Low Contact Frequency Research Articles

Information and communication technology use among social ties of varying strength: Who benefits and how?

Information and communication technology (ICT) use has been associated with well-being among older adults. This link is often attributed to the fact that ICT use facilitates connecting with others. The purpose of this study is to assess how contact frequency and social tie strength impact the relationship between ICT use and depressive symptoms among older adults. Using data from the Detroit-based Social Relations Study collected in 2015, we use Bayesian analyses to examine the extent to which contact frequency with social network members moderates and the strength of these social tie (strong, moderate, and weak) mediate the link between ICT use and depressive symptoms among adults age 60+ (n=483). ICT use was found to be associated with fewer depressive symptoms. Furthermore, ICT use was associated with more moderate and weak ties which were, in turn, associated with fewer depressive symptoms. Finally, a moderating effect was also found as ICT use was associated with fewer depressive symptoms only among those with lower contact frequency. Our findings suggest that for older adults who communicate with others less frequently, ICT use can prove beneficial to mental health (i.e. fewer depressive symptoms). Furthermore ICT use may be especially meaningful to connect with weaker social ties. These findings may be due in part to ICTs capabilities which enable older adults to maintain connection to a diverse array of social ties and bridge social and physical distance.

Loneliness and social isolation association with incidence of disability, dementia and mortality in Mexican older adults: three follow‐up years

AbstractBackgroundLoneliness is defined as the feeling of being alone and can be considered as persistent, unavoidable and unpleasant. Social isolation is characterized by low frequency of contact with the social network, which may or may not include family members. The study of each of these entities is important because of their high frequency in OA and their association with negative outcomes as disability, dementia even mortality.MethodWe performed a secondary analysis of 1,668 adults aged 65 years or older, evaluated within Dementia Research Group 10/66 protocols in Mexico, after 3‐year follow‐up. Loneliness presence was assessed based on three questions included in the Geriatric Mental State Inventory (GMS): do you feel lonely, does this feeling of loneliness generate discomfort or sadness, can you avoid feeling lonely. Social isolation was identified by assessing friends, relatives and neighbors contact frequency; co‐residence; church attendance and social gatherings. Association of loneliness with and without emotional discomfort, as well as social isolation with incidence of disability, dementia, and mortality after three years of follow‐up was estimated using multivariate competing risk models.ResultLoneliness without emotional discomfort was about 35.4%, 24.0% reported loneliness with emotional discomfort, meanwhile social isolation prevalence was 41.1%. A differential distribution of loneliness with and without emotional discomfort, age groups and education by catchment area was observed (Table 2). After three years of follow‐up loneliness was found to be associated with incident dementia subHR = 1.5 (95%CI:1.1‐2.1), and social isolation with mortality, subHR = 1.5 (95%CI:1.1‐2.0).ConclusionAfter three years follow‐up one out 3 OA reported feeling lonely without emotional discomfort, 1 out 4 felt lonely with emotional discomfort, while 2 out 5 reported social isolation. Loneliness without emotional discomfort showed an association with dementia development, meanwhile social isolation was associated with mortality. Finally, no association was found between loneliness with emotional discomfort with disability, dementia or mortality in the analyzed sample.

The Relationship Between Cognitive Decline and All-Cause Mortality Is Modified by Living Alone and a Small Social Network: A Paradox of Isolation.

Although cognitive decline is a well-known mortality risk, it has not been adequately investigated, whether social relationships modify the relationship between cognitive decline and mortality. We examined the modifying effects of social relationships (household composition, social network [frequency of social contact with individuals outside the household], and social participation) on the association between cognitive decline and all-cause mortality in older Japanese people. In 2015, a baseline questionnaire was distributed to all 132,005 independent community-dwelling individuals aged ≥65 years resident in Adachi Ward of the Tokyo Metropolitan area. The final sample analyzed comprised 74,872 participants (men: 44.9%; mean age: 73.7 ± 6.0 years). Cognitive decline was assessed using a self-administered dementia checklist that was validated using the Clinical Dementia Rating Scale. A Cox proportional hazard model with an average follow-up of 1,657 days revealed that cognitive decline was associated with higher mortality (hazard ratio [HR]: 1.37, 95% confidence interval [95% CI]: 1.25-1.50). We identified significant associations among household composition, social networks, and cognitive decline. Stratified analyses indicated that the cognitive decline-mortality association was stronger among participants with low contact frequency (HR = 1.60, 95% CI: 1.39-1.85) than high frequency (HR = 1.24, 95% CI: 1.11-1.39). Conversely, the association was weaker among individuals living alone (HR = 1.13, 95% CI: 0.90-1.40) than among cohabiting individuals (HR = 1.43, 95% CI: 1.29-1.57). Although living alone and having a small social network represent an isolated status, their modifying effects were the opposite. These findings indicate that the isolation type should be considered when implementing support strategies for older adults with cognitive decline or dementia.

Social relations and health in an ethnically diverse social housing area selected for large structural changes compared to municipal levels: a Danish survey study

BackgroundThis study aims to describe demographics, social relations and health in an ethnically diverse social housing area selected to undergo large structural changes and compare it to the surrounding municipality. Furthermore, to explore the association between social relations and self-rated health (SRH) and the interaction with country of origin in both populations.MethodsData sources include a multilingual interviewer-driven survey study in a social housing area (N = 209) and a municipal health survey (N = 1,638) among residents aged 45 + years. Information on social relations include contact frequency with and support from family, friends, and neighbors. Descriptive and multivariate logistic regression analyses adjusted for age, sex, and country of origin are presented, as well as joint effect analyses of social relations and country of origin on SRH.ResultsIn the social housing area, 38.8% of the respondents reported poor SRH compared to 19.5% in the municipality. In both study populations low contact frequency was associated with poor SRH, however insignificantly in the social housing area compared to the municipality sample, OR = 1.50 (0.65–3.46) vs. OR = 2.42 (1.70–3.45). Joint exposure to having non-Western background and low contact frequency was strongly associated with poor SRH in the social housing area, OR = 6.28 (1.80–21.89) but less so in the municipality, OR = 3.67 (1.55–8.69). The same tendency was seen regarding low support from social relations.ConclusionsThis study provides insight to a population that is generally underrepresented in survey studies. In the social housing area, approximately twice as many reported poor SRH compared to the municipality data. In both populations, low contact frequency and low support were associated with poor SRH. Residents with weak social relations and non-Western origin simultaneously were more likely to report poor SRH in the social housing area specifically but less so in the municipality, indicating a higher vulnerability among the residents in the social housing area.

Similarity and Contact Frequency Promote Mentorship Quality among Hispanic Undergraduates in STEM.

Mentoring relationships can be important for promoting the success and persistence of undergraduates, particularly for students from historically underrepresented groups in science, technology, engineering, and mathematics (STEM) disciplines. While mentoring is often cited as important for attracting and retaining students from underrepresented groups in STEM, little is known about the differential mentoring processes that can result from similar and dissimilar mentor–protégé pairs. The present study tests the process-oriented mentorship model (POMM) regarding how mentor–protégé similarities and the moderating role of contact frequency influence mentorship quality and STEM research career persistence intentions among faculty-mentored Hispanic STEM majors in their senior year of college. The results indicate that mentor–protégé similarity matters. Specifically, higher levels of mentor–protégé psychological similarity were related to higher levels of psychosocial support and relationship satisfaction. Hispanic students with a Hispanic faculty mentor reported engaging in more coauthoring opportunities than peers with non-Hispanic mentors. Among those with higher contact frequency, students with same-gender mentors had higher levels of relationship satisfaction than peers with different-gender mentors; however, there were no differences among those with low contact frequency. Additionally, protégés who reported coauthoring support were more likely to also report commitment to pursuing a STEM research career.

Frequency of diabetes team contacts in children and adolescents using insulin pumps

Background: The purpose of this study is to assess if a relationship exists between A1c within target (£ 7.5%) and frequency of patient-initiated contact with diabetes team, in children with type 1 diabetes (T1DM) on an insulin pump. Additionally, to determine factors impacting frequency of contact. Methods: This was a retrospective study of children with T1DM on an insulin pump. Frequency of contact, type of contact, and A1c were collected. Study participants filled out a questionnaire at study entry. Results: One hundred and seventy-six participants were enrolled, with a mean age of 13 years. The median duration of T1DM was 6 years with a median duration of pump use, 3.6 years. One hundred and sixteen subjects (66%) contacted the diabetes team for insulin dose adjustments between clinic visits with a mean (standard deviation [SD]) of 1.2 (± 1.7) contacts, 90% of which were by e-mail. There was no significant relationship between achieving target A1c and frequency of contact. However, increasing age and longer duration of pump use were associated with decreased frequency of contact. Common barriers to contact included being too busy and technical problems with software. Conclusions: There was no significant relationship between the frequency of patient-initiated contact with diabetes team and A1c. Overall, there was low frequency of contact in the cohort. Older children and children with longer duration of pump use had fewer contacts with low rates of self-directed pump adjustments. These results raise the importance of defining strategies to increase patient engagement and empower diabetes data review.

Weak Ties That Bind: ICT Use, Social Relations, and Depressive Symptoms Among Older Adults

Information and communication technology (ICT) use has been associated with well-being among older adults. This link is often attributed to the fact that technology use facilitates connecting with social relations generally. What is less known, however, is the extent to which distinct dimensions of social relations uniquely influence how ICT use affects health. Thus, the importance of weak ties is receiving increased attention. Using data from the Detroit-based Social Relations Study collected in 2015, we examine the extent to which separate dimensions of weak ties (contact frequency and network size) mediate and moderate the link between technology use and depressive symptoms among adults age 65+ (n=213). A greater number of less close relations mediated the link as it was associated with technology use and fewer depressive symptoms. A moderating effect was also found as technology use was associated with fewer depressive symptoms only among those with lower contact frequency.

Characteristics of Performance according to Type of Semantic Lexical Task in Normal Elderly and Individuals with Subjective Memory Impairment

Purpose: For comparison of a semantic knowledge processing of the elderly, particularly the normal individuals and individuals with subjective memory impairment, this study aims to clarify what factors of semantic knowledge task could sensitively discriminate between the two groups by conducting various types of tasks and analyzing the aspects.Methods: High/low frequency category fluency test, concrete/abstract noun word defining test, and semantic association task were performed by 30 normal subjects and 30 subjective memory impaired subjects over 65 years old. Total and each subcategory scores were assessed for the category fluency test and word defining test, and correct response and reaction time were measured for the semantic association task.Results: It was found that there were significant differences between the two groups in the total score of the category fluency task (p < 0.001), low-frequency category score, abstract noun word defining task score (p < 0.05), and reaction time of semantic association task (p < 0.01).Conclusion: The result showed that in case of a target word with lower contact frequency and more abstract concept, the elderly with subjective memory impairment have difficulties in neural-networking activation of semantic knowledge and control of interruption stimulation when approaching a target word, with increased reaction time. This findings demonstrate that a semantic and lexical task has a clinical significance in discriminating a subjective memory impairment group.

Prevalence and factors associated with psychological burden in COVID-19 patients and their relatives: A prospective observational cohort study.

BackgroundDue to the dramatic measures accompanying isolation and the general uncertainty and fear associated with COVID-19, patients and relatives may be at high risk for adverse psychological outcomes. Until now there has been limited research focusing on the prevalence of psychological distress and associated factors in COVID-19 patients and their relatives. The objective of our study was to assess psychological distress in COVID-19 patients and their relatives 30 days after hospital discharge.MethodsIn this prospective observational cohort study at two Swiss tertiary-care hospitals we included consecutive adult patients hospitalized between March and June 2020 for a proven COVID-19 and their relatives. Psychological distress was defined as symptoms of anxiety and/or depression measured with the Hospital Anxiety and Depression Scale (HADS), i.e., a score of ≥8 on the depression and/or anxiety subscale. We further evaluated symptoms of post-traumatic stress disorder (PTSD), defined as a score of ≥1.5 on the Impact of Event Scale-Revised (IES-R).ResultsAmong 126 included patients, 24 (19.1%) had psychological distress and 10 (8.7%) had symptoms of PTSD 30 days after hospital discharge. In multivariate logistic regression analyses three factors were independently associated with psychological distress in patients: resilience (OR 0.82; 95%CI 0.71 to 0.94; p = 0.005), high levels of perceived stress (OR 1.21; 95%CI 1.06 to 1.38; p = 0.006) and low frequency of contact with relatives (OR 7.67; 95%CI 1.42 to 41.58; p = 0.018). The model showed good discrimination, with an area under the receiver-operating characteristic curve (AUC) of 0.92. Among 153 relatives, 35 (22.9%) showed symptoms of psychological distress, and 3 (2%) of PTSD. For relatives, resilience was negatively associated (OR 0.85; 95%CI 0.75 to 0.96; p = 0.007), whereas perceived overall burden caused by COVID-19 was positively associated with psychological distress (OR 1.72; 95%CI 1.31 to 2.25; p<0.001). The overall model also had good discrimination, with an AUC of 0.87.ConclusionA relevant number of COVID-19 patients as well as their relatives exhibited psychological distress 30 days after hospital discharge. These results might aid in development of strategies to prevent psychological distress in COVID-19 patients and their relatives.

Assessing the Impact of Alternative Responses to COVID-19: Stopping the Spread in Newfoundland and Labrador, Canada

The COVID-19 global health crisis has had a significant impact on societies worldwide. To evaluate the effectiveness of transmission prevention strategies, infectivity modeling can be used to interpret and analyze various virus responses. In this study, compartmental modeling approaches are used to model and quantify the success of various control techniques, such as social behaviors. Newfoundland and Labrador (NL), a province in Canada, is a relatively isolated and easily-monitored region that can be used to study the characterization and effectiveness of infectivity model coefficients. The province has few points of entry and a lower contact frequency than densely populated urban districts. Based on the results, the implications of social distancing removed an estimated 85% of the susceptible population from potential exposure to a viral transmission. The modeling also determined a basic COVID-19 reproductive number of 3.7 in NL, higher than the globalized average of 2.3. Compartmental models are used to determine the validity of alternative pandemic responses, such as nonvaccine social practices to fight the wave of infection. The overall impact of COVID-19 in NL is concluded to have been effectively controlled by the implementation of social distancing behaviors, allowing for accurate quantification of modeling parameters.

Is More Always Better? Examining the Nonlinear Association of Social Contact Frequency With Physical Health and Longevity

Frequent social contact has been associated with better health and longer life. It remains unclear though whether there is an optimal contact frequency, beyond which contact is no longer positively associated with health and longevity. The present research explored this question by examining nonlinear associations of social contact frequency with health and longevity. Study 1 (N ∼ 350,000) demonstrated that once the frequency of social contact reached a moderate level (monthly or weekly), its positive association with health flattened out. Study 2 (N ∼ 50,000) extended these findings to longitudinal and mortality data: Although low contact frequency was associated with poor health and low survival rates, increasing the frequency of social interactions beyond a moderate level (monthly or weekly) was no longer associated with better health and longevity and, in some cases, was even related to worse health and increased mortality risks.

Social relations and self-rated health in a multi-ethnic social housing area undergoing demolition

Abstract Background During the coming years, selected social housing areas in Denmark will undergo large structural changes as part of a political agenda. Previous studies on the effects of such interventions are inconclusive. Residential areas are important for the development of social relations and health. The aim of this study was to explore the associations between social relations and self-rated health (SRH) and the interaction with country of origin in an ethnically diverse social housing area undergoing demolition, and compare results with the municipality. Methods Data include multilingual interviewer driven surveys with residents aged 45+ years before demolition began in 2018 (N = 209) and during the demolition in 2019 (N = 132), and a health survey on municipality level (N = 1638). Information on social relations include contact frequency with and support from family, friends and neighbors. SRH was dichotomized into high/low. Descriptive and multivariate logistic regression analyses adjusted for age, sex and Western/non-Western origin are presented. Results In cross-sectional analyses from 2018, low contact frequency and low support increased the risk of low SRH, OR = 1.44 (0.63-3.29) and OR = 1.23 (0.62-2.48), especially when also having non-Western origin compared to having high contact frequency or support and Western origin, OR = 6.27 (1.80-21.84) and OR = 4.43 (1.68-11.69), respectively. The same association was seen in 2019 and on municipality level. Low contact frequency in 2018 was associated with higher risk of developing or maintaining low SRH in 2019 compared to the group with high contact frequency in 2018 in longitudinal analyses, OR = 3.04 (0.91-10.91). Conclusions Poor social relations increased the risk of low SRH, especially when also having non-Western origin. Having poor social relations before the demolition was associated with an increased risk of developing or maintaining low SRH during the demolition in an ethnically diverse social housing area. Key messages Having low contact frequency before area demolition in a social housing area in Denmark increased the risk of developing or maintaining low self-rated health after demolition had begun. Having poor social relations and non-Western origin is associated with a strong increased risk of low self-rated health in a deprived ethnic diverse social housing area in Denmark.

Prevalence and related influencing factors of depression symptoms among empty-nest older adults in China

BackgroundThe phenomenon of empty-nest older adults has raised growing concerns in contemporary Chinese society. In this study, we examined the prevalence and related influencing factors of depression symptoms among empty-nest older adults in China at a national level. MethodsThe database of the 2015 China Health and Retirement Longitudinal Study (N = 8549, aged ≥ 60) was used. The 10-item version of the Centre for Epidemiologic Studies Depression Scale was employed to measure depression symptoms. ResultsThe prevalence of depression symptoms was 34.7 % for empty-nest respondents, 32.2 % for respondents living with a spouse only and 43.4 % for those living alone. Multivariable logistic regression indicated that, compared with the non-empty-nest respondents, older adults living alone were more susceptible to depression symptoms (OR 1.194, 95 %CI 1.016–1.405) whereas older adults living with a spouse only were not exposed to an elevated probability of being depressed (OR 0.945, 95 %CI 0.847–1.055). Multivariable logistic regression also suggested that empty nesters who were female, lived in rural areas, had a lower frequency of children’s visits, had lower socioeconomic status and had worse physical health conditions were more vulnerable to depression symptoms. ConclusionsThe association between empty-nest status and later-life depression is mixed. More concerns should be raised about the mental health of empty nesters living alone. Increased attention should also be paid to empty nesters who are female, rural residents and have low contact frequency with their children, disadvantaged socioeconomic status and poor physical health conditions.

1323-P: Frequency of Diabetes Team Contacts in Children and Adolescents Using Insulin Pumps

Type 1 diabetes (T1D) management has become increasingly technologically advanced with the use of insulin pumps, continuous glucose monitoring and diabetes data management software. These technologies are underutilized although there is evidence for improvement in A1C when adults review blood glucose trends with their diabetes team in between clinic visits. The primary objective of this study was to assess if a correlation exists between A1C within target (≤ 7.5%) and frequency of contact of pediatric patients with the diabetes team between clinic visits. Secondary objectives included determining barriers to contact and change in A1C from baseline to end of study. T1D patients using an insulin pump for one year or more were approached to participate. Participants completed a questionnaire to assess diabetes management over the past year. A1C and contact with the diabetes team between clinic visits for insulin adjustments in the past year were collected. One hundred and seventy six participants were enrolled, 46% female, with a mean age of 12.9 (± 3.8) years. Mean duration of T1D was 6.7 (± 3.7) years with a mean duration of pump use of 4.5 (± 3.1) years. Mean A1C at baseline was 8.1% (± 1). One hundred and sixteen (66%) patients contacted the diabetes team for insulin adjustments between clinic visits with a mean of 1.2 (± 1.7) contacts, 90% by e-mail. There was no significant relation between target A1C and frequency of contact (p&amp;gt;0.05). Decreased frequency of contact was associated with increased age (r=0.20, p = 0.01) and longer duration of pump use (r=0.17, p = 0.02). Barriers to contact included being too busy (41%) and technical problems with software (39%). In conclusion, there was no significant relationship between frequency of contact of pediatric patients with the diabetes team and A1C. The low frequency of contact raises the importance of defining strategies to increase patient contact which has the potential to improve diabetic control. Disclosure F. Babalola: None. A. Ens: None. P.H. Gallego: None. R.I. Stein: None. C. Clarson: None.

Positive and negative aspects of social relations and low-grade inflammation in Copenhagen Aging and Midlife Biobank.

The association between social relations and health outcomes is well described, but pathways are relatively poorly understood. Inflammation has been suggested as a potential physiological pathway, linking social relations to adverse health outcomes. However, previous studies have shown ambiguous results and have for the vast majority been based on studies small in sample size. The aim of the present study is to examine the association between comprehensive measures of structural and positive as well as negative functional aspects of social relations, across four relational domains-partner/spouse, children, other family and friends, and the level of systemic low-grade inflammation in a large population-based middle-aged cohort and to examine variation by gender and socioeconomic position in these associations. The study comprised of 5576 participants in the Copenhagen Aging and Midlife Biobank. The inflammatory biomarkers collected in late midlife included C-reactive protein, Interleukin-6, and TNF-alpha. Multiple linear regression models were implemented to explore associations between social relations and inflammatory measures controlling for gender, age, socioeconomic position, marital status, early major lifeevents and morbidity. Results show weak and ambiguous associations in all analyses. There were no strong indications of interaction with socioeconomic position. Concluding cautiously, men appear to be more vulnerable toward living alone and low contact frequency with family compared to women as regards high level of low-grade inflammation. In conclusion, this large-scale population-based study among middle-aged men and women showed no association between social relations and low-grade inflammation.

Mycobacterium bovis uses the ESX-1 Type VII secretion system to escape predation by the soil-dwelling amoeba Dictyostelium discoideum

Mycobacterium bovis is the causative agent of bovine tuberculosis and the predominant cause of zoonotic tuberculosis in people. Bovine tuberculosis occurs in farmed cattle but also in a variety of wild animals, which form a reservoir of infection. Although direct transmission of tuberculosis occurs between mammals, the low frequency of contact between different host species and abundant shedding of bacilli by infected animals suggests an infectious route via environmental contamination. Other intracellular pathogens that transmit via the environment deploy strategies to survive or exploit predation by environmental amoebae. To explore if M. bovis has this capability, we investigated its interactions with the soil and dung-dwelling amoeba, Dictyostelium discoideum. We demonstrated that M. bovis evades phagocytosis and destruction by D. discoideum and actively transits through the amoeba using the ESX-1 Type VII Secretion System as part of a programme of mechanisms, many of which have been co-opted as virulence factors in the mammalian host. This capacity of M. bovis to utilise an environmental stage between mammalian hosts may enhance its transmissibility. In addition, our data provide molecular evidence to support an evolutionary role for amoebae as training grounds for the pathogenic M. tuberculosis complex.

The longitudinal association between social network composition and episodic memory in older adulthood: the importance of contact frequency with friends

Objectives: The composition of one’s social network has been associated with cognition such that a greater proportion of family is associated with worse cognition compared to a greater proportion of friends. It is not clear whether this association between network composition and cognitive aging is driven by potential negative effects of family interactions or positive effects of friend interactions.Methods: Using the Health and Retirement Study (T1: 2006/2008, T2: 2010/2012, T3: 2012/2014), a longitudinal mediation model was conducted to test the effects of composition on episodic memory and latent change in memory through contact frequency with friends and family.Results: Analyses revealed indirect effects of composition on both T2 memory and latent change in memory through contact frequency with friends. A greater proportion of family in one’s network was associated with lower contact frequency with friends and in turn lower memory. Composition was also associated with higher contact frequency with family; however, contact frequency with family was not associated with memory.Conclusions: These findings suggest that spending time with family may not affect episodic memory in older adulthood, but spending time with friends may be beneficial. Potential mechanisms and implications regarding the importance of friendships in later life are discussed.

초등학생의 관광 영향 인식이 관광객에 대한 정서와 태도에 미치는 영향

This study examined the influence of elementary school children’s perception of tourism impact on affect and attitudes toward tourists. The research was conducted under the assumption that there will be differences in the 107perception of tourism impacts as well as affect and attitudes of tourists depending on the frequency level of contact with tourists. It was found that the high contact frequency group had lower perception scores of positive tourism impact than the low contact frequency group. In contrast, the high contact frequency group showed higher perception scores of negative tourism impact. Similarly, the high contact frequency group had lower positive affect scores and higher negative affect scores toward tourists than the low contact frequency group. The attitude toward tourists also showed similar results which the high contact frequency group with visitors had lower attitude scores than the low contact frequency group. These results suggest that schools, community and tourists need to work together for preventing emotional hurts by tourists. Second, it is suggested that efforts should be made to minimize the damage to the real life of the local residents.

Inconclusive effects of once‐weekly exenatide on cardiovascular outcomes in type 2 diabetes

Inconclusive effects of once‐weekly exenatide on cardiovascular outcomes in type 2 diabetes

A social network analysis of Germany’s wood-based bioeconomy: Social capital and shared beliefs

The present study undertakes a social network analysis (SNA) to identify some of the main organisations involved in Germany’s wood-based bioeconomy (WBE) innovation system, their relationship to each other and their shared beliefs. The resulting network map shows a rather densely connected “strategic” WBE network where actors exchange mainly information and knowledge. Some 30 organisations are central to the network and act as “brokers” connecting different segments of the network. Despite weak connections, organisations report high levels of trust regarding their cooperation. Most actors share similar visions about the WBE. However, the different meanings and policy preferences associated with these beliefs vary. Given this low frequency of contact and the absence of a shared, common policy vision the WBE networks is less likely to initiate collective action.