Factors associated with physical therapists’ implementation of physical activity interventions in the Netherlands
Huijg, Johanna M. ; Dusseldorp, Elise ; Gebhardt, Winifred A. ; Verheijden, Marieke W. ; Zouwe, Nicolette van der; Middelkoop, Barend J.C. ; Duijzer, Geerke ; Crone, Mathilde R. - \ 2015
Physical Therapy 95 (2015)4. - ISSN 0031-9023 - p. 539 - 557.
Background. Physical therapists play an important role in the promotion of physical activity (PA) and the effectiveness of PA interventions. However, little is known about the extent to which they implement PA interventions following the intervention protocol and about the factors influencing their implementation behaviors. Objective. The study objective was to investigate physical therapists’ implementation fidelity regarding PA interventions, including completeness and quality of delivery, and influencing factors with a Theoretical Domains Framework–based questionnaire. Design. The study was based on a cross-sectional design. Methods. A total of 268 physical therapists completed the Determinants of Implementation Behavior Questionnaire. Questions about completeness and quality of delivery were based on components and tasks of PA interventions as described by the Royal Dutch Society for Physical Therapy. Multilevel regression analyses were used to identify factors associated with completeness and quality of delivery. Results. High implementation fidelity was found for the physical therapists, with higher scores for completeness of delivery than for quality of delivery. Physical therapists’ knowledge, skills, beliefs about capabilities and consequences, positive emotions, behavioral regulation, and the automaticity of PA intervention delivery were the most important predictors of implementation fidelity. Together, the Theoretical Domains Framework accounted for 23% of the variance in both total completeness and total quality scores. Limitations. The cross-sectional design precluded the determination of causal relationships. Also, the use of a self-report measure to assess implementation fidelity could have led to socially desirable responses, possibly resulting in more favorable ratings for completeness and quality. Conclusions. This study enhances the understanding of how physical therapists implement PA interventions and which factors influence their behaviors. Knowledge about these factors may assist in the development of strategies to improve physical therapists’ implementation behaviors.
Infectierisico’s van de veehouderij voor omwonenden
Maassen, C.B.M. ; Duijkeren, E. van; Duynhoven, Y.T.H.P. van; Dusseldorp, A. ; Geenen, P. ; Koeijer, A.A. de; Koopmans, M.P.G. ; Loos, F. ; Jacobs-Reitsma, W.F. ; Jonge, M. de; Giessen, A.W. van de - \ 2012
Bilthoven : RIVM - 65
veehouderij - zoönosen - q-koorts - volksgezondheid - infectieziekten - livestock farming - zoonoses - q fever - public health - infectious diseases
Momenteel kunnen er geen wetenschappelijk onderbouwde uitspraken worden gedaan over het infectierisico van omwonenden van veehouderijen, met uitzondering van Q-koorts. Het is aangetoond dat omwonenden van melkgeitenbedrijven met Q-koorts, een verhoogd risico hebben om deze infectieziekte te krijgen. Voor de overige zoönosen (infectieziekten die van dier op mens worden overgedragen) zijn onvoldoende gegevens beschikbaar over het risico in relatie tot de afstand tot veehouderijen, het bedrijfstype en de bedrijfsgrootte. Wel is bekend dat veehouders, medewerkers op veehouderijen en dierenartsen een verhoogd risico hebben om bepaalde zoönosen op te lopen. Direct contact met dieren is daarbij vaak een risicofactor.
Vulkaanas van de Eyjafjallajokull : risicoschattingen voor Nederland
Dusseldorp, A. ; Hoogenboom, L.A.P. - \ 2010
Bilthoven : RIVM (RIVM briefrapport 609400001/2010) - 47
vulkanische as - luchtkwaliteit - voedselveiligheid - risicoschatting - gezondheid - volcanic ash - air quality - food safety - risk assessment - health
De uitbarsting van de IJslandse vulkaan Eyjafjallajökull op 14 april 2010 heeft in Nederland geen risico's opgeleverd voor de volksgezondheid. Hoewel er door de heersende windrichting as van de vulkaan over Nederland is getrokken, is er nauwelijks as op leefniveau terecht gekomen. Dat heeft het RIVM geconcludeerd in diverse adviezen die tussen 15 en 29 april 2010 zijn uitgebracht. Dit rapport bundelt de adviezen en geeft enkele aanknopingspunten voor de beoordeling van een eventueel toekomstige situatie, in het geval een vulkaanuitbarsting zou leiden tot de verspreiding van vulkaanas naar Nederland. Het betreft de analyse van regenwater, de inschatting van risico's bij inademing van vulkaanas en de inname van elementen uit de as bij consumptie van gewassen.
Low bone mineral density and bone mineral content are associated with low cobalamin status in adolescents
Dhonukshe-Rutten, R.A.M. ; Dusseldorp, M. van; Schneede, J. ; Groot, C.P.G.M. de; Staveren, W.A. van - \ 2005
European Journal of Nutrition 44 (2005)6. - ISSN 1436-6207 - p. 341 - 347.
pernicious-anemia - homocysteine levels - macrobiotic diets - methylmalonic acid - early-life - vitamin-d - risk - deficiency - infants - osteoporosis
Background Cobalamin deficiency is prevalent in vegetarians and has been associated with increased risk of osteoporosis. Aim of the study To examine the association between cobalamin status and bone mineral density in adolescents formerly fed a macrobiotic diet and in their counterparts. Methods In this cross–sectional study bone mineral density (BMD) and bone mineral content (BMC) were determined by DEXA in 73 adolescents (9–15 y) who were fed a macrobiotic diet up to the age of 6 years followed by a lacto–(–ovo–) vegetarian or omnivorous diet. Data from 94 adolescents having consumed an omnivorous diet throughout their lives were used as controls. Serum concentrations of cobalamin, methylmalonic acid (MMA) and homocysteine were measured and calcium intake was assessed by questionnaire. Analysis of covariance (MANCOVA) was performed to calculate adjusted means for vitamin B12 and MMA for low and normal BMC and BMD groups. Results Serum cobalamin concentrations were significantly lower (geometric mean (GM) 246 pmol/L vs. 469 pmol/L) and MMA concentrations were significantly higher (GM 0.27 µmol/L vs. 0.16 µmol/L) in the formerly macrobiotic–fed adolescents compared to their counterparts. In the total study population, after adjusting for height, weight, bone area, percent lean body mass, age, puberty and calcium intake, serum MMA was significantly higher in subjects with a low BMD (p = 0.0003) than in subjects with a normal BMD. Vitamin B12 was significantly lower in the group with low BMD (p = 0.0035) or BMC (p = 0.0038) than in the group with normal BMD or BMC. When analyses were restricted to the group of formerly macrobiotic–fed adolescents, MMA concentration remained higher in the low BMD group compared to the normal BMD group. Conclusion In adolescents, signs of an impaired cobalamin status, as judged by elevated concentrations of methylmalonic acid, were associated with low BMD. This was especially true in adolescents fed a macrobiotic diet during the first years of life, where cobalamin deficiency was more prominent.
Vitamin B12 status is associated to bone mineral content and bone mineral density in frail elderly women, but not in men
Dhonukshe-Rutten, R.A.M. ; Lips, M. ; Jong, N. ; Chin A Paw, M.J.M. ; Hiddink, G.J. ; Dusseldorp, M. van; Groot, C.P.G.M. de; Staveren, W.A. van - \ 2003
The Journal of Nutrition 133 (2003)3. - ISSN 0022-3166 - p. 801 - 807.
physical-activity scale - methylmalonic acid - osteoporosis - determinants - nutrition - exercise - mass - absorptiometry - homocysteine - vegetarian
Subclinical vitamin B-12 deficiency is common in the elderly. Encouraged by early indications, we investigated the plasma vitamin B-12 status in association with bone mineral content (BMC) and bone mineral density (BMD) in frail elderly people. Data of 194 free-living Dutch frail elderly (143 women and 51 men) were available. BMC and BMD were measured by dual energy X-ray analysis. Biochemical analyses were performed on plasma or serum including vitamin B-12, methylmalonic acid, homocysteine, 25-hydroxy vitamin D and parathyroid hormone. Women had higher plasma vitamin B-12 (288 and 238 pmol/L, respectively) and lower plasma homocysteine levels (15.8 and 21.3 mumol/L, respectively) than men. Of the total explained variance of BMC and BMD in women (46 and 22%, respectively), 1.3-3.1% was explained by plasma vitamin B-12, in addition to weight and height or energy intake. In men, the variance of BMC and BMD was explained by weight, smoking and/or height (total R-2 was 53 and 25%, respectively), but not by plasma vitamin B-12. Osteoporosis occurred more often among women whose vitamin B-12 status was considered marginal or deficient than in women with a normal status, i.e., the prevalence odds ratios (after adjustment for weight, age and calcium intake) (95% confidence intervals) were 4.5 (0.8;24.8) and 6.9 (1.2;39.4), respectively. These results suggest that vitamin B-12 status is associated with bone health in elderly women. Future studies on bone health should take into account a possible role of vitamin B-12 status in different populations.
Influence of processing on total, monoglutamate and polyglutamate folate contents of leeks, cauliflower, and green beans
Melse-Boonstra, A. ; Verhoef, P. ; Konings, E.J. ; Dusseldorp, M. van; Matser, A. ; Hollman, P.C.H. ; Meyboom, S. ; Kok, F.J. ; West, C.E. - \ 2002
Journal of Agricultural and Food Chemistry 50 (2002)12. - ISSN 0021-8561 - p. 3473 - 3478.
Bioavailability of dietary folate might be impaired by the polyglutamate chain to which ~70␘f dietary folates are bound. This chain must be removed enzymatically in the intestine before folate is absorbed as a monoglutamate. To increase formation of monoglutamate folate in vegetables, the vegetables were subjected to various processing treatments. Treatments included freezing (-18 C, 16 h) and thawing (4 C, 24 h) and hydrostatic high-pressure treatment (200 MPa, 5 min). Both freezing/thawing and high-pressure treatment increased the proportion of folate in the monoglutamate form in leeks, cauliflower, and green beans 2-3-fold. However, loss of total folate after these treatments was >55ÐIt is concluded that conversion of folate polyglutamate to the monoglutamate form in vegetables is possible by certain processing treatments. Potentially this could lead to vegetables with higher folate bioavailability. However, to prevent folate loss into processing water, processing in a closed system should be applied.
|Development participation in Sri Lanka: An arena of struggle between leaders and followers'
Frerks, G. ; Dusseldorp, D. van - \ 2001
In: Kinship structures and enterprising actors: Anthropological essays on development / Andersson, J.A., Breusers, M., Wageningen : Wageningen University - ISBN 9789064643873 - p. 263 - 280.
|Can folate bioavailability from vegetables be increased by processing treatments that stimulates endogenous glutamate carboxypeptidase II activity?
Melse-Boonstra, A. ; Verhoef, P. ; Konings, E.J.M. ; Dusseldorp, M. van; Matser, A. ; Hollman, P.C.H. ; Meyboom, S. ; West, C.E. - \ 2001
In: Bioavailability 2001, Interlaken Congres Centre, Switzerland, may 29-june 1, 2001
Are levels of bone turnover related to lower bone mass of adolescents previously fed a macrobiotic diet?
Parsons, T.J. ; Dusseldorp, M. van; Seibel, M.J. ; Staveren, W.A. van - \ 2001
Experimental and Clinical Endocrinologie and Diabetes 109 (2001). - ISSN 0947-7349 - p. 288 - 293.
Dutch adolescents who consumed a macrobiotic (vegan-type) diet in early life, demonstrate a lower relative bone mass than their omnivorous counterparts. We investigated whether subjects from the macrobiotic group showed signs of catching up with controls in terms of relative bone mass, reflected by higher levels of serum osteocalcin and alkaline phosphatase and lower levels of urinary cross-links. Group differences in calciotropic hormones and mineral excretion were also investigated. Bone measurements, blood, and urine samples were obtained from 69 macrobiotic (34 girls, 35 boys) and 99 control (57 girls, 42 boys) subjects, aged 9-15. Bone turnover markers and 1,25(OH)2D reached maximal levels at pubertal stages 3-4, and decreased thereafter. After adjusting for puberty, age, and lean body mass, no group differences were found in markers of bone turnover, 1,25(OH)2D, PTH, or calcium excretion, but phosphate excretion was 23␕ower in macrobiotic girls. After adjustment for puberty, 1,25(OH)2D was positively related to osteocalcin. In summary, we found no evidence for group differences in bone turnover, or catch up in relative bone mass, which might be due to the fact that 60␘f subjects were still in early stages of puberty.
Bioavailability and bioefficacy of folate and folic acid in man
Brouwer, I.A. ; Dusseldorp, M. van; West, C.E. ; Steegers-Theunissen, R.P.M. - \ 2001
Nutrition Research Reviews 14 (2001). - ISSN 0954-4224 - p. 267 - 293.
Folic acid is important because supplementation around the time of conception has been proven to lower the risk of having offspring with a neural-tube defect. Furthermore, both dietary folate and folic acid decrease plasma total homocysteine concentrations. Elevated plasma homocysteine concentrations are considered to be an independent risk factor for cardiovascular disease. The aim of the present review is to give an overview of factors influencing bioavailability and bioefficacy (the proportion of ingested nutrient converted to its active form) of food folate and folic acid, and to discuss the functional bioefficacy of folate and folic acid in decreasing plasma homocysteine concentrations. We use the mnemonic SLAMENGHI to group factors influencing bioavailability and bioefficacy: Species of folate; Linkage at molecular level; Amount of folate and folic acid consumed; Matrix; Effect modifiers; Nutrient status; Genetic factors; Host-related factors; mathematical Interactions between the various factors. Bioefficacy of folate from some foods is <50 % that of folic acid. This factor is most probably explained by the matrix factors, encapsulation and binding. However, often such effects cannot be distinguished from factors such as species, chain length of folate in food, effect modifiers and the amount of folate consumed in a meal. Folic acid provided as a supplement is well absorbed. However, the homocysteine-lowering capacity of doses of folic acid >500 g is limited. It is unclear whether unmetabolised folic acid poses health risks. This factor is of importance, because food fortification is now implemented in many countries and folic acid supplements are freely available. In particular circumstances host-related factors, such as gastrointestinal illness and pH of the jejunum, can influence bioavailability. Genetic factors also deserve attention for future research, because polymorphisms may influence folate bioavailability.
Intervention processes and irrigation institutions : sustainability of farmer managed irrigation systems in Nepal
Pant, D.R. - \ 2000
Agricultural University. Promotor(en): D.B.W.M. van Dusseldorp; L.F. Vincent. - S.l. : S.n. - ISBN 9789058082787 - 285
irrigatie - waterbeheer - waterverdeling - ontwikkelingsplannen - boeren - nepal - irrigation - water management - water distribution - development plans - farmers - nepal
With the support from various donors, His Majesty's Government of Nepal has implemented support programmes with a view to transform water availability, improve production, and increase the institutional capabilities of farmers to develop and sustain efficient, fair and reliable irrigation management practices in irrigation systems in Nepal. In this respect, this study aimed to understand the social, administrative and political processes involved in the social and institutional changes brought about by development interventions at local level. This study focused mainly on the physical aspects of the interventions, the way they were implemented and the consequences for local institutions.
The study consists of seven chapters. The first chapter consists of the nature of the problem, research focus and research objective. The various concepts and the theoretical framework along with the various methods used in generating information are presented in the second chapter. The socio-political and administrative environment of the country along with government policies and the priority in irrigation and agriculture development in different plan periods are discussed in the third chapter. The four case studies are discussed in chapters four to six. The case studies consist of the description of the general environment along with the presentation of the cases. The presentation is followed by an analysis of the case. The final chapter includes major findings of the case studies and conclusions. The changes in the government policy at various times have resulted in differences in the intervention strategies designed for various programmes. Moreover, there was no consistency in the intervention policies for various programmes at the same time. The government policy of seeking users' participation in the decision making of project design and implementation was mixed during the 1980s, as indicated by the interventions under different programmes. For example, small-scale financial support for the improvement of the FMIS was implemented with a more or less 'participatory approach'. The processes followed in new construction projects were not based on a 'participatory approach'. However, users' participation in the decision making since the early 1990s was a precondition for the initiation of intervention processes.
The study shows that the initiation of interventions is complicated and not always very transparent due to the different objectives and hidden agendas of all the actors involved such as: the users, local leaders, local and regional institutions, government agencies, and external donors. The initiative for interventions started at the local level. The users, local leaders and VP officials formed a linking loop to obtain the resources from in which, they were successful. The VP acted as intermediary between the users and the government agencies in the initiation process of the intervention. However, the linking loop did not function well during the design of the project, as the government officials designed the interventions and great emphasis was placed on the financial and technical aspects, which were not discussed at length with the users. As a result the knowledge of the users' was not fully utilised by the agency officials. The cases indicate that the interface between the users and the other actors were not so intensive to reflect a 'participatory approach'.
The implementation of the intervention could be categorised into three types. They are the new construction, rehabilitation and improvement. The objective of the intervention determined the type and scale of financial, technical and the institutional involvement in its implementation. The cases indicate that most of the UCs formed for the purpose of the intervention acted as 'construction committees' and failed to function after the completion of the intervention. In this respect the objectives of creating institutions for the implementation were partially achieved, but they could not ensure the complete participation of the users. Thus, the linking loop formed to obtain the government resources disintegrated during the implementation of the project. However, users with the help of the VP/VDC were quick to form a linking loop to obtain resources for other interventions.
The analysis of the cases reveals that four institutions a) the Ditthawal system, b) DIO, c) VP/VDC and d) UC were important for the governance and the management of irrigation systems. The cases also indicate that the legitimacy of the institutions was established through the confidence of the users. The formal or informal status of the institution is secondary. The cases indicate that the fundamental reform of collective-choice rule due to the changes effected by the irrigation intervention in the governance structure contributed to increasing anarchy in 'rules in use'. Besides, there was little contribution in the design by the users due to an absence of constitutional-choice rule. The study also shows that many aspects of 'conditions for successful schemes' were violated due to changes in village administration. The study also shows that agency taking over constitutional-choice rule (policy) without adequate understanding of the village needs.
The construction of permanent headworks and the canal lining has facilitated the operations of the system and the task of the users has been made easier. As a result, less participation of the users was needed for the system development, regular repair and cleaning of the canal. The users however lost the social control of the irrigation system due to the introduction of new technology and their dependence on outside resources was increasing. The user allocation of water in the case study area is based on irrigable land. Three types of water distribution practices are prevailing in the case study area. They are rotation, field to field and unregulated allocation. The cases indicate that the contributions in the operation and maintenance of the irrigation system are not the sufficient condition for a fair access to irrigation water. The degree of social control on which the institutions would rely was an important factor for ensuring fair distribution of water resources among the members.
Three types of conflicts have been identified from the analysis of the cases. They are the conflict between the irrigation systems over the use of a single water source. However, the construction of the permanent weir did facilitate in defining the water rights between the irrigation systems. The second type of dispute is among the users due to weak institutional arrangements for the distribution of water. The third type of conflict is between the agency and the users due to lack of intensive interfaces during the planning and implementation of the intervention, which had implications on turning over the management of the irrigation system.
The nature and extent of the participation by the users reflects that the interventions were not successful in seeking the active participation of the people in decision making due to a lack of an intensive interface between the actors involved in the design and implementation of the interventions. The analysis of the cases suggests that the most common form of participation for resource mobilisation was labour, land and time. The pattern of resource mobilisation shows that the newly introduced irrigation technologies such as permanent structures of the irrigation systems make the user more dependent on the external resources. The cash contribution was almost negligible. The complexity of the technology has considerable consequences for the need for external resources and expertise. The increasing dependence on external agencies for the sustenance of the irrigation system reflects that new linking loops are emerging through interfaces between the actors involved in irrigation development. This indicates that the technical intervention is demanding new organisational control.
In all the four case studies, the maintenance of the system after the interventions depended largely on external resources when it came to cash contributions. The newly introduced UCs were only functioning during the time of the intervention but were not functional in mobilising resources for the maintenance of irrigation system. This means a greater dependence on government support. When this is not forthcoming the sustainability of the FMIS is questionable. It is therefore necessary that in the future more attention be given by the government to the institutional aspects of intervention that aims at the improvement of rehabilitation of FMIS. However it was not only the intervention and the way they were implemented that led to a diminishing participation of the users in the maintenance of their irrigation system. The changes in the local, political, and administrative institutions, the opening of the villages via new roads lessened cohesion of the rural communities and opportunities were created or made accessible what led among others to a diminished social control. The provision of all kinds of facilities (school, health-posts) led farmers to look for new roles for the government e.g. to support them with the maintenance of the irrigation system.
Think big, start small : restricted room for manoeuvre by practitioners in socio-spatial planning of peripheral regions in Third World Countries
Ham, A. van den; Veenstra, J. - \ 2000
Agricultural University. Promotor(en): D.B.W.M. van Dusseldorp, co-promotor(en): J.G.M. Hilhorst. - S.l. : S.n. - ISBN 9789058083005 - 341
ontwikkelingsstudies - plattelandsontwikkeling - marginale gebieden - ontwikkelingsprojecten - ontwikkelingsplanning - armoede - internationale samenwerking - ontwikkeling - duurzaamheid (sustainability) - ontwikkelingslanden - bedrijfsvoering - basisbehoeften - hulpbronnenbeheer - ontwikkelingshulp - vermogensverdeling - development studies - rural development - less favoured areas - development projects - development planning - poverty - basic needs - international cooperation - development aid - development - sustainability - resource management - management - developing countries - wealth distribution
In a first part of this study van den Ham reacts to the increased free-market thinking and makes in chapter 1 a plea for continued efforts in active, public socio-spatial development policies in order to contribute to sustainable poverty alleviation in remote areas. This policy should aim at lifting restrictions, both material and socio-cultural, of people to realise their human capabilities to qualitatively and sustainably change the conditions of life and livelihood. It is argued why, from a development practitioner's perspective, it is important to understand the dynamics in both development thinking and doing. A research construct is introduced to explore the framework within which development paradigms, policies and practices at normative ( "what for" and " for whom?" ), strategic ( "how ") and operational ( "what, where, when, by and with whom?" ) level change over time. This change is assumed to be influenced by key-development practitioner's 'inner-guiding' individual beliefs and values, acquired academic insights and practical, learning-by-doing experiences. In practice the proposed policies seem to be very much constrained or stimulated by the development practitioner's appreciated, influenceable and controllable environment which are subject to changing power relations between the state, the corporate sector and civil society.
In chapter 2 Veenstra elaborates the above research framework by highlighting the various components on the three axes depicting (1) inward-looking personal perspectives, focusing on habitual life-attitudes and roles of both indigenous and expatriate development practitioners (2) outward-looking, professional knowledge bases expanding in substantive, procedural as well as politico-institutional sense and (3) problem and action orientations as tried-out in time at various levels.
In chapter 3 van den Ham reviews at a glance the origins of international development co-operation and the elements that in practice impact upon the outcome of foreign-supported, expatriate-staffed development projects; they relate to identification, organisational setting, the role of expatriate practitioners, co-operation with local counterparts, the time dimension, the role models in transfer of knowledge and "voice, loyal and exit" strategies of the practitioners.
In the second part of the book seven case studies from Africa and Asia, all within the framework of international development assistance, are presented and related to the framework that has been introduced in the previous three chapters. In chapter 4 Veenstra explores his sequential experiences and struggles with emic and etic aspects in the evolving design of development programmes and practices in five projects in Sierra Leone, Tanzania, Yemen, Indonesia and Cameroon with special reference to area development planning and natural resource management. Both in sub-sections 4.6 and 6.3 Veenstra sums up his conclusions from outer and inner learning rounds in socio-spatial planning practices. In reaching after 'sustainable' livelihoods, -particularly in agrarian societies under patrimonial resource control in Sierra Leone, West Africa, of the 1960s-, strategic and operational incommensurabilities, with hindsight, cropped up as related to large-scale 'hard' infrastructure and agro-technical innovations. After actuality had completed its developmental course, shortcomings were, later on, laid open inside and between knowledge bases used, of corresponding policy instruments (not) employed, of statutory powers (not) granted and skilled personnel, budgets plus equipment (not) available. Above all, incongruity made itself manifest among stakeholders' normative outlooks holding sway at various territorial levels for prioritising their own resource claims. So it happened that in spite of 'common-good and great cause' intentions, 'kleptocratic' life styles both of rural and urban élites in a 'soft-state' setting were to be, distrustfully, endured.
In the case of socialist single-party Tanzania of the 1970s 'integrated' rural development pointed toward self-reliance, poverty alleviation and fair distribution of social and physical infrastructure. These laudable aims were thwarted, however, by a over-burdened state-apparatus and the rural populace, of necessity, exiting both into 'black-market' sales of its produce and clientship-like distribution channels for local provision of its basic services,- without revenues for the state coffers. So, both the Tanzanian bureaucracy and its open-handed foreign-aid advisors made themselves not responsive and trust-worthy, - in terms of the 'good local governance' fashion of the 1990s. Under these adversary working conditions expatriate area planners were willy-nilly forced to self containment, - for instance, in our 'remote' case of the neglected Shinyanga Region. Here, a prudent step-by-step integration both in planning and eventual implementation was intended 'from overseas' through initially restricting sectoral, time/space, problem and resource development perspectives to prioritised, low-level and small-scale, concentrated area project packages. So, 'for the time being', long-haul normative policy making, including its medium-term strategic issues, were put aside; socio-spatial arithmetics were to prevail through index-number, factor-, and flow-analysis methods; thus entrapped, both expatriate and indigenous planning officers felt their 'rationalising' efforts being frustrated by short-sighted detachment in public choice situations - like ostriches bury sometimes their heads in the sand.
In entering the 1980s, this neutral technocratic habitus was, -depending on politico-institutional contexts-, re-shaped towards those of mediatory brokers and advocates on behalf of beneficiary target groups. In the Rada'-case of North Yemen, 1981/82, phased social differentiation and changing leadership-styles in the long run were accounted for, but immediately shifting gears from operational towards strategic models of resource management emerged as leading theme. Here, in promoting still sustainable livelihoods, foreign development practitioners were to manoeuvre between the 'devil and the deep blue sea' of conflicting policy sets:
After a decade of Rada'-development efforts, i.e. 1975-85, it was concluded that in spite (or because) of selectively applied, concentrated area project packages local village life remained principally unchanged; that at a higher level of district government implementation capacity improved through ad hoc foreign assistance; but that at the higher sub-national level of the province strategic planning and governance did not find their co-ordinating niche, neither divergent statesman-like leadership. Therefore, the two case-studies of Aceh in Indonesia, 1977-1986, and of the Tikar water catchment basin around 1990 in Cameroon, West Africa, refrained initially from formulating a e state, corporate sector and civil society was rather modest.
In sub-sections 6.1 and 6.2 van den Ham concludes that the views of the key-players in the development projects can very much be traced to their previous experiences. The extent to which their views can be 'translated' into new approaches towards local area development is only to a small extent influenced by the 'power' of either the normative/inward-looking or the academic/outward-looking perspective of the concerned development practitioners. Effectuating the aspired 'real' participatory development, -implying redistribution of resources and (decision-making) power-, within the context of 'foreign' projects would for example run up against the resistance of vested interests; such an approach, whatever its desirability, can therefore not be pursued. Political room for manoeuvre turns out to be the determining factor in the normative domain. However, there is usually (limited) room at the strategic and operational levels. There it appears that the design and implementation of the advocated strategies and practices is guided by the (normative) disposition of the key players towards the essence of development and their perception of the (strategic) role of the various actors in the development process. These are fed by a commensurate cognitive outlook on reality as well as their practical experiences. Again, substantive 'objective' knowledge bases appear to play only a rather limited role in the actual formulation of programmes and practices. Hence, the foreign-funded socio-spatial development projects 'ploughed through' with limited, isolated and above all 'accidental' (because very much depending on the individual practitioner involved and very specific local conditions capacitating or constraining the potential actors) experiments.
With a view towards the future van den Ham outlines in sub-section 6.4 a changing context for local development practitioners. As in sub-section 6.5 van den Ham explains, this changing context poses new challenges to, and requires new roles to be played by (teams of) future development practitioners. It is suggested that specific capabilities are required to more structurally and successfully address the socio-spatial inequalities from the local level upwards. Development practitioners should not only be technically trained in a number of skills that have traditionally been linked to the function of regional development officer. They rather should start with acquiring a thorough understanding of the dynamic way normative, strategic and operational dispositions are achieved in practice and can be influenced in an effective and legitimate way. Empathy towards other stakeholder's dispositions and potential contributions as actors in their own right, as well as self-critically reflecting on their own positioning, should development practitioners make more conscious of the link between personal or inner change, and social or outer change. This (un-)conscious reflection on implementation will contribute again to reshaping the perspectives on intended societal advancement and results in new approaches to deal with the outstanding issues.
However, development practitioners should be aware that neither their own understanding of reality and their way to deal with it, nor the other stakeholder's positioning and his/her use of the results are fixed or value-neutral. These are all very much influenced by personal and professional life history, inner normative guidelines of individual beliefs as well as values, economic interests, gender, class - all very much time-, space- and context-bound possibilities and constraints. Therefore, it is for development practitioners highly important that they are capable of opening up space for public dialogue on the directions of development. They should be able to analyse the diverse options of the participants and identify the potential conflict of interest that will occur among the various stakeholders, before certain positions getting accepted as "appreciated' and translating them in (normatively) disputable strategies, projects and programmes.
In addition to the 'traditional' technical skills in economics, regional science, physical geography, public administration, data management etc., communicative and analytical skills as well as abilities in the field of conflict prevention and resolution are needed to (help) translating the normative dispositions in strategic and operational terms. Next to engaging actor groups in shaping development processes, local development practitioners should also be able to facilitate reconciliation of the claims of people living in poverty with those of other contesting actor groups and to integrate them in the framework of (central) state policies. Thus, the development practitioner should facilitate that lower-level needs, aspirations and potentials meet response at the higher influenceable/strategic and appreciated/normative levels with the ultimate aim of creating an effectively enabling environment that continuously facilitates and supports people to build sustainably upon their own strengths.
Signs of impaired cognitive function in adolescents with marginal cobalamin status
Louwman, M.J. ; Dusseldorp, M. van; Vijver, F.J.R. van de; Thomas, C.M.G. ; Schneede, J. ; Ueland, P.M. ; Staveren, W.A. van - \ 2000
American Journal of Clinical Nutrition 72 (2000). - ISSN 0002-9165 - p. 762 - 769.
Records and reputations : everyday politics of a Philippine Development NGO
Hilhorst, D. - \ 2000
Agricultural University. Promotor(en): D.B.W.M. van Dusseldorp; N.E. Long. - S.l. : s.n. - ISBN 9789058083166 - 261
niet-gouvernementele organisaties - toerekenbaarheid - efficiëntie - filippijnen - politiek - plattelandsontwikkeling - non-governmental organizations - accountability - efficiency - politics - rural development - philippines - cum laude
This study looks into the working of policies, practices and accountability of NGOs. It is based on fieldwork with one development NGO in the Cordillera of the Philippines: the Cordillera Women NGO, or CWNGO (a pseudonym). Through this study I wanted to find out why certain groups of actors form organizations that they call an NGO, and how they ascribe meanings to the organization in practice. Meaning making is central to everyday practice, since it underlies the numerous small and big, pro-active and responsive decisions and actions that together make up the organization. In addition, the study focuses on matters of everyday politics. On the one hand, this entails the way ideology was important in shaping the organization. On the other, this involves the question how NGOs acquire legitimation as a development organization vis-à-vis relevant other parties, including clients, donors and constituency. This means that I look into processes by which NGO actors convince stakeholders that a situation requires development, that NGO intervention is indispensable and appropriate, and that the NGO has no self-interest in the envisaged programme.
The approach I developed for this rests on three pillars. Firstly, I use an actor orientation. Such an orientation starts with the premise that social actors have agency. They reflect upon their experiences and what happens around them and use their knowledge and capabilities to interpret and respond to development. An actor orientation recognizes the large range of constraints that impinge on social actors, but emphasizes that such constraints operate through people. To find out how NGOs work in a particular environment I followed their actors in their different domains of work, studying how NGO practices come about and acquire meaning, through formal manifestations and actions as well as more informal everyday operations.
Secondly, the study focuses on how people (not just anthropologists) grapple with the relation between processes and things. In their everyday practices people have a practical awareness of the process nature of organizations and other phenomena. Yet, they simultaneously adhere to thing notions about the same. One focus of the study was how actors accommodate these different notions, how they use them strategically, and how they respond to other people's thing notions. One such a thing is the label of NGO. By most definitions, development NGOs are intermediary organizations that bring about development for poor and marginalized people. Instead I defined the name of NGO as a label claiming the organization does good for the development of others. The question then becomes why actors take on this identity and how they find recognition as the do-good organizations implied in the label. Another class of things of particular interest is representations. Through their accounts and practices NGO actors convey images about what their organization is, does and wants. Unlike the multiple realities and nitty-gritty of everyday practices, representations provide a single understanding and closure. As John Law stated, instead of asking ourselves whether a representation corresponds to reality, we should be concerned with the workability and legitimacy of a representation. Through this study, then, I wanted to see how actors compose different representations, and the contests involved in their efforts to enrol others in accepting them.
Given my interest in issues of meanings and legitimation, discourse is important. Discourses are more or less coherent sets of references for understanding and acting upon the world around us. As was pointed out by Foucault, discourses intertwine knowledge and power. However, how discourse works, how it exactly intertwines knowledge and power is a matter for debate. This study spoke of the 'duality of discourse', following Giddens' notion of the 'duality of structure'. There are always multiple discourses and actors find room for manoeuvre to renegotiate them. The other side of the duality of discourse stipulates that discourses can indeed become powerful, although never hegemonic. The more dominant a discourse, the more it operates as a set of rules about what can and cannot be said and done and about what.
These three pillars of my approach are elaborated in chapter 1. Chapter 2 reviews how social movement discourses are constructed and what this means for the relation between leaders and followers, as well as for power struggles in the movement. This is elaborated with a case of social resistance against hydro-electric schemes in the Chico River of the Cordillera. Chapter 3 addresses the question of how, in a situation of multiple realities, a particular discourse becomes dominant. It shows the struggles of a political movement aiming to restore its grip on development NGOs, and how women's organizations endeavoured to accommodate gender issues in a dominant political discourse. The chapter ends with a discussion of the multi-dimensional working of a powerful discourse, -as coercing, convincing and seducing-, which makes understandable why social actors submit themselves to an ideological regime that confines their room for manoeuvre.
Chapter 4 enters the life world of village women. These women identify different meanings of development and cleverly play these out in dealing with the ensemble of development projects in their community. However, their appropriation of development interventions leads to unintended changes, in particular the erosion of the position of elder women. Chapter 5 elaborates the room for manoeuvre of NGOs. On the basis of a number of cases, it is concluded that villagers are much more decisive in the outcome of organizing processes than the NGOs. Chapter 6 provides a theoretical analysis of the concept of accountability and leads to the conclusion that transparency is a myth. A case study following a conflict in a weaving project for women shows that, instead of revealing what really happens in the localities, accounts are permeated by what happens in the accountability process.
Chapter 7 explores how NGO actors in their everyday practices give meaning to the organization. This question turns out to be much more complex than 'management-directing-the-organization', or 'management-versus-the-rest' perspec-tives, can account for. The chapter shows how, through the symbolic use of particular locales, social networks and cultural institutions, a certain coherence nonetheless emerges. Chapter 8 gives a social analysis of successful NGO leadership. It is organized around the life history of one NGO leader, who was followed in her dealings with international arenas and funding agencies. NGO leaders appear as brokers of meaning. They enrol stakeholders to acknowledge their position, and accept their representation of situations, organizations and themselves. Chapter 9 deals with funding agencies. An extended case study is presented of the relation between CWNGO and a UN related program, which ended because the donor claimed the NGO was not efficient and was not accountable to its target group. Underlying this outcome were complex factors including organizational competition, political differences and different interpretations of 'partnership'.
Chapter 10 is the conclusion. It outlines some implications of the study for issues of NGO everyday politics. Politics of legitimation are closely linked to accountability, which is considered a problematic issue. My analysis corroborates this. There does not seem to be a single solution or methodology to realize accountability. We shall always need to critically improvise, combine methods and make the best of them.
Those that demand accountability, in particular donors, should acknowledge different modes of accountability instead of solely relying on formal accountability procedures. Perhaps this may bring them to invest more in trust and less in disciplining through detailed accountability demands. In particular they should invest in becoming trustworthy partners of development NGOs thereby forging the moral commitment of NGOs to live up to their promises. It was also concluded that the everyday politics of legitimation that tend to corrupt accountability also contain pressures to move towards more meaningful accountability. NGOs are vulnerable to losing their good name. The easiest way to protect one's good name is by living up to one's proclaimed standards. If they don't succeed, they risk losing their appeal for funding agencies, their legitimacy as advocates, their credibility in the eyes of the media, and eventually their status as an organization that is seen to do good for the benefit of others.
It has been suggested that there is a tendency among development NGOs in the South to converge towards variations of Western dominated neo-liberal and liberal-democratic development agendas. On the basis of this study I find this notion an exaggeration. The future of development NGOs is likely to be much more diversified than observers of convergence expect. With or without the label of NGO, organising processes will continue to shape differential development outcomes. I expect that commitment to values which advance public and collective interests and that radically side with the poor will continue to be an important element of the ideological visions of many NGOs.
Bioavailability of folate from processed spinach in humans
Castenmiller, J.J.M. ; Poll, C.J. van de; West, C.E. ; Brouwer, I.A. ; Thomas, C.M.G. ; Dusseldorp, M. van - \ 2000
Annals of Nutrition & Metabolism 44 (2000). - ISSN 0250-6807 - p. 163 - 169.
The effect of the food matrix and dietary fibre on the bioavailability of folate is not known. In a controlled, 3-week dietary intervention study, 28 men and 42 women were divided into six groups to receive either a control diet (n = 10), or the control diet plus 20 g/MJ per day (n = 12 per group) of whole-leaf spinach, minced spinach, liquefied spinach, or liquefied spinach to which dietary fibre (10 g/kg wet weight) was added. The sixth group received the control diet plus a synthetic carotenoid supplement with similar amounts of -carotene and lutein as found in spinach. A significantly higher plasma folate response was found for the pooled spinach groups than for the control group. Among the spinach groups no significant differences were detected. However, the plasma folate response of the pooled minced and liquefied spinach groups was greater than that of the whole-leaf spinach group (p = 0.03). Re-addition of dietary fibre to the liquefied spinach to compensate for the fibre broken down during liquefaction did not reduce the plasma folate response. The consumption of the carotenoid supplement did not have an effect on plasma folate concentrations compared with the control group. The food matrix in which the folate is entrapped plays a role in folate bioavailability.
|Verlaging van homocysteoneconcentraties in plasma bij gezonde vrijwilligers door voedingsfolaat uit groenten en fruit en door lage doses synthetisch foliumzuur
Brouwer, I.A. ; Dusseldorp, M. van; Eskes, T.K.A.B. ; Hautvast, J.G.A.J. ; Steegers-Theunissen, R.P.M. - \ 2000
Nederlands Tijdschrift voor Geneeskunde 144 (2000)39. - ISSN 0028-2162 - p. 1869 - 1874.
Homocysteine-lowering effect of 500 ug folic acid every other day versus 250 ug/day
Brouwer, I.A. ; Rooij, I.A.L.M. van; Dusseldorp, M. van; Thomas, C.M.G. ; Blom, H.J. ; Hautvast, J.G.A.J. ; Eskes, T.K.A.B. - \ 2000
Annals of Nutrition & Metabolism 44 (2000). - ISSN 0250-6807 - p. 194 - 197.
Elevated plasma total homocysteine (tHcy) concentrations are a risk factor for neural tube defects and vascular diseases. Supplementation with folic acid decreases tHcy. We investigated whether supplementation with 500 ?g folic acid every other day is as effective in lowering tHcy as 250 ?g folic acid each day. Methods: In a 4-week intervention study, 22 healthy young women (18-40 years old) took either 500 ?g folic acid every other day (500-?g/2d group) or 250 ?g folic acid each day (250-?g/d group). Fasting blood was collected on days 0 and 28. Results: Plasma folate concentrations increased by 11.4 nmol/l (6.8-15.9) in the 250-?g/d group and by 9.1 nmol/l (95␌l 1.9-16.3) in the 500-?g/2d group. These increases were not significantly different from each other. THcy concentrations decreased by 1.52 ?mol/l (95␌l -2.09 to -0.95; p < 0.001) in the 250-?g/d group and by 0.88 ?mol/l (-1.53 to -0.23; p < 0.05) in the 500-?g/2d group. The difference in decrease between the 250-?g/d group and the 500-?g/2d group was 0.64 ?mol/l (p = 0.11). Conclusion: Although not conclusive, this study suggests that supplying subjects with folic acid each day decreases tHcy more effectively than a double dose every other day.
|The role of glutamate chain in bioavailability of dietary folate
Melse-Boonstra, A. ; Verhoef, P. ; Dusseldorp, M. van; West, C.E. ; Kok, F.J. - \ 1999
In: Abstract Book Symposia 'Nutrition and Health',Cape Town and Pretoria,South Africa,august 17-18,1999. - [S.l.] : [s.n.], 1999 - p. 32 - 32.
Re-humanizing the development process : on participation, local organizations and social learning as building blocks of an alternative development view in Algeria
Malki, M. - \ 1999
Agricultural University. Promotor(en): D.B.W.M. van Dusseldorp. - S.l. : Malki - ISBN 9789058080356 - 332
plattelandsontwikkeling - ontwikkelingsplanning - participatie - duurzaamheid (sustainability) - algerije - staat - verhoudingen tussen bevolking en staat - rural development - development planning - participation - sustainability - algeria - state - relations between people and state
This study concerns agricultural development planning and policy-making in the context of post-independent Algeria, which went unquestioned for more than three decades. Algeria won its independence in 1962 after 132 years of French colonization. A post-independence State was formed, taking over the colonial power, and set a centralized planning for economic and social development.
In the agricultural sector, the effects of this planning model were far-reaching and turned a potential agricultural country par excellence into one of the most net importers of food in the developing world.
The onset of this study sterns from the questioning of whether planning, as a fundamental item of the development process, and in addition of being inspired by de-humanizing philosophy and methods, can still be seen as a mere technical discipline. The response of this study is that development planning and policymaking is not only a technical discipline but certainly a political process. By deduction, the development process was and could never be apolitical.
The study tries to describe how the influence of different political actors, in particular, and the political system, in general, shape the outcomes of the development process. To achieve this, the study compares two sets of development actions (policies, programmes and projects) planned and implemented under two different political perspectives: the first set represents the authoritarian regime era (1962-1988), based on the one-party system and an arrogant interventionist bureaucracy; the second introduces some development actions conducted during the transitory process of democratization (1988-1998). The study describes in parallel the changes introduced by the process of democratization and how these influenced the conventional development vision adopted by the state in postindependent Algeria.
In more a detailed explanation, the study starts first by describing the shortcomings of the conventional development thinking and the different influences that the Algerian development planning system underwent since the independence time. Then, it develops the research hypotheses which will orient the comparison of the two set of development actions presented in this book. Finally, it reflects on the advantages offered by an alternative development view, based on participation, local organizations and social learning, and their effects on the issue of sustainability. In this study, the conceptualization of sustainability refers to the "critical triangle of sustainability" (Oram et al , 1998:1).
The basic assumption of this study is that the main condition for a development action to secure some substantial and sustainable outcome resides in the fulfillment of the four following prerequisites formulated by van Dusseldorp (1992:12):
1. The possibility of formulating a consistent, realistic and durable set of objectives , which is acceptable to all, or at least to a large majority of the people who will be involved in/or and affected by the planned development;
In most development actions designed for and implemented in Third World countries, these prerequisites were never completely fulfilled, especially in people-centered development actions. More clearly put, in some development actions, sorne prerequisites might have been fulfilled to some extent, but others have never been fulfilled, even to a very small extent. In fact, in the general case, objectives were ill-defined and top-down decided; knowledge was mobilized in a very reductionist way - most of time supposedly rational/scientific - with a complete denial of people's knowledge; means and power were never sufficiently made available, and when available, were not fairly distributed among the needy ones; and finally, the political will was never concretized unless the development action in concern aimed to incorporate, encapsulate and increase control over rural populations, or at sustaining an actual status quo in benefit of the powerful actors.
In this context, the study suggests that integration of some features, such as participation , either directly (individually) or indirectly (through local organizations ), on the one hand; and social learning , (either as a flexibility in the project design and implementation and/or as a monitoring & evaluation mechanism), on the one hand, increases the probability of fulfillment of the aforementioned prerequisites.
At the level of operationalization of the basic concepts on which the study bases the present work, it faced a dilemma with the concept 'sustainable development'. To which actor or group of actors should development be sustainable in the context of this study? As the implicit and explicit assumptions of this study may suggest, the sustainability of the outcomes of a given development action is posited here to be in line with the interests of the 'hitherto excluded', the disadvantaged segments of the population. Hence, in the context of this study, the pre-requisites and conditions of sustainability rely to a large extent on the centrality of the beneficiaries' knowledge, and the importance of participation of these beneficiaries in their (self-)development. In this order, up till now and for not less than three decades, development actions in Algeria were designed without consultation of their supposed beneficiaries, and yielded a huge gap between the priviligentsia and the disadvantaged. It was thus important that the study focuses more on the impact of beneficiaries' participation and knowledge in steering a given development action towards their needs of development.
However, although the study considers that beneficiaries' participation and knowledge is a necessary condition for sustainable development, it is not a sufficient condition per se . This is true given that the so-called beneficiaries are still strongly interacting with other actors that hold a great power of decision, and are extremely self-referent and self-impressed by the rationality and 'scientificality' of their knowledge, such as planners, researchers, development staff, etc. It is, thus, important that the availability of the beneficiaries' knowledge must be acknowledged by these latter actors. Moreover, all this must be supported by a real social learning process whose importance for sustainable development is acknowledged and supported by all social actors who have some interest at stake in a given development action.
Consequently, the study aims at answering the following general research and
GQ. How can (direct and indirect) participation of the beneficiaries and the social learning ability of diverse actors acting in the development theater secure sustainable achievements of a people-centered planned development action ?
Ql. To which extent and when is participation of the beneficiaries required in order to steer development actions towards their (self-) development?
The results of the study shows that:
Bioavailability of lutein from vegetables is 5 times higher than that of beta-carotene
Hof, K.H. van het; Brouwer, I.A. ; West, C.E. ; Haddeman, E. ; Dusseldorp, M. van; Weststrate, J.A. ; Hautvast, J.G.A.J. - \ 1999
American Journal of Clinical Nutrition 70 (1999)2. - ISSN 0002-9165 - p. 261 - 268.