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Objective: To compare the perceived seriousness and risk of type 2 diabetes among low risk with high risk profile non-diabetic subjects and examine the relationship of perceived risk with multiple self-reported risk indicators. Methods: A cross-sectional population-based study among 4435 low risk profile and 2607 high risk profile non-diabetic residents of the Hoorn region, participating in a stepwise type 2 diabetes screening study. Main outcome measures were perceived seriousness and risk of diabetes in subjects categorized (low vs. high risk profile) using the Symptom Risk Questionnaire. Results: 85.0% of the low risk and 81.2% of the high risk profile subjects perceived diabetes as a moderate to very serious disease. About half (43.0%) of all 7042 subjects reported that they do not know their risk of having diabetes. The mean perceived risk of having diabetes was slightly lower for the low risk compared with the high risk profile subjects (difference=2.8%; 95% confidence interval [CI]=1.8% to 3.8%; P <0.001). This difference was mostly explained by having a parent or sibling with diabetes, frequent thirst and claudication (difference=0.6%; 95% CI=−0.7% to 1.9%). Interestingly, perceived risk decreased with increasing age within both groups (P for trend<0.001). Conclusions: Both low risk and high risk profile subjects perceive diabetes as a serious disease. Even among those at high risk profile for type 2 diabetes, almost half appeared not to know their risk. Perceived risk of having diabetes was slightly lower for the low risk compared with the high risk profile subjects. Furthermore, perceived risk decreases with increasing age. Practice implications: This study points to a greater need to effectively address people's (mis)perceptions, and how to raise the awareness and understanding of type 2 diabetes and its risk factors in the general population in order to influence early detection and healthy lifestyle changes. [Copyright &y& Elsevier]

To explore the relationship between personal characteristics of older adults with multiple chronic conditions (MCCs) and perceived shared decision making (SDM) resp. decisional conflict. In a video-observational study (N = 213) data were collected on personal characteristics. The main outcomes were perceived level of SDM and decisional conflict. The mediating variable was participation in the SDM process. A twostep mixed effect multilinear regression and a mediation analysis were performed to analyze the data. The mean age of the patients was 77.3 years and 56.3% were female. Health literacy (β.01, p <.001) was significantly associated with participation in the SDM process. Education (β = −2.43, p =.05) and anxiety (β = −.26, p =.058) had a marginally significant direct effect on the patients' perceived level of SDM. Education (β = 12.12, p =.002), health literacy (β = −.70, p =.005) and anxiety (β = 1.19, p =.004) had a significant direct effect on decisional conflict. The effect of health literacy on decisional conflict was mediated by participation in SDM. Health literacy, anxiety and education are associated with decisional conflict. Participation in SDM during consultations plays a mediating role in the relationship between health literacy and decisional conflict. Tailoring SDM communication to health literacy levels is important for high quality SDM. • Personal characteristics of older adults may influence their involvement and experience in SDM and decisional conflict. • Health literacy, anxiety and education are associated with decisional conflict. • The effect of health literacy on decisional conflict is mediated by participation in SDM communication during consultation. • Tailoring SDM communication to health literacy levels is important for high quality SDM. [ABSTRACT FROM AUTHOR]

Objective: To explore across countries the extent to which physicians understand Type 2 diabetes patients’ perceptions of seriousness, worries about complications, emotional distress, and needs for care improvement. Methods: Cross-sectional data were collected in a multinational survey (SHARED). Type 2 diabetes patients (n =1609), general practitioners (n =818) and diabetes specialists (n =697) from eight countries were included. Data were gathered online and via telephone interviews. Responses from patients and professionals were compared using descriptive statistics and multilevel analyses. Results: Patients generally perceived diabetes as a serious condition and reported moderate distress. Physicians tended to underestimate patients’ perceived seriousness, while overestimating their level of distress. Physicians had difficulty estimating which diabetes complications concerned patients most, and what they needed to feel more confident about their diabetes. Patients did not wish for more consultation time, but rather active involvement, information and easy access to their physician. Conclusion: Results of this large survey highlight the importance of patient involvement and shared decision making. Practice implications: Further improvement of patient–provider communication as a basis for shared responsibilities and achieving optimal treatment outcomes is needed. With the growing numbers of diabetes patients worldwide, task delegation should be considered, in the framework of a multidisciplinary diabetes care model. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate the effectiveness of three different training protocols on physical function of older adults living in long-term care facilities. Emphasis was placed on feasibility in real-life situations. Methods: Subjects (N =224) were randomised to 6 months of twice weekly (1) resistance training; (2) all-round functional-skills training; (3) a combination of both; or (4) a control program. Fitness and performance measures and self-reported disability were measured at baseline and after 24 weeks intervention. Results: Attendance to the strength training was 76%, to the functional-skills training 70% and to the combined training 73%. In those who attended at least 75% of all classes (n =97) the functional-skills and combined training program improved several fitness and performance measures compared to the control group. Conclusion: Twice weekly functional-skills training, or a combination of resistance and functional-skills training can improve several fitness and performance measures of institutionalised older people. Practice implications: An important finding from our study was that less than twice a week exercise training is not enough for functional improvement, while it proved difficult for the elderly subjects to exercise twice weekly. Education on the health benefits of regular exercise, and a larger availability of classes in long-term care facilities may improve attendance. [Copyright &y& Elsevier]

In this study a randomised controlled trial was carried out to investigate the effectiveness of an education programme for patients with asthma or chronic obstructive pulmonary disease (COPD). All asthma and COPD patients using medication and experiencing pulmonary symptoms were randomly assigned to the intervention (n=139) or usual-care group (n=137). The intervention consisted of taylor-made education conducted by a general practice assistant and focussing on a patients’ technical skills and coping with the disease. Measurements took place at baseline, and after 1 and 2 years of follow-up. After 1 and 2 years the inhalation technique was significantly better in the intervention group compared to the usual-care group. No significant differences were observed regarding disease symptoms, health related quality of life, compliance, smoking cessation, self-efficacy, and coping. The results only support the implementation of the intervention regarding the technical skills (inhalation technique). However, given the importance of improvement of patients’ coping and the need for more efficient care, we recommend further exploration of the possibilities of a more structured and intensive education programme. [Copyright &y& Elsevier]