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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    S(up)port your future! : A salutogenic perspective on youth development through sport
    Super, Sabina - \ 2017
    Wageningen University. Promotor(en): M.A. Koelen, co-promotor(en): K.T. Verkooijen. - Wageningen : Wageningen University - ISBN 9789463436489 - 284
    sport - youth - quality of life - disadvantaged youth - health promotion - community health - coaching - child development - sport - jeugd - kwaliteit van het leven - minder bevoorrechte jongeren - gezondheidsbevordering - gezondheid op regionaal niveau - coachen - kinderontwikkeling

    Background

    Sport is often recognised as an avenue for the positive development of young people. In line with this, policymakers and health professionals in the Netherlands, and elsewhere in the world, encourage socially vulnerable youth to participate in sport. Socially vulnerable youth are characterised as having an accumulated amount of negative experiences with the societal institutions in their lives, leading to distorted relationships with those institutions and, eventually, to feelings of isolation and low self-esteem. As socially vulnerable youth participate less in sport than their non-vulnerable peers, encouraging them to participate may support these youths in leading a healthy and productive life. However, to date, our understanding of the role of sport in positive youth development has been primarily based on research conducted in non-vulnerable populations and very little research has been conducted among socially vulnerable youth. The research that has been conducted for this thesis has been inspired by the salutogenic model of health, allowing us to examine the underlying mechanisms and processes of sports participation in alleviating social vulnerability.

    Aim

    The overall aim of this thesis is to unravel the value of sports participation for socially vulnerable youth. Four research objectives were formulated:

    To provide insights into the mechanisms underlying people’s capacity to cope with stressors (sense of coherence) to underpin health promotion activities that aim to strengthen this coping capacity.

    To provide insights into the relation between sports participation and youth development for socially vulnerable youth;

    To examine if and how community sports coaches can create optimal conditions for the personal development of socially vulnerable youth;

    To explore how socially vulnerable youth experience their participation in sport and the value they derive from sports participation in a socially vulnerable childhood.

    Methods

    This study has adopted a mixed-methods research design. More specifically, this study has used literature review (objective 1 and 2), questionnaire research (objective 2), semi-structured interviews (objective 3), and narrative interviews and life-course interviews (objective 4).

    Results

    The findings provide insights into the mechanisms underlying sense of coherence which reflects people’s capacity to deal with stressors in a health promoting way ( i.e., research objective 1). Sense of coherence consists of three components: the extent to which people experience the world as consistent and structured (comprehensibility); the extent to which people feel that there are resources available to meet the demands of everyday life (manageability); and the extent to which people feel that dealing with the stressors of everyday life is worthy of investment and engagement (meaningfulness). Based on a literature review of the salutogenic model of health, two opportunities for strengthening this sense of coherence in health promotion activities were identified: the behavioural mechanism and the perceptual mechanism. Both empowerment and reflection processes are important for the development of sense of coherence and can strengthen the healthy development of individuals.

    The findings provide insights into the relation between sports participation and youth development for socially vulnerable youth (i.e., research objective 2). In the systematic review, it was demonstrated that relatively few studies have been conducted regarding the life skill development of socially vulnerable youth in sports programs and that the evidence that is available is inconclusive regarding the benefits of sports. In the quantitative study, a positive relation was found between sports participation and several youth developmental outcomes (i.e., pro-social behaviour, subjective health, well-being, school performance and sense of coherence) but not with problem behaviour and the self-regulation skills. However, no conclusions can be drawn about a causal relationship between sports participation and youth development based on these data.

    The findings also demonstrated the crucial role of the sports coach in reaching optimal social conditions for life skill development and transferability (i.e., research objective 3). The community sports coaches mainly adopted an implicit approach to life skill transferability, meaning that they did not employ explicit strategies to stimulate the transfer of life skills from the sports setting to other societal domains. Nonetheless, the sports coaches believed that socially vulnerable youth could develop life skills in the sports setting that could also be used in school, the family or in the community. Coaching actions were directed at creating meaningful, comprehensible, and manageable sports experiences for socially vulnerable youth.

    Finally, the findings shed a light on how socially vulnerable youth experience their participation in sport and the role that sports participation could play in a socially vulnerable childhood (i.e., research objective 4). The youths’ positive and negative sports experiences rested on an intricate balance of the extent to which they experienced visibility of their skills, the extent to which they felt confident while playing their sport, and the extent to which they felt sport was a nice challenge that they liked to take on. The roles that sports participation could play in a socially vulnerable childhood are diverse: sport as a safe place, sport as a learning experience, sport as an instrument to reach goals, and sport as a purpose in life. As the challenges that socially vulnerable youth face in the sports setting can resemble some of the struggles they find in everyday life, their negative sports experiences could also potentially increase feelings of vulnerability.

    Conclusion

    Sports participation can support socially vulnerable youth in their personal development, but we also have to remain critical towards to use of sport as a means to reach positive youth development. The results from this thesis provide a deeper understanding of the conditions under which sport can contribute to positive youth development and offers recommendations for professionals in the field.

    The Care Sport Connector in the Netherlands
    Leenaars, Karlijn - \ 2017
    Wageningen University. Promotor(en): M.A. Koelen, co-promotor(en): M.A.E. Wagemakers; G.R.M. Molleman. - Wageningen : Wageningen University - ISBN 9789463436106 - 261
    sport - sport policy - health care workers - physical activity - public health services - health promotion - primary health care - netherlands - case studies - physical education - sport - sportbeleid - gezondheidswerkers - lichamelijke activiteit - voorzieningen ten behoeve van de volksgezondheid - gezondheidsbevordering - eerstelijnsgezondheidszorg - nederland - gevalsanalyse - lichamelijke opvoeding

    Introduction
    To stimulate physical activity (PA) and guide primary care patients towards local PA facilities, Care Sport Connectors (CSC) (in Dutch Buurtsportcoach), to whom a broker role has been ascribed, were introduced in 2012. This function is new, and to our knowledge no study has yet explored a broker role and its impact on improving intersectoral collaboration between both sectors. The aim of this thesis was to explore CSCs’ role and impact in connecting the primary care and the PA sector.
    Method
    This thesis employed a multiple case study design in which 15 CSCs from nine municipalities spread over the Netherlands were followed in their work from 2014 to the end of 2016. Different data collection methods were used (literature review, interviews, focus groups, document analysis, and questionnaires), and perspectives of different stakeholders (policymakers, professionals, CSCs) on different levels (policy and community) were taken into account (Chapter 2).

    Results
    The connection between the primary care and the PA sector: a chain approach
    The connection between both sectors can be characterised as a chain in which CSCs guide the target group towards PA facilities after referral by primary care professionals or their own recruitment. In this connection CSCs fulfilled three roles - broker, referral, and organiser – which did not change over time (Chapter 4 and 5).

    Barriers at system and sector level hinder the established connection

    Barriers related to the primary care (lack of time, money and knowledge) and the PA sector (lack of suitable PA activities and adequate instructors) are currently hindering the connection between both sectors (Chapter 4 and 6). Barriers related to the collaboration between both sectors, like cultural differences and different interests as identified in our literature review (Chapter 3) were not identified.

    The importance of an integral approach for CSCs and the connection between both sectors
    An integral approach to structural embed CSCs (Chapter 7) seemed to influence CSCs’ work and subsequently their impact. CSCs working in municipalities who structurally embedded CSCs only at the PA sector, connected both sectors mostly by jointly organising activities. CSCs working in municipalities who adopted an integral approach connected both sectors by a variety of activities targeting different audiences, and primary care professionals fulfilled mostly a role in the referral of their patients. The structural imbedding of the CSC according an integral approach seems the most promising in reaching the desired outcomes (Chapter 8).

    Conclusion
    CSC’ role is promising for establishing a connection between the primary care and the PA sector. However, to make a success of the connection changes are needed at system and sector level. Further research should focus on CSCs’ impact on stimulating PA among primary care patients, and the development of CSC’ role and the connection between both sectors over time.

    Endocannabinoids derived from n-3 PUFAs - Formation, release and possible roles in inflammation and obesity
    Wang, Ya - \ 2017
    Wageningen University. Promotor(en): R.F. Witkamp, co-promotor(en): J. Meijerink; J.-P. Vincken. - Wageningen : Wageningen University - ISBN 9789463432016 - 195
    polyunsaturated fats - health promotion - obesity - inflammation - cannabinoids - neurology - energy restricted diets - meervoudig onverzadigde vetten - gezondheidsbevordering - obesitas - ontsteking - cannabinoïden - neurologie - energiearme diëten

    The fatty acid composition of our daily diet is considered a major determinant of long-term health risk and the development of disease. Several lines of evidence point toward a state of chronic ‘low-grade’ inflammation as an overarching process that is modulated by fatty acids and their different metabolites. Diets rich in omega-3 polyunsaturated fatty acids (PUFAs), among which docosahexaenoic acid (22:6n-3; DHA) have been found to be associated with a reduction of inflammatory activity. However, the mechanisms underlying these immune-modulatory effects of n-3 PUFAs are only partly known. Earlier data from our group and from other labs have provided evidence for an as yet largely unexplored mechanism involving the formation of DHA-derived fatty acid amides. Fatty acid amides (FAAs) are a group of lipids formed from fatty acids and biogenic amines, which are widely occurring in nature. An increasing number of FAAs, including conjugates of fatty acids with neurotransmitters and mono-amines, have been detected as endogenous molecules in different cells and tissues. However, their bioactivities have remained largely unknown so far.

    In the first experimental part (chapter 2 and 3) of this thesis, we explored the immune-modulatory profiles of two relatively unknown DHA-derived FAAs conjugates with dopamine and serotonin, respectively. In chapter 2, we enzymatically synthesised the dopamine conjugate of DHA, N-docosahexaenoyl dopamine (DHDA), and demonstrated that DHDA significantly suppressed the production of several mediators involved in (neuro-)inflammation. We showed that these immune-modulatory effects involved the enzyme cyclooxygenase-2 (COX-2), as its gene-expression and (or) production of its metabolite PGE2 were down-regulated by DHDA in both activated macrophages as well as microglia. Additionally, the immune-modulatory activities of DHDA were compared with those of N-arachidonoyl dopamine (NADA) and similar potencies were found in the cell types tested. In chapter 3, we investigated the effects of docosahexaenoyl serotonin (DHA-5-HT), the serotonin conjugate of DHA on inflammatory processes in human PBMCs. By comparing the immune-modulatory potencies of 6 serotonin-conjugates with palmitic acid (PA-5-HT), stearic acid (SA-5-HT), oleic acid (OA-5-HT), arachidonic acid (AA-5-HT), eicosapentaenoic acid (EPA-5-HT) and docosahexaenoic acid (DHA-5-HT), DHA-5-HT turned out to exert the strongest inhibitory effects on the production of IL-17 from ConA-stimulated human PBMCs. Furthermore, DHA-5-HT concentration-dependently inhibited the production of IL-17 and CCL-20, two important Th17 mediators involved in the pathogenesis of IBD. Also, we demonstrated the in vivo presence of N-acyl serotonins in human intestine. Taken together, we revealed the immune-modulatory effects of two n-3 PUFA-derived fatty acid amides with thus far largely unknown functions and showed that these compounds were far more potent than its parent compound DHA. These findings were shown not only for innate inflammatory processes in stimulated mouse macrophages, but were also found to be present in human PBMCs and likely involved the adaptive CD4+ Th17 response.

    In order to study the effects of dietary omega-3 fatty acids on endocannabinoid tone in relation to obesity and metabolic health, a parallel-designed, randomized human study was conducted in the second part of the thesis. In this 12 weeks intervention hundred men and women with abdominal obesity were assigned to either a Western type energy restricted (ER) diet, a Targeted ER diet or a control group. The two ER diet groups were both subjected to energy restriction but their diets differed in nutrient composition. The traditional, more Western-style diet (Western ER diet) included both saturated as well as unsaturated fats, whereas the Targeted ER diet was amongst others enriched with monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs). This intervention resulted in significant weight loss and significant improvements of metabolic parameters in both energy restriction (ER) dietary intervention groups. In chapter 4, we revealed that the two weight loss regimes (ER-diets) with different fatty acid composition did not significantly affect fasting peripheral levels of AEA and 2-AG in both plasma and abdominal adipose tissues. By contrast, plasma DHEA was found to be significantly decreased in the Western ER group compared with the Targeted ER group. Additionally, circulating EC-related compounds DHEA, DHAGly, PEA and SEA were significantly decreased in the Western ER diet group after intervention. Furthermore, decreased levels of DHEA were positively associated with body weight reduction. In chapter 5, by performing a high calorie mixed meal test (MMT) before and after the intervention, we found that postprandial AEA and 2-AG levels were significantly reduced in the targeted ER group upon the intervention. By contrast, the DHA-derived compounds DHEA and DHAGly showed a significant increase in the Targeted ER group after 12 weeks of intervention. Additionally, all measured endocannabinoids and related compounds, with the exception of 2-AG, showed a similar characteristic time curve in response to the MMT, with EC levels reaching their highest concentration as early as 5 minutes after food intake (T=10min in experiment).

    In conclusion, we showed here that two largely unknown amidated DHA conjugates are more potent mediators of inflammatory processes than their parent compound DHA. These findings support our previously proposed idea that DHA-derived FAAs play a role in the underlying mechanism of the beneficial health effects of DHA. We further uncovered that a combination of ER and n-3 PUFAs in the diet alters the postprandial endocannabinoid tone. Given the fact that the endocannabinoid system (ECS) plays an important role in both the central and peripheral regulation of food intake and energy homeostasis, these findings provide new insights in the potentially mechanisms involved in an over-activated endocannabinoid system during obesity.

    How to measure health improvement? : assessment of subtle shifts in metabolic phenotype
    Fazelzadeh, Parastoo - \ 2017
    Wageningen University. Promotor(en): A.H. Kersten; J.P.M. van Duynhoven, co-promotor(en): M.V. Boekschoten. - Wageningen : Wageningen University - ISBN 9789463430739 - 187
    health promotion - improvement - measurement - metabolic profiling - elderly - obesity - microarrays - rna - peripheral blood mononuclear cells - gezondheidsbevordering - verbetering - meting - metabolische profilering - ouderen - obesitas - microarrays - rna - perifere mononucleaire bloedcellen

    Human health is impacted by a complex network of interactions between biological pathways, mechanisms, processes, and organs, which need to be able to adapt to a continuously changing environment to maintain health. This adaptive ability is called ‘phenotypic flexibility’. It is thought that health is compromised and diseases develop when these adaptive processes fail. As the product of interactions between several factors such as genetic makeup, diet, lifestyle, environment and the gut microbiome, the ‘metabolic phenotype’ provides a readout of the metabolic state of an individual. Understanding these relationships will be one of a major challenges in nutrition and health research in the next decades. To address this challenge, the development of high-throughput omics tools combined with the application of elaborate statistical analyses will help characterize the complex relationship of (bio) chemicals in human systems and their interaction with other variables including environment and lifestyle to produce the measured phenotype. An important aim of this thesis was to identify phenotype shifts by looking at effect of prolonged resistance-type exercise training on skeletal muscle tissue in older subjects and the possible shift toward the features of younger subjects as a reference for a healthier phenotype. A second aim was to identify phenotype shifts by looking at the response to a challenge in obese subjects and the possible shift toward lean subjects as a reference for a healthier phenotype.

    Chapter 2 and 3 of this thesis show how the significant remaining plasticity of ageing skeletal muscle can adapt to resistance-type exercise training. The data indicate that frail and healthy older subjects have two distinct phenotypes according to the skeletal muscle tissue metabolite profiles and that exercise training shifts aged muscle towards a younger phenotype. We showed that the effect of exercise on amino acid derived acylcarnitines (AAAC’s) in older subjects points towards decreased branched chain amino acid catabolism, likely due to compromised activation of the branched chain α-keto acid hydrogenase (BCKDH) complex. Furthermore, we found that the protocadherin gamma gene cluster might be involved in aged-muscle denervation and re-innervation. Finally, plasma was found to be a poor indicator of muscle metabolism, emphasizing the need for direct assessment of metabolites in muscle tissue.

    Chapter 4 of this thesis examines whether a mixed meal challenge response provides a readout for a shift in phenotype upon weight loss in obese male subjects. We concluded that weight loss moderately affects the mixed meal challenge response of both plasma metabolome and transcriptome of peripheral blood mononuclear cells in obese subjects. Measurements at the fasted and postprandial state also provide us with a different type of information.

    In Chapter 5 it is demonstrated that the global testing of pathways could provide a concise summary of the multiple univariate testing approach used in Chapter 4. In Chapter 6 it is discussed how the findings of this thesis increase our understanding of how to measure phenotypic flexibility as a proxy of health. In this thesis it is shown that the correlations between tissue and plasma metabolites are rather weak, emphasising the need to perform organ-specific studies. Availability of less invasive/painful sampling techniques and the use of small amounts of tissue would enable larger scale human studies on adipose tissue and skeletal muscle to more accurately define phenotypical shifts due to diet or lifestyle interventions. With respect to the assessment of phenotypical flexibility by omics approaches, significant complications can be expected in trying to relate plasma metabolism to PBMC gene expression. Organ-focussed approaches that integrate multiple omics levels using system biology approaches are considered to be a lot more promising.

    Wat moet je doen en laten als je gezonder wilt
    Witkamp, R.F. - \ 2015
    Universiteit van Nederland
    diëten - voeding en gezondheid - voedselwetenschappen - fysiologie - voedselproducten - gezondheidsvoedsel - gezondheidsbevordering - voedingsonderzoek - diets - nutrition and health - food sciences - physiology - food products - health foods - health promotion - nutrition research
    Slik jij de praatjes van afslankguru's als zoete koek? Ken jij alle diëten uit je hoofd? Renger Witkamp, hoogleraar Voeding en Farmacologie (Wageningen UR) bekijkt al deze hypes met een nuchtere en wetenschappelijke blik. Na dit praatje kun je alles wat je voorgeschoteld krijgt in de media over je gezondheid beter in perspectief plaatsen.
    Aantafel! helpt tegen kinderobesitas
    Ramaker, R. ; Hoek, E. van - \ 2015
    Resource: nieuwssite voor studenten en medewerkers van Wageningen UR (2015). - ISSN 1389-7756
    overgewicht - obesitas - kinderen - gezondheid van kinderen - voeding en gezondheid - programmaeffectiviteit - gezondheidsbevordering - gezondheidsprogramma's - overweight - obesity - children - child health - nutrition and health - program effectiveness - health promotion - health programs
    Steeds vaker komt overgewicht voor bij kinderen. Doelgroepen bereiken is grote uitdaging.
    Hoe gevarieerder de darmflora, des te beter
    Olie, A. ; Blaak, E.E. ; Vos, W.M. de - \ 2015
    Suiker in Perspectief 2015 (2015)juli. - p. 14 - 17.
    microbiota van het spijsverteringskanaal - darmen - voeding en gezondheid - gezondheidsbevordering - voedselconsumptie - gastrointestinal microbiota - intestines - nutrition and health - health promotion - food consumption
    'We zijn nog niet zo ver dat we nu al kunnen zeggen wat iemand met een bepaald microbiootprofiel van de darmen het beste kan eten, maar dit zal in de toekomst wel mogelijk zijn', zegt prof. dr. Willem de Vos. Hij doet samen met prof. dr. Ellen Blaak onderzoek om duidelijkheid te krijgen over de ideale samenstelling van microbiota zodat iemand gezond en slank wordt.
    Geen extra chips na zoutarm eten
    Janssen, A.M. - \ 2015
    WageningenWorld (2015)2. - ISSN 2210-7908 - p. 6 - 6.
    voedingsmiddelen - zoutgehalte - smaak - voedingsonderzoek bij de mens - reductie - gezondheidsgevaren - gezondheidsbevordering - behoeftenbevrediging - foods - salinity - taste - human nutrition research - reduction - health hazards - health promotion - need gratification
    Minder zout in etenswaren zorgt ervoor dat mensen daadwerkelijk minder zout eten; ze zoeken geen zoutcompensatie op andere momenten van de dag.
    Ben Witteman - Surgery is top sport for the patient - TEDxEde 2014
    Witteman, B.J.M. - \ 2015
    TEDxEde
    patiëntenzorg - chirurgie - voeding en gezondheid - gezondheidsbevordering - patient care - surgery - nutrition and health - health promotion
    Professor Doctor Ben Witteman is gastrointestinal liver physician at Gelderse Vallei Hospital and associate professor Nutrition and gut health in integrated care at Wageningen University. He knows how food influences our health.
    Prof. Ben Witteman over Patiënt meer baas in eigen buik
    Witteman, B.J.M. - \ 2015
    Wageningen UR
    voeding en gezondheid - lichaamsbeweging - lichamelijke activiteit - patiënten - gezondheidsbevordering - nutrition and health - exercise - physical activity - patients - health promotion
    Interview Ben Witteman ter gelegenheid van zijn inauguaratie op 21 mei 2015. Meer aandacht voor voeding en bewegen bij patiënten met chronische aandoeningen en rond operaties. Daar pleit maag-lever-darmarts prof. Ben Witteman voor.
    Vechten tegen verleiding
    Rademaker, R. ; Vet, E.W.M.L. de - \ 2015
    Resource: nieuwssite voor studenten en medewerkers van Wageningen UR 9 (2015)17. - ISSN 1389-7756 - p. 10 - 10.
    voeding en gezondheid - voedselconsumptie - obesitas - overgewicht - gezondheidsbevordering - snacks - nutrition and health - food consumption - obesity - overweight - health promotion - snacks
    Onze omgeving maakt dik. Porties worden groter, eten is overal en beweging wordt ontmoedigd. Emely de Vet, universitair hoofddocent bij Strategische communicatie, zoekt daarom naar strategieën om de lokroep van brownies en zakken chips te weerstaan.
    Langer fit met beter eten
    Smit, A. ; Groot, C.P.G.M. de; Kremer, S. ; Ziylan, C. ; Peppelenbos, H.W. - \ 2015
    WageningenWorld (2015)1. - ISSN 2210-7908 - p. 10 - 15.
    ouderen - ouderenvoeding - voeding en gezondheid - ondervoeding - voedingstoestand - eiwitrijke voedingsmiddelen - voedselverrijking - voedselconsumptie - gezondheidsbevordering - elderly - elderly nutrition - nutrition and health - undernutrition - nutritional state - protein foods - food enrichment - food consumption - health promotion
    Ouderen die zelfstandig thuis wonen, lopen het risico ondervoed te raken. Wageningen UR onderzoekt hoe dat is te voorkomen met producten en maaltijden die verrijkt zijn met extra eiwit. Maar hoe breng je die op de markt? De meeste ouderen voelen zich niet oud en zijn zich totaal niet bewust van hun voedingsstatus.
    Interview Professor Joost van Neerven over onderzoek naar vermindering van allergieën door gerichte voeding en aanvullende micronutriënten
    Neerven, R.J.J. van - \ 2014
    Wageningen : Wageningen UR
    voeding en gezondheid - voedselonderzoek - immuunsysteem - ziektepreventie - infectieziekten - allergieën - gezondheidsbevordering - nutrition and health - food research - immune system - disease prevention - infectious diseases - allergies - health promotion
    Met gerichte voeding en aanvullende micronutriënten kan de weerstand tegen infecties in de luchtwegen, tegen allergieën, en tegen ontstekingen worden vergroot. Dat is van groot belang voor kinderen onder de 5 jaar en voor 65-plussers, die het vaakst door deze aandoeningen worden geplaagd. De weerstand in weefsels die bedekt zijn met een slijmvlies in het gebied van de mond, keel, en neus is nog nauwelijks onderzocht. Toch kan dit onderzoek veel opleveren, vindt prof. Joost van Neerven.
    Rapportcijfer voor je eetgewoontes
    Lee, L. van - \ 2014
    Resource: weekblad voor Wageningen UR 9 (2014)7. - ISSN 1874-3625 - p. 10 - 10.
    voeding en gezondheid - eetpatronen - voedselconsumptie - gezondheidsbevordering - nutrition and health - eating patterns - food consumption - health promotion
    Wageningse voedingsonderzoekers hebben een snelle vragenlijst ontwikkeld die met één rapportcijfer aangeeft hoe gezond iemand eet.
    Laagopgeleide wil samen gezonder worden
    Bukman, A.J. - \ 2014
    Resource: weekblad voor Wageningen UR 9 (2014)6. - ISSN 1874-3625 - p. 8 - 8.
    gezondheidsbevordering - levensstijl - sociaal-economische positie - voeding en gezondheid - health promotion - lifestyle - socioeconomic status - nutrition and health
    Samen werken aan je gezondheid werkt beter. Mensen met een lage sociaaleconomische status werken het liefst in groepsverband aan een gezondere levensstijl.
    Voeding en kanker info : Wetenschappelijk antwoord van experts op vragen van patiënten
    Kampman, E. ; Beijer, S. ; Veen, M. van - \ 2014
    Wageningen UR/IKNL/Alpe d'HuZes/LWDO
    voeding en gezondheid - neoplasma - ziektepreventie - gezondheidsbevordering - behandeling - nutrition and health - neoplasms - disease prevention - health promotion - treatment
    Op deze website worden vragen beantwoord over voeding en de preventie van kanker, voeding rondom de behandeling van kanker en voeding ná de behandeling van kanker. Deze antwoorden zijn geformuleerd op basis van de beschikbare wetenschappelijke literatuur.
    Dossier Gezondheid. 35 manieren om gezonder te leven (interview met Lisette de Groot)
    Pek, A. ; Groot, C.P.G.M. de - \ 2013
    Psychologie Magazine 32 (2013)november. - ISSN 0167-6598 - p. 35 - 50.
    gezondheidsbevordering - voeding en gezondheid - lichaamsbeweging - voedingswaarde - dieetadvisering - health promotion - nutrition and health - exercise - nutritive value - diet counseling
    Lekker lang gezond blijven, dat willen we allemaal wel. Psychologie Magazine zocht uit welke leefregels meteen effect hebben, en ook hoe je die makkelijk inbouwt in je leven. De allerbeste adviezen van 14 prominente Nederlandse gezondheidsexperts.
    Vitaal naar de eindstreep
    Tieland, C.A.B. ; Rest, O. van de; Groot, C.P.G.M. de - \ 2013
    WageningenWorld 2013 (2013)4. - ISSN 2210-7908 - p. 26 - 29.
    voeding en gezondheid - ouderen - verouderen - vitaminetekorten - vetzuren - eiwit - gezondheidsbevordering - nutrition and health - elderly - aging - vitamin deficiencies - fatty acids - protein - health promotion
    Hoe worden we gezond oud? Trainen en extra eiwitten werken, blijkt uit onderzoek van de afdeling Humane voeding. Over het effect van vitamines en omega-3 vetzuren is het laatste woord nog niet gezegd.
    Immuunmodulatie door voeding "Van black box naar toolbox"
    Wolthuis, A. ; Wichers, H.J. - \ 2013
    Immuun 2 (2013)2. - p. 30 - 31.
    voeding en gezondheid - immuunsysteem - immuniteit - gezondheidsbevordering - modulatie - immunomodulatoren - bèta-glucaan - voedingsvezels - nutrition and health - immune system - immunity - health promotion - modulation - immunomodulators - beta-glucan - dietary fibres
    Prof. dr. Harry Wichers van Wageningen University & Research Centre doet onderzoek naar hoe voeding ons immuunsysteem een oppepper kan geven. "We kijken standaard naar medicijnen wanneer het er om gaat onze gezondheid te verbeteren. De mogelijkheden en het belang van voeding worden onderschat."
    Voeding voor wie lang fit wil blijven
    Groot, C.P.G.M. de - \ 2012
    In: Voeding voor vitale 50-plussers Wageningen : Food Valley - ISBN 9789081609371 - p. 9 - 9.
    ouderenvoeding - voeding en gezondheid - ouderen - productontwikkeling - gezondheidsbevordering - voedingsstoffenbehoeften - elderly nutrition - nutrition and health - elderly - product development - health promotion - nutrient requirements
    Goede voeding kan helpen ouderdomskwalen te voorkomen, ook voor wie al 50-plus is. En tot die categorie behoren steeds meer mensen, in Nederland en daarbuiten. Ook gaat met de jaren de behoefte aan sommige voedingsstoffen omhoog. Volop kansen voor productontwikkeling dus.
    Helpt 'nudgen' bij een gezonde en duurzame keuze? : zes nudges en de keuze voor duurzaam of gezond voedsel
    Trijp, J.C.M. van - \ 2012
    Den Haag : Schuttelaar & Partners - 18
    voeding en gezondheid - duurzaamheid (sustainability) - gezondheidsbevordering - voedselconsumptie - consumentengedrag - nutrition and health - sustainability - health promotion - food consumption - consumer behaviour
    Hoe werken 'bewezen' nudges voor duurzaam en gezond voedsel? En in hoeverre zijn deze nudges ethisch verantwoord? Dat zijn de kernvragen in dit onderzoek. De belangrijkste conclusie van dit onderzoek is dat nudges kunnen bijdragen aan een duurzamere en gezondere productkeuze van de consument. Tegelijkertijd laat dit onderzoek ook zien dat niet elke vorm van nudgen altijd acceptabel is. Deze brochure laat op praktische en eenvoudige wijze zien welke nudges in het onderzoek getest zijn en in welke mate effect is gemeten.
    Project van SLIM naar SLIMMER
    Feskens, E.J.M. ; Duijzer, G. ; Blaak, E.E. ; Boer, A. de; Haveman-Nies, A. ; Oord-Jansen, S.J. van - \ 2012
    Voeding Nu 4/5 (2012). - ISSN 1389-7608 - p. 20 - 20.
    gezondheidsbevordering - diabetes type 2 - suikerziekte - levensstijl - voeding en gezondheid - ziektepreventie - health promotion - type 2 diabetes - diabetes - lifestyle - nutrition and health - disease prevention
    In 1998 is in Maastricht een onderzoek gestart naar de mogelijkheid om het optreden van type 2 diabetes te voorkomen door middel van een gecombineerd leefstijlprogramma (SLIM). Dit programma was gebaseerd op de Finse Diabetes Prevention Study, en omvatte de richtlijnen Goede Voeding van destijds, en een beweegadvies annex sportprogramma. De interventie duurde maximaal 6 jaar. Onlangs zijn alle deelnemers opnieuw opgeroepen. Ook is het programma omgezet in draaiboeken voor de praktijk die op dit moment worden getest in de gemeente Apeldoorn. Dt project heet SLIMMER.
    Kijk naar de context : de alledaagse sociale omgeving als startpunt voor patiëntgebonden leefstijladvisering
    Bouwman, L.I. ; Koelen, M.A. ; Binsbergen, J.J. van; Dapper, T. - \ 2012
    Voeding Nu 14 (2012)6/7. - ISSN 1389-7608 - p. 18 - 20.
    gezondheidsbevordering - levensstijl - voeding en gezondheid - gedrag - patiënten - sociaal milieu - health promotion - lifestyle - nutrition and health - behaviour - patients - social environment
    Het verband tussen leefstijl en gezondheid is evident. De voordelen van een gezonde leefstijl zijn bekend, maar hoe begeleid je patiënten optimaal op hun pad richting die gezonde leefstijl? Deze intrigerende vraag, die speelt op zowel het gebied van beleid, wetenschap als in de huisartsenpraktijk, stond centraal tijdens een afscheidssymposium op 10 mei 2012 in Nijmegen.
    Een gedeelde passie voor gezonder leven. Evaluatieonderzoek naar netwerken rondom de beweegkuur en gecombineerde leefstijl interventies
    Hartog-van den Esker, F.G. den; Wagemakers, A. ; Vaandrager, L. ; Koelen, M. - \ 2012
    Wageningen : Wageningen University - 69
    gezondheidsbevordering - gezondheidsbeleid - levensstijl - lichamelijke activiteit - lichaamsbeweging - voeding en gezondheid - overgewicht - netwerken - health promotion - health policy - lifestyle - physical activity - exercise - nutrition and health - overweight - networks
    NISB (Nederlands Instituut voor Sport en Bewegen), projectleider van de BeweegKuur, is in 2010 gestart met het project 'Netwerken bouwen in de BeweegKuur'. In dit project gaat het om het opbouwen van regionale en lokale netwerken voor de afstemming tussen preventie, curatie en sport en voor de borging in gezondheidsbeleid. NISB heeft de Leerstoelgroep Gezondheid en Maatschappij van Wageningen University gevraagd onderzoek te doen naar de netwerkvorming rondom de BeweegKuur. Het doel van het onderzoek is inzicht te krijgen in de factoren van belang voor duurzame netwerken, de resultaten die de netwerken boeken en de wijze waarop netwerken gefaciliteerd kunnen worden. Een tweede doel is het leveren van direct bruikbare kennis voor de netwerken.
    Er is geen enkel werkzaam principe dat altijd werkt. Een eerste verkenning van het begrip werkzame principes
    Wartna, J. ; Vaandrager, L. ; Wagemakers, A. ; Koelen, M. - \ 2012
    Wageningen : Wageningen University - 31
    gezondheidsbevordering - levensstijl - interventie - gezondheidsbescherming - health promotion - lifestyle - intervention - health protection
    Sinds 2008 onderhoudt RIVM Centrum Gezond Leven (CGL) het loketgezondleven.nl met een interventie database (I-database). In deze I-database zijn leefstijlinterventies opgenomen die geclassificeerd zijn als ‘theoretische goed onderbouwd’, als ‘waarschijnlijk effectief’ of als ‘bewezen effectief’. In de databank Effectieve Jeugdinterventies staan jeugdinterventies die op dezelfde manier geclassificeerd zijn evenals op de web portal het Nederlands Centrum Jeugdgezondheid. Professionals kunnen een interventie indienen en ter beoordeling voorleggen aan de Erkenningscommissie Interventies. Werkzame principes zijn gekoppeld aan de doelen van een interventie en gaan over principes die het effect van een interventie tot stand brengen. Het is echter nog onduidelijk wat er precies bedoeld wordt met 'werkzame principes' en wat dit vervolgens betekent voor het erkenningstraject. De leerstoelgroep Gezondheid en Maatschappij is daarom gevraagd een beperkt literatuuronderzoek te doen en een aantal interviews uit te voeren met personen uit de praktijk van gezondheidsbevordering en de jeugdgezondheidszorg (december 2011- februari 2012). Doel van dit onderzoek is om meer helderheid te krijgen over het begrip werkzame principes zodat er een besluit kan worden genomen of het expliciteren van werkzame principes waardevol is voor het erkenningstraject.
    Evaluatie netwerken Amsterdam. Onderzoek naar netwerken rondom gecombineerde leefstijlinterventies in Amsterdam
    Hartog-van den Esker, F.G. den; Wagemakers, A. - \ 2012
    Wageningen : Wageningen Universiteit - 35
    gezondheidsbevordering - levensstijl - netwerken - gezondheidsbescherming - health promotion - lifestyle - networks - health protection
    Op verzoek van 1ste Lijn Amsterdam heeft Wageningen Universiteit (WUR) een evaluatieonderzoek gedaan naar de netwerken rondom gecombineerde leefstijlinterventies in Amsterdam. Het doel van het evaluatieonderzoek van de netwerken in Amsterdam was om inzicht te krijgen in de succes- en verbeterpunten van de netwerken, de doelen en beoogde resultaten van de netwerken, de resultaten die de netwerken boeken en factoren van belang voor het opbouwen van duurzame netwerken ofwel blijvende netwerkverbindingen.
    Zout, bloeddruk en hart- en vaatziekten
    Geleijnse, J.M. - \ 2011
    In: Hart- en vaatziekten in Nederland 2011 / Vaartjes, I., van Dis, I., Visseren, F.L.J., Bots, M.L., Den Haag : Hartstichting - ISBN 9789075131703 - p. 73 - 90.
    zout - reductie - hart- en vaatziekten - bloeddruk - hypertensie - natriumchloride - zoutgehalte - ziektepreventie - gezondheidsbevordering - salt - reduction - cardiovascular diseases - blood pressure - hypertension - sodium chloride - salinity - disease prevention - health promotion
    Dit hoofdstuk richt zich op het belang van zoutreductie in de Nederlandse bevolking, waarbij achtereenvolgens het verband met bloeddruk en hart- en vaatziekten, de dagelijkse zoutinname en bronnen van zout, de potentiële gezondheidswinst door zoutreductie en lopende initiatieven op het gebied van zoutreductie in de bevolking besproken worden.
    Evidence-based curative health promotion : a systems biology-orientated treatment of seasonal allergic rhinitis with Citrus/Cydonia comp.
    Baars, E.W. - \ 2011
    Wageningen University. Promotor(en): Huub Savelkoul. - [S.l.] : S.n. - ISBN 9789461730947 - 245
    gezondheidsbevordering - zelfzorg - allergische rhinitis - stapsgewijze regressie - citrus - cydonia - antroposofie - health promotion - self care - allergic rhinitis - stepwise regression - citrus - cydonia - anthroposophy
    The prognosis of higher life expectancies of both men and women in the Netherlands, often related to chronic diseases and high healthcare costs, the changed role of patients into competent patients, and the increasing interest of patients in complementary medicine worldwide provides the scientific rationale to put more emphasis in healthcare on developing valid, effective, cost-effective and safe strategies that support and enable patients to actively contribute to their own health and disease status in order to promote their health in a preventive and/ or curative manner.
    Although much effort has been invested worldwide, a lot of scientific and practical work still has to be done to develop the health promotion approach into one that is evidenced-based and professional like the fighting disease approach. This thesis focuses on some of the conceptual, methodological and empirical issues of developing professional preventive and curative health promotion as a contribution to the further innovation of medicine and healthcare.
    Chapter 2 analyzed historic and current health concepts and developed and preliminarily validated the new concept of ‘health by self-regulation’ by means of analyzing its internal consistency, its accordance with other scientific concepts (e.g. the concepts of epigenetics, systems biology, and emergence) and its accordance with empirical facts. Finally, it demonstrated two examples of integration of the fighting disease and the health promotion approach and discussed the theoretical and practical implications of this new concept.
    In Chapter 3, the fundamental scientific discussion of holism versus reductionism was summarized. This chapter demonstrated that there are several arguments against the current reductionist point of view. This provides a scientific opening for a more holistic or systems biology-oriented concept of health and a more holistic or systems biology-oriented methodological approach.
    Chapter 4 described a new system’s biology-oriented methodological approach in developing immunological biomarkers for monitoring treatment effect in seasonal allergic rhinitis (hay fever) research. Using permuted stepwise regression, pattern variables that reflect immune system functioning on the systems level were computed and tested. Computation was based on a dataset (from a randomized controlled trial comparing two routes of administration) of allergen-specifically induced expression levels of cytokines (IL-1β, IL-5, IL-10, IL-12, IL-13, IL-17, IFN-γ and TNF-α) and symptom severity scores from 22 seasonal allergic rhinitis (SAR) patients measured before and after six weeks of treatment with medicinal products containing Citrus and Cydonia. Further computation and biomarker validation with larger datasets, including data from healthy persons and SAR patients, is indicated.
    In Chapter 5, the experiences of 39 Dutch general practitioners with anthroposophic SAR treatment were examined. The results of this survey provide the first practice-based evidence of positive treatment results of Citrus/Cydonia comp. for SAR.
    Chapter 6 examined, in two in vitro studies, the immunological pathways of the effects of Citrus/Cydonia comp. from a healthy and an allergic donor, respectively. Peripheral blood mononuclear cells (PBMCs) were isolated out of peripheral blood and analyzed in vitro after polyclonal stimulation of T-cells. The differentiation capacity and the influence regarding Th1 (IFN-γ) and Th2 (IL-5) cells were examined. Citrus/Cydonia comp. has a selective effect on the differentiation of Th-cells by producing relatively more IL-10 than IL-12. It also seems to have an effect on the induction of regulatory (IL-10 producing) T-cell subsets. It is in vitro capable of partly neutralizing the changes, characteristic to allergic rhinitis, regarding the maturation, differentiation, and activity of the immune system. Thus, it was concluded that Citrus/Cydonia comp. can potentially restore the disturbed immune state of rhinitis patients, which essentially could be sufficient to make allergic symptoms disappear permanently.
    Chapter 7 examined the effects of the combined product, Citrus e fructibus/Cydonia e fructibus (Citrus/Cydonia), and separate products of Citrus and Cydonia on the immuno-pathological pathways involved in seasonal allergic rhinitis (SAR). Peripheral blood mononuclear cells (PBMCs) from five healthy and five grass pollen-allergic donors were isolated and analyzed in vitro after polyclonal and allergen-specific stimulation of T-cells in the presence of the three extracts. The analyses demonstrated acceptable cell survival with no signs of toxicity. Citrus mainly had a selective effect on reducing allergen-specific chronic inflammatory (TNF-a) and Th2 (IL-5) pathway activity; whereas both Cydonia and Citrus/Cydonia mainly affected the induction of the allergen-specific Th1 (IFN-g) pathway. Citrus and Cydonia demonstrated differential working mechanisms in the treatment of SAR, and the combination product did not demonstrate larger effects than the separate preparations. Hence, it was concluded that further effectiveness and efficacy studies comparing the effects of the products on SAR in vivo are required.
    Chapter 8 studied a small group of 13 patients with a mean history of hay fever with grass pollen allergy of 9 years’ duration, who in previous years used conventional hay fever medication because of the severity of their symptoms during the pollen season. Gencydo injections were administered to 12 patients before the onset of and during the grass pollen season, and in one patient during the grass pollen season only. Nasal and non-nasal hay fever symptom severity, use of rescue medication (antihistamines or corticosteroids), and the subjective experiences of patients were used as outcome measures. It was concluded that there are clear indications that Gencydo treatment is effective in a large subgroup of the research population.
    Chapter 9 compared the efficacy and safety of two routes of administration (subcutaneous injections (SI) versus nasal spray (NS)) in a national, randomized, comparative clinical trial with two parallel groups.  A total of 23 patients fulfilled the study requirements. After a one- or two-week wash-out period, twenty-three patients were randomized to a six-week treatment period. The outcomes assessed were immunological and symptom severity changes and safety. Immunologic outcome assessments were blinded to group assignment.It was concluded that both routes of administration are safe and demonstrate immunological and clinical effects, with larger inflammatory and innate immunological effects of the NS route and larger allergen-specific clinical effects in the SI group.
    Chapter 10 reported a study that was aiming to update the safety status of anthroposophic and homeopathic solutions for injection through a systematic evaluation of the reported adverse drug reactions (ADRs). ADRs were extracted from the pharmacovigilance databases of eight German anthroposophic and homeopathic manufacturers covering the period of 2000-2009. These eight manufacturers represent, in total, more than 94 percent of the sales of anthroposophic and homeopathic solutions for injection in Germany. Analyzed ADRs included reports in humans only, reports from post-marketing surveillance, literature cases and clinical/safety trials, and spontaneous reports from healthcare professionals and patients. The results suggest an excellent safety profile of solutions for injection as therapeutically applied in anthroposophic medicine and homeopathy, where the overall incidence of ADRs are very rare.
    Chapter 11 presented the major findings of this thesis, studying the concept of health, the methodology to monitor (changes in) health states, the effects and safety of Citrus/ Cydonia comp. on seasonal allergic rhinitis as an example of curative health promotion, and the cost-effectiveness of integrative medicine in the Netherlands. The theoretical and practical implications of the results of this thesis were discussed and reflected on the scientific fundament of anthroposophic medicine. Future perspectives were also described for the implementation of new research lines, the further development of professional preventive and curative health promotion as a contribution to the further innovation of medicine and healthcare, and the investment in CAM/IM/AM research.

    In the Appendix, a cost-effectiveness study is presented in which the possible contribution of integrative medicine to the reduction of healthcare costs was studied. This study compared the performance of general practitioners who have completed certified additional training in CAM after obtaining their conventional medical degree (GP-CAMs) with general practitioners who have not (GPs). Patients whose GP has completed additional CAM training have 0–30 percent lower healthcare costs and mortality rates, depending on age group and the type of CAM. The lower costs result from fewer hospital stays and fewer prescription drugs. Since the differences are obtained while controlling for confounders, including neighborhood-specific fixed effects at a highly detailed level, the lower costs and longer lives are unlikely to be related to differences in socioeconomic status. Possible explanations include selection (e.g. people with low interest in medical interventions might be more likely to choose CAM) and better practices (e.g. less overtreatment, more focus on preventive and curative health promotion) by GPs with knowledge of complementary medicine. More controlled studies (replication studies, research based on more comprehensive data, cost-effectiveness studies on CAM for specific diagnostic categories) are required. These findings highlight the fact that the health-promoting methods that are considered CAM today could be effective and might have significant cost-saving potential.

    With the example of Citrus/Cydonia comp. in SAR treatment, this thesis demonstrates the safety, moderate efficacy and specific immunological working mechanism of this medicine, underscoring that CAM could be effective and might have a significant cost-saving potential, and collectively, the validity of the concept of preventive and curative health promotion.  
    'Voedingsindustrie denkt nog onvoldoende na over gezondheid'
    Kok, F.J. - \ 2011
    Kennis Online 8 (2011)okt. - p. 3 - 5.
    voeding en gezondheid - voedselindustrie - gezondheidsbevordering - overgewicht - gezondheidsvoedsel - voedselconsumptie - consumenten - lichamelijke activiteit - nutrition and health - food industry - health promotion - overweight - health foods - food consumption - consumers - physical activity
    We eten te zout, te zoet, te vet en vooral ook te veel. Al jaren horen we dat we gezond moeten eten en voldoende bewegen, maar toch wordt Nederland alsmaar dikker. Om echt een slag te maken, zouden voedingsmiddelenbedrijven meer hun best mogen doen hun producten gezonder te maken. 'Anders krijgen ze straks ongewild nog de schuld van de obesitasepidemie.'
    Preventieve aanpak diabetes getest
    Duijzer, G. - \ 2011
    Kennis Online 8 (2011)okt. - p. 7 - 7.
    ziektepreventie - gezondheidsbevordering - diabetes type 2 - diabetes mellitus - voeding en gezondheid - disease prevention - health promotion - type 2 diabetes - diabetes mellitus - nutrition and health
    Bijna de helft van de gevallen van diabetes type 2 is in theorie te voorkomen. Mits mensen gezonder gaan eten en meer gaan bewegen. Wageningen University onderzoekt samen met de GGD Gelre-IJssel een preventieve aanpak van ouderdomssuiker in de reguliere zorg van huisarts, fysiotherapeut en diëtist.
    Gezonde voeding belangrijk voor ex-patiënt
    Kampman, E. - \ 2011
    Kennis Online 8 (2011)okt. - p. 8 - 8.
    gezondheidsvoedsel - voeding en gezondheid - neoplasma's - gezondheidsbevordering - behandeling - health foods - nutrition and health - neoplasms - health promotion - treatment
    Dat er een relatie is tussen voeding en het ontstaan van kanker weten al veel mensen. Veel minder bekend is nog dat voeding ook tijdens en na behandeling van de ziekte invloed heeft op het herstel en de kwaliteit van leven. Ellen Kampman, hoogleraar aan Wageningen University en met financiering van de stichting Alpe d’HuZes ook aan de VU in Amsterdam, onderzoekt het.
    Towards salutogenichealth promotion : organizing healthy ageing programs at the local level
    Lezwijn, J. - \ 2011
    Wageningen University. Promotor(en): Cees van Woerkum, co-promotor(en): Lenneke Vaandrager; Annemarie Wagemakers. - [S.l.] : S.n. - ISBN 9789085859864 - 200
    gezondheidsbevordering - voorzieningen tbv de gezondheid op regionaal niveau - gezondheidsprogramma's - ouderen - verouderen - health promotion - community health services - health programs - elderly - aging
    Als gevolg van landelijke wetgeving, zoals de Wet Publieke Gezondheid (WPG) en de Wet Maatschappelijke Ondersteuning (WMO), hebben gemeenten meer verantwoordelijkheden gekregen ten aanzien van hun oudere populatie. Het onderzoek beschreven in het proefschrift ‘Towards salutogenic health promotion. Organizing healthy ageing programs at the local level’ moet bijdragen aan het opdoen van kennis over hoe lokale programma’s ten behoeve van gezond ouder worden te ontwikkelen, te implementeren en te evalueren. Drie punten bleken belangrijk bij het ontwikkelen, implementeren en evalueren van gezondheidsprogramma’s voor gezond ouder worden. De perceptie van ouderen zelf: De ideeën die ouderen zelf hebben ten aanzien van gezond ouder worden zijn belangrijk. Een salutogene benadering biedt handvaten om de perceptie van ouderen ten aanzien van nieuwe gezondheidsprogramma’s te onderzoeken. Samenwerken voor gezond ouder worden. Samenwerken draagt bij aan het opbouwen van kennis nodig om gezondheidsprogramma’s te ontwikkelen. Samenwerking is echter niet vanzelfsprekend. Daarom zou samenwerking een expliciet onderdeel moeten zijn van gezondheidsprogramma’s. Combineren van bewijs. Door samenwerking met verschillende partijen is het mogelijk om verschillende vormen van bewijs te combineren. Een voorbeeld hiervan is het programma ‘Voor Elkaar in de Buurt’.
    Van vonkjes naar vuurtjes. Pilot evaluatie netwerkvorming rondom de BeweegKuur
    Wagemakers, A. ; Hartog-van den Esker, F.G. den; Vaandrager, L. - \ 2011
    Wageningen : Leerstoelgroep Gezondheid en Maatschappij. Wageningen Universiteit. - 68
    gezondheidsbevordering - gezondheidsbescherming - lichamelijke activiteit - lichaamsbeweging - netwerken - levensstijl - voeding en gezondheid - health promotion - health protection - physical activity - exercise - networks - lifestyle - nutrition and health
    NISB heeft de leerstoelgroep Gezondheid en Maatschappij van de Wageningen Universiteit gevraagd onderzoek te doen naar de netwerkvorming rondom de BeweegKuur. Het doel van het onderzoek is het evalueren van de lokale en regionale netwerkvorming rondom de BeweegKuur. Hiertoe is onderzocht hoe de netwerkvorming vorm is gegeven, wat de successen en knelpunten zijn en welke werkwijzen geschikt zijn voor het evalueren van de netwerkvorming. Dit verslag beschrijft het pilot onderzoek.
    Twenty years of capacity building. Evolution of Salutogenic Training: The ETC 'Healthy Learning' Process
    Pavlekovic, G. ; Pluemer, K.D. ; Vaandrager, L. - \ 2011
    Zagreb, Croatia : European Training Consortium in Public Health and Health Promotion (ETC-PHHP) and Andrija Štampar School of Public Health, School of Medicine, University of Zagreb - ISBN 9789536255474 - 172
    gezondheidsbevordering - gezondheidseducatie - volksgezondheid - opleiding - capaciteitsopbouw - europa - geschiedenis - health promotion - health education - public health - training - capacity building - europe - history
    Healthy aging in complex environments : exploring the benefits of systems thinking for health promotion practice
    Naaldenberg, J. - \ 2011
    Wageningen University. Promotor(en): Maria Koelen; Cees Leeuwis, co-promotor(en): Lenneke Vaandrager. - S.l. : s.n. - ISBN 9789085859123 - 208
    verouderen - welzijn - gezondheidsbevordering - methodologie - efficiëntie - aging - well-being - health promotion - methodology - efficiency

    Background
    Many different stakeholders and contextual factors influence the success or failure of health promotion activities. Conventional approaches and evaluation designs underlying health
    promotion interventions, often explicitly take contextual variables out of consideration by
    controlling them. In doing so, relevant information about why a project was successful or
    failed to reach success remains invisible and ‘black boxed’. Next to this, in health promotion
    practice, control over contextual variables often is not possible.
    Aim
    Given the complexity of health promotion practice, research approaches often do not fit the realities of practice. As a result, health promotion activities are not always experienced as meaningful by all stakeholders involved. This thesis aims to appreciate the complex environment in which health promotion takes place by applying a systems
    thinking perspective to healthy aging in order to contribute to more robust strategies and
    interventions to support the aging population.
    Methods
    Systems thinking aims to include a diversity of viewpoints on an issue. Therefore, to be
    able to answer the research questions, multiple methods were required. A combination of
    literature review, semi-structured and open interviews, interactive workshops, case study
    and survey research was used. Different sources for data collection included the aging
    population, local and national stakeholders, and AGORA project members.
    Results
    Part I of this thesis concludes that a systems thinking approach strengthens health promotion by 1) including diverse stakeholder perspectives, 2) explicitly addressing contextual factors, and 3) co-creating solutions with all involved.
    Following this conclusion, Part II addressed the application of systems thinking at the local level by investigating different stakeholders perspectives on healthy aging. Results show how there is a discrepancy between the way aging individuals experience healthy aging as an integral part of everyday life and the way services and interventions are presented with a focus on isolated health themes. Local healthy aging strategies can benefit by taking into account an assets based approach that better matches aging persons’ perspectives. Next to this, collaboration between local stakeholders can be facilitated when shared issues are made visible and contextual preconditions are taken into account. Since the operationalization of systems thinking in health promotion can benefit from learning experiences with application in practice, findings from Part II were discussed in interactive presentations and workshop formats within participating municipalities. This resulted in the co-creation of a model to facilitate collaboration and the co-creation
    of an intervention through application of this model. The salutogenic concept Sense of
    Coherence was identified as a promising concept to operationalize systems approaches
    in health promotion practice. It was therefore expected that quantitative measurement of
    SOC could provide useful information for both the development and evaluation of health
    promotion. The OLQ-13 scale to measure Sense of Coherence was therefore investigated for its psychometric properties. Results indicate difficulties with the use of this scale in aging
    populations. Deleting two items from the original 13 items, improved the functioning of OLQ.
    Conclusion
    The importance of the fact that health issues and possible intervention strategies are perceived differently by involved actors was argued within this thesis. Research is one amongst many stakeholders and a systems thinking approach implies linking all kinds of
    actors in order to enable co-creation of projects. Consequently, the definition of health
    risks, health determinants, and possible intervention effects have to be verified in both
    scientific research and everyday practice.
    Strategies to improve health are context sensitive, and consequently, certain strategies may not work in some settings whereas they function perfectly well in others. Measurement of successes of interventions should therefore use multi-method evaluations combining
    the use of quantitative and qualitative approaches to gain insight in the ‘black box’ of why
    an intervention failed or was successful. If not, alternatives are overlooked and at the same
    time successes may go unnoticed.

    Ik eet gezond maar ik ben geen freak. Resultaten van consumentenonderzoek
    Bouwman, L.I. ; Molder, H.F.M. te; Koelen, M.A. ; Woerkum, C.M.J. van - \ 2010
    Voeding Nu 12 (2010)4. - ISSN 1389-7608 - p. 18 - 21.
    eetpatronen - consumentengedrag - consumentenonderzoeken - gezondheidsbevordering - dieetrichtlijnen - voedingsgedrag - voedselconsumptie - voeding en gezondheid - eating patterns - consumer behaviour - consumer surveys - health promotion - dietary guidelines - feeding behaviour - food consumption - nutrition and health
    De huidige voedingsrichtlijn voor gezond eten gaat uit van een focus op biomedische gezondheid. Nu zou het voor consumenten ook een vanzelfsprekende zaak (moeten) zijn dat voedingskeuze direct te linken is aan fysieke gezondheid. Andere, sociale, culturele en economische aspecten spelen echter ook een rol in de keuze voor bepaald voedsel. Hoe kan voedingscommunicatie worden ingezet om daadwerkelijk een gedragsverandering teweeg te brengen bij consumenten, inpasbaar in hun alledaagse leven?
    Actie-onderzoek vertelt over de successen. Wetenschappers, professionals en burgers werken samen. [Action research reports the successes. Scientists, practitioners and residents collaborate
    Geerts, A. ; Wagemakers, A. - \ 2010
    VoedingsMagazine 23 (2010)6. - ISSN 0922-8012 - p. 8 - 10.
    gezondheidsbevordering - buurtactie - sociale participatie - voeding en gezondheid - actieonderzoek - health promotion - community action - social participation - nutrition and health - action research
    In actie-onderzoek worden de resultaten teruggekoppeld naar de mensen om wie het gaat. 'Als er activiteiten zijn waarover men tevreden is, dan moet je dat vertellen. Het is belangrijk om de succesen te melden', zegt dr. ir. Annemarie Wegemakers. 'mensen zelf laten meedenken en meewerken is essentieel en leidt tot activiteiten en voorzieningen waar mensen werkelijk wat mee kunnen'.
    Samenwerkingsproject van RIVM, TNO en Wageningen Universiteit / Gezondheidseffecten van groenten en fruit
    Hendriks, H. ; Verhagen, H. ; Büchner, F. ; Duijnhoven, F.J.B. van; Witkamp, R.F. ; Peppelenbos, H. ; Woltering, E.J. - \ 2010
    Voeding Nu 12 (2010)3. - ISSN 1389-7608 - p. 26 - 28.
    voedselconsumptie - voedingsonderzoek bij de mens - groenten - fruit - gezondheidsbevordering - obesitas - samenwerking - onderzoeksinstituten - kennis - voeding en gezondheid - food consumption - human nutrition research - vegetables - fruit - health promotion - obesity - cooperation - research institutes - knowledge - nutrition and health
    In 2007 publiceerden Wageningen-UR, TNO en RIVM samen met ZonMW het rapport 'Wat gaan we eten?' Een van de aanbevelingen was om tot meer samenhang en afstemming in het onderzoek te komen. Sindsdien stemmen de drie kennisinstituten hun activiteiten voor de ministeries van VWS en LNV op elkaar af. Het parapluproject dat sindsdien is opgestart 'Gezondheidseffecten van groenten en fruit', heeft tot doel de kennisbehoefte van overheid, maatschappelijke praktijkgerichte organisaties en wetenschap in kaart te brengen. In dit geval met betrekking tot obesitas, een belangrijk probleem waarmee de maatschappij zich geconfronteerd ziet
    Samenwerking rondom de implementatie van een landelijke actie : De scholenactie ‘Ga voor gezond!’
    Wagemakers, A. ; Blok, M. ; Bon, S. ; Jansen, J. - \ 2010
    Tijdschrift voor Gezondheidswetenschappen 88 (2010)7. - ISSN 1388-7491 - p. 358 - 361.
    gezondheidsbevordering - basisonderwijs - gezondheidsbescherming - basisscholen - voeding en gezondheid - health promotion - elementary education - health protection - elementary schools - nutrition and health
    De nationale scholenactie 'Ga voor gezond!' van het Gezondheidsinstituut NIGZ heeft tot doel om scholen op een laagdrempelige manier met thema's op het gebied van gezondheid en veiligheid in aanraking te laten komen. Dit artikel beschrijft Ga voor gezond!, de resultaten van het onderzoek en de factoren die van belang zijn bij de samenwerking en kennisuitwisseling rondom een landelijke actie.
    Consument op automatische piloot laat zich moeilijk verleiden
    Riet, J.P. van 't - \ 2010
    Kennis Online 7 (2010)okt. - p. 3 - 5.
    gezondheidsbevordering - consumentengedrag - levensstijl - voedselconsumptie - voeding en gezondheid - health promotion - consumer behaviour - lifestyle - food consumption - nutrition and health
    Mensen verleiden om gezond te leven is lastiger dan je denkt. Je maakt niet de hele dag rationele keuzes. En met eten alom aanwezig, val je al snel voor instant genot. Wat helpt zijn gezonde alternatieven en meer ruimte om te bewegen. Mensen leren om zichzelf te beheersen is misschien wel minstens zo effectief.
    FOVEA - Food Valley Eating Advisor
    Gorselink, M. - \ 2010
    Wageningen UR - Food & Biobased Research
    gezondheidsbevordering - voedselconsumptie - consumptiepatronen - voeding en gezondheid - health promotion - food consumption - consumption patterns - nutrition and health
    The governments of the countries in the Western World are currently spending large amounts of money in campaigns promoting a healthier lifestyle. In spite of all this money, the effectiveness of these campaigns is rather low, and it is postulated that the effectiveness of the message will be larger when it is personalized. The incentive for the start of the FOVEA is to develop a system for personalized feedback to stimulate a healthier behavior.
    Ik Kies Bewust; Effecten van het logo op het koopgedrag
    Kornelis, M. ; Meeusen, M.J.G. - \ 2010
    Den Haag : LEI Wageningen UR (Rapport / LEI : Onderzoeksveld Consument & gedrag ) - ISBN 9789086154159 - 49
    etiketteren van voedingsmiddelen - reclamecampagne van voedsel - consumentenvoorkeuren - consumentengedrag - effecten - gezondheidsbevordering - keuzegedrag - voeding en gezondheid - nutrition labeling - food merchandising - consumer preferences - consumer behaviour - effects - health promotion - choice behaviour - nutrition and health
    Dit rapport beschrijft de effecten van het Ik Kies Bewust-logo in de markt. Daarbij wordt gekeken of en in welke mate de vraag naar de producten met het Ik Kies Bewust-logo groter wordt en welke effecten dit heeft op de vraag naar andere producten in diezelfde of andere productcategorieën.
    Community health promotion : facilitating and evaluating coordinated action to create supportive environments
    Wagemakers, A. - \ 2010
    Wageningen University. Promotor(en): Cees Leeuwis, co-promotor(en): Maria Koelen; Lenneke Vaandrager. - [S.l. : S.n. - ISBN 9789085856306 - 192
    gezondheidsbevordering - gemeenschappen - efficiëntie - health promotion - communities - efficiency
    Introduction
    Community programs to promote health have been launched all over the world and fit
    well with Dutch policy that emphasizes the participation of all citizens in all facets of
    society. However, researchers, practitioners, and policy makers report uncertainty about how to implement and evaluate health promotion programs. In particular, the social environment of health is still overlooked and underexposed due to a lack of consensus on concepts relating to the social environment of health, a lack of information on interventions that bring about social change, and a lack of feasible methods and tools. Consequently, the effectiveness of health promotion may not be evaluated under all relevant headings.

    Methods
    The aim of the studies reported in this thesis was to gain the required knowledge to
    contribute to the development of methods, tools, and theory to facilitate and evaluate
    community health promotion. Case studies have been selected that are guided
    by action research or in which action research was part of the research activities.
    Methods, tools, and theory have been developed, piloted, and evaluated simultaneously and iteratively in the Eindhoven program Working on Healthy Neighborhoods and the Healthy Lifestyles program in Amsterdam. Based on these case studies and the experiences in other Dutch community health programs, factors that are important in community health promotion were identified and a framework to facilitate and evaluate the social environment of health was developed. Based on the factors and the framework a Checklist for Coordinated Action was developed and assessed for usability in six different partnerships: a national program, an academic collaborative and four local partnerships.

    Results
    In the Eindhoven program the participatory action research facilitated the restart
    and continuation of the program, the achievement of intersectoral collaboration,
    the initiation of community participation, and other accompanying research. In the
    Amsterdam program, participatory approaches facilitated the participation of 15%
    of the target population at the desired level in the different phases of the program.
    The factors important in community health promotion are representation of relevant
    societal sectors, discussing aims, objectives, roles and responsibilities, communication infrastructure, visibility and management. These factors helped to develop a framework and guidelines which offer operational variables of participation and collaboration and thereby provide common ground for researchers and practitioners. The developed Checklist for Coordinated Action facilitates and evaluates partnerships that differ in context and level, phase of the program and topics addressed.

    Conclusion
    The thesis has revealed that action research methods and tools are valuable because they fit community health promotion, they generate actionable knowledge for relevant stakeholders, and they are essential and complementary in capturing and
    assessing the full effects of a community health promotion intervention. Scientific
    quality is assured by the use of different verification techniques and scientific criteria.
    Participation is of cardinal value as it contributes to health and serves multiple purposes in health promotion programs. Systematic learning processes can make participation manageable, and research activities are a proper way to facilitate those learning processes. Nonetheless, the potential of participation has not yet been harnessed. Participation thrives in principle-based programs: programs that are characterized by the co-generation of knowledge by involved stakeholders in a flexible and tailored way. To further develop and harvest the full benefit of participation and principle-based programs, researchers are challenged to broaden their research paradigm, practitioners are challenged to foster and coordinate principle-based programs, participation and learning processes and policymakers are challenged to stimulate and support science and practice. By participating and collaborating supportive social environments for health can be created.
    Cafestol: a multi-faced compound kinetics and metabolic effects of cafestol in mice
    Cruchten, S.T.J. van - \ 2010
    Wageningen University. Promotor(en): Renger Witkamp; Michael Muller, co-promotor(en): Guido Hooiveld. - [S.l. : S.n. - ISBN 9789085855545 - 196
    diterpenen - koffie - doseringseffecten - gezondheidsbevordering - gezondheidsgevaren - toxiciteit - cafestol - voeding en gezondheid - biotransformatie - toxicokinetiek - diterpenes - coffee - dosage effects - health promotion - health hazards - toxicity - cafestol - nutrition and health - biotransformation - toxicokinetics
    Cafestol and kahweol are two diterpenes present in unfiltered coffees such as Scandinavian-style boiled coffee, French press coffee and espresso. The health effects of cafestol and kahweol can be positive but also potentially harmful. On the one hand cafestol shows chemo-preventive properties, which might contribute to a reduction of the risk for certain cancers, especially colorectal cancer. On the other hand cafestol is known as the most potent cholesterol-raising compound present in the human diet and also causes a temporally rise in plasma ASAT and ALAT enzymes. This apparently ‘two-faced’ behavior of cafestol was the starting point of this thesis. It was demonstrated that in mice cafestol is extensively metabolized by the liver. Metabolism was found to be associated with Nrf2 activation, causing an induction of biotransformation enzymes and cellular antioxidant defense. This mechanism might explain the proposed anti-carcinogenic effects of cafestol. Furthermore, distribution studies indicated that in mice cafestol accumulates almost exclusively in liver and intestine, and suggested that cafestol undergoes enterohepatic cycling. Further studies showed that cafestol prevents the development of diet-induced obesity, its metabolic complications, and the development of hepatic steatosis in mice. Modulation of the dietary fat content was also used to study the hepatic and intestinal response to cafestol at a transcriptomic level. We showed that dietary fat content is an important determinant of the effects of cafestol. This has been evaluated for several processes already known to be influenced by cafestol, such as bile acid metabolism and Nrf2-mediated biotransformation. Furthermore it was shown that cafestol activated Nrf2-mediated biotransformation both in liver and small intestine.
    It is concluded that cafestol behaves as a hormetic compound. It elicits a combination of mechanisms which together determine the balance between positive and negative health outcomes. Although for some mechanisms, i.e. the induction of biotransformation enzymes and acute liver toxicity, a connection seems plausible, several questions remain regarding their interrelations. This thesis has generated new mechanistic insights in the multi-faced behavior of cafestol. More studies, including in humans, are needed to study its dose-effect relations and interactions with dietary compounds. For the time being it is advisable to keep cafestol under scrutiny.

    Leven om te eten : Surinaamse en Antilliaanse vrouwen over eten, bewegen en overgewicht
    Wijk-Jansen, E.E.C. van; Jager, L.C. ; Kroon, S.M.A. van der - \ 2010
    Den Haag : LEI Wageningen UR (Rapport / LEI : Onderzoeksveld Consumenten & gedrag ) - ISBN 9789086154067 - 68
    voedingsgewoonten - overgewicht - beweging - etnische groepen - suriname - nederlandse antillen - vrouwen - gezondheidsbevordering - voeding en gezondheid - feeding habits - overweight - movement - ethnic groups - suriname - netherlands antilles - women - health promotion - nutrition and health
    In dit onderzoek is op basis van literatuurstudie en kwalitatief onderzoek meer inzicht verkregen in verklaringen voor het meer vóórkomen van overgewicht en obesitas bij vrouwen met een Surinaamse en Antilliaanse afkomst. Op basis van deze inzichten wordt een aantal aanbevelingen afgeleid voor overheidscommunicatie over overgewicht en obesitas richting vrouwen met deze afkomst.
    Gezond gewicht voor kleine mensen : informatie over gezond gewicht, gezonde voeding en beweging voor kleine mensen
    Appelhof, P. ; Rienks, J. ; Win, S. de - \ 2009
    BVKM Utrecht
    groeistoornissen - gezondheidsbevordering - lichaamsgewicht - dieetadvisering - voedselconsumptie - voeding en gezondheid - growth disorders - health promotion - body weight - diet counseling - food consumption - nutrition and health
    In dit onderzoek is gekeken op welke wijze mensen die door een groeistoornis klein blijven geholpen kunnen worden een gezond gewicht te bereiken en te behouden. Deze brochure bevat informatie over gewicht, productkeuzes, vetten, tussendoortjes, voedingsvezels, uit eten gaan en beweging voor kleine mensen
    Maak kennis met elkaars werkwijze en vakgebied : Vraag het de Expert: Senioren’ bijeenkomsten
    Groot, C.P.G.M. de - \ 2009
    VoedingsMagazine 22 (2009)5. - ISSN 0922-8012 - p. 21 - 23.
    ouderen - gezondheid - diëtisten - gezondheidsbevordering - voeding en gezondheid - elderly - health - dietitians - health promotion - nutrition and health
    About 4.2 million people over 55 years of age ('senior citizens') are currently living in the Netherlands, and anticipations are that their number will increase to 6 million by the year 2035. Like for other age groups, behavioural change yields health benefits for older people. Smoking cessation, a healthier diet and more physical exercise have positive health effects. Even if people do not pick up such behavioural change until after the age of 65, that change can still be effective. For example, men who quit smoking when they are 65 years old, live 1.4-2.0 years longer, and women even 2.7-3.7 years. For all people healthy ageing is a precondition for a happy life. Healthy ageing also implies living independently a life of good quality and taking part in society. The chance of realizing that is greater when senior citizens are coached by primary care professionals
    Interventies in het aanbod van voedsel : aangrijpingspunten voor overheidsbeleid om het aanbod van gezonde voedselproducten structureel te verbeteren
    Zondervan, C. ; Aramyan, L.H. ; Bakker, H.C.M. de; Feskens, E.J.M. ; Gilissen, L.J.W.J. ; Jansman, A.J.M. ; Knol, J.J. ; Koops, A.J. ; Meer, I.M. van der; Nap, J.P.H. ; Mul, A. de; Sluis, A.A. van der; Temme, E.H.M. ; Uijl, W. ; Wijk, R.A. de - \ 2009
    Wageningen : Agrotechnology & Food Sciences Group (Rapport / Agrotechnology and Food Innovations nr. 1039)
    voedselconsumptie - eetpatronen - consumentengedrag - gezondheidsbevordering - voedingsbeleid - gedragsveranderingen - overheidsbeleid - voeding en gezondheid - food consumption - eating patterns - consumer behaviour - health promotion - nutrition policy - behavioural changes - government policy - nutrition and health
    In opdracht van de ministeries van LNV en VWS geeft dit rapport een aantal aanbod- en productgeoriënteerde interventies die door overheden toegepast kunnen worden om Nederlandse consumenten te verleiden tot gezonder eet- en leefgedrag. Achterliggend doel is om met kwalitatief beter voedsel en een beter consumptiepatroon een bijdrage te leveren aan de algemene gezondheidstoestand
    'Bedroevende eetgewoonten jongeren zorgen over dertig jaar voor kanker'
    Kampman, E. - \ 2009
    Kennis Online 6 (2009)dec. - p. 12 - 12.
    neoplasma's - voedselconsumptie - eetpatronen - gezondheidsbevordering - voedingsgewoonten - ziektepreventie - voeding en gezondheid - neoplasms - food consumption - eating patterns - health promotion - feeding habits - disease prevention - nutrition and health
    Veertig procent van alle gevallen van kanker die artsen jaarlijks vaststellen, is het gevolg van een slechte voeding en overgewicht. Voedingswetenschappers weten ondertussen vrij precies welke veranderingen in het dieet die gevallen zouden voorkomen, maar krijgen dat niet voor het voetlicht. “De sociale wetenschappen zijn nu aan zet”, zegt Ellen Kampman, die is gespecialiseerd in de relatie tussen voeding en kanker
    Stofniveau biologische varkensstal onveilig hoog
    Winkel, A. ; Aarnink, A.J.A. - \ 2009
    V-focus 2009 (2009)12. - ISSN 1574-1575 - p. 35 - 36.
    varkenshouderij - varkens - varkensstallen - strooisel - stofbestrijding - stof - biologische landbouw - gezondheidsbevordering - arbeidsomstandigheden - dierenwelzijn - fijn stof - pig farming - pigs - pig housing - litter (plant) - dust control - dust - organic farming - health promotion - working conditions - animal welfare - particulate matter
    Biologische varkenshouders werken vaak langdurig in de stal vanwege de grote zorg voor de dieren. Daarnaast is strooisel een vereiste in de biologische varkenshouderij. Dit leidt ertoe dat biologische varkenshouders aan hoge stofconcentraties worden blootgesteld. Wageningen UR Livestock Research onderzocht samen met biologische varkenshouders hoe hoog de stofbelasting is en hoe zij zich tegen het stof kunnen beschermen
    National strategies for physical activity promotion
    Wink, G. ; Vlasveld, A. ; Vaandrager, L. ; Kronenburg, J. - \ 2009
    Tijdschrift voor Gezondheidswetenschappen 87 (2009)7. - ISSN 1388-7491 - p. 299 - 300.
    lichamelijke activiteit - lichaamsbeweging - gezondheidsbevordering - physical activity - exercise - health promotion
    Op 13 en 14 november 2008 kwamen vijftig professionals uit vijftien verschillende Europese landen bijeen in Wageningen om kennis en ervaring uit te wisselen over nationale strategieën voor beweegstimulering. De internationale werkconferentie werd georganiseerd door het Nederlands Instituut voor Sport en Bewegen (NISB), in samenwerking met Wageningen Universiteit, ZonMw en WHO/HEPA (European network for the promotion of health-enhancing physical activity). Speciale aandacht ging uit naar het betrekken van groepen met een lage sociaal-economische status (SES). Het programma en de gekozen werkvormen bood de deelnemers uit praktijk, beleid en onderzoek, volop gelegenheid met elkaar in gesprek te gaan.
    De gezondheid van Obelix? : over feestmalen en toverdrankjes
    Feskens, E.J.M. - \ 2009
    Wageningen : Wageningen Universiteit - ISBN 9789085852674 - 32
    stofwisselingsstoornissen - metabolisme - diabetes mellitus - obesitas - overgewicht - gezondheidsbevordering - volksgezondheid - metabolic disorders - metabolism - diabetes mellitus - obesity - overweight - health promotion - public health
    De verrassende X-factor van klinische voeding
    Vries, J.H.M. de; Witkamp, R.F. ; Schols, A.M. - \ 2008
    Voeding Nu 10 (2008)12. - ISSN 1389-7608 - p. 26 - 27.
    klinische voeding - voedselwetenschappen - voedingsonderzoek - humane voeding - gezondheidsbevordering - voeding en gezondheid - clinical nutrition - food sciences - nutrition research - human feeding - health promotion - nutrition and health
    In hoeverre kan de voeding een rol spelen bij de behandeling van een ziekte of mogelijk zelfs de genezing bevorderen? Waar houdt de rol van voeding op en waar begint de farmacotherapie? De kloof tussen voeding en farma wordt echter smaller en op sommige terreinen is er sprake van een verregaande integratie. Het vakgebied van de klinische voeding ontwikkelt zich erg snel
    Water en olie, dat mengt niet vanzelf : onderzoek naar theoriegebruik bij leefstijlcampagnes
    Wevers, A. ; Renes, R.J. ; Woerkum, C.M.J. van - \ 2008
    [S.l.] : ZonMw - ISBN 9789085852292 - 99
    levensstijl - campagnes - ziektebestrijding - gezondheidseducatie - gezondheidsbevordering - informatieverspreiding - efficiëntie - theorie - onderzoek - kwalitatieve analyse - kwantitatieve analyse - volksgezondheid - nederland - kwalitatieve methoden - kwantitatieve methoden - lifestyle - campaigns - disease control - health education - health promotion - diffusion of information - efficiency - theory - research - qualitative analysis - quantitative analysis - public health - netherlands - qualitative methods - quantitative methods
    Zorglandbouw op koers, maar blik op verdere professonalisering
    Oltmer, K. ; Venema, G.S. - \ 2007
    Agri-monitor 2007 (2007)mei. - ISSN 1383-6455 - 3
    landbouwondernemingen - bedrijfsontwikkeling in de landbouw - agrarische bedrijfsvoering - ondernemerschap - bedrijfsresultaten in de landbouw - gezondheidsbevordering - zorgboerderijen - farm enterprises - farm development - farm management - entrepreneurship - farm results - health promotion - social care farms
    Het aantal agrarische bedrijven met een zorgtak is de afgelopen jaren sterk toegenomen. Terwijl de opbrengsten vrij goed in beeld te brengen zijn, is er weinig zicht op de kostprijs van een zorgplaats. In een verdere professionaliseringsslag zou de sector zich, naast de nadere concretisering van de kostprijs, moeten richten op een verdieping van het ondernemerschap.
    Effect van teeltmaatregelen, afrijping en bewaring op inhoudstoffen, droge stofgehalte en kiemrust van uien
    Broek, R.C.F.M. van den; Versluis, H.P. - \ 2007
    Kennisakker.nl 2007 (2007)15 feb.
    uien - allium cepa - kunstmeststoffen - gezondheidsbevordering - gewasopbrengst - bemesting - akkerbouw - onions - allium cepa - fertilizers - health promotion - crop yield - fertilizer application - arable farming
    De teelt van uien heeft zich altijd gericht op de productie en het verkrijgen van een gezond en houdbaar product. Er blijken echter meer producteigenschappen te zijn die door de teelt beïnvloed kunnen worden. Bij een groot aantal mensen is bekend dat uien gezond zijn en smaak geven aan het voedsel. De gezondheidsbevorderende eigenschappen heeft de ui te danken aan onder andere quercetin en organische zwavelverbindingen. De smaak van de ui wordt bepaald door het pyruvaatgehalte en de hoeveelheid en samenstelling van de suikers (fructanen). De vraag is of door teeltmaatregelen deze stoffen verhoogd kunnen worden. In 2003 en 2004 is door middel van veldproeven nagegaan wat het effect is van stikstofbemesting, zwavelbemesting, rassenkeuze en oogsttijdstip op de opbrengst en bewaring van uien en op de genoemde inhoudsstoffen.
    Dit product werkt tegen kanker (misschien)
    Baars, J.J.P. - \ 2007
    Paddestoelen : onafhankelijk vakblad voor Nederland en België 2007 (2007)6. - ISSN 1380-359X - p. 20 - 21.
    eetbare paddestoelen - gezondheid - gezondheidsbevordering - pleurotus - lentinula edodes - functionele voedingsmiddelen - consumenteninformatie - voedingsmiddelenwetgeving - voeding en gezondheid - edible fungi - health - health promotion - functional foods - consumer information - food legislation - nutrition and health
    In een tijd van lage prijzen en een verzadigde markt, is het aantrekkelijk om de verkoop van paddenstoelen kracht bij te zetten met nieuwe argumenten. Het meest voor de hand liggend is om de mogelijk gezondheidsbevorderende stoffen in paddenstoelen in te zetten voor vermarkting. Dat gaat echter niet zomaar
    Handleiding - Audit Referentiekader Gezondheidsbevordering. Deelrapport 2A, Pilot project Referentiekader Gezondheidsbevordering.
    Saan, H. ; Haes, W. de; Hekkink, C. ; Wagemakers, A. - \ 2007
    Woerden : NIGZ (NIGZ - Rapport ) - 31
    gezondheidsbevordering - volksgezondheid - gezondheidsbeleid - gezondheidsbescherming - health promotion - public health - health policy - health protection
    Deze handleiding bij de ontwikkelde audit, die gebaseerd is op het referentiekader volgt het stimulerende spoor: professionals die dat willen kunnen met het Referentiekader in de spiegel kijken en onderzoeken of hun uitgangspunten wel voldoende tot zijn recht komen, of de voorliggende kansen wel benut worden en of goed gebruik gemaakt is van beschikbare professionele inzichten en wetenschappelijke kennis. Het is bedoeld om een beleidsplan of een programma goed door te lichten
    Verslag 2e themacongres Gezondheidsmanagement, Bedrijf in Beweging 15 maart 2007
    Baart, L. ; Cappelleveen, C. van; Hofstee, M. ; Raaijmakers, T. ; Straaten, I. van; Vaandrager, L. - \ 2007
    Amersfoort : WUR/IHMQ/B&R/Lifeguard - 26
    arbeid (werk) - gezondheid op het werk - gezondheidsbeleid - gezondheidsbevordering - bedrijfsvoering - levensstijl - gezondheid - labour - occupational health - health policy - health promotion - management - lifestyle - health
    Verslag van de discussies, lezingen en presentaties gehouden tijdens het congres Gezondheidsmanagement, Bedrijf in Beweging, over gezondheidsbeleid op het werk
    Hoe zoutconsumptie beperkt kan worden: theorie en praktijk
    Sikkes, E. ; Geleijnse, J.M. - \ 2007
    Voeding en Diëtetiek 62 (2007)3. - p. 26 - 27.
    zout - consumptie - gezondheidsbevordering - gezondheidsbescherming - maaltijden - zoutgehalte - salt - consumption - health promotion - health protection - meals - salinity
    Ellen Sikkes, diëtist bij Dianet Dialysecentra, locatie Utrecht, en Marianne Geleijnse, epidemioloog/voedingskundige bij de afdeling Humane Voeding, Wageningen Universiteit, over de kwestie hoe zoutconsumptie in theorie en praktijk beperkt kan worden. Overmatig zoutgebruik is niet goed voor de gezondheid
    Verspreidings- en Implementatieplan Life 21
    Sneijder, P.W.J. ; Koelen, M.A. ; Lamerichs, J.M.W.J. ; Molder, H.F.M. te; Nierop, P. van - \ 2007
    Wageningen : Sectie Communicatiewetenschap Wageningen UR, ism GGD Eindhoven - 46
    gezondheidsbevordering - levensstijl - adolescenten - jeugd - health promotion - lifestyle - adolescents - youth
    In februari 2007 zijn de sectie Communicatiewetenschap van Wageningen Universiteit en de afdeling Gezondheidsbevordering van de GGD Eindhoven gestart met het verspreidings- en implementatieplan LIFE 21. Ingegaan op de achtergronden van het project LIFE 21 en op het ontstaan van de discursieve actie methode. Tijdens LIFE21 is deze methode ontwikkeld waarmee jongeren in staat waren hun eigen gesprekken op toegankelijke wijze te analyseren. Ook komt aan de orde hoe de methodiek aansluit bij huidige ontwikkelingen in gezondheidsbevordering
    Paddenstoelen als functional foods?
    Baars, J.J.P. ; Sonnenberg, A.S.M. - \ 2007
    Voeding Nu 9 (2007)10. - ISSN 1389-7608 - p. 13 - 15.
    functionele voedingsmiddelen - eetbare paddestoelen - gezondheidsbevordering - voedingswaarde - glucanen - productontwikkeling - voedselconsumptie - functional foods - edible fungi - health promotion - nutritive value - glucans - product development - food consumption
    De laatste jaren is er een toenemende wetenschappelijke belangstelling voor gezondheidsbevorderende stoffen in paddenstoelen. De auteurs zien aanknopingspunten voor een advies om de paddestoelenconsumptie in de bevolking te verhogen, gezien de voedingswaarde ervan. Ook zouden volgens hen functional foods op basis van paddenstoelen het licht kunnen zien
    Sociaal draagvlak : verslag van de uitwerking van 'sociaal draagvlak' voor het pilot project Referentiekader Gezondheidsbevordering
    Wagemakers, M.A.E. ; Vaandrager, L. ; Koelen, M.A. ; Dijkema, P. ; Corstjens, R. - \ 2007
    Wageningen : Gezondheid en Maatschappij, Wageningen Universiteit - 115
    gezondheidsbevordering - attitudes - volksgezondheid - maatschappelijk draagvlak - health promotion - attitudes - public health - public support
    Sociaal draagvlak is uitgewerkt aan de hand van de begrippen participatie en samenwerken. Immers, door participatie en door samenwerking ontstaat sociaal draagvlak. Dit is een belangrijke reden dat in zogeheten community-based programma’s op het terrein van gezondheidsbevordering zowel participatie als samenwerken als essentiële elementen opgenomen worden. In verschillende stappen komen aan bod: het definiëren en operationaliseren van sociaal draagvlak, het in kaart brengen van de werkwijzen en meetinstrumenten om sociaal draagvlak te meten en te evalueren, het (verder) ontwikkelen van een aantal meetinstrumenten en het toetsen van deze meetinstrumenten in de praktijk.
    Consumer understanding of health claims : summary report of a workshop held in May 2006 in Florence, Italy, organised by the ILSI Europe Consumer Science Task Force
    Leathwood, P.D. ; MacFie, H. ; Trijp, J.C.M. van - \ 2007
    Brussels : ILSI (Report Series / ILSI Europe Consumer Science Task Force ) - ISBN 9789078637073 - 26
    etiketteren van voedingsmiddelen - consumenteninformatie - consumenten - gezondheidsbevordering - voedingsmiddelenwetgeving - functionele voedingsmiddelen - Nederland - nutrition labeling - consumer information - consumers - health promotion - food legislation - functional foods - Netherlands
    The pregnancy: time for a new beginning! : exploring opportunities and challenges for healthy nutrition promotion
    Szwajcer, E.M. - \ 2007
    Wageningen University. Promotor(en): Gerrit Jan Hiddink; Cees van Woerkum, co-promotor(en): Maria Koelen. - [S.l.] : S.n. - ISBN 9789085046707 - 170
    zwangerschap - dieet - voedingseducatie - voedingsinformatie - gezondheidsbevordering - voedingsgedrag - vrouwen - pregnancy - diet - nutrition education - nutrition information - health promotion - feeding behaviour - women
    In literature it has been suggested that there are certain special and critical transitions in life that my have a long-term impact on health and health behaviours in later periods of the life course. This is also known as the Life Course Perspective (LCP). The purpose of this thesis was to contribute to the rationale of healthy nutrition promotion activities aimed at women and their health behaviour in and around pregnancy, as such a special and critical transition in life. This was done by means of cross-sectional studies on nutrition awareness (qualitative and quantitative), nutrition-related information-seeking behaviours (qualitative) and underlying motivations (qualitative) among women before, during and after their pregnancy. In order to do this, the concept of nutrition awareness was explored and redefined. Mostly, awareness is defined as a matter of knowing about something. The result of this conceptualisation is that the link with behaviour becomes a problematic one. Therefore, we have chosen for a more ‘active’. Nutrition awareness was defines as in saliency, preoccupation and supervision of nutrition. Furthermore, we looked at the autonomy of motivations of nutrition awareness. Autonomously motivated women in the period around the pregnancy are more likely to make longer lasting behavioural changes, which is favour of the LCP. Finally, special attention was paid to nutrition communication in the midwifery practice as a more specific setting for healthy nutrition promotion directed at all pregnant women. The results of these studies showed that the LCP is a new and hardly or insufficient explored domain in nutrition promotion and pregnancy. It can be concluded that the LCP-concept provides interesting opportunities for healthy nutrition promotion directed at women who are starting a family. In transition to pregnancy and motherhood, women are motivated to change health-related behaviours that are difficult to modify at other times. Moreover, it can be concluded that our conceptualisation of awareness is fruitful in obtaining a better understanding of possible behavioural changes in health in relation to the LCP. Also nutrition awareness, nutrition-related information-seeking behaviours and associated motivations are a good basis for distinguishing groups of women in the period around their pregnancy.
    Televisie voor dik en dun : onderzoek naar de effecten van een Entertainment-Education programma
    Mutsaers, K. ; Woerkum, C.M.J. van; Renes, R.J. - \ 2006
    Wageningen : Communicatiemanagement, Wageningen Universiteit - ISBN 9789085851035 - 174
    gezondheidseducatie - gezondheidsbevordering - vertier - methodologie - televisie - uitstrooien - efficiëntie - publiek - psychologie - motivatie - menselijk gedrag - gewichtscontrole - Nederland - health education - health promotion - methodology - television - broadcasting - entertainment - weight control - efficiency - audiences - psychology - motivation - human behaviour - Netherlands
    Nutrition Communication in Dutch General practice: integration of the patients' perspective and the family doctors' perspective
    Dillen, S.M.E. van - \ 2005
    Wageningen University. Promotor(en): Gerrit Jan Hiddink; Cees van Woerkum, co-promotor(en): Maria Koelen. - Wageningen : Grafisch Service Centrum - ISBN 9789085042488 - 180
    gezondheidsbevordering - gezondheidseducatie - communicatie - huisartsen - patiënten - ziekten - hart- en vaatziekten - suikerziekte - nederland - voedingseducatie - voedingsinformatie - diëten - health promotion - health education - communication - general practitioners - patients - diseases - cardiovascular diseases - nutrition education - nutrition information - diets - diabetes - netherlands
    A sound nutrition advice is important for patients with coronary heart disease, diabetes and obesity. The family doctor has high potential to promote nutrition to their patients through its broad reach, including the hard-to-reach low socio-economic class. Unfortunately, in daily practice of most family doctors, this nutrition communication is not optimal. Therefore, a combination of qualitative and quantitative studies among patients and family doctors was performed in order to explore and assess their communicative characteristics regarding nutrition communication.

    In our literature review, we searched for studies about the occurrence, the patients' perspective and the family doctors' perspective regarding nutrition communication in general practice. It can be concluded that results about the occurrence of nutrition communication in general practice differed widely. Moreover, patients' perceptions regarding nutrition communication through family doctors appeared to be positive. Family doctors' perceptions were positive too, but they also experienced several barriers, such as lack of time and patient non-compliance.

    To explore and assess the patients' perspective, we used focus groups, in-depth interviews and face-to-face interview-assisted questionnaires. A discrepancy between perceived relevance and information needs regarding food topics was discovered. Patients' perceptions regarding nutrition communication through family doctors were positive. Whereas patients had difficulties with estimating their nutrition behaviour, nutrition awareness is important as a first step in behavioural change. With our hypothetical model, we were able to unravel the concept of nutrition awareness. Individual variables were more prominent than environmental variables. In addition, gender and age added to our model. Total explained variance appeared to be 54%.

    In order to explore and assess the family doctors' perspective, we used focus groups and questionnaires. These studies showed that family doctors' were positive about nutrition communication towards their patients. However, they did not always feel capable to communicate about overweight. Moreover, family doctors used a combination of nutrition communication styles, namely informational, reference, motivational, confrontational and holistic nutrition communication styles. Our hypothetical model was tested for each nutrition communication style and showed explained variances up to 57%. Individual variables were the best predictors and socio-demographic variables did not add to the models. It is recommended that family doctors become convinced that patients prefer them for nutrition communication. Raising nutrition awareness among patients is necessary. Finally, we advise that family doctors realise that they can apply different nutrition communication styles.
    Halvarine met plantensterolen van de verzekering [Cost of foods fortified with plant sterols refunded by a health insurance company]
    Katan, M.B. - \ 2005
    Nederlands Tijdschrift voor Geneeskunde 149 (2005)7. - ISSN 0028-2162 - p. 330 - 332.
    margarine - sterolen - voedselsamenstelling - gezondheidsbevordering - cholesterolverlagende middelen - voedselverrijking - volksgezondheid - ziektepreventie - ziektekostenverzekering - foliumzuur - margarine - sterols - food composition - health promotion - anticholesteremic agents - food enrichment - public health - disease prevention - health insurance - folic acid
    The Dutch health insurance company VGZ recently decided to refund part of the cost of using spread, yogurt and milk fortified with plant sterols. Plant sterols lower plasma cholesterol concentrations but they do so less effectively than statins. For health insurance companies wishing to improve the health of their clients, it would be more logical to reimburse costs of folic acid supplements for the prevention of neural tube defects, and vitamin-D-enriched products to prevent fractures in elderly people
    Marktwerking in het voedingsonderzoek : goed voor de volksgezondheid?
    Katan, M.B. - \ 2005
    Voeding Nu 7 (2005)2. - ISSN 1389-7608 - p. 11 - 13.
    marktconcurrentie - voedingsonderzoek - gezondheid - innovaties - volksgezondheid - gezondheidsbevordering - market competition - nutrition research - health - innovations - public health - health promotion
    Marktwerking in het voedingsonderzoek werkt niet, het leidt niet tot werkelijke innovatie of verbetering van de gezondheid. Samenvatting van de Gezondheidraadslezing die Martijn Katan, Wageningen Universiteit, op 28 oktober 2004 hield in de Nieuwe Kerk in Den Haag
    Health Education and Health Promotion
    Koelen, M.A. ; Ban, A.W. van den - \ 2004
    Wageningen : Wageningen Academic Publishers - ISBN 9789076998442 - 285
    gezondheidseducatie - gezondheidsbevordering - studieboeken - health education - health promotion - textbooks
    This book is a comprehensive resource for theory, research and action in health education and health promotion. The authors describe strategies and actions for health education and health promotion based on theories for understanding, predicting and changing behavioural, social and environmental determinants of health. The book also offers a conceptual framework for planning, evaluation and research and discusses ethical issues in health promotion.
    Voeding en gezondheid - zin en onzin van voedingssupplementen en functionele voedingsmiddelen
    Katan, M.B. ; Roos, N.M. de - \ 2003
    Nederlands Tijdschrift voor Geneeskunde 147 (2003)2. - ISSN 0028-2162 - p. 60 - 65.
    voedselsupplementen - gezondheidsbevordering - ziektepreventie - gezondheidsvoedsel - wetgeving - bescherming van de consument - nederland - functionele voedingsmiddelen - food supplements - health promotion - disease prevention - health foods - legislation - consumer protection - netherlands - functional foods
    In sommige gevallen hebben functionele voedingsmiddelen een meerwaarde boven traditionele voedingsmiddelen, maar de regelgeving in Nederland is onvoldoende om de consument te beschermen tegen misleiding
    Nutrigenomics onmisbaar voor onderzoek naar veilige en gezonde voeding
    Keijer, J. - \ 2003
    Voedingsmiddelentechnologie 36 (2003)23. - ISSN 0042-7934 - p. 30 - 32.
    voedingsonderzoek bij de mens - voedingsonderzoek - genetische merkers - voedingsmiddelen - bio-informatica - gezondheidsbevordering - genexpressieanalyse - invloeden - human nutrition research - nutrition research - genetic markers - foods - bioinformatics - health promotion - genomics - influences
    Nutrigenomics en onderzoek naar de manier waarop voeding onze gezondheid beïnvloedt. In onderzoek naar vroege biomarkers kunnen de effecten op de gezondheid in een vroeg stadium worden voorspeld
    Consumentgerichte ontwikkeling van functionele voedingsmiddelen
    Kleef, P.W. van; Trijp, J.C.M. van; Luning, P.A. ; Jongen, W.M.F. - \ 2003
    Elsevier Voedingsmiddelen Industrie 4 (2003)2. - ISSN 1570-6907 - p. 35 - 44.
    productontwikkeling - chemische samenstelling - voedingswaarde - voedingsstoffenverbetering - voedseladditieven - voedselsupplementen - eigenschappen - gezondheidsbevordering - voedingsmiddelenwetgeving - consumentenvoorkeuren - functionele voedingsmiddelen - product development - chemical composition - nutritive value - nutrient improvement - food additives - food supplements - properties - health promotion - food legislation - consumer preferences - functional foods
    Innovatie in voedingsmiddelen kan voortkomen uit hetzij een beter begrip van de vraag van de consument (pull) of uit een verbetering aan de toeleveringskant (push) door wetenschap en technologie. In ieder geval hangt een marktsucces af van de mate waarin de nieuwe producten tegemoetkomen aan tot nu toe onvervulde wensen van de consument. Dit onderzoek levert een kader dat het mogelijk maakt om relevante input te verkrijgen van zowel consumenten als deskundigen in de eerste fasen van de ontwikkeling van funcionele voedingsmiddelen. Door middel van het systematisch genereren en zorgvuldig screenen van een omvangrijke verzameling concepten van functionele voedingsmiddelen, zowel binnen het bedrijf (deskundigen m.b.t. functionele voedingsmiddelen) als buiten het bedrijf (consumenten), wordt met dit kader voorkomen dat men mogelijkheden met veel potentieel over het hoofd ziet. Op zijn beurt verschaft dit een platform voor productontwikkelaars t.b.v. discussie en besluitvorming aangaande welke mogelijkheden een vervolg moeten krijgen. De illustratie van het kader laat de mate zien waarin de oordelen van deskundigen een accurate weergave vormen van de vraag van de consument
    Voeding en gezondheid - genetisch gemodificeerd voedsel
    Kuiper, H.A. ; Kleter, G.A. ; Kok, E.J. - \ 2003
    Nederlands Tijdschrift voor Geneeskunde 147 (2003)2. - ISSN 0028-2162 - p. 56 - 60.
    genetische modificatie - gewassen - voedselgewassen - transgene planten - gezondheidsbevordering - voedselveiligheid - genetic engineering - crops - food crops - transgenic plants - health promotion - food safety
    Tot nu toe hebben genetisch gemodificeerde gewassen alleen voordeel voor de landbouw. In de toekomst valt te verwachten dat deze gewassen zullen bijdragen tot een verbetering van de voedselkwaliteit en gezondheid. De voedselveiligheid wordt onderzocht door nieuwe en oude gewassen met elkaar te vergelijken en de verschillen toxicologisch en op voedingswaarde te testen
    Mum to mum : an evaluation of a community based health promotion programme for first-time mothers in the Netherlands
    Hanrahan-Cahuzak, M.H. - \ 2002
    Wageningen University. Promotor(en): C.M.J. van Woerkum; C.M.H. Hosman; M.A. Koelen. - S.l. : S.n. - ISBN 9789058086389 - 175
    gezondheidsbevordering - gezondheidseducatie - sociaal welzijn - moeders - ziektepreventie - voorlichting - zuigelingen - gezondheidszorg - nederland - baby's - health promotion - health education - health care - disease prevention - extension - social welfare - mothers - infants - netherlands - babies

    Background This study evaluated the Dutch Mothers Inform Mothers (MIM) programme. In that programme a visiting mother meets with a first-time mother in her home on a monthly basis to discuss the caring and rearing of her infant. The first-time mothers went also to the well-baby clinics in their locality where they discussed topics in the areas of psychosocial, cognitive and physical development, language, play and safety. The programme lasted for 18 months.

    Aim/objectives To evaluate the MIM programme with the view to:

    - provide information and, where appropriate, recommendations concerning the positioning of the programme in the Dutch public infant health services;

    - integrate appropriate theoretical perspectives into the MIM programme;

    - determine outcomes in relation to maternal mental health, maternal and infant general health, maternal competence with parenting and satisfaction with the well-baby clinic.

    Study design/ A literature review on parenting support programme focused on infant health.

    Instruments A cohort-study using a pre-test - post-test design with one experimental and two control groups. This was used to develop and test a model for the programme and to determine its effects. The mothers' progress was followed for 15 months, which covers the period of infancy. (After 15 months is the toddler period). Validated instruments were used to gather information.

    - An infant food consumption survey using 24 hour recall and questions on feeding practices (breast feeding or feeding bottle). For maternal fat consumption a popular questionnaire of the National Food Centre was used.

    Timing The pre-tests for mental health, social support and breastfeeding were administrated when the infants were approximately 6 weeks old (T1). Infant temperament, maternal and infant general health, maternal competence with parenting and satisfaction with the well-baby clinic were measured at 10 months, as was the nutritional survey. The post-tests were administrated when the infants were approximately 15 months old (T3).

    - A qualitative study was carried out to gain insights in the way MIM co-ordinators perceive visiting mothers and visa versa.

    Study population Total number of mothers was 346. In control group 1 (no MIM but using the

    same well-baby clinics as the experimental mothers) N = 221, control group II (no MIM and not the same well-baby clinics), experimental group (MIM plus attending well-baby clinic) N = 42.

    Results The visiting mothers visit on average two first-time mothers. This is very not enough for developing expertise as a visiting mother. The workload of co-ordinators was on average 25 visiting mothers / 50% FTE. Some mothers needing the programme were not accommodated due to illness of the programme's co-ordinator, absence of MIM co-ordinator, or because the caseload of visiting mothers are the co-ordinator were felt to be to high.

      • A first attempt was made to develop a theoretical framework for the MIM using maternal and infant characteristics together with social support factors. The boundaries of the model were set by Bronfenbrenner's theory on human ecology. Social support and infant temperament are important factors when caring and rearing a child. These factors are present in the maternal and infant health and maternal competence models. Partners' support with caring and household activities is especially important when a baby arrives. The factor lack of support is also present on numerous occasions.

    Unexpected was the importance of the factor life events during pregnancy and complicated delivery, which remained so in the development of maternal general health, even after 15 months.

      • MIM had no impact on maternal mental and general health, although maternal general health scores of the experimental mothers increased over time and those of the control mothers decreased. MIM also had no impact on infant general health. The administration of the last inoculation of the Mumps, Measles and Rubella vaccines coincided with the post-test. This may have influenced the infant health score. MIM had a significant impact on maternal competence with parenting. The lower score for maternal competence for MIM mothers measured at baseline had disappeared by T3 relative to the two control groups. The most important influence on maternal competence with parenting seems to be infant temperament. Satisfaction with the well-baby clinic increased over time for all groups. Participation in the MIM programme was not significant in the final longitudinal model, but was significant at baseline and T3. This means that there was no further deterioration in satisfaction with the well-baby clinic of MIM mothers relative to the other two groups in the last six months of the study.

    Given that lack of support has an important relationship with maternal mental health in T1, T3 and longitudinal regression models, it means that the factors identified by this regression indirectly contribute to the mother's state of mind.

    Conclusions The evaluation has shown positive programme effects, but these effects need to be improved for the programme to be cost-effective. The programme is instrumental in enhancing the quality of health promotion activities of well-baby clinic members; it plays a role in the quality assurance process and it has an effect on enhancing mothers' competence with parenting. There are no indications that MIM had an influence on the mediating variables. This may be influenced by the fact that variables not included in the study, such as maternal attitudes, locus of control, or self-efficacy, play a role in the theoretical MIM model. Making healthy choices the easy choices through MIM is a strategy for helping people to accept responsibility for healthiness of their own lives, recognising health as a resource to be protected and actively enhanced. In line with the nurses' scope of practice their role as facilitator and coach could be strengthened, giving more responsibilities to the visiting mothers and making MIM a truly community based and community-led programme.

    Antioxidatieve enzymen uit eendekroos
    Merck, K. ; Gerritsen, Y. ; Willemsen, J. - \ 2002
    Voedingsmiddelentechnologie 35 (2002)10. - ISSN 0042-7934 - p. 20 - 21.
    lemna minor - lemnaceae - medicinale planten - chemische samenstelling - enzymen - antioxidanten - vitaminen - essentiële aminozuren - waterplanten - toegepast onderzoek - voedselindustrie - gezondheidsbevordering - lemna minor - lemnaceae - medicinal plants - chemical composition - enzymes - antioxidants - vitamins - essential amino acids - aquatic plants - applied research - food industry - health promotion
    De toegenomen vraag naar gezondheidsbevorderende levensmiddelingrediënten en het enzym superoxide dismutase (SOD) dat als voedingssupplement wordt gebruikt
    Functional foods : verbindende schakel tussen food en farma?
    Stijnen, D. ; Dagevos, H. - \ 2001
    Voedingsmiddelentechnologie 34 (2001)3. - ISSN 0042-7934 - p. 16 - 17.
    voedselsamenstelling - voedingsmiddelen - voedseladditieven - toevoegingen - voedingswaarde - ingrediënten - effecten - gezondheidsbevordering - gezondheidsvoedsel - farmacologie - marketing - marketing van voedingsmiddelen - welzijn - food composition - foods - food additives - additives - nutritive value - ingredients - effects - health promotion - health foods - pharmacology - marketing - food marketing - well-being
    Argumenten voor het met vereende krachten betreden van de markt voor functional foods. De resultaten van een gezamenlijke studie door ATO en het LEI zijn vastgelegd in het rapport: "De wereld van functional foods: op het raakvlak van twee ketens". In twee artikelen wordt dit rapport behandeld
    The turtle and the peacock : collaboration for prosocial change : the entertainment - education strategy on television
    Bouman, M. - \ 1999
    Agricultural University. Promotor(en): C.M.J. van Woerkum, co-promotor(en): G.J. Kok; E.M. Rogers. - S.l. : Bouman - ISBN 9789054859956 - 279
    gezondheidseducatie - gezondheidsbevordering - gezondheid - communicatie - televisie - vertier - zepen - samenwerking - onderwijs - health education - health promotion - health - communication - television - entertainment - soaps - cooperation - education

    In the early eighties, a popular prime time drama serial Zeg eens A was being broadcast in the Netherlands. Health communication professionals who saw this series regarded it as an interesting setting in which to introduce and deal with health communication messages (see for example Bouman, 1984). At that time, however, collaborating with scriptwriters of popular television programmes was a problematic issue, due to the fact that health organizations had great reservations about using a popular medium like a tabloid, a gossip magazine, a soap opera or other drama series to communicate serious health messages (Dekker, 1985 personal conversation). Apart from their unfamiliarity with popular culture, health organizations feared losing their respectable image and, as a possible ultimate consequence, their funding. Although understandable, this showed an explicit tension between the goals of health communication and the goals of public relations and fundraising. Health communication professionals however saw that the messages of health organizations have to compete with thousands of other communication messages. If the attention of the target audience is to be caught and held, and more especially if that audience is not spontaneously interested in health messages, it is no longer sufficient to rely solely on the rationality of the message: other, more emotionally appealing and popular communication methods must also be brought into play. Some health organizations acknowledged this, but did not yet accept its consequences. Zeg eens A became the most popular Dutch drama serial of the eighties, but never carried a purposively designed and eloquently interwoven health message1.

    As time went by, the climate for using entertainment television for health communication purposes changed however, and worldwide a number of ways were found to incorporate health promotion messages into popular television entertainment. This approach is now known as the entertainment-education (E&E) strategy (Coleman & Meyer, 1989). In the Netherlands also, some challenging experiments were carried out in the late eighties, such as the drama series Familie Oudenrijn in 1987 (Verbeek, 1990), the Way of Life Show in 1988 (Nederlandse Hartstichting, 1988; Bouman, 1989) and Villa Borghese in 1991 (Bouman & Wieberdink, 1993).

    The first experiments with E&E television programmes initiated a lively discussion and debate about norms and values in the Dutch health communication field. This provided an impetus for the creation of new and experimental ways of reaching the so-called 'hard to reach' groups. Because of the many still unanswered questions, research in the field of the entertainment-education strategy is both necessary and rewarding.

    In the next four sections, some matters that need to be explicated will be touched upon. Section 1.1 defines some concepts frequently used in this thesis. Section 1.2 lists the research questions of the thesis. Section 1.3 gives a short overview of the health communication field, divided into organizations, health communication professionals and health communication strategies. Section 1.4 briefly describes the field of television in the Netherlands. Section 1.5 gives an overview of the thesis chapters, and section 1.6 summarizes this chapter.

    Definitions
    The subject of this thesis is collaboration for prosocial change; the entertainment-education strategy on television. The concepts in the title of this thesis are defined as follows:

    1. In this thesis, collaboration refers to two different professional fields working together to design and produce a television programme in which entertainment and education are combined. The two professional fields concerned are the field of health communication and that of television production. In a wider sense these represent national health organizations on the one hand and broadcasting companies and independent production companies on the other; in a narrower sense they are the health communication professionals and television professionals working within these respective organizations.
    2. The term prosocial denotes 'that which is socially desirable'. From a critical theory perspective, questions can be raised about what is socially desirable (see also Chapter 2, section 2.4.). In this thesis, health is the object of prosocial change. Health is defined by the World Health Organization (WHO) as 'a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity' (WHO, 1986). The goals of prosocial and health communication, as referred to in this thesis, are directly derived from policy papers as formulated and formalized by national governments, and indirectly by international organizations, such as the WHO.
    3. In this thesis, change agencies are national health organizations. National health organizations as change agencies are defined here as either government related agencies or non-governmental organizations (NGOs) and the change agents are health communication professionals who work within these organizations. Health communication is regarded here as an essential element of the wider concept of health promotion. Some of the researched projects in this thesis also concern broader health related issues, such as environmental communication or road safety, but the term 'health communication' will be used as an overall concept for all forms of prosocial communication with which this thesis deals.
    4. Entertainment-education (E&E) strategy refers to the combination of entertainment and education in order to promote prosocial change. In Chapter 2 the definition of the entertainment-education strategy will be elaborated. The E&E strategy can be applied to different popular media: theatre, music, film, radio, television, etc. This thesis focuses on the use of the E&E strategy in television.

    Research questions
    Television entertainment as a potential vehicle for health promotion is regarded as a challenging concept. A study into the use of the E&E strategy in television refers to such questions as: 'What are the characteristics of television programmes in which education has been or can be combined with entertainment?' 'How effective is the E&E strategy?' 'Which facilitating or hindering factors play a role in the collaboration between health communication and television professionals when making an E&E television programme?' 'Is it possible to develop a working model that helps practitioners to decide if and how an entertainment-education programme can be designed and produced successfully?' These - and other - questions have led to the central research question, which is twofold:

    • A) What are the characteristics of entertainment-education (E&E) television programmes which are purposively designed to enhance prosocial behaviour, and what is known about their effects and conditions for success?
    • B) How do health communication and television professionals collaborate in the design and implementation of an E&E television programme and what recommendations can be made for the management of E&E collaboration in the future?

    Anderson and Meyer (1988) indicate that the motives of a researcher to investigate a certain topic can be epistemological in nature, but the results and implications of the research can be ideological and economic. In this study all these components play a part. As E&E practice is ahead of E&E theory, the aim of this research is to transpose the experiences of E&E practice into a theoretical framework and to add new concepts to the discourse of E&E communication professionals. In order to answer the questions posed in this thesis, the following research has been undertaken:

    • A review of the literature on the theory and practice of health communication, mass media (television) and the entertainment-education strategy;
    • An analysis of the quantitative data of Dutch E&E research;
    • An analysis of E&E television programmes worldwide;
    • A review of the literature on television production and collaboration;
    • An in-depth qualitative study into the collaboration process between health communication professionals (N=18) and television professionals (N=12) on twelve Dutch E&E television programmes.
    • As the E&E strategy is not yet widely known, let alone implemented in Dutch health communication and television practice, a rather broad scope has been chosen in this thesis. The disadvantage of this is that not all related subjects can be given an exhaustive treatment. The advantage, however, is that a solid basis is created for further analysis and research.

    Epilogue I

    Conclusions and lessons learned (Summary part I)
    The purpose of this section is to summarize some of the experiences and lessons of the E&E television programmes studied here in order to assist the design of E&E television programmes in the future and to answer the first part of the central research question in this thesis:

    A)What are the characteristics of entertainment-education (E&E) television programmes which are purposively designed to enhance prosocial behaviour, and what is known about their effects and conditions for success?

    Characteristics
    Entertainment-education (E&E) television programmes which are purposively designed to enhance prosocial behaviour are not just regular television programmes. In order to be effective, the design of E&E television programmes (drama, comedy and soaps, or quizzes, gameshows and talkshows/magazines) should be based on the principles of vicarious learning and social modelling. The actual modelling and observational learning process is governed according to Bandura (1986) by four interrelated subprocesses: attention, retention, production and motivation (see Chapter 2, section 2.3.5). Based on these four processes, combined with the research results of the design and effects of E&E television programmes worldwide, the following characteristics can be identified as important for the design and success of E&E television programmes:

    Attention process
    First, the socially desirable television model must catch the attention of the audience (observer). In entertainment-education television, this is achieved by using a popular programme genre. Other variables, such as the perceived credibility and attractiveness of the model, also come into play. It is important to use spokespersons (show host, stars, actors) that the audience will trust and believe. Entertainment-education television must be of high quality, using skilled and talented professionals. The production quality has to meet or exceed media standards. It is important to keep entertainment in the foreground and education in the background. First the audience has to get involved in the programme, later messages can be introduced and incorporated. It is important to cater for both the head and the heart and to be dramatic and moving. Although different kinds of programme formats have been used in E&E television studies, varying from talk and gameshows and variety shows to popular soap and drama series, realistic social drama is especially successful in involving people emotionally. There is much inconsistancy about the effectiveness of humour. Studies concluded that in order to be an effective aid to learning, humour must be at least meaningfully related to the material to be learned. The humour should coincide perfectly with the critical learning opportunity.

    Retention process
    In order to reproduce the behaviour without the presence of the model, it is necessary to retain the image and verbal symbols that are provided. Retention of modelled information is enhanced when viewers perceive the model and the circumstances to be similar to themselves and significant in their lives. The programme has to involve a variety of problems which are eventually solved to the benefit of positive role modelling characters.

    It is necessary to present role models who exchange ideas and opinions about the prosocial issue involved. In this way, different segments of the population will be able to identify with the issue at hand. Vicarious learning can best take place when viewers identify with and relate to these role models and when viewers recognize issues as relevant for their daily lives. This way, television programmes can serve as touchstones for experiences which viewers have and which they see reflected in the programme. The programme has to be realistic, set in todays world, include events in different settings (urban and rural), and depict characters who are regarded by the viewers as 'people like us'.

    Depicting lifelike situations and portraying social models who are 'people like us' is an essential part of E&E television programming to create the circumstances necessary for social learning and to enhance a feeling of involvement. A realistic programme does not mean that every detail must conform to reality, but that it has a contemporary setting, that it concerns itself with secular action (human action described in exclusively human terms) and that it is socially extended, which means that it deals with the lives and experiences of ordinary people. With reference to the latter, to avoid feelings of embarassment or stigmatization, it is advised to depict positive role models with a slightly higher aspiration level. Domestic productions with outdoor scenes at well known sites, using colloquial language, make E&E television more realistic.

    The essence of the entertainment-education strategy is to use television characters as models of behaviour and to encourage audience members to talk each other into practising the desirable behaviour they see portrayed. Entertainment-education programmes are designed to stimulate and enhance parasocial interaction between viewers and television personalities and characters and encourage talking with neighbours, family and friends about what they have seen on television. Memorable images and the acting out of prosocial behaviour are remembered better and longer than dialogues and lectures about such behaviour. E&E television programmes have to link in with what is already part of public awareness. The influence is problably greater when a message evokes recognition and then adds an idea or concrete information to that, rather than when it is contradictory to the prevailing opinion. It is important that E&E television programmes address their objectives by associating them with pre-existing human values and dramatizing how specific role models learn to actualize these values in their lives by practising the prosocial behaviour.

    Production process
    The third subprocess that influences the degree of modelling is called the production process. This process addresses the ability of the individual to replicate the observed behaviour, or the translation of retained symbols into guides for future behaviour. In order to reproduce the modelled behaviour it is important to tell audiences what they can do now, referring them to sites (e.g. address, telephone, Internet page) for answers on questions or to services or service providers that are familiar, available and ready. Some ways to do this are: (1) by using several 'reality reminders' epitomizing appropriate behaviour; (2) by 'advising' viewers how to deal with specific situations; and (3) by introducing epilogues to programmes to summarize the main educational points and to provide specific information about the services and infrastructure needed for viewers to convert an intention, motivated by the television programme, into action. Direct messages work best, especially with hard to reach audiences. Researchers report that respondents with lower levels of education gained more from factual information and knowledge about health issues than from more subtle messages conveying particular attitudes from which they were sometimes unable to draw appropriate inferences. Respondents with higher levels of education, however, gained most from the inferential messages tackling prejudice and attitudes. This confirms that different audiences demand different kind of message frames. Clear cut factual information and practical advice seems to meet especially the needs of the less well educated, while implicit contextual information suits more highly educated audiences. It is also suggested that a more direct approach may be more successful in addressing issues where attitude change is likely to be particularly difficult. It is important to focus on so-called 'personal efficacy', or the extent to which people think that they have the skills to change their behaviour. Focusing on imparting skills to handle different situations seems to offer a better prospect for changing behaviour than emphasising the damaging effects for health. Another approach which does not place too heavy an emphasis on the transfer of information and does not become too serious, is to depict how ordinary people deal with dilemmas in everyday life: how they share emotions, exchange ideas and arguments about a certain issue and how they make their final choice for one or the other behaviour.

    Message framing based on a 'consumer approach' supports and empowers lay people, in contrast to a 'medical approach', which underlines and supports the central role of the educated health care professional. Message framing according to a 'look after yourself' approach focuses on individual lifestyle determinants of health problems, and an 'environmental approach' stresses the socio-economic determinants and conditions of health problems.

    Motivation and reinforcement process
    The most important and decisive subprocess is motivation and reinforcement. An individual may observe, retain and have the ability to translate the retained symbols into specific behaviour, yet not do so unless favourable incentives are introduced. Motivational processes address incentives to exhibit modelled behaviour, including direct and vicarious rewards. There are three types of modelling characters with whom the audience needs to identify closely in order to vicariously experience the rewards (or punishment) for practising the promoted behaviour: (1) those who support the prosocial behaviour (positive role models), (2) those who reject it (negative role models), and (3) those who move from antisocial to prosocial behaviour (transition models). In entertainment-education television programmes, the observer or viewer learns vicariously by watching a television model being visibly rewarded or punished immediately after the model engages in prosocial or antisocial behaviour. These rewards or punishments must be realistic and can vary from subtle gestures to more explicit moral statements.

    Effects
    In general we can say that, from a social marketing perspective, the use of entertainment television formats has been very beneficial. Most programmes gratified both the need for entertainment and education and attracted a huge public, in ways that cannot be achieved by straight-forward didactic approaches. The programmes had favourable prime time slots which are never given to more conventional health education television formats. The most reported impact of E&E television programmes was at the level of exposure and awareness. Several results have also been reported in affecting knowledge, attitude and even in some cases a change of behaviour regarding the prosocial issue. The strength of E&E television programmes lies especially in social modelling, social reinforcement and interpersonal communication. Some E&E television programmes were also successful in triggering and mobilizing local communities (collective efficacy). While the direct effects of most E&E programmes were modest, the indirect effects via the encouragement of peer comunication can be substantial. Effects occur through the social psychological processes of social modelling, parasocial interaction and efficacy building which take place particularly when audience members discuss the content of an E&E message in peer communication. Although generally E&E television proved successful in raising the attention of the audience in respect of the prosocial issue and in communicating the message as intended, clearly failure has to be accepted in certain areas. The entertainment education strategy is not free of problems. Viewers did not always identify with the intended characters and it was sometimes difficult to find the right balance between entertainment and education. In addition, many summative research designs had methodological limitations.

    Entertainment-education by itself can sometimes bring about social change, and under certain conditions (in combination with other sources of influence) it can create a climate for social change.

    There are several contextual differences between non-western and western countries that may explain why some E&E televison projects are more successful than others, such as differences in infrastructure, available audiences, novelty and timing and other societal factors.

    Conditions for success
    As indicated earlier, the entertainment-education strategy is based on a social marketing approach, implying a strong focus on the social adoptability of prosocial messages and a consumer orientation. In order to position the 'product' and to be responsive to consumer needs, pre-production research and 'product testing' (formative research) is of utmost importance. Various techniques of social marketing are used in the design of entertainment messages (e.g. formative evaluation, audience segmentation, needs assessment, product development, pre-testing).

    Research-based knowledge about the characteristics, needs and preferences of the target audiences can substantively inform and support the design of entertainment-education programmes. This may be done by having the scripts of E&E television programmes read by representatives of the target audience, by inviting audience representatives to participate in the design process, or by organizing focus groups to get actual information and feedback from the specific target group. In order to achieve realistic portrayals, visiting the sites and neigbourhoods where the target audience lives and talking with them about their day to day problems and experiences have proved to be of considerable value. In particular, establishing whether there are any rumours, myths or misinformation around the issue involved is helpful in designing the content of the programme and very helpful in choosing positive and negative role models. Besides improving the messages and materials, the process of audience analysis and pretesting also proves helpful in generating a sense of involvement in the collaboration process between television professionals and health communication professionals. Some researchers report that by attending the focus-group discussions and reflecting on the feedback from the potential audience, the collaboration partners came all the more to the realization that communication is a process, not a product.

    This extensive formative research, however, demands more preparation time before and during the design of an E&E television programme than conventional television programmes. This calls for careful planning in advance and communicating with the television professionals in order to meet the demands of the production schedule. Effective implementation requires the creation of solid ground in order to optimize programme effects. The research shows that E&E television programmes that are part of a multi-media campaign and are combined with a variety of other promotional and educational activities to inform and influence target groups are the most effective. E&E television alone cannot cause change without the support of other socio-cultural and structural factors. The importance of providing adequate infrastructural services to support E&E is emphasized. In order to be effective E&E television programmes need to be well planned, researched and orchestrated, but even the most thorough planning, research and orchestration do not guarantee success. Enough time, adequate funding over a sustained period, applied by a dedicated staff of able people using strategies based on research, is also essential. Effective communication demands a high level of commitment and multidisciplinary teamwork. The way in which collaboration partners succeed in building a win-win relationship is important for success.

    Epilogue II

    Conclusions and Lessons Learned (Summary part II)
    In this section, an overall view of the experiences and lessons of the E&E collaboration processes as studied in Part II of this thesis will be given, and an answer will be provided to the second part of the central research question of this thesis:

    B)How do health communication and television professionals collaborate in the design and implementation of an E&E television programme and what recommendations can be made for the management of E&E collaboration in the future?

    Characteristics
    In general, the E&E collaboration between health communication and television professionals was experienced as complicated. Bourdieu's general theory of practice (see Chapter 6) may be of assistance in gaining more insight into the hows and whys of the complexities of the E&E collaboration process. The key concept in this theory is that of 'habitus'. The habitus is sometimes also described as a 'feel for the game', a 'practical sense' that inclines agents to act and react in specific situations in a manner that is not always consciously calculated, but nevertheless fits the rules of its 'field' (the 'territory' of the habitus). It is clear that health communication and television professionals belong to different fields and thus employ a different habitus. In collaborations, however, where fields more or less have to integrate in order to reach a common goal, like in E&E production, it is necessary that both parties attune (make 'congruent') their habitus to that of their collaboration partner.

    In the E&E collaboration processes under study, health communication and television professionals experienced a lot of incongruency because they had different interpretations of the habitus the collaboration required. Television professionals talked about 'viewers' and 'viewers satisfaction', and health communication professionals about 'target groups' and 'behaviour change'. With regard to programme content, television professionals looked at potential topics in terms of visualization and gaining the attention of the audience, seeing these as goals in themselves. Health communication professionals were interested in the topics' potential for vicarious social learning and influencing audiences' awareness, attitude and behaviour. What was an end in itself for television professionals was a means for health communication professionals. Consequently, both wanted to obtain and maintain steering power during the whole E&E collaboration process. Health communication professionals wanted to work along the principles of behaviour change theories and to have influence on all programme aspects: content, form, angle, context. Television professionals, however, expected a clear division of tasks: health communication professionals to deliver and to take care of the content of the message, and television professionals to design the format in which the health message could be best televisualized. So it appears that instead of creating common ground (or habitus), both fields first just employed their own habitus. Then almost automatically the question arose as to whose habitus was the strongest and could force the other to comply with its rules.

    According to Bourdieu, in order to be accepted by a field (to be 'consecrated'), one must possess the habitus which predisposes one to enter that field. Without full recognition of the habitus, a field will always reject or try to exclude new 'players'. Although television organizations often took the initiative for the E&E collaboration, and in that sense were the requesting party with regard to health organizations, practice showed reversed positions. Besides paying an entrance fee (delivering economic, cultural and/or social capital), health communication professionals were more or less forced (not always conciously) to incorporate the televison field's habitus in order to be 'consecrated' and allowed to 'play along'. For health communication professionals, especially when they were newcomers to the television field, this proved to be a complex and demanding task that often made them feel they were drifting away from their own field. In their eyes, working along the television professionals' frame of reference caused an asymmetry of power. This was not what they had in mind when they started the collaboration. Moreover, this acquisition of the habitus of the television field jeopardized their relations with their own organization. By 'going native', they put not only the backing of their organization at risk, but also its symbolic capital (fear of misrepresenting their health message, losing their respectable image, damaging their networks). Health communication professionals, knowing this, became hesitant to assimilate the television field's habitus, and experienced difficulties in shifting between the two fields.

    Differences in field mechanisms also played a significant role in the complexity of the collaboration. According to Bourdieu, the field with the greatest economic and commercial interests will (try to) dominate other fields. Ultimately, the competition for high viewing rates always determined the way the E&E television programme was designed. In this case, the television field dominated the health communication field. Health communication professionals had to prove that an effective E&E television programme could not be made without their professional input and expertise with regard to behaviour change. That burden of proof was additionally complicated by the fact that the collaboration motives of national health organizations ranged from raising money, creating publicity and selling products to influencing behaviour change. In cases where behaviour change was not an aim, specific behaviour change expertise indeed was not needed. Television professionals in such situations could just follow their own knowledge and expertise. To design E&E television programmes, however, their knowledge and expertise are not sufficient, and there is a requirement for the specific expertise of health communication professionals about the way the programme can be attuned to the goal of prosocial behaviour change, and therefore the merging of professional cultures becomes inevitable. Because of all this, combining entertainment and education in the television field means working within a high risk context.

    Conditions for success
    The nature of the habitus will in almost all cases militate against fields easily merging and working together in harmony. Specific measures have to be taken to stimulate the fusion of one habitus with the other and to build an E&E collaborationship based on symmetry of power. What is required is a joint frame of reference which incorporates elements of the habitus of both professional fields. Both partners have to acquire a new 'E&E habitus' that materializes in an E&E television programme with specific genre features and working principles, and which is consecrated by both constituting fields. The next important question is how both types of professional can be convinced of the advantages of collaborating on common ground. The answer to this question is not yet fully clear, but engaging in some informed speculation may provide a few clues. When health organizations experience the asymmetry of power in the collaboration as a crucial factor hindering success, they may find ways to exert their power to exclude: 'if the television field does not collaborate on our terms, they cannot have our money or expertise'. This will certainly help health communication professionals to gain self-esteem, and maybe even stimulate the expansion of their habitus. It would be an antagonistic strategy however, which in the long run probably would result in unwanted adverse effects on the power balance.

    The designing of new incentives to create a joint frame of reference can be expected to have more, and positive, effects. Probably the best incentive will be the attraction of a new television genre which is both challenging and promising. Health organizations as well as television organizations, therefore, are recommended to invest in establishing the features for this genre and to stimulate the formation of capital relevant to an 'E&E habitus'. Cultural, social and symbolic capital can be formed by establishing professional standards and by achieving success. Cultural and social capital originate where a body of knowledge and expertise is acknowledged and distributed by a core network of professionals. Symbolic capital is ultimately confirmed by success. In order to achieve this, a substantial investment is inevitably required from both fields: health organizations must become more television literate, television organizations must combine commercial interest with social accountability, and both must move from a production-centred to a truly audience-centred attitude.

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