Staff Publications

Staff Publications

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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

    Publications authored by the staff of the Research Institutes are available from 1995 onwards.

    Full text documents are added when available. The database is updated daily and currently holds about 240,000 items, of which 72,000 in open access.

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De groene agenda: Ontwerptool Groene Gezonde Stad
Snep, Robbert - \ 2017
urban areas - water harvesting - climate - projects - plants - health - urban parks

De Ontwerptool Groene Gezonde Stad is een tool in ontwikkeling die het effectief gebruik van stadsgroen door planners, ontwerpers, ontwikkelaars, hoveniers en groenvoorzieners ten behoeve van maatschappelijke doelstellingen (gezonde woon-/werk-/leefomgeving) moet stimuleren. De plek die groen nu inneemt in het proces is redelijk achteraan. Het doel is dat planners, ontwerpers, ontwikkelaars, grondeigenaren etc. het groen meenemen in het ontwerpproces. Dan wordt de vraag naar groen en de kwaliteit van groen ook beter. Professionals krijgen met via de tool beter inzicht in waar en welk groen welk gezondheidseffect op welk doelgroep heeft, en worden daarmee uitgenodigd die kennis te benutten in hun plannen en projecten. Dit levert een gezondere stedelijke samenleving op, en maakt dat de economische waarde van het groen duidelijker wordt meegenomen in de besluitvorming over de inrichting en het beheer van de stad.

Non-digestible polysaccharides to support the intestinal immune barrier: in vitro models to unravel molecular mechanisms
Tang, Yongfu - \ 2017
University. Promotor(en): Harry Wichers, co-promotor(en): Jurriaan Mes; Coen Govers. - Wageningen : Wageningen University - ISBN 9789463437134 - 166
polysaccharides - health - immunomodulatory properties - homeostasis - intestinal diseases - human nutrition research - polysacchariden - gezondheid - immunomodulerende eigenschappen - homeostase - darmziekten - voedingsonderzoek bij de mens

Non-digestible polysaccharides (NDPs) are considered as important ingredients to support health. Among these health effects, immunomodulatory effects raised interests in the past decade. The intestine is the primary organ that interact with NDPs. The intestinal epithelial cells (IECs) form a dynamic physical barrier and together with associated immune cells determine for a large part our immune homeostasis. Studying the direct interaction between NDPs and intestinal and immune cells could help us to uncover the mechanism by which NDPs exert immunomodulatory effects and how NDPs can differ in this activity. In this thesis, we investigated the immunomodulatory effects of NDPs through interaction with intestinal immune cells using in vitro methods in order to characterise the NDPs and preselect NDPs with differential activity for further in vivo evaluations.

The intestinal immune barrier is formed by various IECs and immune cells, which are introduced and their specific functions discussed in Chapter 1. NDPs could interact directly with both IECs and immune cells that sample in or from the lumen. The majority of IECs are enterocytes and most relevant immune cells responsible for sampling in the lumen have been characterised as macrophages, which leads us to focus on these cell types by in vitro approaches. In addition, basic information on NDPs and current status on health effects of NDPs both in vitro and in vivo are discussed.

In Chapter 2, the direct response of IEC to NDPs stimulation was investigated. IECs form the largest surface of the body that, with a crucial role as barrier also, perform a role in signalling towards immune cells. We used 21-day transwell cultured Caco-2 to resemble the small intestinal enterocytes that form largest part of this intestinal layer. We first characterized the chemical composition of five NDPs which revealed different mono sugar composition, linkages of backbone and side chains and a wide range of MW (from 17 KDa to 2100 KDa). The NDPs could reduce translocation of FITC-Dextran of 4 kDa across the epithelial layer, potentially through physical interference. Gene expression analysis indicated the induction of unique gene expression characteristics in Caco-2 cells upon exposure to different NDPs. An arabinoxylan preparation from wheat and a lentinan-containing extract from shiitake mushrooms showed upregulation of gene expression of the NF-κB family and chemokines CCL20 and CXCL10. Besides these immune related changes by some NDPs, we also observed changes in receptor expression (like TLR2, CD14 and GPCRs) and other pathways, amongst which the cholesterol biosynthesis pathway.

Macrophages, as the resident population of immune cells penetrating between or associating with close contact with the IECs, are generally classified as inflammatory (M1) or as tolerant (M2) macrophages. In Chapter 3, we set up a macrophage differentiation method based on primary blood cells and selected and validated M1 and M2 specific gene expression markers. Next, we analysed the effect when macrophages are exposed to NDPs and compared the resulting macrophages with M1 and M2 macrophages. Based on M1 and M2 markers we identified an alternative subset that we named MNDP. This MNDP was further studied by microarray analysis and revealed a commonly modulated set of genes, involved in migration, metabolic processes, cell cycle, and inflammatory immune function.

In Chapter 4, we further functionally characterize these MNDP in comparison to M1 and M2 macrophages based on a set of functional assays. NDP-treated macrophages showed no IDO activity and showed an inhibited antigen uptake and processing capacity compared to M1 and M2 macrophages. Also their phagocytic capacity was reduced compared to both M1 and M2 macrophages. Furthermore, the alternative expression pattern for NDP-treated macrophages, as demonstrated by gene expression, was confirmed by protein measurements. The signature mix of the chemokines CCL1, CCL5, CCL20, CCL24, CXCL8, and IL1β secreted by MNDP, and in particular when macrophages were treated with Naxus, was shown to induce a recruitment of monocytes.

As macrophage plasticity could be essential for intestinal immune homeostasis, resolving activity of inflammatory responses upon a challenge is important. Besides, redirecting differentiation and function of tolerant macrophages can also be beneficial to the intestinal immune status. In Chapter 5, we analysed plasticity of M1 and M2 macrophages to NDPs exposure. Macrophage plasticity was demonstrated as M1 and M2 could be skewed to an alternative subset indicated by a dedicated set of gene expression markers, selected to characterize M1, M2 and MNDP macrophages. In addition, phagocytosis and antigen processing capacity of both M1 and M2 were decreased by the NDP Naxus. Besides, Naxus could change the secretion of cytokines by macrophages that previously were differentiated towards M1 and M2. For M2, this resulted in an increase of recruitment of monocytes by M2 macrophages.

In Chapter 6, we discussed the important findings in each chapter of this thesis together with current literature, and gave a general perspective on this research line focussing on the immunomodulating activity of NDPs and the direction for future research. We suggested NDPs in terms of Naxus as candidate for guiding investigations in ex vivo and in vivo studies for immunomodulation of intestinal disease.

Groene initiatieven in de stad : handelingsperspectief provincies voor het stimuleren van maatschappelijke betrokkenheid bij groen in de stad
Dijkshoorn-Dekker, M.W.C. ; Soma, K. ; Blaeij, A.T. - \ 2017
Wageningen : Wageningen Economic Research (Wageningen Economic Research rapport 2017-012) - ISBN 9789463438032 - 47
participatie - groene gevels - groene daken - planten - gezondheid - luchtkwaliteit - communicatie - klimaat - regenwateropvang - participation - green walls - green roofs - plants - health - air quality - communication - climate - water harvesting
Metropolitan Solutions: Helende tuinen
Jansma, J.E. - \ 2017
WUR
tuinen - gezondheid - planten - herstellen - welzijn - participatie - gardens - health - plants - reconditioning - well-being - participation
Voldoende bewegen en gezond eten helpt bij het herstel van ziektes of verbetert de kwaliteit van leven bij chronische ziektes. Helaas lukt het lang niet iedereen om dit toe te passen. Daarom zijn Wageningen University & Research (Division of Human Nutrition, Wageningen Plant Research, Rural Sociology) en AMS institute binnen Flevo Campus het pilotproject Helende tuinen gestart om te onderzoeken of we mensen een manier kunnen bieden die wel makkelijk is om in te passen in je leven. We laten ze samen tuinieren. Jan Eelco Jansma, onderzoeker stad-landrelaties bij Wageningen University & Research, vertelt erover in deze video.
Greenery: more than beauty and health : A summary of the benefits of greenery on health, productivity, performance and well-being
Hiemstra, J.A. ; Vries, S. de; Spijker, J.H. - \ 2017
Wageningen : Wageningen University & Research - 6 p.
health - well-being - plants - trees - reconditioning - air quality - biodiversity - air conditioning - learning - labour - green roofs - green walls - gezondheid - welzijn - planten - bomen - herstellen - luchtkwaliteit - biodiversiteit - klimaatregeling - leren - arbeid (werk) - groene daken - groene gevels
Greenery in our living environment is beneficial for more than just our health and well-being. It facilitates water management and stimulates biodiversity in built-up areas, and it can also reduce the effects of noise pollution. Greenery also has a positive impact on the property value of homes and offices. This document provides general information on the benefits of greenery, supplementary to the detailed fact sheets on how greenery can improve health and well-being in Residential, Professional, Educational and Healthcare contexts.
Greenery and Education : A summary of the positive effects of greenery on well-being in educational environments
Hiemstra, J.A. ; Vries, S. de; Spijker, J.H. - \ 2017
Wageningen : Wageningen University & Research - 7 p.
learning - children - universities - climate - educational institutions - education - social welfare - well-being - health - pupils - students - schools - leren - kinderen - universiteiten - klimaat - onderwijsinstellingen - onderwijs - sociaal welzijn - welzijn - gezondheid - leerlingen - studenten - scholen
Greenery in and around schools, childcare centres and on campuses is good for the climate at education institutions, both inside and out. It has a positive effect on the health and general well-being of students and staff alike, improving student performance and their ability to concentrate, as well as fostering the social climate. This document provides information on the benefits of greenery in relation to education and well-being, including references to scientific literature. It concludes with some tips on how to ensure the successful and beneficial inclusion of greenery.
Green and Healthcare : A summary of the positive effects of greenery on well-being in recovery environments
Hiemstra, J.A. ; Vries, S. de; Spijker, J.H. - \ 2017
Wageningen : Wageningen University & Research - 6 p.
health - hospitals - patient care - patients - well-being - public green areas - botanical gardens - plantations - social welfare - health indicators - stress - rehabilitation - gezondheid - ziekenhuizen - patiëntenzorg - patiënten - welzijn - openbaar groen - botanische tuinen - beplantingen - sociaal welzijn - gezondheidsindicatoren - herstel
Greenery in and around nursing homes, hospitals and clinics is beneficial for the climate inside and outside the organisation, and has a positive effect on the patients’ state of mind and ability to recover, as well as the general well-being of patients, staff and visitors. This document provides information on the benefits of greenery in relation to recovery and well-being, including references to scientific literature. It concludes with some tips on how to ensure the successful and beneficial inclusion of greenery.
Greenery and Work : A summary of the positive effects of greenery on well-being in working environments
Hiemstra, J.A. ; Vries, S. de; Spijker, J.H. - \ 2017
Wageningen : Wageningen University & Research - 6 p.
offices - work - climate - health - well-being - stress - stress tolerance - labour - kantoren - werk - klimaat - gezondheid - welzijn - stresstolerantie - arbeid (werk)
Greenery in and around offices and other working environments is good for both the indoor and outdoor climate, and has a positive effect on the health and general well-being of employees and visitors. It aids concentration, helps reduce stress and increases staff productivity. This document provides information on the benefits of greenery in relation to work and well-being, including references to scientific literature. It concludes with some tips on how to ensure the successful and beneficial inclusion of greenery.
Are school meals a viable and sustainable tool to improve the healthiness and sustainability of children´s diet and food consumption? A cross-national comparative perspective
Oostindjer, Marije ; Aschemann-Witzel, Jessica ; Wang, Qing ; Skuland, Silje Elisabeth ; Egelandsdal, Bjørg ; Amdam, Gro V. ; Schjøll, Alexander ; Pachucki, Mark C. ; Rozin, Paul ; Stein, Jarrett ; Lengard Almli, Valerie ; Kleef, Ellen van - \ 2017
Critical Reviews in Food Science and Nutrition 57 (2017)18. - ISSN 1040-8398 - p. 3942 - 3958.
children - food behavior - health - learning - School meals - sustainability

There is little agreement among governments, institutions, scientists and food activists as to how to best tackle the challenging issues of health and sustainability in the food sector. This essay discusses the potential of school meals as a platform to promote healthy and sustainable food behavior. School meal programs are of particular interest for improving public diet because they reach children at a population scale across socio-economic classes and for over a decade of their lives, and because food habits of children are more malleable than those of adults. Current research on the history and health implications of school meal programs is reviewed in a cross-national comparative framework, and arguments explored that speak for the need of a new developmental phase of school meals as an integrative learning platform for healthy and sustainable food behavior. Nutritional, social, practical, educational, economical, political, and cultural perspectives and challenges linked to the implementation of healthy and sustainable school meals are discussed. Finally, the need for long-term interventions and evaluations is highlighted and new research directions are proposed.

Monitoringsonderzoek Gezonde Schoolpleinen : monitor van het proces Gezonde Schoolpleinen van 70 Icoonscholen, inspiratie voor een gezond schoolplein en landelijke bekendheid van het proces Gezonde Schoolpleinen
Goossen, Martin ; Pleijte, Marcel ; Langers, Fransje ; Donders, Josine ; Vries, Sjerp de - \ 2017
Wageningen : Wageningen Environmental Research (Wageningen Environmental Research rapport 2814) - 89
basisscholen - kinderen - gebiedsontwikkeling - campus - gezondheid van kinderen - architectuur - ontwerp - sociale gevolgen - cognitieve ontwikkeling - lichamelijke activiteit - gezondheid - elementary schools - children - area development - child health - architecture - design - social impact - cognitive development - physical activity - health
Quantifying the impact of socioeconomic development and climate change on Escherichia coli concentrations in the Pakistani Kabul River
Iqbal, Shahid - \ 2017
University. Promotor(en): Rik Leemans, co-promotor(en): Nynke Hofstra. - Wageningen : Wageningen University - ISBN 9789463434478 - 183
escherichia coli - rivers - climatic change - socioeconomics - water quality - regression analysis - water pollution - health - rivieren - klimaatverandering - sociale economie - waterkwaliteit - regressieanalyse - waterverontreiniging - gezondheid

Clean water is indispensable for the sustenance of life and maintenance of health. However, water quality is threatened by changes in socio-economic developments (population growth, urbanisation, livestock increase and sanitation) and climate (surface air temperature and precipitation patterns). Major water quality contaminants include microorganisms, such as fecal coliforms, Escherichia Coli (E.coli) and pathogens. Microbial contamination poses serious health risks in developing countries like Pakistan, where people do not have access to clean water due to lack of waste water treatment and thorough manure management. Therefore, to reduce the present and future health risk, it is important to understand the impacts of socio-economic development and climate-change on microbial fate and transport in surface water resources in the Kabul River Basin in Pakistan.

The objective of this study is quantifying the impact of socio-economic development and climate change on E.coli concentrations in the Pakistani Kabul River. To reach the objective, I sampled E.coli concentrations at several locations in Kabul River, applied statistical and process based modelling, developed future global change scenarios and analysed the impact of these scenarios on E.coli concentrations. I focus on E.coli rather than pathogens, because sampling of pathogens and its chemical analysis are expensive. Kabul River Basin is a tributary of the Indus river and is located in the Hindukush-Karakoram-Himalayas (HKH) and suffers from floods every year. The population suffers from a high risk of waterborne diseases. The water is contaminated by direct sewage inputs from large cities, like Peshawar, direct manure inputs from animal sheds along the river and indirect manure inputs from the land.

Kabul River Basin is subjected to hazardous levels of microbiological pollution. The concentration of micro-organisms is influenced by hydro-climatic variables, such as water and surface air temperature, precipitation and discharge. However, the net effect of these variables remains thus far unclear. High concentrations of E.coli were found in the main stream and its tributaries (Chapter 2). Samples were collected along the Kabul river and drinking water samples from the city of Nowshera (April 2013 to July 2015) and all surface water samples violate the bathing water criteria and all drinking water samples violate the drinking water criteria. The correlation between hydro-climatic variables and E.coli concentration was analysed. Water temperature and surface air temperature were positively correlated, most likely because high temperatures coincide with high precipitation and discharge. Precipitation and river discharge data were also positively correlated with E.coli concentrations. This shows that precipitation, which increases the surface runoff, transports E.coli and other waterborne pathogens to the river nearby (correlation with precipitation) and further upstream (correlation with discharge). A regression model was also applied that explained 61% of the E.coli variability in surface water and 55% of E.coli variability in drinking water resources, even when other factors, such as location and land-use variables are ignored (Chapter 2).

To better understand the hydrology in the basin, the current and future flows of Kabul river were modelled using the Soil and Water Assessment Tool (SWAT), which serves as a basis for the process-based E.coli model. Flash floods occur every year in the basin as a result of increased discharge due to snow and glacier melt together with monsoon precipitation. The Kabul River Basin is one of the most vulnerable regional basin to climate change. The hydrological model was calibrated and validated for the full Kabul River Basin and performed well (NSE equals 0.77 and 0.72 respectively). Flood frequency and expected return period were analysed for a contemporary period (1981-2000) and two future periods (i.e. 2031-2050 and 2081-2100) using the Representative Concentration Pathway (RCP) 4.5 and RCP8.5 scenarios based on four bias-corrected downscaled climate models (Chapter 3). The flood frequency analysis shows that the present day’s one-in-a-fifty year event could occur between once in every 3 year (EC-EARTH and MIROC climate-models) and once in every 24 years (IPSL climate-model). This study presents climate-change impact assessment in the Kabul River Basin. The selected approach is in general well accepted in the scientific community and the results can be useful in flood management in the region. Outcomes of this study can be helpful for regions that have similar hydro-climatological conditions.

To better understand the fate and transport of bacteria from land to water resources and to assess source contribution, the SWAT model was calibrated and validated for E.coli. Our study is the first bacterial modelling study for the Kabul River Basin (Chapter 4). The simulated concentrations have slightly lower variability than the observed concentrations. The model performance could be improved further by using more input E.coli data, but the current model results agree well enough with our measured E.coli concentrations (NSE equals 0.69 and 0.66 for calibration and validation respectively). Based on the pathogen source estimations, point (direct) sources are identified to be the most important microbial pollution sources. Pollution from upstream areas is also important, while non-point (diffuse) sources play a role mostly during the periods with high discharge. Our study underlines the importance of wastewater treatment and manure management both in and upstream of the study area. Studies like ours were lacking in developing countries like Pakistan and can be used for scenario analyses in the region (Chapter 4). The model can be useful in microbial water quality assessments in other watersheds and for pathogenic microorganisms, such as Cryptosporidium and Rotavirus.

The calibrated and validated SWAT bacterial model (Chapter 4) was used to assess E.coli concentrations in a comprehensive scenario analysis (Chapter 5). We developed two future scenarios based on state-of-the-art approaches, using the Shared Socio-economic Pathways (SSPs), RCPs and own assumptions in line with the SSP storylines. We took the modelled E.coli concentrations from Chapter 4 as baseline scenarios and defines two future scenarios as Scenario_1 (sustainability scenario) and Scenario_2 (uncontrolled scenario). These scenarios represent different socio-economic development and climate change. The two scenarios were developed by combining SSP1, a sustainable, equitable and environmentally focussed world with RCP4.5 (limed climate change) in Scenario_1, and SSP3 (a divided world, with no interest in the environment) with RCP8.5 (strong climate change) in Scenario_2. Currently, no wastewater treatment plant exists in the basin, because the 2010 floods destroyed the available plants. We assumed excellent and poor wastewater and manure treatment for 2050s and 2100s for Scenario_1 and Scenario_2 respectively, in line with the storylines. Scenario_2 resulted in higher E.coli concentrations compared to the baseline scenarios due to high population growth, poor wastewater and manure treatment and land-use changes. However, microbial water quality was found to improve under Scenario_1. This was achieved by implementing improved and technologically advanced wastewater treatment and manure management. Future concentrations were found to be between 0.6% and 7% of the baseline concentrations depending on the treatment technology used (Chapter 5). This study highlights the need for substantial improvements in wastewater and manure treatment systems in the Kabul River Basin to assure future E.coli concentrations in water sources will be within the limits of WHO and US-EPA regulations for drinking and bathing water quality. The primary treatment facility that is currently installed is a good start, but insufficient to strongly reduce concentrations. Hence major investments are required to install technologically advanced wastewater treatment and manure treatment plants to cut-down the current contamination level of Kabul river.

My PhD thesis provides a base for devising optimal coping strategies that are essential for the sustainability of hydrological resources under socio-economic developments and climate-change impacts. The results of our research are helpful to further assess alternative water quality management options. The outcomes of this study also increase the knowledge in the field of microbial fate and transport in water resources in a developing country like Pakistan, where such studies are lacking. A limited number of previous studies on global change impacts on microbial contamination of surface water in other areas of the world focused only on the climate-change impacts on microbial water quality. This is the first study to evaluate the influence of combined socio-economic and climate-change impacts on E.coli concentrations in the Kabul River Basin. The developed SWAT model and scenario analysis can be used for other contaminants, such as nutrients, pesticides and heavy metals. Our study can be a first step to improve water quality of the Kabul River Basin by providing tools for water managers and health specialists to improve the water quality and reduce the risks related to the use of contaminated water resources. This study will be useful not only in this region, but also for other regions of the world with similar microbial water contamination issues.

Dietary patterns for healthier cognitive ageing
Berendsen, Agnes A.M. - \ 2017
University. Promotor(en): Lisette de Groot; Edith Feskens, co-promotor(en): Ondine van de Rest. - Wageningen : Wageningen University - ISBN 9789463436014 - 190
meal patterns - feeding habits - aging - cognition - health - food supplements - dementia - nutritional intervention - elderly - elderly nutrition - nutrition and health - maaltijdpatronen - voedingsgewoonten - verouderen - kenvermogen - gezondheid - voedselsupplementen - dementie - maatregel op voedingsgebied - ouderen - ouderenvoeding - voeding en gezondheid

With ageing of our population and the accompanying increase in the number of people living with dementia, it is important to find modifiable risk factors to postpone the onset of cognitive decline. Diet has been proposed such a modifiable risk factor. To date, numerous studies have been conducted demonstrating a possible role of specific nutrients and foods in cognitive functioning. However, as people do not consume single nutrients, the research field has shifted towards studying dietary patterns in which synergistic effects of single nutrients and/or foods can be studied. The main aim of this thesis was to study the association of healthful dietary patterns with cognitive functioning. In addition, nutrient intake inadequacies were assessed and the potential to change dietary intake in older adults aged 65 years and older was studied.

Chapter 2 describes nutrient intake of 245 Dutch adults aged 65-80 years. We identified the contribution of nutrient dense foods, fortified foods and dietary supplements to the total intake of micronutrients. Nutrient density of foods was evaluated using the Nutrient Rich Food score 9.3. Nutrient intake inadequacies were observed for vitamin D, vitamin B6 and selenium. Conventional foods were the main source of vitamin D, vitamin B6 and selenium intake. Foods with the highest nutrient density contributed most to total vitamin B6 intake. In order to optimize nutrient intakes of elderly, combinations of natural food sources, fortified foods and dietary supplements should be considered.

Chapter 3 provides a systematic review of the literature on human studies up to May 2014 that examined the role of dietary patterns in relation to cognitive decline or dementia. The results demonstrate that better adherence to a Mediterranean diet was associated with less cognitive decline, dementia or Alzheimer’s Disease (AD) in four out of six cross-sectional studies, six out of 12 longitudinal studies, one trial and three meta-analyses. Other healthy dietary patterns, among which the Healthy Diet Indicator, have shown to be associated with reduced cognitive decline and/or a reduced risk of dementia in all six cross-sectional studies and six out of eight longitudinal studies. The conclusion of this literature review was that more conclusive evidence is needed to come to more targeted and detailed dietary guidelines to prevent or postpone cognitive decline.

In chapter 4 the association between the Healthy Diet Indicator (HDI) and cognitive functioning in older adults from three different cohort studies was investigated. The cohorts included in total 21,837 subjects from Europe (SENECA and the Rotterdam Study [RS]) and the Unites States (Nurses’ Health Study [NHS]). Cognitive functioning was measured using the Mini-Mental State Examination (MMSE) in SENECA and RS, and the Telephone Interview for Cognitive Status (TICS) in NHS. In all three cohorts, the HDI was not significantly associated with cognitive decline, nor with cognitive function.

In chapter 5 the association of long-term adherence to the Dietary Approaches to Stop Hypertension (DASH) diet with cognitive function and decline in older American women was examined. A total of 16,144 women from the Nurses’ Health Study, aged ≥70 years, who underwent cognitive testing a total of 4 times by telephone from 1995-2001 (baseline), with multiple dietary assessments between 1984 and the first cognitive exam were studied. Greater adherence to long-term DASH score was significantly associated with better average global cognition, verbal memory and TICS score at older ages, but not with cognitive decline.

In chapter 6, the same cohort as in chapter 5 was studied to examine the association between long-term adherence to a recently developed Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet with cognitive function and decline. Higher MIND diet scores were associated with better verbal memory at older ages, but not with cognitive decline over 6 years in global cognition, verbal memory or TICS.

Chapter 7 provides an overview of the NU-AGE (NUtrients and AGEing) dietary intervention study. The NU-AGE study is a randomized one-year intervention in 1,250 apparently healthy, independently living European subjects aged 65 to 80 years. Subjects were randomised into either the intervention group or the control group. Participants in the intervention group received dietary advice aimed at meeting the dietary recommendations of the ageing population. At the start of this thesis, the NU-AGE study was the first dietary intervention investigating the effect of a whole diet and providing targeted dietary recommendations for optimal health and quality of life in apparently healthy European elderly.

In chapter 8, we evaluated if the NU-AGE intervention could be effective to shift the dietary intake of apparently healthy older adults aged 65-80 years living in Italy, the UK, the Netherlands, Poland, and France towards a more healthful diet. The NU-AGE index was created to assess adherence to the NU-AGE diet. At baseline and after one-year follow-up dietary intake was assessed by means of 7-day food records. In total, 1,296 participants were randomized and 1,145 participants completed the intervention (571 in intervention group, 570 in control group). After one-year follow-up, the intervention group improved mean intake of 13 out of 16 dietary recommendations of the NU-AGE diet (p<0.05) with a significant increase of the total NU-AGE index, compared to the control group (mean change in NU-AGE index 21.3±15.9, p<0.01). The NU-AGE dietary intervention, based on dietary recommendations for older adults, may be a feasible strategy to improve dietary intake in an ageing European population.

Chapter 9 shows the results of the NU-AGE parallel randomized dietary intervention study on cognitive functioning in the Dutch NU-AGE subpopulation, including 252 older adults aged 65-80 years (123 intervention, 129 control). The primary outcome was one-year change in global cognition and in four cognitive domains as measured through a comprehensive neuropsychological test battery. Comparing the intervention with the control group, there was no effect of the intervention on cognitive functioning.

In chapter 10 the main findings of this thesis were summarized and a reflection on methodological aspects was given. When grading the reported associations in previous studies and studies in this thesis, it was concluded that there is probable evidence for a role of the Mediterranean diet on cognitive functioning. For the DASH and MIND diet there is a possible link with cognitive functioning; for the HDI and the NU-AGE diet there is no sufficient evidence yet to conclude that there is a relation with cognitive functioning. Not only is there a need for well-designed intervention and prospective studies, we also call for communication strategies to the general public about the consumption of healthier diets to not only impact cardiovascular but also potentially impact brain health as many individuals will face progressive cognitive decline in the near future.

The GroupHouseNet COST Action: exploiting European synergy to reduce feather pecking in laying hens
Rodenburg, T.B. ; Berk, J. ; Dimitrov, I. ; Edgar, J. ; Eijk, J.A.J. van der; Estevez, I. ; Ferrante, V. ; Haas, E.N. de; Kostal, L. ; Liaubet, L. ; Michel, V. ; Nordgreen, J. ; Ozkan, S. ; Pietta, D. ; Pichova, K. ; Riber, Anja B. ; Sossidou, E. ; Toscano, M.J. ; Valros, A. ; Zupan, M. ; Janczak, A.M. - \ 2017
In: Xth European Symposium on Poultry Welfare, 19-22 June 2017, Ploufragan - France. - World's Poultry Science Association (WPSA) - p. 41 - 46.
broiler breeders - nesting behaviour - genetics - nest design - housing - climate - feather pecking - prenatal effects - health - damaging behaviour - sensor technology
Broilers have been selected for growth related characteristics, which are negatively correlated to reproductive traits. This genetic background creates challenges in broiler breeders, as the hens do not make optimal use of the nests provided. This project aims to investigate what factors determine nesting behaviour, i.e. where a broiler breeder hen prefers to lay her eggs. Factors such as genetic background, social interactions, physical characteristics of the nest and climate might interfere with the natural nesting behaviour of the hen. Also fundamental trade-offs between different motivations, such as hunger, comfort and safety, might influence nesting behaviour. Behaviour and use of space will be measured in experimental set-ups in order to gain insight in the importance of different system components. This knowledge will be used to optimise housing conditions and develop strategies that stimulate the hen to lay her egg in the nest. The performance of this improved system will be tested in field experiments to investigate the transferability of results from experimental to field conditions.
The GroupHouseNet COST Action: exploiting European synergy to reduce feather pecking in laying hens
Rodenburg, Bas - \ 2017
feather pecking - genetics - prenatal effects - health - damaging behaviour - sensor technology
Factsheet Groene re-integratiepraktijken voor mensen met psychische problemen
Hassink, J. ; Vaandrager, L. ; Jansen, Joke - \ 2017
Wageningen University & Research - 7 p.
burgers - participatie - sociaal welzijn - gezondheid - herstellen - beplantingen - natuur - beweging - citizens - participation - social welfare - health - reconditioning - plantations - nature - movement
Gemeenten zijn per 1 januari 2015 verantwoordelijk voor uitvoering van de Jeugdwet, Wmo en de Participatiewet. De invoering van de Participatiewet leidt tot de toestroom van een nieuwe doelgroep waaronder veel mensen met psychische problemen die behoefte hebben aan langdurige ondersteuning.
De decentralisaties vormen een grote uitdaging voor gemeenten. Niet alleen komen er nieuwe taken op gemeenten af, maar er wordt ook flink bezuinigd. Gemeenten moeten dus meer doen met minder geld. Maar er zijn ook kansen.
Voor het eerst krijgt één partij, de gemeente, zeggenschap over praktisch het hele sociale domein. De decentralisaties maken dwarsverbanden tussen de Wmo/Awbz, de jeugdzorg en het domein van werk en inkomen mogelijk. Werkplekken waar mensen vanuit de participatiewet, WMO en jeugdzorg terecht kunnen hebben daarom de aandacht van gemeenten.
Deze factsheet gaat over de mogelijkheden die het groen biedt voor re-integratie van mensen met psychische problemen. Interessante voorbeelden van re-integratie initiatieven zijn stadslandbouwbedrijven, landschapsonderhoud,
zorgboerderijen, groenonderhoud en groene wijkinitiatieven.
De factsheet is gebaseerd op literatuuronderzoek, interviews en groepsgesprekken met initiatiefnemers, mensen met psychische problemen die werken in het groen (deelnemers) en betrokken beleidsmedewerkers van verschillende groene re-integratie initiatieven. In deze factsheet komen de volgende thema’s aan bod:
• Welke vormen van groene re-integratie bestaan er in Nederland?
• Wat is de mogelijke theoretische onderbouwing en wat zijn de werkzame elementen van groene re-integratie?
• Wat zijn de randvoorwaarden van groene re-integratie? En wat is er nodig om deze vorm van re-integratie verder in
te bedden en op te schalen?
Gezondheidseffecten onder de loep : weldadig groen
Spijker, J.H. ; Vries, S. de - \ 2017
Stadswerk (2017)6. - ISSN 0927-7641 - p. 34 - 36.
gezondheid - warmtestress - temperatuur - kwaliteit - beplantingen - biodiversiteit - stedelijke gebieden - bevolking - stressfactoren - sociaal welzijn - klimaat - health - heat stress - temperature - quality - plantations - biodiversity - urban areas - human population - stress factors - social welfare - climate
Groen speelt een sleutelrol bij een gezonde leefomgeving. De gezondheidseffecten spelen op diverse manieren, maar vooral door de stressverlagende effecten van groen en de hittedempende werking op warme dagen. Het is daarbij wel belangrijk om niet alleen naar de kwantiteit maar ook naar de kwaliteit van het groen te kijken.
Greenery and residential : a summary of the positive effects of greenery on well-being in residential
Hiemstra, J.A. ; Vries, S. de; Spijker, J.H. - \ 2017
Wageningen University & Research - 7 p.
residential areas - housing - plantations - public green areas - gardens - domestic gardens - health indicators - green roofs - green walls - temperature - climate - heat stress - health - woonwijken - huisvesting - beplantingen - openbaar groen - tuinen - tuinen bij het huis - gezondheidsindicatoren - groene daken - groene gevels - temperatuur - klimaat - warmtestress - gezondheid
Greenery and residential : a summary of the positive effects of greenery on well-being in residential
Spațiile verzi și Locuința : Pe scurt, valoarea adaugată a spațiilor verzi pentru bunăstarea la locul de muncă
Hiemstra, J.A. ; Vries, S. de; Spijker, J.H. - \ 2017
Wageningen University & Research - 7 p.
residential areas - green roofs - green walls - plantations - health - heat stress - climate - woonwijken - groene daken - groene gevels - beplantingen - gezondheid - warmtestress - klimaat
Amenajările verzi din locuințe și din exteriorul acestora sunt benefice atât climatului interior, cât și exterior al locuințelor, având un efect pozitiv asupra sănătății și a bunăstării generale a locatarilor și a vizitatorilor, mărind valoarea imobilului. Acest document oferă o mai bună înțelegere a avantajelor spațiilor verzi asociate cu locuința și bunăstarea locatarilor, inclusiv trimiteri către documentări științifice. La finalul documentului, regăsiți sfaturi privind amenajarea cu succes a spațiilor verzi.
Spațiile verzi și Munca : Pe scurt, valoarea adaugată a spațiilor verzi pentru bunăstarea la locul de muncă
Hiemstra, J.A. ; Vries, S. de; Spijker, J.H. - \ 2017
Wageningen University & Research - 7 p.
work - work stress - offices - well-being - plantations - gardens - climate - health - air quality - labour - werk - werk stress - kantoren - welzijn - beplantingen - tuinen - klimaat - gezondheid - luchtkwaliteit - arbeid (werk)
Amenajările verzi din clădirile de birouri și din exteriorul acestora sunt benefice atât pentru climatul interior, cât și exterior al clădirilor de birouri, având un efect pozitiv asupra sănătății și bunăstării generale a angajaților și a vizitatorilor. Contribuie la îmbunătățirea capacității de concentrare, la reducerea stresului și la o mai mare productivitate din partea angajaților. Acest document oferă o mai bună înțelegere a avantajelor spațiilor verzi în relația cu munca și bunăstarea, inclusiv trimiteri către documentări științifice. La finalul documentului, regăsiți sfaturi privind amenajarea cu succes a spațiilor verzi.
Networked health sector governance and state-building legitimacy in conflict-affected fragile states : the variable impact of non-state provision of public health services in eastern Democratic Republic of Congo
Aembe, Bwimana - \ 2017
University. Promotor(en): Thea Hilhorst, co-promotor(en): D. Dijkzeul; Murhega Mashanda Job. - Wageningen : Wageningen University - ISBN 9789463431606 - 231
governance - health - congo democratic republic - central government - local area networks - non-governmental organizations - conflict - gezondheid - democratische republiek kongo - rijksoverheid - lokale netwerken - niet-gouvernementele organisaties

State fragility in the Democratic Republic of Congo (DRC) has impacted the state’s ability to provide public services, as well as and the population’s experiences and perceptions of the state. For public health and for social welfare more broadly, the contributions of the state are weak and contingent on the involvement of non-state service providers (NSPs). The population has become dependent on non-state actors for the provision of basic social services, and NSPs are especially important in public health, where their engagement accounts for the survival of the sector. The state and NSPs interact through networked governance, where relevant actors are involved in a network through resource interdependency, cooperation, collaboration and even competition to achieve social goals (Klijn, 2004). Networked governance processes in the DRC public health sector take place at three structural levels: national, provincial and operational. Networked governance serves as an institutionalised public model for health sector management through these three levels.

A great deal of previous work has studied the link between legitimacy and state service delivery, but there has been little investigation of the link between basic service provision by NSPs and state legitimacy in fragile states. This study explored how the networked governance of the health sector contributes to state-building processes and to state legitimacy in the DRC, also examining how the image of the state is shaped by NSP service provision. The study focused on state-building outcomes related to effective public health governance, the strengthening of system management and health service provision through state–non-state interactions. The study also explored state legitimacy and the population’s experiences and perceptions of the state, in a context where the delivery of public health services is mediated by non-state actors.

The research was guided by the following key question:

How does the networked governance of health services, involving state and non-state actors through multi-stakeholder interactions, affect state-building and legitimacy in the fragile setting of eastern Democratic Republic of Congo?

Networked Governance in the Management of the DRC’s Health Sector

Non-state stakeholders have been actively involved in the delivery of basic public services throughout the history of the DRC (Pearson, 2011; Seay, 2013; Waldman, 2006). Some scholars have argued that strong inputs from NSPs, supported by international funding, gives the DRC’s health sector its ‘current resilient’ outlook (Pearson, 2011: 12; Seay, 2013). Although these inputs have not been homogeneous across provinces or health zones (HZs) within provinces (Pavignani, Michael, Murru, Beesley & Hill, 2013; Pearson, 2011), their aggregate contribution accounts for the persistence of the sector in terms of policy making and enforcement, health system management and service delivery.

NSPs can be categorised as national or international, and as traditional or situational partners. Faith-based organisations (FBOs) are classified as national and as traditional partners of the state. International actors recognised as traditional health policy partners mostly include bilateral and multilateral institutions that have long supported state-building in the DRC. In contrast, most international NGOs are situational partners whose emergence was spurred by state fragility and the humanitarian consequences of wars. In collaboration with the Ministry of Health (MoH), traditional international partners contribute to the process of national policy making and system strengthening. Situational partners are mostly engaged in unintegrated projects and humanitarian interventions focusing on circumstantial situations of social vulnerability. Through their frequent use of different policies and stand-alone projects, these organisations have involuntarily contributed to a decentralised and rather fragmented system. Traditional partners such as FBOs and international donor organisations play a crucial role in the networked governance of the health sector and in public health care delivery.

Networked Governance and State Legitimacy in the DRC’s Fragile Health Sector

The DRC has a long history of state fragility and deficiencies in performing the functions of modern states. NSPs operate like surrogate state service providers, and both the state and NSPs are engaged in the process of health care provision through networked governance.

In this study’s examination of state legitimacy, ‘a state is more legitimate the more it is treated by its citizens as rightfully holding and exercising political power’ (Gilley, 2006). A lack of legitimacy is a major contributor to state fragility, because it undermines state authority (Unsworth, 2010). In most cases, declines in service delivery have been found to reduce the population’s support of the state and its leadership (OECD/DAC, 2008). However, little is known about how this works in fragile settings characterised by institutional multiplicity, so how NSP interventions contribute to state legitimacy was treated as an open question in this study.

Actor-oriented Interactions in the Networked Governance of the DRC’s Health Sector

Networked governance arrangements in the DRC’s health sector have the characteristics of a social arena, which is ‘typical of actor-oriented interactions’ (Hilhorst & Jansen, 2010). As symbolic locations, arenas are neither geographical entities nor organisational systems; rather, they describe the political actions of all of the social actors involved in a specific issue (Kitschelt 1980 in Renn, 1993).

The Multilevel Nature of Health Sector Networked Governance Arenas

Health sector governance in the DRC has a pyramidal organisation involving the central (national), intermediate (provincial) and operational (HZ) levels (Bukonda, Chand, Disashi, Lumbala & Mbiye, 2012).

The central level consists of the national MoH, which is expected to play a strategic role, engaging in policy formulation, elaboration of the mechanisms for public policy implementation, sector funding and high-level interactions with non-state stakeholders (i.e. signing framework agreements or specific agreements). The MoH is responsible for general sector policy and system regulation, national programmes and tertiary hospitals (Waldman, 2006). Although policy making is an exclusive function of the MoH (Zinnen, 2012), donors and other development partners inform and support the process through technical and financial assistance.

The intermediate level concerns the management of the provincial health system and the oversight of the operational (HZ) level. The intermediate level organises and provides technical support to the HZ (World Bank, 2005). At this level, state and non-state actors interact to improve the structural system governance and to manage the provision of health services. Through the Comité Provincial de Pilotage Santé, stakeholders work towards harmonising interventions and establishing the model of engagement at the provincial level. Using HZ evidence-based reports, the Comité Provincial de Pilotage Santé defines provincial-level stakeholder priorities in line with the national health policy.

The HZ is the operational unit that integrates primary health care services and the first-referral level. An HZ covers an average population of 110,000 and consists of a central HZ office, an array of health posts and centres, and a general referral hospital (Carlson, Maw & Mafuta, 2009). Because of the lack of government financing over the last decades, HZs and their constituent facilities have operated with considerable autonomy, although MoH structures have retained administrative control, particularly over human resources (Carlson et al., 2009). Many facilities have become in effect privatised, relying on patient fees to pay staff and operating costs. At the HZ level, networked governance of the local health system takes place through the Bureau Central de Zone de Santé (HZ Management Board). In this arena, interactions take place among representatives of the state, non-state actors (where possible) and community-based organisations—especially the community health development committees (Comité de Développement Sanitaires).

Research Methods

This research is part of the Secure Livelihoods Research Consortium, which focuses on state legitimacy, capacity for state-building and livelihood trajectories in conflict-affected situations (Levine, 2014). This study fell under the first two of these themes, with a focus on the population’s experiences, perceptions and expectations regarding state legitimacy and on building effective states that deliver services and social protection. This study began in 2012, with the empirical research starting in August 2013. The fieldwork lasted 19 months, ending in April 2015.

Most of the research was conducted in the province of South Kivu, with complementary data collection in Kinshasa. A case study design was used, with two multi-stakeholder governance arrangements serving as the cases. The first case was performance-based financing (PBF), which is the transfer of money or material goods from a funder to a contracting recipient, on the condition that the recipient will take a measurable action or achieve a predetermined performance goal. The second case was a community-based health insurance (CBHI) programme—Mutuelle de Santé (MUS). The case study of PBF focused on health system governance because of PBF’s pivotal role in the process of building the health system. The CBHI case study explored MUS outcomes related to equity in access to health services, protection from financial risk and the financing of health services. The CBHI case study was based primarily on observations in a rural area (Katana) and a semi-urban area (Uvira).

Focusing on the multilevel networked governance of the DRC’s health sector, this study drew on institutional ethnography, which examines work processes and studies how they are coordinated, typically through examining various texts and discourses (Smith, 2009). Attention was given to discourses, relationship patterns, writings and multi-stakeholder governance arrangements throughout study period.

Six types of participants were interviewed: public health officials and state actors from MoH offices at national and provincial levels (approximately 30 participants); representatives of donor organisations, international NGOs and national NGOs (16 organisations: three donor organisations, six international organisations and seven national NGOs); health service providers throughout the province (20 medical doctors); individuals involved in the management of CBHI/MUS at multiple levels, especially in Katana and Uvira (approximately 68 participants); CBOs (35 people from Comité de Développement de l’Aire de Santé, CODESA); and community members (beneficiaries, clients and citizens), especially in Katana, Bukavu, Uvira and Idjwi (approximately 1,000 participants). For the last category of respondents, community opinions on health services, the state and NSPs were assessed through interviewees’ personal storytelling, semi-structured interviews and focus groups. To assess the baseline situation in the health sector, a content analysis of the four main official policy papers was also conducted.

Main Research Findings

The findings of this research revolved around three main study concerns: 1) the institutional outlook, functioning and state-building outcomes of networked health governance and international intervention models; 2) the review of the two schemes fostering networked governance through multi-stakeholder governance engagement; and 3) the exploration of the impact of NSP interventions on the population’s perceptions and the legitimacy of the state.

Institutional Functioning and State-building Outcomes of Networked Health Governance and International Intervention Models

Networked health sector governance and state-building outcomes (chapter 2). Longstanding patterns of interaction exist between state and non-state actors seeking to improve public health in the DRC. In many cases, private actors have stepped in to fill the void created by the lack of state health care provision. The findings demonstrate that state–non-state interactions in the DRC’s health sector create a burgeoning form of multilevel networked governance and that these interactions play a role in explaining the persistence of the health sector despite the weakness of the state. It is difficult to assess the real influence of these interactions on state-building in a context of critical fragility, where coordination and alignment are problematic. The findings also indicate that several factors—specifically, the fragmented nature of interventions conducted by the majority of international NGOs, imbalanced power relations during negotiations with development partners and weaknesses in governance—impede the construction of a coherent, resilient and sustainable health system in the DRC. Generally, the findings indicate that networked governance through interactions between the state and non-state providers may contribute to state-building.

State fragility discourse and the challenge of policy coalition-building for interventions programming and stakeholder engagement models (Chapter 3)

State fragility is a discourse without a policy coalition in the DRC’s health sector governance network. The government and donors/international NGOs have not yet harmonised their perceptions of fragility. These key stakeholders have also not reached a common understanding on intervention policy, and there is a clash between opposing institutional logics in the processes of policy making and intervention programming. The contentious nature of the concept of fragile statehood has hampered the construction of a policy coalition for health sector interventions. Donors rationalise the persistence of emergency-based interventions by emphasising fragile statehood, whereas state officials assert political statehood and argue for a paradigm shift towards a higher degree of state control. The lack of consensus around state fragility has influenced perceptions of the state and international NGOs/donors in their engagement with health interventions programming in the DRC. Government officials in the DRC see fragile statehood as a stigmatising concept that contributes to difficulties with getting international NGOs to comply with the Paris Declaration on Aid Effectiveness. However, representatives of the state and donor organisations agree that, because public health sector funding is lacking, donors’ financial contributions ensure the sector’s survival.

Multi-stakeholder Health System Arrangements: Strengthening Networked Health Governance and Community Health Coverage

International organisations and donors have supported schemes, such as PBF and CBHI/MUS, which have impacted the networked governance and system-building in the local health sector, as well as improving health care delivery.

PBF and strengthening public health governance (Chapter 4)

This study examined the effectiveness of PBF in three areas of health system governance: structural governance from a capacity-building perspective, health service provision management and demand-side empowerment for effective accountability. In general, the study found that PBF positively impacted the process of health system-building in these three areas. Although much is still lacking, health governance and the provision of services have improved, and patient-centred care and social accountability have strengthened the provider–patient relationship. The research found positive outcomes for incentive-based contracting and output-based financing. However, donors, state officials and other stakeholders doubt the sustainability of these approaches, and PBF faces obstacles associated with state fragility. In addition to structural threats and uncertain sustainability, transforming transactional motivation into transformational change is a challenge. Ultimately, the research found out that PBF supports health sector-based state-building, but it cannot repair a collapsed state.

CBHI and community health coverage (Chapter 5)

The MUS CBHI scheme began operating just after the wars in South Kivu. The research findings indicate that MUS schemes lead to improvements in access and social protection only for a portion of the population. Similar findings for outcomes related to resource mobilisation and the financial sustainability of the health sector point to continued management challenges facing MUS schemes. These challenges are compounded by state fragility. To contribute effectively to universal health coverage, the state should reinforce its stewardship presence in strengthening MUS.

NSPs and Local Perceptions of the State (Chapter 6)

Service provision—especially health care delivery—serves as a public sphere and an arena for interactions and multi-stakeholder processes. The findings indicated that the population’s perceptions of the state reflect a breach of social contract, because the state has failed to live up to the population’s needs and expectations. The presence of NSPs may have negative effects on the population’s perceptions of the state, because NSPs’ performance establishes their benevolent image while solidifying a negative image of the state. However, the state-building legitimacy outcomes of NSPs’ engagement in this context are contingent on how the services are delivered: When NSPs engage with the state on the ground, people also see the state in action. People then assign credit not only to the NSPs, but also to the state, which is important for state-building and legitimacy. There is no direct correlation between service provision by NSPs and the positive image of the state; what positively impacts the image of the state is its visibility on the ground.

Overall, this study explored state-building outcomes resulting from networked health sector governance in a war-affected context with an empirically weak state. In this context, the public health provision inputs of NSPs are crucial for the population’s welfare. The findings indicate that NSP engagement contributes strongly to public health provision and the management of the health system. However, state fragility has a negative impact on networked health governance and donor-supported interventions. Bids to respond to population vulnerability and humanitarian needs should include state-building engagement, as state fragility hampers the success and undermines the sustainability of any rational intervention carried out by non-state actors.

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