The 20th anniversary of the Department of Nursing Home Medicine

Yesterday, the department of nursing home medicine of the VU University medical center celebrated its 20th anniversary. In 1989, the first training course for nursing home physicians in the world was established at the Vrije Universiteit Amsterdam (now the VU university medical center). Now, 20 years later, 750 nursing home physicians have been trained at VU medical center. Also the research at the department, embedded in the EMGO Institute for Health and Care Research, has seen a spectacular growth with more than 400 scientific publications, and an impressive list of PhD graduates. The twentieth anniversary was celebrated October 1st, in Artis Zoo Amsterdam with more than 200 visitors, many of them trained at the VUmc. They enjoyed speeches of national and international speakers. After the head as well as founding father of the department, Prof. Miel Ribbe gave a brief introduction, profs. Douwe Draaisma from Groningen University, Paul Schnabel, director of the Netherlands Institute for Social Research, and Sheryl Zimmerman from the University of North Carolina provided their entertaining, thought provoking and evidence-based views on aging, the elderly and elderly care. After a tour along the elderly animals in the Zoo, the people present, and Miel Ribbe most of all, were pleasantly surprised by the dean of VUmc, Prof. Wim Stalman, who proudly announced that Prof. Miel Ribbe was honoured by Queen Beatrix with a knighthood, among others for his excellent work in establishing, nursing, promoting and disseminating the art and science of nursing home medicine of these outstanding performances.

American Journal of Health Promotion's new definition of Health Promotion

In the September/October issue of the American Journal of Health Promotion, the journal's editor in chief, Michael O'Donnel presents his, and the journal's, definition of 'health promotion 2.0: Embracing Passion, Enhancing Motivation, Recognizing Dynamic Balance, and Creating Opportunities'. This 2.0 definition (see below) is rather complex and embracing a very broad range of health aspects, but the deifinition includes a few important messages. First of all the definition 2.0 puts (even) more emphasis on environmental conditions and opportunities for health and health practices, building upon the growing body of evidence linking environmental conditions, such as availability and accessibility of healthy options, to engagement in health behavior, and to the WHO slogan 'Making the healthy choice the easy choice'. The definition certainly also links to the behavioral determinants highlighted in well-known behavioral theories such as the Theory of Planned Behavior, Social Cognitive Theory, or Protection Motivation Theory, i.e. the determinants that have been targetted most frequently in health promotion interventions that had health education as the central change strategy. For example, the definition highlights enhancement of awareness, motivation and skills as important goals for health promotion interventions. But the definition explicitely states that creation of environmental opportunities is "most important". There is much circumstancial evidence for the importance of health promoting environments, but there is still a lack of intervention studies showing that creating opportunities that make healthier choices the easiest choices indeed lead to healthier lifestyles.

The full definition of Health Promotion 2.0 proposed by O'Donnel is:
"Health promotion is the art and science of helping people discover the synergies between their core passions and optimal health, enhancing their motivation to strive for optimal health, and supporting them in chnaging their lifestyle to move toward a state of optimal health. Optimal health is a dynamic balance of physical, emotional, social, spiritual, and intelectual health. Lifestyle changes can be facilitated through a combination of learning experiences that enhance awareness, increase motivation, and build skills and, most important, through the creation of opportunities that pen access to environments that make positive health practices the easiest choice."

The A-CaRe kick off meeting

On Friday September 18 the kick off meeting of the A-CaRe (Alpe d’huzes cancer rehabilitation research program) was held in the Amsterdam Olympic stadium. In the conference rook at the Regarz meeting center in the stadium, with a view on the track and field practice going on the Olympic track itself, the A-CaRe program was presented.

A-CaRe is the first research program funded by the special Alpe D’Huzes fund from the Dutch Cancer Society. The Alpe D’Huzes foundation organises events, cycling events in particular, to raise money for caner research to develop evidence-based cancer rehabilitation and patients support programs.

Chaired by the former minister of health Dr. Els Borst, the chair (Coen van Veenendaal) and the ambassador (Peter Kapitein) of the Alpe D’Huzes foundation first presented the foundation and its philosophy mission and vision.

After their inspiring presentations, the three subprograms of A-CaRe were introduced, i.e. a subprogram on scientific research, on implementation preparations and on communication. Subprogram 1, i.e. on scientific research, is coordinated by EMGO+, by Dr. Mai Chin A Paw , Dr. Laurien Buffart, and myself and coordinated b. Two studies have now been started within subprogram 1, a study to study if intensive training or a more extensive active lifestyle works best to improve fatigue, quality of life and return to work among breast and colon cancer patients, after they completed their chemotherapy. on physical training after chemotherapy , and a study to investigate if physical training may improve fatigue and quality of life among children with cancer.

Research infrastructure at the VU University Medical Center

On Thursday 17 September, the directors of the VU University Medical Center’s (VUmc) research institutes (EMGO+, CCA/V-ici, ICarvu, NCA and MOVE) met, joined by VUmc’s experts on data management, knowledge valorisation, research project management. The meeting was led and chaired by the Dean of VUmc, Prof. Wim Stalman, and supported by his staff.

VUmc has made impressive progress in its research accomplishments and output, for example illustrated by its 2nd place in the research rank order based on the ‘CWTS crown indicator’(i.e. a measure of the relative frequency of citations of international scientific research publications) of the Dutch university medical centers. However, this grown and now relative large research output should be supported by an adequate research infrastructure including data-management, biobanking, project management and control, as well as support for valorisation of the research findings.

At the September 17 meeting these issues were discussed and the different topics were further specified and each topic was adopted by one of the participants to translate in a concrete plan for development and inclusions in the upcoming management contracts. This developments should lead to a better basis and support for the continuous research efforts and developments of VUmc.

I pleaded myself to start regarding and treating the main VUmc cohort studies, such as the NESDA study on depression and anxiety disorders, the LASA study on aging and health issues, and the HOORN studies on determinants and effects of diabetes, as part of research infrastructure in stead of mere projects. These cohort studies ensure a continuous output in terms of high ranking and often cited research papers, and university funding for the basis data management and continuation of these studies increases the chances to multiply this initial investment by external acquisition.

Obesity prevention among schoolchildren and adolescents

Yesterday Wilma Jansen, senior researcher at the Municipal Health Service of the Rotterdam-Rijnmond area, defended her thesis entitled ‘Prevention of Childhood Obesity in a Municipal Setting’. The studies presented in her thesis further confirmed that the prevalence of being overweight in the Rotterdam area among children and adolescents is high (approximately 25%), and substantially higher than in other parts of the Netherlands. Her studies further showed that many parents do not recognize or deny their children’s overweight status.
Part of her thesis research was the description and evaluation of the ‘Lekker Fit!’ (‘nice and fit’) intervention at Rotterdam schools to contribute to obesity prevention by promotion of healthful physical activity and nutrition. The Lekker Fit! intervention combined structural changes in the school and neighbourhood environment with health education activities, with involvement of different municipal services related to education, sports and recreation, and public health. The Lekker Fit! intervention resulted in somewhat lower rates of overweight and lower mean waist circumferences among the younger participants, i.e. indications that the intervention may indeed contribute to obesity prevention.
After the thesis defence, in a symposium on local and municipal obesity prevention, Drs. Frank van Lenthe of Erasmus University medical center and Mai Chin A Paw from the department of Public and Occupational Health of the EMGO+ Institute, and Prof. Jaap Seidell, from the department of Health Sciences and the EMGO+ Institute presented their views on the issue. All speakers argued that larger and multiple changes in the micro level and macro level food and physical activity environments are needed to make meaningful changes in behavioral nutrition and physical activity.
In two articles Prof. Ken Resnicow has argued that changes in behavioral nutrition and physical activity may be better described by quantum changes and chaos theory instead of the most often used more linear health behaviour theories. A characteristics of chaos theory that is often described is that small initial differences may lead to huge consequences, e.g. the butterfly clapping its wings causing a big storm at the other side of the world. However, I believe, and the literature indicates that and the speakers, especially Jaap Seidell kind of argued the same, that for obesity prevention almost the opposite is true: we need large and many enduring changes in multiple obesogenic environments to cause small but meaningful effects in eating and physical activity behaviours, as well as overweight and obesity. The EPODE initiative, i.e. Ensamble Prévenon l'Obésité Des Enfants, may be the best example of such multiple changes in multiple environments that lead to first small but extending meaningful changes in childhood rates of overweight.

Ineke Vogel defends her thesis on behavior and possible precautions related to exposure to loud music among adolescents

Listening to music is great. Listening to loud music can be a lot of fun, but too loud and too long will damage your ears. Risk of hearing impairment is nowadays especially high among youth who are exposed to long spells of loud music by listening to ‘MP3’ players and such, and by visiting discotheques and music concerts.
How big this potential problem is, who runs the highest risk, and what the possible precautionary actions are, was largely unclear. But yesterday Dr. Inke Vogel defended her doctoral thesis called “Music-listening behaviour of adolescents and hearing conservation: many risks, few precautions” successfully. Her thesis consists of 11 scientific papers of which the majority has already been published or accepted for publication in high ranking journals such as Pediatrics, American Journal of Preventive Medicine, and the American Journal of Public Health. In her series of studies, Dr. Vogel assessed what proportion of Dutch youth runs considerable risk (at least 25%), and what differentiates youth with higher risk from those with lower risk (especially level of education; youth at vocational schools have much higher exposure to loud music than youth at university preparation education). Ineke Vogel also explored what could motivate youth to take voluntary precautions and what possible other health protection measures may be considered to tackle this considerable population health problem.

Her conclusions are that exposure to long spells of loud music, especially through personal music devices, is very prevalent, may lead to extensive hearing impairments, but that there are very few opportunities to motivate youth to voluntarily reduce their exposure. Health protection measures, i.e. measures such as legal sound level limitations should be considered.

Nanna Tak defends her thesis on promoting Fruits and Vegetables among schoolchildren

Yesterday, Nannah Tak defended her thesis on the evaluation of the ‘Schoolgruiten’ project, an intervention scheme to promote fruit and vegetable intakes among school children in the Netherlands.

This intervention scheme builds on similar projects (such as Pro Children and Pro Greens) in which fruit and vegetable provision in schools is combined with health education about the merits and recommendations regarding fruit and veggie intakes.

Nannah’s thesis consists of a series of scientific papers published in such journals as Journal of Human Nutrition and Dietetics, International Journal of Behavioral Nutrition and Physical Activity, and Public Health Nutrition, and combines observational research exploring possible determinants of fruit and vegetable intakes with intervention research to assess the (cost) effectiveness of the scheme. The results indicate that Schoolgruiten was successful in promotion of fruits, but effect sizes were small.

Nannah’s thesis was well received, and her defence successful!