Friday, January 11, 2008

HOPE: Health Promotion through Obesity Prevention in Europe



Today we had our second work package leader and researcher meeting for the HOPE project (see http://www.hopeproject.eu/) at the EMGO Institute (http://www.emgo.nl/) in Amsterdam. HOPE is a European Commission funded FP7 project. In this project we aim to bring the scientific knowledge on overweight, obesity and their determinants together and use the expertise of researchers all over Europe to help to tackle the obesity epidemic. This project aims to integrate and further enrich the widely available and diverse knowledge on all these topics across Europe and use this information for designing various scenarios based on careful evidence-based epidemiological modelling. This will provide entry-points for policy making, and will help the European Commission and member states to set priorities for curbing the obesity epidemic.
The project also aims to build a network of researchers across Europe active in the further study to inform obesity prevention efforts.

The HOPE team consists of international experts in the field of the study and prevention of obesity, such as Philip James and Tim Lobstein of the International Obesity Task Force (www.iotf.org/), Frank van Lenthe and Anton Kunst of Erasmus University Medical Center in Rotterdam (http://www2.eur.nl/fgg/mgz/), Knut Inge Klepp of the University of Oslo (http://www.uio.no/), ILse de Bourdeaudhuij and Lea Maes of Ghent University (http://www.ugent.be/), Adriano Cattaneo of the institute of child health in Trieste (http://www.burlo.trieste.it/), Jean Michel Oppert of INSERM, France (http://www.inserm.fr/fr/), and Agneta Yngve of the Karolinska Institute, Sweden (http://ki.se/).

Today in Amsterdam we prepared a ‘network-ofnetworks meeting’ that will be held preceding the European Congress on Obesity (http://www.eco2008.org/), where we will present the HOPE project to our colleagues from across Europe and where we hope to learn from our colleagues to further inform and target our efforts within the HOPE project.
Posted by at 1 comment:

Sunday, January 6, 2008

From ice to snow



After the two days of ice on the Dutch canals that provided proof that environmental factors do predict specific physical acivities, and the Christmas days, I took a few days off. We travelled to Norway where a very good friend and colleague let us stay in his mountain hut in the Hogfjell mountains near Honefoss. The days in Norway at this time of year are very short. It gets light at about 9.00 am and dark at about 3.30 pm. The hours inbetween we used for cross country skiing, the afternoons I was able to write a paper based on a presentation I gave at the fifth Heelsum conference early December 2007. The Heelsum conferences are bi-annual invitation meetings focussed on the possibilities of healthful nutrition promotion in primary care. Professor Gerrit Hiddink from Wageningen University is the main initiator of thse conferences. This time one of the aims was to explore how nutrition education by the general practitionar fits within the broader physical and social environmental determinants of health eating.
I also wrote a draft edotorial for a special issue I am guest editing together with Prof. Arja Aro from Denmark on risk perceptions and risk communication related to emerging infectious diseases. To control new infectious diseases the identification of the organisms, the infectivity, development of vaccines and therapies, contact tracing, isolation, and screening may all be important. Many of these issues are partly dependent on human behaviours. For example, the success of prevention of infectivity (e.g. engaging in precautionary behaviours such as wearing masks, hand hygiene, isolation etc.), vaccination, contact tracing and population screening are all more or less dependent on whether people at risk comply with behavioural recommendations. Especially in the early phases of a possible epidemic, compliance to precautionary behaviours among the populations at risk is often the only means of prevention of a further spread of the disease. However, very little research has been conducted to explore the determinants of behavioural responses to infectious disease outbreaks, and risk perceptions and communications are regarded as important factors for behavioral responses. The International Journal of Beavioral Medicine now prepares this special issue on this important topic.
For further reading, please see:
Posted by at No comments:

Saturday, December 22, 2007

Physical environmental factors do predict specific physical activities; an N=2 study



In the last decade it has been posited that the so-called obesogenic environment is the main driving force behind the obesity epidemic. Experts claim that our environment characterised by an over-abundant availability of palatable energy-dense foods that can be eaten anywhere and anytime, as well as lack of opportunities to be physically active make people eat too much calories and burn too little calories, leading to unnecessary weight gain and eventually to overweight and obesity. However, the scientific evidence for the hypothesis that physical environmental factors predict eating and physical activity behaviours is not yet strong, probably due to a lack of well-designed studies. Over the past few years we have conducted a series of systematic reviews on the availbale studies on associations between environmental factors and different nutrition behaviours and physical activity. These reviews (of mostly cross-sectional studies, using weak measurement instruments and often failing to adjust for possible confounding factors) indicated that the evidence was not yet strong. Only for very few associations was convincing and consistent evidence found, and the evidence for social environmental determinants of health behaviours was much stronger than for physical environmental factors. Recent studies further indicate that individual factors such as motivation and abilities remain important predictors of health behaviours. (See a list of links to the pubmed abstracts of the scientific papers on these reviews later in this message). However, today I did an N=2 study that illustrated that physical environmental circumstances can determine specific forms of physical activity, if motivation and ablities are taken care of. For the first time this year the ice on a few canals in the Netherlands was strong enough to allow ice skating on natural ice. We have had a few days of frost now, and although the ice is hardly reliable yet, many Dutch grabed their skates and went for it (some did get wet). My wife and I found a nice stretch of great ice a bit north of Haarlem. The icy environment allowed us to act on our motivation and to use our abilities!

Posted by at No comments:

Friday, December 21, 2007

A drink before the Christmas break


On Thursday afternoon, December 20, the EMGO Institute met for an informal drink at the café attached to the VU University medical center. This was a great occasion to look back at a good year for the EMGO institute (http://www.emgo.nl/) . We had good scientific accomplishments with more than 20 PhD theses, Over 300 publications in Science Citation Index or Social Science Citation Index journals, and good acquisition of projects that will ensure scientific output for the years to come.
Our societal impact was also of good quality with policy and media attention for many of our projects, for example regarding e-health interventions, patient safety research, childhood obesity, and studies on environmental determinants of health lifestyles.
The year to come also looks good, with many interesting ongoing projects within our four research tracks, and some very interesting opportunities for additional research projects. One of these opportunities is research to test physical activity and training programs for cancer patients to build evidence based cancer rehabilitation programs, in collaboration with and supported by Alp-dhuzes (http://www.alpe-dhuzes.nl/templates/mercury.asp?page_id=1473). This is a yearly sponsored cycling event on the Alp D’Huez mountain to raise money for cancer research. I get back on this topic in the weeks to come.
Another important event in the coming year will be the preparation and probabale start of an interfaculty research institute together with partners from the faculty of Psychology and Education and the faculty of Earth and Life Sciences.
The next week I will celebrate Christmas with family and friends and then go to Norway for some days to do cross country skiing.
I wish you all a very merry Christmas and a great new year.
Posted by at 1 comment:

Saturday, December 15, 2007

Prevention of unnecessary weight gain at the worksite


Yesterday Lydia Kwak defended her PhD thesis at a public meeting at Maastricht University. Her thesis describes the development, implementation and evaluation of an intervention program aiming to contribute to prevention of unnecessary weight gain among employees. Her PhD research was part of the NHS-NRG project, a comprehensive project funded by the Netherlands Heart Foundation on obesity prevention. This project consisted of two studies exploring behavioural, cognitive and environmental determinants of weight gain and energy-balance related behaviours, and three intervention studies; one aimed at adolescents (the Do-IT intervention), one for elderly people (the WAAG-study), and the one Lydia used for her PhD thesis which was called the In-Balance study.
Lydia Kwak used the Intervention Mapping protocol to develop the intervention that consisted of health education, self monitoring and environmental change components. The evaluation study used a controlled design and the results indicated that employees in intervention worksites had a lower fat mass at follow-up than employees of control worksites where the intervention program was not implemented. Her studies also showed the difficulties to convince worksites to participate in such an important study and to convince employees to participate in weight gain prevention activities. Prevention of weight gain should be key in attempts to curb the obesity epidemic, since treatment of obesity is hardly ever successful on the loner run.
Lydia Kwak’s thesis studies have been published in different international scientific journals. See for example:

Posted by at No comments:

Sunday, December 9, 2007

How can we evaluate national health promotion campaigns?





In the Netherlands as in many other countries, we invest in promotion of healthful and safe behaviours to contribute to prevention of chronic disease, accidents, et cetera. One of the ways to contribute to promotion of healthy lifestyles are so-called national campaigns, that often make use of mass media to communicate health promotion messages to the population at large.

Such campaigns should be evaluated to study if these campaigns indeed contribute to more healthful lifestyles among the population, i.e. we should study if money and other resources allocated to such campaigns are well spend.

A valid evaluation of national campaigns is not easy. The strongest research design to evaluate the effects of interventions is the so-called randomized controlled trial (RCT). RCTs are considered the most reliable form of scientific evidence in healthcare because they eliminate spurious causality and bias. RCTs are mainly used in clinical studies, but are also employed in other sectors such as judicial, educational, and social research. As their name suggests, RCTs involve the random allocation of different interventions (or treatments) to subjects or respondents/participants. This ensures that confounding factors are evenly distributed between treatment groups.

However, in evaluation of national campaigns randomization is not possible and a control group is not available because the population at large is exposed to the intervention.

Many national campaigns are therefore evaluated by means of a very simple design with one before and one after measurement. This often means that before and after the campaign is launched a sample of the target population is surveyed on the behaviour the campaign is addressing. If the after-campaign survey shows better results, this is supposed to indicate that the campaign was successful. The weakness of this research design can be illustrated with an example. The first picture next to this blog message shows the results of such before and after campaign measures related to the introduction of a bicycle helmet law in Australia. Before wearing a helmet became compulsory the number of head injuries was much higher than after. Conclusion: making people wear helmets prevents head injuries!? The second picture shows that this was not the case. In this picture not one before and one after campaign measurement was used, but a whole series of before and after measurements. This is called an interrupted time-series design. This picture shows that the reduction in head injuries was already ongoing before the helmet law was introduced, that this downward trend was continued after the law was in place. The picture indicates that the law did not change this trend in any way. Conclusion: the bicycle helmet law had no effect at all on head injuries.

The interrupted time series design is generally regarded as best-practice in evaluation of national campaigns or other circumstances where a control group is not possible. The Dutch Health Council recently published an advice on evaluation of national campaigns in which this was confirmed (http://www.gr.nl/samenvatting.php?ID=1454&highlight=landelijke%20campagnes). However, such an interrupted time-series design requires careful and timely planning of evaluation, additional resources to do the extra measurements, and expertise for statistical analyses of time series data. Time, extra resources and specialized statistical expertise is not always available for the organizations that develop and implement the campaigns, and these organizations feel that interrupted time-series design may be the best but not a realistic option for them. Furthermore, evaluation of national campaigns may not always need to be concerned with effects in terms of lifestyle behaviour changes, but sometimes evaluation in terms of reach, adoption, implementation or maintenance (see RE-AIM framework, http://www.re-aim.org/) of campaign activities may be sufficient, and such evaluations may require different research designs.

The Netherlands Organisation for Health Care Research and Development, ZonMW (http://www.zonmw.nl/) has ask me to further explore best and realistic practice in evaluations of national campaigns in the Netherlands. In the few months interviews will be held with representatives of all the organizations in the Netherlands that organize and implement national campaigns to learn about their evaluation goals, barriers and wishes for improvements.
Posted by at 1 comment:

Sinterklaas day with the Board of the VU University Medical Center


Five December is Sinterklaas day in the Netherlands (see http://nl.wikipedia.org/wiki/Sinterklaas for detailled information in Ducth, and http://en.wikipedia.org/wiki/Sint_Nicolaas for information in English). Sinterklaas or Sint Nicolaas (Saint Nicolaus) was a bishop from Myra in present day Turkey during early Christianity. His remains were abducted to Bari in southern Italian where a very beautiful Roman Sinterklaas church can be found. But the Dutch Sinterklaas legend tells us that Sinterklaas comes from Spain to the Netherlands with his ‘Moor’ servants (‘Zwarte Pieten’), bringing all children who have been good presents and treats. The story goes that the Coca Cola company adopted this wonderful celebration, transferred it to Christmas, and created Santa Claus, a kind of weak and stupid looking cousin of the real Sinterklaas.
This year I spend Sinterklaas day and night in the castle-hotel Vanenburg (http://www.vanenburg.nl/cnt/devanenburg.htm). The board of the VU University Medical Center (http://www.vumc.nl/) had invited the heads of the six Divisions to discuss such issues as the VUmc’s mission, the key stakeholders that the VUmc wishes to serve, and necessary human resource management to fulfil the mission.
For me it was a great opportunity to get to know the chairs of the other Divisions a little better and to join in fruitful discussions on VUmc’s ambitions (yes, we do wish to get better in what we do in health care, education and research) and the way we wish to realise these ambitions.
Posted by at No comments:
Subscribe to: Posts (Atom)