Women with a family history of breast or ovarian cancers may be eligible for genetic testing to see if they have a genetic mutation that increases their risk of either disease. Two prevalent mutations increasing breast and ovarian cancer risks are BRCA1 and BRCA2. Women carrying a BRCA mutation may consider risk-reducing breast and or ovarian surgeries to reduce their risk of future disease. When faced with these decisions, women often turn to health professionals for support, but they also access their wider support network that includes partners, family and friends. Most previous research of these decisions has focused on the patient-doctor relationship. Understanding how social influences impact women’s decisions is integral to the effective support of those accessing genetic services. With four empirical studies using both qualitative and quantitative methods this thesis aimed to develop a greater understanding of the distal and proximal social influences on women’s decisions to have genetic testing and risk-reducing surgery. In Study 1, a content analysis was used to examine UK broadsheet and tabloid newspapers’ coverage of genetic testing and risk-reducing surgery. Four newspapers were coded, and the results showed that newspapers supported testing but were nuanced in their coverage of the value of surgery, with this discussion played out through coverage of celebrity experiences. The newspapers presented the decisions as primarily medical decisions taken by rational decision makers. Studies 2 and 3 then used a qualitative approach to examine the influence non-health professionals on decision makers’ testing and surgical decisions. Study 2 involved interviews with sixteen women and showed that familial influences, appealing to both rational and emotional decision-making processes, were common in women’s testing decision which many women saw as a minor decision compared to the decision to have surgery. Study 3 involved interviews with ten female BRCA carriers and showed that firstly, carriers valued peer experiences, and secondly, carriers’ self-concept influenced dual decision-making processes. In particular, the results from these studies found, firstly, that participants used both rational and emotional decision making but were more inclined to emotional decision making when they adopted a relational identity, such as sister, which anchored them to emotive familial cancer experiences. Secondly, participants valued the support of women who had experienced like surgery, support they perceived of as neutral and of having added value. This was often epitomised in a ‘show and tell’ event whereby women meet with other women who have been through similar experiences. This qualitative work therefore highlighted the role of both rational and emotional decision-making processes. It also emphasised the impact of peer support, specifically the ‘show and tell’ experience. To further examine the role of ‘show and tell’ in the decision-making process study 4, used a quantitative design to explore differences from before to after a ‘show and tell’ intervention. Due to recruitment problems this study used a retrospective quantitative design, and an online survey with 29 women. The results showed increases in participants’ intentions to have mastectomy after their show and tell experience and a reduction in decisional conflict. Overall, this thesis demonstrates that genetic testing and risk-reducing surgical decision making occurs, at the distal level, in a social environment generally positive to towards testing, where women are encouraged to be rational decision-makers. At the proximal level, decision makers are influenced by family and peers with shared cancer or decision-making experiences. The dual processes of rational and emotional decision-making are influenced by the decision makers’ individual and relational identities and this relationship between self-concept and dual process decision making is illustrated in the concluding model of this thesis.
Background: Processed foods are typically praised/revered for their convenience, palatability, and novelty; however, their healthfulness has increasingly come under scrutiny. Classification systems that categorise foods according to their “level of processing” have been used to predict diet quality and health outcomes and inform dietary guidelines and product development. However, the classification criteria used are ambiguous, inconsistent and often give less weight to existing scientific evidence on nutrition and food processing effects; critical analysis of these criteria creates conflict amongst researchers.
Scope and approach: We examine the underlying basis of food classification systems and provide a critical analysis of their purpose, scientific basis, and distinguishing features by thematic analysis of the category definitions.
Key findings and conclusions: These classification systems were mostly created to study the relationship between industrial products and health. There is no consensus on what factors determine the level of food processing. We identified four defining themes underlying the classification systems: 1. Extent of change (from natural state); 2. Nature of change (properties, adding ingredients); 3. Place of processing (where/by whom); and 4. Purpose of processing (why, essential/cosmetic). The classification systems embody socio-cultural elements and subjective terms, including home cooking and naturalness. Hence, “processing” is a chaotic conception, not only concerned with technical processes. Most classification systems do not include quantitative measures but, instead, imply correlation between “processing” and nutrition. The concept of “whole food” and the role of the food matrix in relation to healthy diets needs further clarification; the risk assessment/management of food additives also needs debate.
Responsibility is crucial to governance and key to achieving legitimacy within complex systems, yet there is limited attention to how it should be conceptualized within the context of food research and innovation (R&I). Understanding how diverse stakeholders in food R&I conceptualize responsibility is vital because it shapes the way problems are identified, goals are set and solutions are put in place. We report on empirical research with diverse stakeholders across Europe to understand and map the dimensions of responsibility for food R&I to support healthy and sustainable food systems. Semi-structured interviews were conducted with 32 stakeholders working in R&I in the cutting-edge domains of: cultured meat as a substitute for livestock meat; new crop breeding of potatoes; and a new approach to obesity reduction that focuses on weight acceptance. Drawing from the empirical evidence collected, we developed a classification system that reflects various conceptualizations of stakeholders' responsibility for food R&I to support healthy and sustainable food systems. Our thematic analysis revealed four overlapping rationales of responsibility—accountability, impact, reflexivity, and responsiveness, and characterized them in terms of: who the researcher is responsible to; whether the assessments of responsibility focus on R&I processes or impact; whether responsibility implies societal engagement; and how responsibility is assessed—retrospectively or prospectively. The article provides a basis for systematic application of these criteria to the specific instances of food R&I governance and for future joint decisions, about the ways to allocate responsibilities.
Lada Timotijevic, Carys Banks, Patrice Rusconi, Bernadette Egan, Matthew Peacock, Ellen Seiss, Morro Touray, Heather Gage, C. Pellicano, G. Spalletta, F. Assogna, M. Giglio, A. Marcante, G. Gentile, I. Cikajilo, D. Gatsios, S. Konitsiotis, D. Fotiadis (2020)Designing a mHealth Clinical Decision Support System for Parkinson’s Disease: A Theoretically Grounded User Needs Approach, In: BMC Medical Informatics and Decision Making2034
BMC (Springer Nature)
Background: Despite the established evidence and theoretical advances explaining human judgments under uncertainty, developments of mobile health (mHealth) Clinical Decision Support Systems (CDSS) have not explicitly applied the psychology of decision making to the study of user needs. We report on a user needs approach to develop a prototype of a mHealth CDSS for Parkinson’s Disease (PD), which is theoretically grounded in the psychological literature about expert decision making and judgement under uncertainty. Methods: A suite of user needs studies was conducted in 4 European countries (Greece, Italy, Slovenia, the UK) prior to the development of PD_Manager, a mHealth-based CDSS designed for Parkinson’s Disease, using wireless technology. Study 1 undertook Hierarchical Task Analysis (HTA) including elicitation of user needs, cognitive demands and perceived risks/benefits (ethical considerations) associated with the proposed CDSS, through structured interviews of prescribing clinicians (N=47). Study 2 carried out computational modelling of prescribing clinicians’ (N=12) decision strategies based on social judgment theory. Study 3 was a vignette study of prescribing clinicians’ (N=18) willingness to change treatment based on either self-reported symptoms data, devices-generated symptoms data or combinations of both. Results: Study 1 indicated that system development should move away from the traditional silos of ‘motor’ and ‘non-motor’ symptom evaluations and suggest that presenting data on symptoms according to goal-based domains would be the most beneficial approach, the most important being patients’ overall Quality of Life (QoL). The computational modelling in Study 2 extrapolated different factor combinations when making judgements about different questions. Study 3 indicated that the clinicians were equally likely to change the care plan based on information about the change in the patient’s condition from the patient’s self-report and the wearable devices. 3 Conclusions: Based on our approach, we could formulate the following principles of mHealth design: 1) enabling shared decision making between the clinician, patient and the carer; 2) flexibility that accounts for diagnostic and treatment variation among clinicians; 3) monitoring of information integration from multiple sources. Our approach highlighted the central importance of the patient-clinician relationship in clinical decision making and the relevance of theoretical as opposed to algorithm (technology)-based modelling of human judgment.
Dimitris Gatsios, Angelo Antonini, Giovanni Gentile, Andrea Marcante, Clelia Pellicano, Lucia Macchiusi, Francesca Assogna, Gianfranco Spalletta, Heather Gage, Morro Touray, Lada Timotijevic, Charo Hodgkins, Maria Chondrogiorgi, George Rigas, Dimitrios I Fotiadis, Spyridon Konitsiotis (2020)Feasibility and Utility of mHealth for the Remote Monitoring of Parkinson Disease: Ancillary Study of the PD_manager Randomized Controlled Trial, In: JMIR mHealth and uHealth8(6)e16414
L Timotijevic, MM Raats, J Barnett, K Brown, R Shepherd, L Fernandez, L Domolki, J Ruprich, A-M Sonne, M Hermoso, B Koletzko, L Frost-Andersen, A Timmer (2010)From micronutrient recommendations to policy: consumer and stakeholder involvement, In: EUROPEAN JOURNAL OF CLINICAL NUTRITION64pp. S31-S37
NATURE PUBLISHING GROUP
L Timotijevic, J Barnett, K Brown, R Shepherd, L Fernandez-Celemin, L Domolki, J Ruprich, RA Dhonukshe-Rutten, AM Sonne, M Hermoso, B Koletzko, L Frost-Andersen, A Timmer, MM Raats (2011)The process of setting micronutrient recommendations: A cross-European comparison of nutrition-related scientific advisory bodies., In: Public Health Nutrition14(4)pp. 716-728
Cambridge University Press
Objective To examine the workings of the nutrition-related scientific advisory bodies in Europe, paying particular attention to the internal and external contexts within which they operate. Design Desk research based on two data collection strategies: a questionnaire completed by key informants in the field of micronutrient recommendations and a case study that focused on mandatory folic acid (FA) fortification. Setting Questionnaire-based data were collected across thirty-five European countries. The FA fortification case study was conducted in the UK, Norway, Denmark, Germany, Spain, Czech Republic and Hungary. Results Varied bodies are responsible for setting micronutrient recommendations, each with different statutory and legal models of operation. Transparency is highest where there are standing scientific advisory committees (SAC). Where the standing SAC is created, the range of expertise and the terms of reference for the SAC are determined by the government. Where there is no dedicated SAC, the impetus for the development of micronutrient recommendations and the associated policies comes from interested specialists in the area. This is typically linked with an ad hoc selection of a problem area to consider, lack of openness and transparency in the decisions and over-reliance on international recommendations. Conclusions Even when there is consensus about the science behind micronutrient recommendations, there is a range of other influences that will affect decisions about the policy approaches to nutrition-related public health. This indicates the need to document the evidence that is drawn upon in the decisions about nutrition policy related to micronutrient intake.
Scientific Advisory Bodies (SABs) are seen as “boundary organisations” working at the interface between science, policy and society. Although their narrowly defined remit of risk assessment is anchored in notions of rationality, objectivity, and reason, in reality, their sources for developing recommendations are not limited to scientific evidence. There is a growing expectation to involve non-scientific sources of information in the formation of knowledge, including the expectation of stakeholder consultation in forming recommendations. Such a move towards “democratisation” of scientific processes of decision making within SABs has been described and often studied as “post-normal science” (PNS) (Funtowicz and Ravetz, 1993). In the current paper we examine the application of PNS in practice through a study of stakeholder consultations within the workings of the UK Scientific Advisory Committee for Nutrition (SACN). We use the theoretical insights from PNS-related studies to structure the analysis and examine the way in which PNS tenets resonate with the practices of SACN. We have selected a particular case of the SACN UK recommendations for salt as it is characterized by scientific controversy, uncertainty, vested interests and value conflict. We apply the tenets of PNS through documentary analysis of the SACN Salt Subgroup (SSG) consultation documents published in 2002/2003: the minutes of the 5 SACN SSG’s meetings which included summary of the SACN SSG’s stakeholder consultation and the SSG’s responses to the consultation. The analysis suggests that the SACN consultation can be construed as a process of managing sources of risk to its organisation. Thus, rather than being an evidence of post normal scientific practice, engagement became a mechanism for confirming the specific framing of science that is resonant with technocratic models of science holding authority over the facts. The implications for PNS theory are discussed. The work herein has been carried out within the EURRECA Network of Excellence (http://www.eurreca.org), financially supported by the Commission of the European Communities, Specific Research Technology and Development (RTD) Programme Quality of Life and Management of Living Resources within the sixth framework programme, contract no. 0136196. This does not necessarily reflect the Commission’s views or its future policy in this area. We would like to acknowledge the contribution made to editing of the article from Israel Berger, University of Surrey. No conflicts of interest have been declared by authors.
L Timotijevic, KA Brown, L Lähteenmäki, L de Wit, AM Sonne, I Řehůřková, M Jeruszka-Bielak, E Sicinska, N Brito García, A Guzzon, BB Jensen, R Shepherd, J Barnett, MM Raats (2013)EURRECA- A framework for considering evidence in public health nutrition policy development, In: Critical Reviews in Food Science and Nutrition53(10)pp. 1124-1134
Taylor & Francis
A key step towards developing appropriate evidence-based public health nutrition policies is determining exactly how that evidence should be collected and assessed. Despite this the extent to which different evidence bases influence policy selection is rarely explored. This paper presents an epistemological framework which offers a range of considerations effecting this process generally and with particular implications for both micronutrient requirements and the role of behaviour in the policy-making process. Qualitative case study data covering six European countries/regions (Czech Republic, Italy, Netherlands, Nordic countries, Poland and Spain), and three micronutrients (folate, iodine and vitamin D), have been presented to illustrate the relevance of the Framework.
Food-based dietary guidelines (FBDG) have primarily been designed for the consumer to encourage healthy, habitual food choices, decrease chronic disease risk and improve public health. However, minimal research has been conducted to evaluate whether FBDG are utilised by the public. The present review used a framework of three concepts, awareness, understanding and use, to summarise consumer evidence related to national FBDG and food guides. Searches of nine electronic databases, reference lists and Internet grey literature elicited 939 articles. Predetermined exclusion criteria selected twenty-eight studies for review. These consisted of qualitative, quantitative and mixed study designs, non-clinical participants, related to official FBDG for the general public, and involved measures of consumer awareness, understanding or use of FBDG. The three concepts of awareness, understanding and use were often discussed interchangeably. Nevertheless, a greater amount of evidence for consumer awareness and understanding was reported than consumer use of FBDG. The twenty-eight studies varied in terms of aim, design and method. Study quality also varied with raw qualitative data, and quantitative method details were often omitted. Thus, the reliability and validity of these review findings may be limited. Further research is required to evaluate the efficacy of FBDG as a public health promotion tool. If the purpose of FBDG is to evoke consumer behaviour change, then the framework of consumer awareness, understanding and use of FBDG may be useful to categorise consumer behaviour studies and complement the dietary survey and health outcome data in the process of FBDG evaluation and revision.
Richard A Harrington, Peter Scarborough, Charo Hodgkins, Monique M Raats, Gill Cowburn, Moira Dean, Aiden Doherty, Charlie Foster, Edmund Juszczak, Cliona Ni Mhurchu, Naomi Winstone, Richard Shepherd, Lada Timotijevic, Mike Rayner (2019)A pilot randomised controlled trial of a digital intervention aimed at improving food purchasing behaviour: the Front of pack Labels Impact on Consumer Choice (FLICC) study, In: JMIR Formative Research
Journal of Medical Internet Research
Background: Most food in the UK is purchased in supermarkets and many of these purchases are routinely tracked through supermarket loyalty card data. Using such data may be an effective way to develop remote public health interventions and to measure objectively their effectiveness at changing food purchasing behaviour.
Objectives: The FLICC study is a pilot randomised controlled trial of a digital behaviour change intervention. This pilot trial aimed to collect data on recruitment and retention rates and to provide estimates of effect sizes for the primary outcome (healthiness of ready meals and pizzas purchased) to inform a larger trial.
Methods: The intervention consisted of a website where participants could access tailored feedback on previous purchases of ready meals and pizzas, set goals, model behaviour and practice using traffic light labels. The control consisted of web-based information on traffic light labelling. Participants were recruited via email from a list of loyalty card holders held by the participating supermarket. All food and drink purchases for the participants for the six months prior to recruitment, during the six week intervention period and during a twelve week wash out period were transferred to the research team by the participating supermarket. Healthiness of ready meal and pizzas was measured using a pre-developed scale based solely on the traffic light colours on the foods. Questionnaires were completed at recruitment, end of intervention and end of wash out to estimate the effect of the intervention on variables that mediate behaviour change (e.g. belief and intention formation).
Results: We recruited 496 participants from an initial email to 50,000 people. Only three people withdrew from the study and purchase data were received for all other participants. 208 participants completed all three questionnaires. There was no difference in the healthiness of purchased ready meals and pizzas between the intervention and control arms either during the intervention period (P = 0.315) or at wash-out (P = 0.594).
Conclusions: Whilst the FLICC study did not find evidence of an impact of the intervention on food purchasing behaviour, the unique methods used in this pilot trial are informative for future studies that plan to use supermarket loyalty card data in collaboration with supermarket partners. The experience of the trial showcases the possibilities and challenges associated with the use of loyalty card data in public health research.
The use of dietary supplements is increasing globally and this includes the use of plant food supplements (PFS). A variety of factors may be influencing this increased consumption including the increasing number of older people in society, mistrust in conventional medicine and the perception that natural is healthy. Consumer studies in this area are limited, with a focus on dietary supplements in general, and complicated by the use of certain plant food supplements as herbal medicines. Research indicates that higher use of dietary supplements has been associated with being female, being more educated, having a higher income, being white and being older, however the drivers for consumption of supplements are complex, being influenced by both demographic and health-related factors. The aim of this paper is to provide an overview of current knowledge about the users and the determinants of usage of plant food supplements. With growing consumption of these products, the need for effective risk-benefit assessment becomes ever more important and an insight into who uses these types of products and why is an important starting point for any future science-based decisions made by policy makers, PFS manufacturers and ultimately by consumers themselves.
The objective of this study was to relate behaviour change mechanisms to nutritionally relevant behaviour and demonstrate how the different mechanisms can affect attempts to change these behaviours. Folate was used as an example to illuminate the possibilities and challenges in inducing behaviour change. The behaviours affecting folate intake were recognised and categorised. Behaviour change mechanisms from "rational model of man", behavioural economics, health psychology and social psychology were identified and aligned against folate-related behaviours. The folate example demonstrated the complexity of mechanisms influencing possible behavioural changes, even though this only targets the intake of a single micronutrient. When considering possible options to promote folate intake, the feasibility of producing the desired outcome should be related to the mechanisms of required changes in behaviour and the possible alternatives that require no or only minor changes in behaviour. Dissecting the theories provides new approaches to food-related behaviour that will aid the development of batteries of policy options when targeting nutritional problems.
R Gemen, J Breda, D Coutinho, L Fernández Celemín, S Khan, S Kugelberg, R Newton, G Rowe, M Strähle, L Timotijevic, C Urban, M Zolotonosa, K Hadwiger (2015)Stakeholder engagement in food and health innovation research programming - key learnings and policy recommendations from the INPROFOOD project, In: Nutrition Bulletin40(1)pp. 54-65
© 2015 British Nutrition Foundation.Europe recognises the need for technological innovation along with the importance of bridging the gap between science and society. The European Commission has developed a strategy to foster public engagement and a sustained two-way dialogue between science and civil society, and has set up a framework for Responsible Research and Innovation. The EU-funded project INPROFOOD aimed to find new ways to establish dialogue and mutual learning among stakeholders meant to inform subsequent work and future initiatives towards Responsible Research and Innovation. More specifically, INPROFOOD aimed to: (1) increase understanding of the landscapes of food and health innovation research programming; (2) adapt, test and evaluate the application of different stakeholder engagement methods to the area of food and health innovation research programming, which included European Awareness Scenario Workshops, PlayDecide games and an Open Space conference; and (3) to develop an action plan to progress towards Responsible Research and Innovation in this domain. The latter entailed a so-called Mobilisation and Mutual Learning Action Plan, which lays down a concrete framework for inclusive stakeholder involvement at different stages of the research and innovation process, with tangible key actions in five priority areas.
Kerry Brown, Lada Timotijevic, M Geurts, JL Arentoft, RAM Dhonukshe- Rutten, L Fezeu, P Finglas, M Laville, G Perozzi, M Ocké, K Poppe, N Slimani, HM Snoek, I Tetens, P van ‘t Veer, C Vors, KL Zimmermann (2017)Concepts and procedures for mapping food and health research infrastructure: New insights from the EuroDISH project, In: Trends in Food Science and Technology63pp. 113-131
Background Recent initiatives in Europe have encouraged the formalisation of research infrastructure to unify fragmented facilities, resources and services; and to facilitate world-class research of complex public health challenges, such as those related to non-communicable disease. How this can be achieved in the area of food and health has, to date, been unclear. Scope and approach This commentary paper presents examples of the types of food and health research facilities, resources and services available in Europe. Insights are provided on the challenge of identifying and classifying research infrastructure. In addition, suggestions are made for the future direction of food and health research infrastructure in Europe. These views are informed by the EuroDISH project, which mapped research infrastructure in four areas of food and health research: Determinants of dietary behaviour; Intake of foods/nutrients; Status and functional markers of nutritional health; Health and disease risk of foods/nutrients. Key findings and conclusion There is no objective measure to identify or classify research infrastructure. It is therefore, difficult to operationalise this term. EuroDISH demonstrated specific challenges with identifying the degree an organisation, project, network or national infrastructure could be considered a research infrastructure; and establishing the boundary of a research infrastructure (integral hard or soft facilities/resources/services). Nevertheless, there are opportunities to create dedicated food and health research infrastructures in Europe. These would need to be flexible and adaptable to keep pace with an ever-changing research environment and bring together the multi-disciplinary needs of the food and health research community.
RAM Dhonukshe-Rutten, Lada Timotijevic, AEJM Cavelaars, LS De Wit, EL Doets, Monique Raats, G Tabacchi, TMA Wijnhoven, B Roman, JN De La Cruz, M Gurinovic, LCPGM De Groot, P van't Veer (2010)EURRECA’s General Framework to make the process of setting up micronutrient recommendations explicit and transparent, In: Proceedings of the Nutrition Society69
EURRECA is a Network of Excellence with the objective of addressing the problem of national variations in micronutrient recommendations and working towards a framework of advice to better inform policy-makers. It became apparent that the network needed a framework that puts the process of recommendation setting in the context of science, policy and society. Although variability in recommendations originates from the scientific evidence-base used and its interpretation (e.g. health outcomes, types and methods of evaluation of evidence, quantification of risk/benefit), the background information provided in the recommendation reports does not easily facilitate the disentangling of the relative contribution of these different aspects because of lack of transparency. The present report portrays the general framework (see Figure) that has been developed by and for EURRECA in order to make the process of setting up micronutrient recommendations explicit and transparent. In explaining the link from science to policy applications, the framework distinguishes four principal components or stages (see Figure). These stages are: a) Defining the nutrient requirements: A judgement about the (best) distribution(s) of the population requirement is necessary for estimating nutrient requirements. Many assumptions need to be made about the attributes of the population group. Furthermore, several factors (consumer behaviour as well as physiology) are to be included to characterize optimal health. b) Setting the nutrient recommendations: All available evidence is needed to formulate recommendations. Incorporating different endpoints provide the basis to formulate an optimal diet in terms of (non-)nutrients and food(group)s. c) Policy options: Policy options should be formulated on how the optimal diet can be achieved. They concern the advice of scientist and/or expert committees to the policy makers. Current policy options are setting up a task force, food based dietary guidelines, general health education, educational programme for specific group(s), voluntary or mandatory fortification, labelling, supplementation (general or for specific groups), inducing voluntary action in industry, legislation on micronutrient composition in food products, fiscal change, monitoring and evaluation of intake (via food consumption surveys) and/or nutritional status. d) Policy applications: Policies and planning, usually done by government, that lead to nutritional interventions or programmes. They usually require consideration of scientific, legal, regulatory, ethical and cultural issues, economic implications, and political and social priorities. This framework illustrates three dimensions of the process of setting (micro)nutrient requirements: 1) The logical sequence of scientific thinking from setting physiological requirements for nutritional health leading to evidence-based derivation of Nutrient Intake Values. 2) In the early stages nutritional and epidemiological science is the dominant source and in the later stages evidence from consumer and social sciences as well as stakeholder influences is used in deriving the options for changing the distribution of nutrient intakes. 3) The wider socio-political context: a feedback loop between health perception, actual health and food intake exists and is directly affected by the food industry and many other stakeholders. Moreover, from the viewpoint of policymakers, there are concerns for health promotion and disease prevention because of population health indices, costs of health care, and economic interests in the agro-food sector. In conclusion: A systematic approach for development and regular review of micronutrient requirements in Europe, transparently based on scientific evidence and best practices, enables national and international authorities/bodies to use the best available information obtained through evidence-based nutrition and accomplish well-considered food policy. Funded by an EU FP6 Network of Excellence (EURRECA, grant no. FP 6–036196-2). G. T. performed part of the work under a short-term contract for WHO Europe.
In public health nutrition, sustainability refers to the ability to maintain food system capacity to support the nutritional health needs of current and future populations while protecting the ecological systems that produce food. The FAO defines sustainable diets as those that are ‘protective and respectful of biodiversity and ecosystems, culturally acceptable, accessible, economically fair and affordable; nutritionally adequate, safe and healthy; while optimizing natural and human resources’.
This paper presents the recently finished EU-funded RICHFIELDS project aimed to design a new research infrastructure that would foster research in the areas of food and nutrition with a focus on consumers' behavior and lifestyle. In this project, an architecture of a new consumer data platform was designed and discussed from the researchers, business, management, ethical and legal points of view. Also new methodology for supporting big and open data standardization and interoperability was developed.
KA Brown, M Hermoso, L Timotijevic, J Barnett, ITL Lillegaard, I Rehurková, A Larrañaga, A Loncarevic-Srmic, LF Andersen, J Ruprich, L Fernández-Celemín, MM Raats (2012)Consumer involvement in dietary guideline development: opinions from European stakeholders, In: Public Health Nutrition
Cambridge University Press
Objective The involvement of consumers in the development of dietary guidelines has been promoted by national and international bodies. Yet, few best practice guidelines have been established to assist such involvement. Design Qualitative semi-structured interviews explored stakeholders’ beliefs about consumer involvement in dietary guideline development. Setting Interviews were conducted in six European countries: The Czech Republic, Germany, Norway, Serbia, Spain and the United Kingdom. Subjects Seventy-seven stakeholders were interviewed. Stakeholders were grouped as government, scientific advisory body, professional and academic, industry or non-government organisations. Response rate ranged from 45%-95%. Results Thematic analysis was conducted with the assistance of NVivo qualitative software (QSR International Pyt Ltd.). Analysis identified two main themes: type of consumer involvement and pros and cons of consumer involvement. Direct consumer involvement (e.g. consumer organisations), in the decision-making process was discussed as a facilitator to guideline communication towards the end of the process. Indirect consumer involvement (e.g. consumer research data), was considered at both the beginning and the end of the process. Cons to consumer involvement included the effect of vested interests on objectivity; consumer disinterest; complications in terms of time, finance and technical understanding. Pros related to increased credibility and trust in the process. Conclusions Stakeholders acknowledged benefits to consumer involvement during the development of dietary guidelines, but remained unclear on the advantage of direct contributions to the scientific content of guidelines. In the absence of established best practice, clarity on the type and reasons for consumer involvement would benefit all actors.
D. Gatsios, A. Antonini, G. Gentile, A. Marcante, C. Pellicano, L. Macchiusi, F. Assogna, G. Spalletta, H. Gage, M. Touray, L. Timotijevic, C. Hodgkins, M. Chondrogiorgi, G. Rigas, D.I. Fotiadis, S. Konitsiotis (2020)Mhealth for remote monitoring and management of Parkinson’s disease: determinants of compliance and validation of a tremor evaluation method, In: JMIR mHealth and uHealth
Background: mhealth, predominantly wearable technology and mobile apps, have been considered in Parkinson’s Disease to provide valuable ecological data between face to face visits and improve monitoring of motor symptoms remotely.
Objective: In this study we explore the feasibility of using a technology based mhealth platform comprising a smartphone in combination with a smartwatch and a pair of smart insoles, described in the present study as the PD_manager system, to collect clinically meaningful data. We also explore outcomes and disease related factors which are important determinants to establish feasibility. Finally, we further validate a tremor evaluation method with data collected while patients perform their daily activities.
Methods: PD_manager trial was an open label parallel group randomized study. The mheath platform consists of a wristband, a pair of sensor insoles, a smartphone (with dedicated mobile Android apps and a knowledge platform) serving as the cloud backend. The compliance was assessed with statistical analysis and the factors affecting it using appropriate regression analysis. The correlation of the scores of our previous algorithm for tremor evaluation and the respective UPDRS estimations by clinicians were explored.
Results: There were 65 of the 75 study participants (87%) who completed the protocol. They used the PD_manager system for a median 11.57 days (Std. dev. 3.15). The regression analysis suggests that the main factor associated with high usage was caregivers’ burden. Motor Aspects of Experiences of Daily Living and patients’ self-rated health status also influence the system’s usage. Our algorithm provided clinically meaningful data for the detection and evaluation of tremor.
Conclusions: We found that PD patients, regardless of their demographics and disease characteristics, used the system for 11-14 days. The study further supports that mhealth can be an effective tool for the ecologically valid, passive, unobtrusive monitoring and evaluation of symptoms. Future studies will be required to demonstrate that an mhealth platform can improve disease management and care.
In a policy environment that contains structures to enable public engagement, the validity of expressions of public opinion and concern are in part legitimated through constructions of their representativeness. The current paper examined the ways in which various organisations involved in food and nutrition policy development negotiated the legitimacy of their inclusion in policy processes through claims about who they represented and how, with a specific focus upon older people (aged 60+) as an example of the “hard to reach”. This study is set in the context of theoretical considerations around the forms of representativeness that have been identified in the literature. A thematic analysis of 52 interviews with organisations and stakeholders active in the area of food and nutrition policy in England, UK explores these competing modalities of representation and how they are used both to claim legitimacy for self and to discount the claims of others. Different scripts of representation are deployed by various stakeholders and there is evidence of the strategic and the simultaneous deployment of different representativeness claims. The notions of expert representativeness permeate other modalities of representativeness, suggesting that the dominant framework for food and nutrition policy development is based upon technocratic models of decision-making. This highlights the way in which public views can be distanced from the framing of policy questions.
Young sudden cardiac death (YSCD), often occurring in previously healthy individuals, is a tragic event with devastating impact on affected families, who are at heightened risk of posttraumatic stress and prolonged grief and may themselves be at risk of YSCD. Previous research suggests that surviving family members’ psychosocial support needs are often unmet.
This study sought to identify how YSCD-affected families experience dedicated community and peer support in light of their psychosocial support needs.
The study used a qualitative design, employing a thematic analysis of focus group and interview data. Three focus groups and five individual interviews were conducted with affected family members (N = 19). The sample was drawn from a UK-based charity, Cardiac Risk in the Young. Audio-recordings of the focus groups and interviews were transcribed and subjected to thematic analysis.
Three super-ordinate themes were identified: 1. YSCD community support as offering a place of safety, 2. YSCD community support as fostering sense-making, 3. YSCD community support as facilitating finding new meaning.
YSCD-affected families can benefit from access to dedicated community and peer support that offers a safe environment, provides affiliation, understanding and normalisation and enables sense-making and the rebuilding of a sense of self. Dedicated community support can facilitate meaningful re-engagement with life through helping prevent YSCD and through memorialisation and legacy-building to maintain a continuing bond with the deceased. Clinicians need to be aware of the need to incorporate available community and peer support into patient pathways.
Morro Touray, A Antonini, G Gentile, M Giglio, A Marcante, Heather Gage, D Fotiadis, D Gatsios, S Konitsiotis, Lada Timotijevic, B Egan, Charo Hodgkins, R Biundo, C Pellicano (2018)Acceptability to patients, carers and clinicians of a mHealth platform for the management of Parkinson's disease (PD_Manager): study protocol for a pilot randomised controlled trial, In: Trials19(492)
Background: Parkinson’s disease is a degenerative neurological condition causing multiple motor and non-motor symptoms that have a serious adverse effect on quality of life. Management is problematic due to the variable and fluctuating nature of symptoms, often hourly and daily. The PD_Manager mHealth platform aims to provide a continuous feed of data on symptoms to improve clinical understanding of the status of any individual patient and inform care planning. The objectives of this trial are to (1) assess patient (and family carer) perspectives of PD_ Manager regarding comfort, acceptability and ease of use; (2) assess clinician views about the utility of the data generated by PD_Manager for clinical decision making and the acceptability of the system in clinical practice. Methods/design: This trial is an unblinded, parallel, two-group, randomised controlled pilot study. A total of 200 persons with Parkinson’s disease (Hoehn and Yahr stage 3, experiencing motor fluctuations at least 2 h per day), with primary family carers, in three countries (110 Rome, 50 Venice, Italy; 20 each in Ioannina, Greece and Surrey, England) will be recruited. Following informed consent, baseline information will be gathered, including the following: age, gender, education, attitudes to technology (patient and carer); time since Parkinson’s diagnosis, symptom status and comorbidities (patient only). Randomisation will assign participants (1:1 in each country), to PD_Manager vs control, stratifying by age (1 ≤ 70 : 1 > 70) and gender (60% M: 40% F). The PD_Manager system captures continuous data on motor symptoms, sleep, activity, speech quality and emotional state using wearable devices (wristband, insoles) and a smartphone (with apps) for storing and transmitting the information. Control group participants will be asked to keep a symptom diary covering the same elements as PD_Manager records. After a minimum of two weeks, each participant will attend a consultation with a specialist doctor for review of the data gathered (by either means), and changes to management will be initiated as indicated. Patients, carers and clinicians will be asked for feedback on the acceptability and utility of the data collection methods. The PD_ Manager intervention, compared to a symptom diary, will be evaluated in a cost-consequences framework Discussion: Information gathered will inform further development of the PD_Manager system and a larger effectiveness trial. Trial registration: ISRCTN Registry, ISRCTN17396879. Registered on 15 March 2017.
Lada Timotijevic, Monique Raats, J Barnett, K Brown, L Fernandez, L Dömölki, J Ruprich, RA Dhonukshe-Rutten, A-M Sonne, M Hermoso, B Koletzko, L Frost-Andersen Institutional contexts in which micronutrient reference values are developed across Europe, In: Proceedings of the Nutrition Society69
Progress has been made towards a coherent public health nutrition policy across Europe; however this remains a challenge mainly due to the variety of public health nutrition (PHN) policy traditions between countries and the diversity in scientific bases used to inform policy(1) This is particularly apparent in the misalignment of micronutrient reference values (MRV) across European countries and regions(2). MRV often inform food and nutrition policies which are becoming an increasingly more important part of public health policies due to the burden associated with nutrition-related diseases. Desk research and a questionnaire completed by key informants were used to collect data relating to the processes used to develop current MRV in thirty-one European countries, employing methods reported previously(2). Data were collected on the process of scientific decision-making, including information on the transparency and openness of the process. Considerable diversity was observed across Europe in the institutional context and nutrition policy imperatives driving the process of developing MRV. In those countries that have an established tradition of PHN policy the presence of advisory bodies is seen as key in developing MRV and advising government departments charged with applying science into policy and practice. This position is partly predicated by the institutional context (whether there is a dedicated department in charge of public health and how it is linked with other departments, the diversity of bodies and organisations involved in setting the agendas and making decisions in PHN, the broader governance context etc.), the PHN tradition and the historical context. Although the implication for nutrition policy is that there is a dedicated scientific institution or basis that acts as policy advisor and consequently facilitates development of dedicated national-level nutrition policies, it raises the issue of the extent to which scientific advisory committees are open, transparent and inclusive in the process. It appears that there is a considerable divide in terms of the openness and transparency of the process between the countries with an emerging democracy and those with established and increasingly participatory governance structures; also, in the complexity of the governance system in charge of developing MRV and hence the extent to which these levels are specifically tailored to national needs. In those countries with a more developed institutional architecture, scientific advisory bodies appear to be more than just a source of technical and scientific advice, instead acting as a link between evidence and policy. In particular, the remaining question is to what extent this model of informing national level of PHN policy can service the policy imperatives and the needs of wider society for the development of PHN policy that includes the framing of a wider section of society. In addition, the selection of the advisory panel members is not always clear and could lead to MRV that are eminence rather than evidence based.
RAM Dhonukshe-Rutten, L Timotijevic, AEJM Cavelaars, MM Raats, LS de Wit, EL Doets, G Tabacchi, B Roman, J Ngo-de la Cruz, M Gurinovic, LCPGM de Groot, P van 't Veer (2010)European micronutrient recommendations aligned: a general framework developed by EURRECA, In: EUROPEAN JOURNAL OF CLINICAL NUTRITION64pp. S2-S10
NATURE PUBLISHING GROUP
L de Wit, L Timotijevic, K Brown, A Guzzon, N Brito Garcia, W Roszkowski, I Rehurkova, Y Sarmant, E Alevritou, P Haugaard, L Bucchini, AM Sonne, M Hermoso, J Ruprich, L Lahtteenmaki, M Raats (2011)Selecting options for national nutrition policy: a consideration of scientific evidence and alternative perspectives, In: ANNALS OF NUTRITION AND METABOLISM58pp. 129-129 R Dhonukshe-Rutten, J Bouwman, KA Brown, AE Cavelaars, R Collings, E Grammatikaki, LCPGM de Groot, M Gurinovic, LJ Harvey, M Hermoso, R Hurst, B Kremer, J Ngo, R Novakovic, MM Raats, F Rollin, L Serra-Majem, OW Souverein, L Timotijevic, P van ’t Veer (2013)EURRECA - Evidence-based methodology for deriving micronutrient recommendations, In: Critical Reviews in Food Science and Nutrition
Introduction: There have been calls within Europe to harmonise the process of setting micronutrient recommendations and share best practice between countries and regions. However the various scientific advisory bodies (SAB) responsible for setting recommendations appear to differ by their statutory model of operation as well as the degree of transparency available throughout the decision making process. particularly concerning the handling of risk and uncertainty. Objectives: The present study explored how risk and uncertainty was handled in SABs across Europe. Particular attention was paid to understanding the types of deliberations surrounding the terms of reference. selection of expertise. sources of evidence. evaluation of evidence and communication of findings to policy decision makers. wider stakeholders and the general public. Method/Design: A retrospective in-depth case study design was used to explore how risk and uncertainty were handled in the SABs concerning the vitamin D and folate nutrient recommendations in five countries/regions: England. the Netherlands. Poland. Spain and the Nordic countries. A case study consisted of semi-structured interviews with at least two members of SAB as well as in-depth desk research surrounding the recommendations. Interview data was analysed in the native language using template analysis and a skeleton coding structure created and modified by partners during preliminary analyses. Thematic analysis was then carried out by each country and an English-translated summary of identified themes and illustrative quotes was produced and combined with the desk research to form each case study. Results: This paper will explore any disparity in decision making around risk and uncertainty across countries/regions and micronutrients. Conclusions: Implications for the interaction between science and policy in terms of evidence based policy decision making will be discussed.
Dietary factors are the most important risk factors affecting health and well-being of population in every Member State of the European Region. Finding sustainable solutions to the food and health challenges is one of the key issues that today’s society urgently needs to address. Research prioritisation thus has an essential role in directing public resources to addressing these challenges. However, the processes of prioritisation among the food and health funders are rarely subject to scrutiny and the calls for democratizing science continue, as a means of enhancing both input legitimacy (with its focus on the processes of decision-making) and output legitimacy (the utility and impact of such decisions). The current study examines what conceptualisations of legitimacy (input and output) are held by the European stakeholders of the food and health research and innovation (R&I) process such as business organisations, non-governmental organisations (NGOs) and public sector organisations. We analyse stakeholder views from a series of European Awareness Scenario Workshops across nine EU countries (N = 295). The content and thematic analysis of the outputs identified six criteria determining conceptualisations of legitimacy: Influence; Representation; Procedural issues; Epistemic focus; Strategic vision; and Impact. The statistical analysis of the coded data highlighted stakeholder differences with business sector organisations being significantly less concerned about influence and representation than either NGO or public sector organisations. The results indicate that input legitimacy is of major concern to civil society and public sector actors. They reflect the wider debate about the way in which food and health R&I should be funded and policy decisions conducted, suggesting a need for better delineation of stakeholder roles and power differentials in this process. The findings are discussed with reference to the current discussions about Responsible Research and Innovation.
The rise in use of food supplements based on botanical ingredients (herbal supplements) is depicted as part of a trend empowering consumers to manage their day-to-day health needs, which presupposes access to clear and accurate information to make effective choices. Evidence regarding herbal supplement efficacy is extremely variable so recent regulations eliminating unsubstantiated claims about potential effects leave producers able to provide very little information about their products. Medical practitioners are rarely educated about herbal supplements and most users learn about them via word-of-mouth, allowing dangerous misconceptions to thrive, chief among them the assumption that natural products are inherently safe. Print media is prolific among the information channels still able to freely discuss herbal supplements.
This study thematically analyses how 76 newspaper/magazine articles from the UK, Romania and Italy portray the potential risks and benefits of herbal supplements.
Most articles referenced both risks and benefits and were factually accurate but often lacked context and impartiality. More telling was how the risks and benefits were framed in service of a chosen narrative, the paucity of authoritative information allowing journalists leeway to recontextualise herbal supplements in ways that serviced the goals and values of their specific publications and readerships.
Providing sufficient information to empower consumers should not be the responsibility of print media, instead an accessible source of objective information is required.
RAM Dhonukshe-Rutten, L Timotijevic, AEJM Cavelaars, MM Raats, LS de Wit, EL Doets, B Roman, J Ngo-de la Cruz, M Gurinovic, LCPGM de Groot, P van't Veer (2010)European micronutrient recommendations aligned: a general framework developed by EURRECA Rosalie Dhonukshe, In: EUROPEAN JOURNAL OF PUBLIC HEALTH20pp. 125-125
Background: In Europe, micronutrient recommendations have been established by (inter)national committees of experts and are used by public health-policy decision makers to monitor and assess the adequacy of the diets of population groups. Current micronutrient recommendations are, however, heterogeneous, whereas the scientific basis for this is not obvious. Alignment of setting micronutrient recommendations is necessary to improve the transparency of the process, the objectivity and reliability of recommendations that are derived by diverse regional and (inter)national bodies. Objective: To align transparent decision making for evidence-based policy making, stakeholder involvement and alignment of policies across Europe. Results: The General Framework as proposed by Eurreca envisions the derivation of nutrient recommendations as scientific methodology, embedded in a policy-making process that also includes consumer issues, and acknowledges the influences of the wider sociopolitical context by distinguishing the principal components of the framework: (i) defining the nutrient requirements for health, (ii) setting nutrient recommendations, (iii) policy options and (iv) policy applications. Conclusions: The General Framework can serve as a basis for a systematic and transparent approach to the development and review of micronutrient requirements in Europe, as well as the decision making of scientific advisory bodies, policy makers and stakeholders involved in this process of assessing, developing and translating these recommendations into public health nutrition policy.
In the light of the clear imperative of evidence-based policy development across the European Union, one of the challenges facing policy makers is establishing systems and processes for the collation and assessment of evidence. To date, there has been little clarity about what kind of evidence ends up in policy and in particular the way in which micronutrient recommendations link up to policy has largely been overlooked. The discrepancy between the recommendations of scientific advisory bodies for nutrition and the policy options utilizing their evidence indicates the lack of clarity about the process and that considerations other than scientific evidence influence the final outcome. The current article reports on the Health- Behaviour-Policy Framework which describes a range of considerations that play a role in the decision-making processes about a policy instrument (or a combination of) to adopt based on scientific advice about micronutrient requirements. These considerations include: the scientific advice linking micronutrient recommendations with health outcome; the evidence about human behaviour relevant to the health outcome; the policy and institutional context for the delivery of policy; the wider context. The framework is epistemological as it aims to identify the domains of information from which to draw in order to create a link between a desired health outcome and a policy. It is also a nested framework, as each layer touches upon the central issue under consideration (a desired health outcome) and each is in some way connected and can impact upon the other.
The need for a better understanding of food consumption behaviour within its behavioural context has sparked the interest of nutrition researchers for user-documented food consumption data collected outside the research context using publicly available nutrition apps. The study aims to characterize the scientific, technical, legal and ethical features of this data in order to identify the opportunities and challenges associated with using this data for nutrition research.
A search for apps collecting food consumption data was conducted in October 2016 against UK Google Play and iTunes storefronts. 176 apps were selected based on user ratings and English language support. Publicly available information from the app stores and app-related websites was investigated and relevant data extracted and summarized. Our focus was on characteristics related to scientific relevance, data management and legal and ethical governance of user-documented food consumption data.
This paper reports on an evaluation study of two deliberative methods of public participation of the "hard-to-reach" in food-policy development-the citizens' workshop and the citizens' jury. The participation was conducted on a live food-policy topic (food retailing) and the specific hard-to-reach group of older people was recruited. The evaluation of the two methods was based on an assessment of the participants' and observers' perceptions of the processes and outcomes of the methods, against a set of evaluation criteria, spanning both the individual and group level of analysis. The evaluation used a quasi-experimental, between groups, pre- and post-participation design. The study showed that the properties of the methods alone, such as availability of extra information, had little impact on both satisfaction with the process and the actual task outcomes. It further emphasised the importance of group debate for the perceived satisfaction with the process and the subjective outcomes of the event. The study illustrated that the high level of process satisfaction was not contemporaneous with the perceived impact of participation, such as its perceived influence of policy decision-making, suggesting that the relationship between participation outcomes (i.e. impact of participation) and processes was a complex one. It is argued here that this relationship should be considered in the light of identity processes and the context of public participation. (c) 2006 Elsevier Ireland Ltd. All rights reserved.
The dominant approaches to public health policy on childhood obesity are based on the neoliberal emphasis of personal choice and individual responsibility. We study adolescents’ (N=81) beliefs about responsibility for childhood obesity as a public health issue, through an innovative participatory method, PlayDecide, organised in two countries: the UK and Spain. There is no evidence of a blanket rejection of individual responsibility, rather, a call for renegotiation of the values that inform adolescents’ food choices. The findings suggest the need to broaden the framing of obesity-related policy to go beyond the nutritional paradigm and include other values that signal health.
Kerry Brown, Lada Timotijevic, J Barnett, J Ruprich, I Rehůřková, M Hermoso, LF Andersen, IT Lillegaard, L Fernández-Celemín, A Larrañaga, A Lončarevič-Srmič, Monique Raats (2011)Micronutrient recommendation stakeholders' beliefs on dietary guidelines: a qualitative study across six European countries/regions., In: European Journal of Clinical Nutrition65(7)pp. 872-874
Nature Publishing Group
A range of stakeholders have been involved in the development and implementation of dietary guidelines (DG) across Europe. Seventy-seven semi-structured qualitative interviews explored stakeholders' beliefs of DG in six European countries/regions. A main theme, variation in the interpretation of the term dietary guideline, was identified using thematic analysis. Descriptions of DG varied across stakeholder groups and countries. Reference was made to both food-based and nutrient-based guidelines, including the terms food-based DG and food guides (for example, pyramids), nutrient recommendations, dietary recommendations, dietary reference values and guideline daily amounts. The terminology surrounding DG requires greater clarity. Until that time, stakeholders would benefit from increased awareness of potential misinterpretations and the implications of this on multi-stakeholder, multi-national policy development and implementation.European Journal of Clinical Nutrition advance online publication, 13 April 2011; doi:10.1038/ejcn.2011.38.
KA Brown, L Timotijevic, M Geurts, JL Arentoft, J Bardes, L Fezeu, M Laville, M Ocke, I Tetens, C Vors (2015)New insights from EuroDISH mapping of food and health research infrastructure, In: Ann Nutr Metabsupp 1(67)pp. 392-392 KA Brown, L De Wit, L Timotijevic, AM Sonne, L Lähteenmäki, N Brito Garcia, M Jeruszka-Bielak, E Sicińska, AN Moore, M Lawrence, MM Raats (2015)Communication of scientific uncertainty: International case studies on the development of folate and vitamin D Dietary Reference Values, In: Public Health Nutrition18(8)pp. 1378-1388
Cambridge University Press
Objective Transparent evidence-based decision making has been promoted worldwide to engender trust in science and policy making. Yet, little attention has been given to transparency implementation. The degree of transparency (focused on how uncertain evidence was handled) during the development of folate and vitamin D Dietary Reference Values was explored in three a priori defined areas: (i) value request; (ii) evidence evaluation; and (iii) final values. Design Qualitative case studies (semi-structured interviews and desk research). A common protocol was used for data collection, interview thematic analysis and reporting. Results were coordinated via cross-case synthesis. Setting Australia and New Zealand, Netherlands, Nordic countries, Poland, Spain and UK. Subjects Twenty-one interviews were conducted in six case studies. Results Transparency of process was not universally observed across countries or areas of the recommendation setting process. Transparency practices were most commonly seen surrounding the request to develop reference values (e.g. access to risk manager/assessor problem formulation discussions) and evidence evaluation (e.g. disclosure of risk assessor data sourcing/evaluation protocols). Fewer transparency practices were observed to assist with handling uncertainty in the evidence base during the development of quantitative reference values. Conclusions Implementation of transparency policies may be limited by a lack of dedicated resources and best practice procedures, particularly to assist with the latter stages of reference value development. Challenges remain regarding the best practice for transparently communicating the influence of uncertain evidence on the final reference values. Resolving this issue may assist the evolution of nutrition risk assessment and better inform the recommendation setting process.
Harriëtte M. Snoek, Lars M.T. Eijssen, Marjolein Geurts, Cecile Vors, Kerry Brown, Marc-Jeroen Bogaardt, Rosalie A.M. Dhonukshe-Rutten, Chris T. Evelo, Leopold Fezeu, Paul M. Finglas, Martine Laville, Marga Ocké, Giuditta Perozzi, Krijn Poppe, Nadia Slimani, Inge Tetens, Lada Timotijevic, Karin Zimmermann, Pieter van ’t Veer (2018)Advancing food, nutrition, and health research in Europe by connecting and building research infrastructures in a DISH-RI: Results of the EuroDISH project, In: Trends in Food Science & Technology73pp. 58-66
Background: Research infrastructures (RIs) are essential to advance research on the relationship between food, nutrition, and health. RIs will facilitate innovation and allow insights at the systems level which are required to design (public health) strategies that will address societal challenges more effectively. Approach: In the EuroDISH project we mapped existing RIs in the food and health area in Europe, identified outstanding needs, and synthesised this into a conceptual design of a pan-European DISH-RI. The DISH model was used to describe and structure the research area: Determinants of food choice, Intake of foods and nutrients, Status and functional markers of nutritional health, and Health and disease risk. Key findings: The need to develop RIs in the food and health domain clearly emerged from the EuroDISH project. It showed the necessity for a unique interdisciplinary and multi-stakeholder RI that overarches the research domains. A DISH-RI should bring services to the research community that facilitate network and community building and provide access to standardised, interoperable, and innovative data and tools. It should fulfil the scientific needs to connect within and between research domains and make use of current initiatives. Added value can also be created by providing services to policy makers and industry, unlocking data and enabling valorisation of research insights in practice through public-private partnerships. The governance of these services (e.g. ownership) and the centralised and distributed activities of the RI itself (e.g. flexibility, innovation) needs to be organised and aligned with the different interests of public and private partners.
M Jeruszka-Bielak, E Sicinska, L de Wit, J Ruprich, I Rehurkova, KA Brown, L Timotijevic, A-M Sonne, P Haugaard, A Guzzon, N Brito Garcia, E Alevritou, M Hermoso, Y Sarmant, L Lahteenmaki, W Roszkowski, MM Raats (2015)Stakeholders' Views on Factors Influencing Nutrition Policy: a Qualitative Study Across Ten European Countries, In: POLISH JOURNAL OF FOOD AND NUTRITION SCIENCES65(4)pp. 293-302
DE GRUYTER OPEN LTD
The objective was to identify the main factors inﬂ uencing micronutrient policies in the opinion of policy actors in ten European countries. Study was carried out during Jan-Nov 2010 in European countries: the Czech Republic, Denmark, England, Germany, Greece, Italy, the Netherlands, Nor-way, Poland and Spain. Semi-structured qualitative interviews were conducted with representatives of stakeholders involved in the vitamin D, folate and iodine policy making process. Fifty eight key informants representing mainly scientiﬁ c advisory bodies (n=24) and governmental organisations (n=19) participated in the study. The remaining interviewees represented non-governmental organisations (n=6), industry (n=4) or were indepen-dent academic or health professional experts (n=5). Data were analysed by theoretical interpretative thematic analysis. Insights from interviewees on the development of micronutrient policies were grouped using the Public Health Nutrition Policy-making model. The main factors inﬂ uencing the mi-cronutrient policies were: systematic monitoring of nutrition and health, causal relationships between consumers’ diet-related behaviours and health outcomes, scientiﬁ c recommendations from national bodies (Science area); scientiﬁ c recommendations from international authorities and experiences of other countries, EU legislation, cultural factors (Wider context) and political environment, national capacity to deal with the problem, national leg-islation, economics, stakeholder engagement, relationships between stakeholders (Policy and institutions area). The spectrum and weight of the factors inﬂ uencing nutritional policy depends on nutrient, country and degree of its “advanced status” within nutrition policy, political environment, culture and socio-economic conditions as well as the point of view (who is expressing the opinion).
SS Khan, L Timotijevic, R Newton, D Coutinho, J Luis Llerena, S Ortega, L Benighaus, C Hofmaier, Z Xhaferri, A de Boer, C Urban, M Straehle, L Da Pos, F Neresini, MM Raats, K Hadwiger (2016)The framing of innovation among European research funding actors: Assessing the potential for 'responsible research and innovation' in the food and health domain, In: Food Policy62pp. 78-87
Responsible Research and Innovation (RRI) has recently emerged as a new framework for science and technology governance. The concept articulates the need for mutual exchange by which societal actors become responsive to each other early on in the process of innovation, with a view to facilitate ethically acceptable and sustainable innovation. There is relatively limited evidence to explore the extent to which the process of research and innovation under the terms of RRI is realised in practice, particularly in the context of food and health research. Although research to date has been examining innovation from the point of view of inputs and outputs—R&D funding and patents—we propose to examine the cognitive framing of innovation that shapes decisions of those who constitute a part of the innovation chain. This paper explores how the concept of innovation is understood and used in policy implementation, with a particular focus upon ‘food and health’ science and research policy and funding. Our analysis is based on 55 interviews of various actors engaged in research funding decision-making across eight European countries. Three themes emerged from the analysis: concept of innovation; conditions for innovation; and drivers of innovation; through these themes, the cognitive framing was drawn out. The cognitive framing suggests that innovation in the food and health domain is perceived to be focused on biosciences and marketable applications to the neglect of social sciences and broader public interest; that the “innovation network” is primarily viewed as centred around scientific/technical and industrial actors; and that the demand-pull dynamic is relevant to innovation in the area of food and health, despite having been relegated in contemporary thinking and policies around innovation. These findings point to the inadequate consideration of the normative issues—how problems are to be defined and addressed—among national research funders in the food and health domain, and indicate a gap between the ideas of innovation under the terms of RRI and innovation as conceptualised by those involved in its governance.
R Dhonukshe-Rutten, H Snoek, Kerry Brown, N Slimani, P Finglas, G Perozzi, B van Ommen, I Tetens, M Ocké, M Laville, L Fezeu, A Cavelaars, Lada Timotijevic, K Zimmermann, K Poppe, P van ’t Veer (2013)Research infrastructure in the European food, nutrition and public health area: Current Initiatives from EuroDISH., In: Annals of Nutrition and Metabolism: European journal of nutrition, metabolic diseases and dietetics63pp. 1857-1857
Successful food and health research infrastructure is necessary to conduct high quality research and design effective public health strategies to improve population health through lifestyle, food and nutrition. Objectives: EuroDISH will provide recommendations to stakeholders such as the European Strategy Forum on Research Infrastructures (ESFRI), the Joint Programming Initiative-Healthy Diet Healthy Life (JPI-HDHL) and future European funding programmes (e.g. Horizon 2020) on the needs and best-practice for food and health research infrastructures. Methods/results: Research has been organised using the “DISH” model which represents four areas of food and health research: Determinants of dietary behaviour; Intake of foods and nutrients; Status and functional markers of nutritional health; Health and disease risks of foods and nutrients. The project consists of three phases: - Phase one (completed July 2013): Desk research, interviews (N=30) and stakeholder workshop conducted to map existing research infrastructure and identify gaps and needs. Initial findings suggested that research infrastructure was developed to different degrees across the four “DISH” research areas. - Phase two: Synthesis of research infrastructures and or different areas of research and explore the governance of research infrastructure. - Phase three: Feasible designs and roadmaps for the future development of research infrastructure. Conclusions: The EuroDISH vision is to encourage the development of infrastructures that bring together resources and knowledge from different scientific fields. This will enable state-of-the-art, pioneering and innovative research to be conducted across Europe serving to provide a competitive advantage at a global level and tackle today’s food related social, economic and health challenges.
Obesity is considered a significant risk factor for negative physical health and psychological outcomes. However, factors which account for some of the observed relationship have been under investigation for some time, and as a result have challenged the idea that obesity itself is the cause of the physical health and psychological outcomes. The picture is known to be complex, with influence of biological, psychological, social and behavioural factors. This thesis aimed to increase understanding of the factors involved in the relationship between obesity and psychological distress. In particular, to assess the role of physical self-concept and social comparisons in this relationship. Part one of this portfolio presents a systematic literature review of the relationship between physical self-concept and psychological wellbeing. The findings of the review suggest that positive physical self-concept is associated with better psychological wellbeing, and it highlighted the importance of physical self-worth and global self-esteem on mental health outcomes. Part two presents an empirical paper that investigated the mediating role of physical self-concept in the relationship between Body Mass Index (BMI) and psychological distress in the general population. The findings suggested that physical self-concept mediates the relationship between BMI and psychological distress, and once this indirect effect is accounted for, the relationship between BMI and psychological distress changes in strength and valence. In addition, the study suggests the important influence of social comparisons and social norms in this model.