Adaptations to pain rehabilitation programmes for non-native patients with chronic pain

Purpose. (i) To determine whether adaptations for non-native patients have been implemented in pain rehabilitation programmes; (ii) to determine whether characteristics of the rehabilitation institute are related to having adaptations for non-native patients in place. Subjects. Rehabilitation institutes and rehabilitation departments of general hospitals in The Netherlands who offer a pain rehabilitation programme. Method. A questionnaire was handed over in person or by e-mail to the rehabilitation physicians of the participating institutes. Twenty-seven (90%) questionnaires were returned. The questionnaire concerned programme adaptations and institute characteristics. The data were analysed by

Physical activity as a possible mechanism behind the relationship between green space and health: A multilevel analysis

Background: The aim of this study was to investigate whether physical activity (in general, and more specifically, walking and cycling during leisure time and for commuting purposes, sports and gardening) is an underlying mechanism in the relationship between the amount of green space in people's direct living environment and self-perceived health. To study this, we first investigated whether the amount of green space in the living environment is related to the level of physical activity. When an association between green space and physical activity was found, we analysed whether this could explain the relationship between green space and health. Methods: The study includes 4.899 Dutch people who were interviewed about physical activity, self-perceived health and demographic and socioeconomic background. The amount of green space within a one-kilometre and a three-kilometre radius around the postal code coordinates was calculated for each individual. Multivariate multilevel analyses and multilevel logistic regression analyses were performed at two levels and with controls for socio-demographic characteristics and urbanicity. Results: No relationship was found between the amount of green space in the living environment and whether or not people meet the Dutch public health recommendations for physical activity, sports and walking for commuting purposes. People with more green space in their living environment walked and cycled less often and fewer minutes during leisure time; people with more green space garden more often and spend more time on gardening. Furthermore, if people cycle for commuting purposes they spend more time on this if they live in a greener living environment. Whether or not people garden, the time spent on gardening and time spent on cycling for commuting purposes did not explain the relationship between green space and health. Conclusion: Our study indicates that the amount of green space in the living environment is scarcely related to the level of physical activity. Furthermore, the amount of physical activity undertaken in greener living environments does not explain the relationship between green space and health.

The role of the Ministry of Health, Welfare and Sport in the field of environmental health : An orientation

In de fysieke omgeving is nog veel gezondheidswinst te behalen. Deze winst kan geboekt worden als het ministerie van Volksgezondheid Welzijn en Sport (VWS) geregeld optreedt als katalysator bij beleidsterreinen zoals milieu en ruimtelijk ontwerp. De meeste gezondheidswinst is te behalen met een integrale aanpak die aandacht heeft voor de samenhang tussen de diverse milieu- en omgevingsfactoren. Op verzoek van het ministerie van VWS heeft het RIVM een oriëntatie gemaakt van de beleidsmatige inzet die VWS op het terrein van de medische milieukunde (MMK) kan ontwikkelen. Het is uitdrukkelijk een verkenning, zowel voor wat betreft de inhoudelijke impact van de fysieke omgeving op gezondheid als voor wat betreft de beleidsmatige keuzes die hieruit voort komen. Om tot een afweging van beleidskeuzes te komen is een inventarisatie gemaakt van de gezondheidseffecten van MMK-thema's, zowel in de reguliere fase als in de 'warme fase' (ten tijde van een milieugerelateerde crisis). Als secundaire criteria zijn ook (maatschappelijke) actualiteit en de mate waarin VWS een rol kan spelen op deze terreinen meegewogen. Beleidsmatig is MMK namelijk sterk verbonden met taken van andere departementen, zoals het ministerie van Infrastructuur en Milieu (IenM), het ministerie van Binnenlandse zaken en Koninkrijkrelaties (BZK), het ministerie van Onderwijs, Cultuur en Wetenschap (OCW), het ministerie van Economische Zaken (EZ) en het ministerie van Sociale Zaken en Werkgelegenheid (SZW). De conclusie dat veel MMK-thema's in de praktijk met elkaar verbonden zijn, leidt ertoe dat VWS zich - samen met partijen uit het veld (departementen, gemeenten en GGD'en) - zou moeten toeleggen op het onderling verbinden van belangen. In de praktijk betekent dit het, vanuit een gezondheidsperspectief, actief bijdragen aan het verwezenlijken van de ambities van anderen. Gegeven de complexiteit en ambiguïteit van de het MMK-veld is het tevens van belang om te zorgen voor een breder maatschappelijk draagvlak, resulterend in risk governance.Many health benefits are still to be gained within the physical environment. These benefits can be realized if the Ministry of Health regularly acts as a catalyst in policy areas such as environmental and spatial design. Most of these health benefits can be obtained with an integrated approach that addresses the relationship between the various environmental and surrounding factors. At the request of the Ministry of Health, Welfare and Sport, the RIVM has developed an orientation of the policy commitment the Ministry of Health could develop within the field of environmental health. This is explicitly an exploration, both in terms of the substantive impact of the physical environment on health, as in terms of policy choices that result from it. To establish a consideration of policy choices, an inventory was made of the health effects of themes in environmental health, both in the regular phase and in the "hot phase" (in times of an environmental crisis). As secondary criteria we also considered (social) events, and the role the Ministry of Health could play in these areas. Policy concerning environmental health is after all strongly related to tasks performed by other departments, such as the Ministries of Infrastructure and the Environment, the Interior, Economic Affairs and Social Affairs. The conclusion that many themes in environmental health are connected in a practical sense, means that the Ministry of Health - together with other stakeholders (departments, municipalities and municipal health services) - should focus on the interconnection of interests. In a practical sense and from a health perspective, this means an active contribution to achieving the ambitions of others. Given the complexity and ambiguity of the field of environmental health it is also important to ensure broader public support, resulting in risk governance.Ministerie van VW

Geologie van informatieland: Een Houtskoolschets van het informatielandschap

VW

Health and spatial planning - a match made in heaven?

Al lange tijd wordt geprobeerd de gezondheid te verbeteren via de inrichting van de leefomgeving. Een tijdje was die aandacht er wat minder, maar hij neemt nu weer toe. Voor een slimme en gezonde ruimtelijke inrichting is een goede samenwerking nodig tussen professionals uit de 'domeinen' van het ruimtelijk ontwerp, het milieu en de volksgezondheid. Uit een verkenning over de relatie tussen deze drie domeinen blijkt dat professionals veel meer van elkaars kennis en kunde kunnen profiteren dan ze nu doen. Door de kennis te bundelen, te delen en te vertalen naar de praktijk, krijgen de domeinen beter inzicht in elkaars achtergrond, drijfveren en belangen. Platforms waarin alle domeinen vertegenwoordigd zijn, zoals het Platform Gezond Ontwerp, kunnen daarbij ondersteunen. Gelijksoortige ontwikkelingen De drie domeinen hebben al lange tijd veel met elkaar gemeen. Zo is bij alle een accentverschuiving te zien van maatregelen die risico's beperken (gezondheidsbescherming) naar maatregelen die mensen aanzetten tot gezond gedrag (gezondheidsbevordering). Een ander voorbeeld is de ontwikkeling van een landelijk aangestuurd beleid (top- down) naar een actieve rol van mensen om meer regie op hun gezondheid en leefomgeving te krijgen (bottom-up). Weten wat werkt Verder is het belangrijk te weten welke maatregel of welk beleid 'werkt'. Ondanks de vele praktijkvoorbeelden zijn de effecten van de stedenbouwkundige structuur op gezondheid en welzijn nog maar weinig onderzocht. De drie domeinen blijken bovendien allemaal verschillend naar de effectiviteit van maatregelen en beleid te kijken. Het ruimtelijk domein bijvoorbeeld werkt vooral op basis van ervaringen van de ruimtelijk ontwerper en niet zozeer op basis van 'bewezen effectiviteit' (evidence-based). In de volksgezondheid staat vaak juist de evidencebased benadering centraal. Inzicht in de effectiviteit van maatregelen kan worden vergroot door inzichten hierover uit de drie domeinen bij elkaar te brengen en het effect van ruimtelijke ingrepen als standaard onderdeel van het proces te evalueren. Onder andere het beoordelingssysteem voor de kwaliteit en effectiviteit van leefstijlinterventies van het Centrum voor Gezond Leven (CGL) en partners kan daarbij helpen. De verkenning is uitgevoerd door het RIVM in samenwerking met TU Eindhoven voor het Planbureau van de Leefomgeving.Efforts have long been made to improve public health through spatial planning. The attention devoted to this topic had decreased slightly, but is now once more on the rise. Smart spatial planning that promotes human health requires close collaboration between professionals in the fields of spatial design, the environment and public health. An exploration of the relationship between these three domains shows that professionals can make much greater use of each other's expertise and skills than they currently do. By combining and sharing knowledge and translating it into practical applications, each domain can gain greater insight into the background, motivations and interests at play in the other domains. Support can be provided by organizations that represent all domains, such as the Platform for Healthy Design. Similar developments For already some time, similar developments have been observed in the three aforementioned domains. For instance, a shift in emphasis may be seen in all three domains from measures that reduce risks (health protection) to measures that encourage healthy behaviour (health promotion). Another example concerns the shift from policy orchestrated at the national level ('top down') to encouraging people to adopt an active role and take more control of their health and their environment ('bottom up'). Finding out what works It is important to establish which measures and policies are effective in practice. Despite the many inspiring examples from practice, the impact of urban structures on health and well-being has not yet been extensively studied. In addition, the three domains assess the effectiveness of measures and policies differently. The spatial planning domain, for instance, focuses mainly on the experiences of the planner rather than on 'proven effectiveness'. By contrast, the evidence-based approach is central in the public health domain. Greater insight may be gained into the effectiveness of measures by combining insights from the three domains and assessing the impact of spatial interventions as a standard procedure. The assessment system for the quality and effectiveness of lifestyle interventions developed by the Dutch Centre for Healthy Living and its partners, for example, can be helpful in this regard. This exploratory study was commissioned by the Netherlands Environmental Assessment Agency, and carried out by RIVM in collaboration with Eindhoven University of Technology.Planbureau voor de Leefomgeving PB

Personal and environmental characteristics associated with choice of active transport modes versus car use for different trip purposes of trips up to 7.5 kilometers in the Netherlands

Introduction This explorative study examines personal and neighbourhood characteristics associated with short-distance trips made by car, bicycle or walking in order to identify target groups for future interventions. Methods Data were derived from ‘Mobility Research Netherlands (2004–2009; MON)’, a dataset including information regarding trips made by household members (n = ±53,000 respondents annually). Using postal codes of household addresses, MON data were enriched with data on neighbourhood typologies. Multilevel logistic modelling was used to calculate odds ratio (OR) of active transport versus car use associated with four different trip purposes (shopping (reference), commuting, taking or bringing persons or sports). A total of 277,292 short distance trips made by 102,885 persons were included in analyses. Results Compared to women shopping, women less often take active transport to sports clubs (OR = 0.88) and men less often take active transport for shopping (OR = 0.92), or for bringing or taking persons (OR = 0.76). Those aged 25–34 years (OR = 0.83) and 35–44 years (OR = 0.96) were more likely to use active transport for taking or bringing persons than persons belonging to the other age groups (relative to trips made for shopping by those 65 years or over). A higher use of active transport modes by persons with an university or college degree was found and particularly persons living in urban-centre neighbourhoods were likely to use active transport modes. Conclusion In developing policies promoting a mode shift special attention should be given to the following groups: a) men making short distance trips for taking or bringing persons, b) women making short distance trips to sport facilities, c) persons belonging to the age groups of 25–44 years of age, d) Persons with a primary school or lower general secondary education degree and persons with a high school or secondary school degree and e) persons living in rural or urban-green neighbourhoods

Perceived accessibility is an important factor in transport choice : results from the avenue project

Background\u3cbr/\u3eStimulating active transport by encouraging replacement of short-distance car trips by active transport modes such as cycling or walking has become a popular policy strategy. It has been suggested that neighbourhoods, designed to facilitate healthy behaviour, can influence a person׳s behavioural choices such as transport choice. In the present study, we investigated the association between perceived accessibility of facilities and transport choice for three different trip purposes (shopping, going to public natural spaces, and going to sports facilities) in the Netherlands.\u3cbr/\u3eMethods\u3cbr/\u3eAn online questionnaire (N=3663) was used to collect data concerning transport choice for the general Dutch population over a period of one calendar year starting July 2012. Logistic regression analyses were used to model the odds of cycling versus car use and to model the odds of walking versus car use.\u3cbr/\u3eResults\u3cbr/\u3eWhen perceived accessibility by car is high, persons were less likely to use active transport modes (OR range: 0.09–0.66) and when perceived accessibility by active transport modes is high, persons were more likely to use the bicycle (OR range: 2.18–10.43) or walk (OR range: 2.97–11.22).\u3cbr/\u3eConclusions\u3cbr/\u3eOur results showed a strong association between perceived accessibility and transport choice even after adjusting for personal and environmental characteristics. Our results suggest that perceived accessibility should be taken into account when stimulating a shift from car use to cycling or walking.\u3cbr/\u3