Background. One of the stakeholders in tackling the rise and health consequences of overweight and obesity is the general practice physician (GP). GPs are in a good position to inform and give nutrition guidance to overweight patients. Objective. Assessment of working mechanism of determinants of the nutrition guidance practice: noticing patients’ overweight and guidance of treatment by GPs [linear analysis of structural relations (LISREL) path model] in a longitudinal study. Methods. This longitudinal study measured data in 1992, 1997 and 2007. The 1992 LISREL path model (Hiddink GJ, Hautvast J, vanWoerkumCMJ, Fieren CJ, vantHofMA. Nutrition guidance by primary-care physicians: LISREL analysis improves understanding. Prev Med 1997; 26: 29–36.) demonstrated that ‘noticing patients’ overweight and guidance of treatment’ was directly and indirectly influenced by predisposing factors, driving forces and perceived barriers. This article defines and discusses the path analysis of the 2007 data (compared with 1997). Results. This analysis shows both similarity and differences inworking mechanism of determinants of noticing patients’ overweight and guidance of treatment between 1997 and 2007. The backbone of themechanism with four predisposing factors is the similarity. The number of driving forces and of paths through intermediary factors to the dependent variable constitutes the difference. Conclusions. The backbone of the working mechanism of determinants of the nutrition guidance practice: noticing patients’ overweight and guidance of treatment by GPs was similar in 2007 and 1997. The influence of GPs task perception on noticing patients’ overweight and guidance of treatment considerably increased in 2007 compared to 1997. The longitudinal character of this article gives a strong practice-based evidence for weight management by GPs.
Two key air pollutants that affect asthma are ozone and particle pollution. Studies show a direct relationship between the number of deaths and hospitalizations for asthma and increases of particulate matter in the air, including dust, soot, fly ash, diesel exhaust particles, smoke, and sulfate aerosols. Cars are found to be a primary contributor to this problem. However, patient awareness of the link is limited. This chapter begins with a general discussion of vehicular dependency or ‘car culture’, and then focuses on the discussion of the effects of air pollution on asthma in the Netherlands. I argue that international organizations and patient organizations have not tended to put pressure on air-control, pollution-control or environmental standards agencies, or the actual polluters. While changes in air quality and the release of greenhouse gases are tied to practices like the massive corporate support for the ongoing use of motor vehicles and the increased prominence of ‘car culture’ globally, patient organizations seem more focused on treating the symptoms rather than addressing the ultimate causes of the disease. Consequently, I argue that to fully address the issue of asthma the international health organizations as well as national health ministries, patient organizations, and the general public must recognize the direct link between vehicular dependency and asthma. The chapter concludes with a recommendation for raising environmental health awareness by explicitly linking the vehicular dependency to the state of poor respiratory health. Strategic policy in the Netherlands then should explicitly link the present pattern of auto mobility to public health. https://onlinelibrary.wiley.com/doi/book/10.1002/9781118786949 LinkedIn: https://www.linkedin.com/in/helenkopnina/
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Societal actors across scales and geographies increasingly demand visual applications of systems thinking – the process of understanding and changing the reality of a system by considering its whole set of interdependencies – to address complex problems affecting food and agriculture. Yet, despite the wide offer of systems mapping tools, there is still little guidance for managers, policy-makers, civil society and changemakers in food and agriculture on how to choose, combine and use these tools on the basis of a sufficiently deep understanding of socio-ecological systems. Unfortunately, actors seeking to address complex problems with inadequate understandings of systems often have limited influence on the socio-ecological systems they inhabit, and sometimes even generate unintended negative consequences. Hence, we first review, discuss and exemplify seven key features of systems that should be – but rarely have been – incorporated in strategic decisions in the agri-food sector: interdependency, level-multiplicity, dynamism, path dependency, self-organization, non-linearity and complex causality. Second, on the basis of these features, we propose a collective process to systems mapping that grounds on the notion that the configuration of problems (i.e., how multiple issues entangle with each other) and the configuration of actors (i.e., how multiple actors relate to each other and share resources) represent two sides of the same coin. Third, we provide implications for societal actors - including decision-makers, trainers and facilitators - using systems mapping to trigger or accelerate systems change in five purposive ways: targeting multiple goals; generating ripple effects; mitigating unintended consequences; tackling systemic constraints, and collaborating with unconventional partners.
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