in an era of an aging population, people should be able to remain economically active until later age. To prevent skyrocketing costs for health care, elderly people should be encouraged to adopt and maintain healthy lifestyles to prevent or delay disease and disability to realise a further compression of morbidity in the latest phase in life. In order to enable elderly people to keep out of health care institutions as long as possible, health and care monitoring and facilitating devices such as domotics (http://en.wikipedia.org/wiki/Home_automation) solutions should be developed and tested for their true effectiveness.
These are the challenges that will be met by TIGO (http://www.ti-go.nl/home/), the Dutch national research institute for healthy aging, in which most University Medical Centers in the Netherlands, important research and health care institutes such as TNO, NIVEL and TRIMBOS, as well as key R&D departments of multinationals such as Philips and Unilever have joined forces.
Today the business plan for TIGO was presented to Mrs. Jet Bussemaker, the Dutch secretary of state for health, welfare and sports (http://www.minvws.nl/organisatie/staatssecretaris-bussemaker/) during a symposium. After a series of short keynotes the secretary of state congratulated the TIGO founders with their initiative and confirmed that the TIGO plans fitted well with her own ambitions to improve prevention and care for the elderly.
Sunday, October 12, 2008
Dr. Jantine Schuit inaugurated as professor of health promotion and policy.
Wednesday, October 8, 2008
Explaining socioeconomic status differences in health behaviors.
Inequalities in health according to income, level of education or other socio-economic status indicators have and are being observed across the world. Poorer and less educated people live shorter lives and have higher risk for a range of diseases and health threats. This is also true in a rather egalitarian country like the Netherlands.
One of the reasons why people from lower socioeconomic status groups are less healthy is the fact that these people on average live less healthy lives. Smoking prevalence, lack of physical activity and un-healthful dietary habits are more prevalent. The next question , of course, is to try to find out why that is the case. This is what Carlijn Kamphuis set out to explore in her doctoral thesis research: why do we find socioeconomic differences in physical activity and dietary habits? Her hypothesis was that contextual, or environmental factors, rather than personal factors are the main determinants. More explicitly, she especially explored whether neighbourhood physical environmental factors were important, i.e. the availability and accessibility of opportunities to be physically active and eat a healthful diet.
The thesis contains a series of papers that have been published in different international scientific journals, including two systematic reviews, qualitative research and quantitative analyses of data from the Globe study.
The results indicate that neighbourhood factors do explain only a small proportion of socioeconomic inequalities in health behaviors. It appears that individual cognitions such as attitudes and intentions, and social environmental factors, such as social modelling and support are more important.
For further reading:
Tuesday, September 30, 2008
Dietary guidelines and the obesity epidemic
Local produce and the 100 mile diet
Sunday, September 21, 2008
Literature and medicine
Sunday, September 7, 2008
A PhD thesis that sheds more light on computer-tailored nutrition education
The studies for this thesis have been published in international scientific journals:
Monday, September 1, 2008
EMGO seminar: visiting professor David Crawford
Dr. Frank van Lenthe from the department of Public Health at Erasmus University Medical Center in Rotterdam (http://www.erasmusmc.nl/MAGE/), the Netherlands provided a first reaction to David Crawford’s presentation. He claimed that we need to focus even more on environmental factors, because good quality research in this field is still lacking.
Sunday, August 24, 2008
The VUmc Department of Epidemiology and Biostatistics
Tuesday, August 12, 2008
A ban on new fast food outlets?
The Netherlands Nutrition Centre declared in a press release that the Netherlands should follow the LA initiative, especially restricting access to fast food outlets in school areas http://www.voedingscentrum.nl/Voedingscentrum/Nieuws/2008/Fastfoodbeleid.htm).
However, professor Sally McIntyre, from the MRC Social and Public Health Sciences Unit, Glasgow University, provided evidence that it is certainly not always true that poorer neighbourhoods have poorer access to healthy nutrition (http://www.ijbnpa.org/content/4/1/32). And although eating at fast food places has indeed been found to be associated with a higher body weight, higher fat intake and lower fruit and vegetable consumption, a study conducted by professor Robert Jeffery and others from the Division of Epidemiology & Community Health, University of Minnesota School of Public Health, also showed that proximity of fast food outlets was not associated with eating ate those places or with a higher body mass index (http://www.ijbnpa.org/content/3/1/2).
Furthermore, a recent study by professor David Crawford and colleagues from the Centre of Physical Activity and Nutrition Research (http://www.deakin.edu.au/hmnbs/cpan/) from Deakin University in Melbourne, Australia, found an inversre relation between proximity of fast food outlets and body mass index: having a fast food place close to the home was associated with lower BMI (http://www.ncbi.nlm.nih.gov/pubmed/18608630?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum).
As I have reported here before, there is certainly evidence suggesting that availability and accessibility of healthy and less healthy foods are associated with nutrition behaviours. The studies by Jeffery and Crawford indicate that these associations are, however, not as straightforward as we maybe would like them to be.
Wednesday, July 30, 2008
ENDORSE: ENvironmental Determinants of Obesity related behaviours in Rotterdam School ChildrEn; recent results.
Recently two papers based on the baseline measurements of ENDORSE were published by Elling Bere et al. (http://www.ncbi.nlm.nih.gov/pubmed/18657568?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum) and by Klazine van der Horst et al. (http://www.ncbi.nlm.nih.gov/pubmed/18617354?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum).
Bere and colleagues explored differences in active commuting to school according to ethnicity and distance to school. Almost 50% of the adolescents reported to actively commute to school on most school days, and mode of commuting was associated with ethnicity and distance. Adolescents from Dutch ethnicity were 5 times as likely to be active commuters to school than youth from foreign ethnicity, and they were especially more likely to cycle to school. Walking to school was common up to a distance of 3k one way, while cycling was common up to a distance of 10k.
Van der Horst et al. explored associations between school environmental factors with soft drinks and snack consumption. Their study indicates that personal factors such as motivation and attitudes are more important for adolescents’ soft drink and snack intakes than availability and accessibility of these foods in the school environment.
These studies again show that different environments may have very different effects for very different energy-balance related behaviours.
Wednesday, July 16, 2008
The hundred mile diet or Prehistoric cooking?
The growth of the organic movement and the dissemination of organic produce in main stream supermarkets show that many people are willing to make changes in their food choices to contribute to a more sustainable way of feeding ourselves. However, now that organic foods and produce have become mainstream, the production has increased enormously, and a big challenge is to remain true to the real basis of ecological farming and production. Many organic product travel thousand of miles before they reach your supermarket, grocer or butcher, making their true contribution to a more sustainable environment rather doubtful. This issue is very nicely described and discussed in Paul Roberts (see http://the-end-of-oil.com/) book, ‘The end of food’.
Another interesting way to try to contribute to a more sustainable way of eating is to eat locally, and thus to reduce the transport-related CO2 fingerprint of the foods we eat. In Michael Pollan’s (http://www.michaelpollan.com/) books ‘The omnivore’s Dilemma’ and ‘In defence of food’ he very clearly illustrates the possible ecological differences between foods that may carry the organic label, and locally produced foods, and a case is build for buying locally. The growth in so-called farmers markets is a sign that buying locally is getting more and more popular.
The so-called ‘hundred mile diet’ (see http://100milediet.org/) is a way to strive to eating more locally. This ‘diet’ is based on the experiences of Alisa Smith and James MacKinnon (http://100milediet.org/contact-us/) who realised that the average food they ate had travelled at least 1500 miles. They decided to try to eat only foods that were produced within a hundred mile radius from their apartment in Vancouver, British Colombia. Since then, many other have decided to try similarly.
A very different way of eating, but that links to local food production, that has received attention here in the Netherlands is the ‘Oerdis’ (see http://www.innovatienetwerk.org/nl/concepten/view/16/Oerdis.html/ for a description in Dutch) which is prehistoric cooking (see http://www.channel4.com/history/microsites/T/timeteam/snapshot_cooking.html and ) and eating. Oerdis reconstructs the way of eating and cooking of our prehistoric ancestors based on archaeological, anthropological and historical research. Some research indicates that our hunting and gathering prehistoric ancestors had similar height as we do today and may have enjoyed long and healthy lives, suggesting that such prehistoric eating habits, with, for example, more animal protein from wild omega-3 fatty-acid rich animals and fish, and less carbohydrates, contributed to a healthy diet.
Sunday, July 13, 2008
Cycling in the Alps
Saturday, July 5, 2008
Biofuel, the food crises and the Dutch policy on healthful nutrition promotion
Monday, June 30, 2008
VU Children’s city; a fantastic playground for hospitalized kids.
Prof. John Roord (http://www.vumc.nl/afdelingen/voor-journalisten/zoeken-op-naam/zoeken--naam/855401/), the chair of the VUmc Children’s hospital and one of VUmc’s Division heads, organised a tour of the Kinderstad for the members of VUmc’s board and the other heads of Divisions.
VUmc Kinderstad is meant for children who have to stay in hospital for a longer period. Kinderstad offers them and their parents the opportunity to leave the hospital setting to enjoy a range of play and entertainment activities, from virtual racing in a Spijker sports car (http://www.spykercars.nl/?pag=1), enjoying video’s from and writing directly to the Ajax soccer team (http://www.ajax.nl/) players, surfing the internet, ‘flying’ in an almost real-life KLM airplane, making radio shows, as well as more basic every-day play activities.
Wednesday, June 25, 2008
The Internet and health education: unfulfilled promises?
Two recent studies by Willemieke Kroeze et al. shed further light on the potential of web-based tailored nutrition education. Her studies published in the Journal or Nutrition Education and Behavior (http://ees.elsevier.com/jneb/) and the Journal of Medical Internet Research (http://www.jmir.org/) suggest that an electronic, interactive web-based version of a nutrition education program that provides users with individually tailored feedback and advice to reduce saturated fat intake was as effective as the original print version of the program (http://www.ncbi.nlm.nih.gov/pubmed/18565463?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum). However, the print version was used and saved more often and was rated as somewhat more personally relevant (http://www.jmir.org/2008/2/e12/).
Wednesday, June 18, 2008
Eating and Physical activity: Planned or habitual behaviour?
Behavioural nutrition and physical activity research and interventions have been strongly rooted in theoretical models that presume rational decision making and a certain level of planned health behaviour. In recent years health behaviour researchers more and more argue that such an approach is too limited. Behavioural nutrition and physical activity research more and more studies environmental factors in stead of cognitions as determinants of health behaviours. Such environmental cues, e.g. easy opportunities for healthful or unhealthy behaviours, may induce habitual responses. Habitual behaviour is characterised by three important feature: a history of repetition, automaticity (expressed by uncontrollability, lack of awareness, and efficiency), and expressing identity.
Many physical activities, sedentary behaviors and dietary behaviors are typically routine behaviors. They are repeatedly performed and we may engage in them without much cognitive effort, just like my commuting and breakfast habits. As a result, the concept of habit is important in studying these behaviors, in addition to measures of behavioral frequency, duration and intensity. Two recent studies, first authored by Drs Gert-Jan de Bruijn and Stef Kremers, I was involved in provide further limited but intriguing early evidence to support the concept of habit as being important in dealing with physical activity and diet in children and adults.
Saturday, May 24, 2008
The 7th ISBNPA conference is almost over.
Measurement of physical activity and nutrition behaviors comes with many challenges. Most behavioural nutrition and physical activity research relied and still relies on self-report measures. Such measures are liable to many biases, and we just do not have truly valid self report measures. In recent years more ‘objective’ measures of nutrition and physical activity behaviours have been developed, such as biomarkers, observations, real time monitoring. But such measures may be strong interventions in itself.
Tom argued for using objective measures and moving away from self-report measures, preferably completely, since these measures have too low validity to be used in intervention or determinant studies, and he provided convincing evidence to support that. Gaston argued that we need self report measures, since the available objective measures are not by definition valid measures, and can often not be used in ‘real life’ population studies, again supported by convincing evidence.
The 7th ISBNPA conference was very interesting, with keynotes on the ethics of obesity prevention, the use of theory in development of physical activity interventions, the genetics of obesity and nutrition behaviours, symposiums on a great variety of behavioural nutrition and physical activity topics, and many more oral and poster presentations on cutting edge themes.
Next year’s conference will be in lovely Lisbon. For more information on this year’s (including the program and abstract book) and next year’s conference, see: http://www.isbnpa.org/.
Thursday, May 22, 2008
ISBNPA 2008 has started.
Yesterday evening here in Banff, Alberta, Canada, the 7th annual conference of the International Society of Behavioral Nutrition and Physical Activity started with a word of welcome by Wendy Rodgers, the chair of the local organising committee, myself as president of the society, and a keynote address by Dr. Peter Katzmarzyk, professor at the Pennington Biomedical Research Center in Baton Rouge, USA.
After a full meeting of the executive committee of the society where we followed up on important issues such as renewing the society’s website, preparation for next year’s conference, the society’s financial status, et cetera, the conference actually started. Dr. Katmarzyk builds a case for research on the importance of the ‘physical activity transition’ as an important determinant of changes in mortality and morbidity trends. We are all familiar with the concept of the epidemiological transition, and most nutritionists have read Barry Popkin’s work on the nutrition transition, i.e. the changes in diet and nutrition that have driven associated changes in important burdens of disease, i.e. from infectious diseases and diseases related to under-nutrition, to diseases of affluence and over-nutrition, such as cardiovascular disease, diabetes and certain cancers. Dr. Katmarzyk argued that a physical activity transition has at least been of similar importance.
Thursday, May 15, 2008
Health promotion through Obesity Prevention across Europe (HOPE): the Geneva Network of Networks meeting.
The HOPE project is a sixth framework EU DG-research funded coordination action. HOPE stands for HEALTH-PROMOTION THROUGH OBESITY PREVENTION
ACROSS EUROPE: AN INTEGRATED ANALYSIS TO SUPPORT EUROPEAN
HEALTH POLICY. Please see http://www.hopeproject.eu/ for more information on the project. The HOPE project is led by researchers from Erasmus University Medical Center (see www2.eur.nl/fgg/mgz/) and VU University Medical Center (see http://www.emgo.nl/; http://www.vumc.nl/) in the Netherlands and the International Obesity Task Force (http://www.iotf.org/)/International Association for the Study of Obesity (http://www.iaso.org/), located in London, UK. Information on all partner organisations and researchers involved in the HOPE project can be found on our website, as well as a list of the obesity prevention networks that we identified in HOPE.
The HOPE project focuses on overweight and obesity as one of the main determinants
of loss of healthy life years and of health disparities in Europe. In particular, it focuses on
expanding understanding of the key lifestyle factors nutrition and physical activity,
which are the major proximal determinants of overweight and obesity. It aims at identifying
(I) socio-economic and environmental determinants of these behaviours; and (II)
effective intervention settings and approaches to address these determinants aiming at
obesity prevention and reductions in inequalities in obesity-related health risks.
The overall objective of the present proposal is to improve the understanding of
determinants and interventions for obesity prevention in key age groups across Europe in
order to inform obesity prevention policy. HOPE focuses on obesity prevention, since treatment of obesity is largely ineffective. Specific objectives are:
- To create a network of networks of overweight and obesity research across EU Member
- To improve the understanding of overweight, obesity, nutrition and physical activity,
which may contribute to obesity prevention across Member States in infants, adolescents
- To improve understanding of environmental determinants by assessing the impact of
both macro-policy and micro-level environmental factors at the family, school, workplace
and national policy level on obesity and obesity-preventive nutrition and physical activity
behaviours across Member States;
- To improve understanding of overweight and obesity-related health inequalities and their
determinants across Member States;
- To provide systematic reviews and inventories of evidence-based obesity prevention,
interventions and policies in and across Member States, with an emphasis on schools
and workplaces, taking into account the effectiveness and barriers for successful
- To develop scenarios of the future burden of disease of overweight and obesity, and to
forecast the impact of full implementation of best-practice policies and interventions in
European child, adolescent and adult populations.
One of the main aims is to build a network, or even better, a Network of Networks of researchers, linking with public health professionals and policy advocates, to create better mutual exchange of state-of-the-art information about obesity prevalence and prevention opportunities, and to ensure that the best available information is fed into the HOPE project’s epidemiological modelling to build evidence-based scenarios for the obesity prevention future for Europe.
In Geneva we had our mid-term Network of Networks meeting. In two half days, all the 10 work packages presented their goals and progress, that cover an inventory of obesity prevalence and trends across Europe, identification of important risk factors and behavioural determinants for unnecessary weight gain, and evidence for effectiveness of ongoing obesity prevention interventions. The presentations will be available at http://www.hopeproject.eu/ within the next week or so.
For each work package presentation we had invited 2-3 ‘discussants’ to review the work package, to help us identify the strengths and limitations of the work, and to help us identify opportunities for improvement. Leaders in the field from across Europe and beyond, such as professors and Drs Jaap Seidell, Boyd Swinburn, Carolyn Summerbell, Vojtech Hainer, Maia Konstantinova, Bert Koletzko, Kurt Widhalm, Lesley King, Peter Kopelman, Riva Prattala, , Francesco Branca, and Charlie Foster, representing different universities, national public health institutes and policy organisations, were kind enough to give us their feedback.
The reactions of the discussants triggered lively discussions among the other invitees.
Additionally, on the Tuesday evening we organised a dinner meeting with representatives from more recent EU member states in central and eastern Europe. During this buffet-meeting, short presentations were given by our invitees from these new members states on obesity prevalence and trends in their home countries. Contributions from Slovenia, Check Republic, Romania, Latvia, Lithuania, Poland, Bulgaria and Hungary were much appreciated, and will help us to create a more complete overview of prevalence across Europe.
The next Network of Networks meeting will be held preceding the 2009 ECO meeting, May 2009 in Amsterdam (see www.easoobesity.org/2009/).
Saturday, May 10, 2008
Diabetes care, obesity and the food crisis
Last Friday Laura Welschen defended her thesis in which she describes a series of studies based on the Diabetes Care system employed in the Hoorn region in the Netherlands. This Diabetes Care system organised by the Diabetes Care Centre West Friesland (http://www.diabetes-zorg.nl/) is an integrated approach including evidence-based efforts to promote patient empowerment to support self-management.
Laura’s thesis is a well written series of scientific papers, including a Cochrane review on the effects of self-monitoring of blood glucose in type 2 diabetes patients (see http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005060/frame.html).
The main risk factor for diabetes type 2 is obesity. Presently there is much to do about the ‘food crises’, i.e. the sharply rising prices of staple foods world-wide, leading to food riots by people in poorer countries that can not afford to buy enough food, and to hunger. The first of the UN millennium development goals reads (http://www.un.org/millenniumgoals/): Eradicate extreme poverty and hunger:
- Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day
- Achieve full and productive employment and decent work for all, including women and young people
- Halve, between 1990 and 2015, the proportion of people who suffer from hunger
The present food crisis makes reaching the hunger eradication goal even more difficult to reach. The fact that on the one hand we face an enormous epidemic of obesity and related diseases such as diabetes, cardiovascular problems as well as certain cancers (http://www.dietandcancerreport.org/), and on the other food shortages and hunger is and remains one of the worlds serious scandals. The present increase in food shortages in poorer countries is repeatedly attributed to the fact that certain foods, like corn, sugar cane, and palm oil are now more often used to produce ‘biofuel’ (http://en.wikipedia.org/wiki/Biofuel). However, only a very small percentages of the total production of these crops is indeed used to produce biofuel. A much larger proportion of agricultural land and staple foods is, for example, used to produce meats, dairy and other animal food products.
In an opinion article in one of the main Ducth national newspapers, NRC-Handelsblad (http://www.nrc.nl/opinie/), professor Jan Douwe van der Ploeg (http://www.rso.wur.nl/UK/People/Staff/vdPloeg/), professor of transition studies at Wageningen University and Research Center, argues that the production of biofuel is only a small contributor to the present food crisis, and he sees the (1) ongoing transition from farmer-based, smaller-scale agriculture to large-scale but less productive corporate agriculture; (2) the development of a world food market in stead of more regional food markets that leads to production of foods further away from consumers, and foods exported from countries where local people already have a lack of food; and (3) the domination of the food market by a few what he calls food-imperia that use food to produce processed food products, which is good for making money, but not so much for feeding the hungry.
Monday, April 28, 2008
The 2008 EMGO retreat
During the afternoon, the four EMGO research programs first met to discuss strategic priorities. Thereafter, the 2007 EMGO awards were announced, after short, clear and sometimes very funny presentations from the candidates. Tessa van den Kommer received the science award for the best scientific paper by a junior researcher, for her paper on Cholesterol and oxysterols as possible early markers for cognitive decline (http://www.ncbi.nlm.nih.gov/pubmed/17888546?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum). The Societal Impact Award was given to Marian van Bokhorst for her project on identification of under nutrition in hospital settings that received major media attention in the past year.
The day ended with a nice buffet lunch followed by a smashing performance of the 8-head EMGO-band, performing songs from bands and singers as diverse as The Clash, Dandy Warhols, and Amy Winehouse.
But the day started with a good discussion on our plans to merge EMGO with important research groups from the two other faculties into a more inter- en multidisciplinary research institute for health and care research.
In his last book, “Common Wealth: Economics for a crowded planet”, Jeffrey Sachs (http://www.earth.columbia.edu/articles/view/1804) writes: Scientific research proceeds in intellectual silos that make far too little contact with one another; research in the physical sciences, biology, engineering, economics and public health is rarely intertwined, even though we must solve problems of complex systems in which all of these disciplines play a role. The problems just refuse to arrive in the neat categories of academic departments”.
I truly believe that this merger will better prepare EMGO for the future, since health and care research indeed requires input from and collaboration between, amongst others, medical researchers, health scientists, behavioural researchers, economists and paramedical experts, and concentrating such expertise within one institute will facilitate this.
Sunday, April 13, 2008
Amika Singh’s PhD graduation and Henriette van der Horst’s inaugural address.
That afternoon professor Henriette van der Horst accepted her chair as head of the General Practice department of the VUmc with her inaugural address. The General Practice department is one of the VUmc’s departments that participates in the EMGO Institute (http://www.emgo.nl/) for Health and Care Research. Prof. van der Horst stressed the importance of multidisciplinary collaboration in research tot improve general practioner’s practice.
Sunday, March 30, 2008
The annual meeting of the Scottish Nutrition Society: behavioural nutrition and energy balance in the young.
Dr. Tim Lobstein of the International Obesity Task Force from the international association for the study of obesity presented before me. He gave a very good talk, providing the audience with ten action points to help curb the obesity epidemic, especially among children. Most of his recommendations were aiming to change the market and marketing environment for foods, and the physical environment for physical activity.
Professor John Reilly, from University of Glasgow (he is presenting in the attached picture), presented after me on the evidence that physical activity and sedentary behaviour are important for overweight and obesity in preschoolers. About 20 years ago, he reminded us, this age group was considered to be at really low risk for overweight, since such small children were thought to be moving all the time. In the last decades, things have probably changed, because more recent evidence based on objective measurements of physical activity and sedentary behaviour among 3-6 year olds shows that hardly any kids meet the recommended 60 minutes of moderate or high intensity physical activity per day. The quintile with the highest activity came up to about 45 minutes in research among UK children. Furthermore, about 80% of the waking hours were spent on sedentary ‘activities’.
To get back to my earlier item on regional foods. In his keynote, John Reilly briefly referred to a study in physical activity, sedentary behaviours and environmental determinants in South Africa he is involved in. Some of the regional speciality foods the kids there really like are ‘Walkie Talkies’. Walkie talkies are chicken heads and feet….
Wednesday, March 26, 2008
An expert meeting to inform the Dutch obesity prevention research agenda
In both the discussions it was concluded that the limited means available for obesity prevention research should not be used to start new initiatives or to fund a few more small-scale studies to investigate yet another few details that may in the end contribute to obesity prevention. Both practitioners and researchers agreed that the available funding should add to the existing larger scale ongoing initiatives in the field of obesity prevention in the Netherlands where research, policy development and practical implementations go hand in hand. Important examples of such initiatives are the recently completed NHS-NRG study (see http://www.ncbi.nlm.nih.gov/pubmed/15714217?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum), the city-wide initiatives in the cities of Rotterdam and Zwolle, and the so-called ‘academic workplaces’ in Rotterdam and Amsterdam, where universities, the municipal health services and other local health organisations work together to combine research and practice to enhance obesity prevention. See for example http://www.zonmw.nl/index.php?id=4059. The OPOZ (‘research program for obesity prevention in Zwolle; http://www.onderzoekinformatie.nl/nl/oi/nod/organisatie/ORG1242150/) program with the ChecKid study in the city of Zwolle, led by professor Jaap Seidell is arguably the most comprehensive initiative in the Netherlands to curb the obesity epidemic in a local initiative involving all stakeholders, and accompanied by good-quality research to build the evidence-base for such community-based obesity prevention.
Sunday, March 23, 2008
Socioeconomic position in childhood and adulthood and associations with weight status
Saturday, March 15, 2008
Regionally defined diets for health, the environment and cultural diversity in food habits
During the evenings there was plenty of time for reading. I brought Michael Pollan’s new book, In Defence of Food. Pollan argues in this book in favour of focussing on real foods and meals in stead of on nutrients and processed foods, including the so-called functional foods that claim various health benefits. Pollan builds a strong case in a book that is a very good read.
This same week a paper that I co-authored with my Norwegian colleague Elling Bere appeared in electronic pre-publication in Public Health Nutrition (http://www.ncbi.nlm.nih.gov/pubmed/18339225?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum). This paper, entitled ‘Towards health promoting and environmental-friendly regionally defined diets: A Nordic example’ argues for a similar case as Pollan does in his book. We present a Nordic ‘diet’ with foods and ingredients that are and have been appropriate and abundant in the Nordic countries, for which scientific evidence supports health enhancing effects. The best knows health promoting total diet is the so-called Mediterranean diet, but we claim that diets with similar health enhancing properties can be based on regionally appropriate foods. Such an approach will help to protect cultural diversity in eating habits, bio-diversity and the environment.
Sunday, March 2, 2008
Exploring the possibilities of further developing midwifery research in the Netherlands
The call for a stronger scientific development and underpinning of the profession comes from the professionals and the schools for midwifes, based on a need for evidence-based practice and further innovations in the field. The Scientific Committee has been specifically asked to propose a research agenda, to explore funding possibilities for midwifery research, and to help to establish a scientific network for midwifery research in the Netherlands, that links to international developments in the field.