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Background The value equation of value-based healthcare (VBHC) as a single figure remains ambiguous, closer to a theoretical framework than a useful tool for decision making. The challenge lies in the way patient-centred outcomes (PCOs) might be combined to produce a single value of the numerator. This paper aims to estimate the weights of PCOs to provide a single figure in the numerator, which ultimately will allow a VBHC figure to be reached. Methods A cohort of patients diagnosed with breast cancer (n  = 690) with a 6-month follow-up recruited in 2019–20 across six European hospitals was used. Patient-reported outcomes (PROs), clinical-related outcomes (CROs), and clinical and socio-demographic variables were collected. The numerator was defined as a composite indicator of the PCOs (CI-PCO), and regression analysis was applied to estimate their weights and consequently arrive at a single figure. Results Pain showed as the highest weight followed by physical functioning , emotional functioning , and ability to work , and then by a symptom, either arm or breast. PCOs weights were robust to sensitivity analysis. The CI-PCO value was found to be more informative than the health-related quality of life (HRQoL) value. Conclusions To the best of our knowledge, this is the first research to combine the PCOs proposed by ICHOM to provide a single figure in the numerator of the value equation. This figure shows a step forward in VBHC to reach a holistic benchmarking across healthcare centres and a value-based payment. This research might also be applied in other medical conditions as a methodological pathway. [ABSTRACT FROM AUTHOR]

Does party system polarization mobilize voters? Polarization is increasingly shaping democratic competition across Europe. While often perceived to be negative, polarization can be an effective remedy against voter disengagement. This paper investigates two distinct, but often conflated mechanisms, which could explain why polarization leads to mobilization. Spatial polarization of parties diversifies electoral options at the ballot, while affective polarization mobilizes based on emotional considerations. This article then shows the link between polarization and turnout across 22 European countries. The results are complemented by a difference-in-differences analysis of German local elections. However, voting results alone do not inform about the mechanism at play. Survey data is used to show that negative affect appears to be the main driver of voter participation. Party polarization thus has ambivalent consequences for democracies: It mobilizes the electorate, but its effect is driven by negative emotions. [ABSTRACT FROM AUTHOR]

This paper examines the influence of lack of control, a diffuse attitude closely associated with emotions, on support for radical populist parties of the left and right. Lack of control is the perception of not having control over one's own life. Although this is not political per se, it is hypothesized that underlying emotions and associated feelings shape political preferences. We argue that as populist parties offer a clear distinction between in – and out-group and promise order, less complexity, as well as economic protection for ordinary people, they have a greater appeal to such citizens. In doing so, the paper tests three hypotheses. The findings of two cross-country analyses carried out with data of the European Values Study 2017 lend empirical support for the theoretical arguments made. The two pooled analyses of 12 radical right populist parties and six radical left populist parties yield that lack of control increases support for radical populist parties of both the left and the right. An examination of interaction effects suggests that sensing a lack of control tends to have a reinforcing effect on voters with nativist attitudes in support of RRPP. [ABSTRACT FROM AUTHOR]

This paper examines the family language policies in five case studies of immigrant families in Europe, focusing on the following emotions: Pride, Joy, Sadness and Fear. Families who immigrated from India and Laos to France, Sweden, Norway and Finland expressed their first and foremost emotions over the maintenance of their heritage languages in terms of language ideologies. The principal purpose of this paper is to explore critically the role of emotions of parents and of children regarding the maintenance or loss of the heritage language and the dominant position that the host language occupies in the framework of the family language policy. With an ethnographic approach, the principal tools were interviews, recording of conversations, participant observations and field notes, which yielded significant information on language attitudes, ideologies and practices toward the host-language and heritage language. Findings show that emotions of anxiety toward enfeeblement of the heritage language were common among parents, albeit not explicitly manifested in some families. Fear of losing the heritage language amounts to fear of losing linguistic and cultural identity over which some parents were frustrated, angry and helpless. Pride and joy were other affective displays, notably related to one's command of the host languages or powerful languages like English. [ABSTRACT FROM AUTHOR]

This paper analyzes descriptions of Ukrainian refugees in the aftermath of the Russian invasion of Ukraine. Findings of previous research on news media descriptions of refugees point to problematic descriptions of refugees that downgrade their deservingness of refuge and treat refugee status as an inherent feature of fleeing individuals instead of as contingent on external circumstances. However, there is a widespread perception that Ukrainian refugees are being reported on in a more positive light. We therefore examine how news media describe these refugees. Our corpus includes English media news coverage from February 25, 2022, to March 25, 2022, the initial period of the invasion. A discursive psychological analysis of news interactions where hosts elicit information from correspondents about current ongoings with Ukrainian refugees shows that Ukrainian refugees are constructed as vulnerable, and their actions are treated as reasonable given the situation. These descriptions construct Ukrainian refugees as those who are only contingently refugees and legitimate help‐giving by other parties. Our findings, therefore, highlight distinct, previously unanalyzed ways that refugees are constructed: contingent refugees. We discuss implications of our findings for understanding refugee inclusion and exclusion. [ABSTRACT FROM AUTHOR]

Aim: Non-pharmaceutical interventions such as lockdowns have played a critical role in preventing the spread of the Covid-19 pandemic, but may increase psychological burden. This study sought to examine emotions reflected in social media discourse following the introduction of social contact restrictions in Central Europe. Subjects and methods: German-language Twitter posts containing '#corona' and '#covid-19' were collected between 2020/03/18 – 2020/04/24. A total of 79,760 tweets were included in the final analysis. Rates of expressions of positive emotion, anxiety, sadness and anger were compared over time. Bi-term topic models were applied to extract topics of discussion and examine association with emotions. Results: Rates of anxiety, sadness and positive emotion decreased in the period following the introduction of social contact restrictions. A total of 16 topics were associated with emotions, which related to four general themes: social contact restrictions, life during lockdown, infection-related issues, and impact of the pandemic on public and private life. Several unique patterns of association between topics and emotions emerged. Conclusion: Results suggest decreasing polarity of emotions among the public following the introduction of social contact restrictions. Monitoring of social media activity may prove beneficial for an adaptive understanding of changing public concerns during the Covid-19 pandemic. [ABSTRACT FROM AUTHOR]

Migrants living in Europe constitute over half of the world's international migrants and are at higher risk of poor mental health than non-migrants, yet also face more barriers in accessing and engaging with services. Furthermore, the quality of care received is shaped by the experiences and attitudes of health professionals. The aim of this review was to identify professionals' attitudes towards migrants receiving mental healthcare and their perceptions of barriers and facilitators to service provision. Four electronic databases were searched, and 23 studies met the inclusion criteria. Using thematic synthesis, we identified three themes: 1) the management of multifaceted and complex challenges associated with the migrant status; 2) professionals' emotional responses to working with migrants; and 3) delivering care in the context of cultural difference. Professionals employed multiple strategies to overcome challenges in providing care yet attitudes towards this patient group were polarized. Professionals described mental health issues as being inseparable from material and social disadvantage, highlighting a need for effective collaboration between health services and voluntary organizations, and partnerships with migrant communities. Specialist supervision, reflective practice, increased training for professionals, and the adoption of a person-centered approach are also needed to overcome the current challenges in meeting migrants' needs. The challenges experienced by health professionals in attempting to meet migrant needs reflect frustrations in being part of a system with insufficient resources and without universal access to care that effectively stigmatizes the migrant status. [ABSTRACT FROM AUTHOR]

Background: Premenstrual dysphoric disorder is a depressive disorder affecting 5%–8% of people with menstrual cycles. Despite evidence that facial emotion detection is altered in depressive disorders, with enhanced detection of negative emotions (negativity bias), minimal research exists on premenstrual dysphoric disorder. Objectives: The goal of this study was to investigate the effect of premenstrual dysphoric disorder symptoms and the premenstrual phase on accuracy and intensity at detection of facial emotions. Design: Cross-sectional quasi-experimental design. Method: The Facial Emotion Detection Task was administered to 72 individuals assigned female at birth with no premenstrual dysphoric disorder (n = 30), and provisional PMDD (n = 42), based on a retrospective Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition -based measure of premenstrual dysphoric disorder. Facial emotion detection was examined both irrespective of menstrual cycle phase, and as a function of premenstrual phase (yes, no). The task used neutral-to-emotional facial expression morphs (15 images/morph). Participants indicated the emotion detected for each image within the progressive intensity morph. For all six basic emotions (sad, angry, fearful, happy, disgust, and surprise), two scores were calculated: accuracy of responses and the intensity within the morph at which the correct emotion was first detected (image number). Results: Individuals reporting moderate/severe symptoms of premenstrual dysphoric disorder had more accurate and earlier detection of disgust, regardless of cycle phase. In addition, those with provisional premenstrual dysphoric disorder detected sad emotions earlier. A premenstrual dysphoric disorder group × cycle phase interaction also emerged: individuals reporting premenstrual dysphoric disorder symptoms were more accurate at detecting facial emotions during the premenstrual phase compared to the rest of the cycle, with a large effect size for sad emotions. Conclusion: The findings suggest enhanced facial emotion processing in individuals reporting symptoms of premenstrual dysphoric disorder, particularly for sadness and disgust. However, replication is required with larger samples and prospective designs. This premenstrual dysphoric disorder premenstrual emotion detection advantage suggests an adaptive cognitive mechanism in premenstrual syndrome/premenstrual dysphoric disorder, and challenges stigma surrounding premenstrual experiences. Plain Language Summary: Women with Severe Premenstrual Syndrome or Probable Premenstrual Dysphoric Disorder are Better at Identifying Emotional Expressions on People's Faces, Especially During the Premenstrual Phase Premenstrual dysphoric disorder is a depressive disorder affecting women where they experience emotional and physical symptoms during the premenstrual phase (i.e. the week before one's period). It is a severe form of premenstrual syndrome. Research indicates that depression can affect facial emotion recognition. Accurately recognizing other people's emotions is an important skill that helps us develop social connections and keep ourselves and others safe. Quick recognition of facial emotions allows us to understand and support others, and quickly identify dangerous situations by recognizing other people's emotional responses. The goal of this study was to examine how premenstrual dysphoric disorder symptoms and the premenstrual phase may affect the ability of women to recognize and identify emotions on other people's faces. A total of 72 women (42 with premenstrual dysphoric disorder, 30 without premenstrual dysphoric disorder) completed the Facial Emotion Detection Task. This task measured how accurate and early the women were able to detect happiness, sadness, anger, fear, surprise, and disgust in faces. Women with moderate/severe symptoms of premenstrual dysphoric disorder had more accurate and earlier detection of disgust, regardless of where they were in their menstrual cycle. Women with premenstrual dysphoric disorder detected sad emotions earlier. Furthermore, women with premenstrual dysphoric disorder were more accurate at detecting facial emotions when they were tested in the premenstrual phase, and were especially more accurate in detecting sad emotions. The findings suggest that women with premenstrual dysphoric disorder are better at detecting facial emotions and show a premenstrual dysphoric disorder premenstrual emotion detection advantage. This tendency for women with premenstrual dysphoric disorder to better detect emotions in others, particularly when they are in the premenstrual cycle phase, would have benefits. As one of the first reports of a potentially beneficial effect of premenstrual syndrome for women, the findings may help decrease stigma associated with premenstrual dysphoric disorder and premenstrual syndrome. Further research is needed to replicate and extend these findings. [ABSTRACT FROM AUTHOR]

Cultural differences between countries are customarily calculated by comparing mean scores on multiple dimensions, which ignores heterogeneity within societies. This article proposes a fundamentally new way of measuring cultural differences by evaluating the functioning of the emotional brain—that is, by comparing how people think, rather than what they think. Deep learning as a supervised machine learning technique is used to mathematically represent the emotional brain of the Volksgeist ("folk spirit") with a complex system of nonlinear combinations of value priorities, opinions, and other factors with subjective feelings of well-being. Cross-validating how well one Volksgeist's artificial brain fits another country provides a novel measure for emotional cultural differences, which also considers heterogeneity within a society. This measure is conceptually and statistically unrelated to the Kogut–Singh index calculated from mean scores on cultural dimensions. However, it shows good face validity and supports international marketing and business theory as a negative and highly significant predictor for bilateral trade flows within Europe, using a classic gravity model. [ABSTRACT FROM AUTHOR]

Current outcomes of immigration enforcement policies and apparatuses call for rethinking the ethics behind our understanding of community belonging, human rights and just society. The ethics at work are often presented as emotions creating particular affective atmosphere that permit the ongoing implementation of enforcing migration. This Special Issue tackles emotions as processes of organizing that are mobilized in support of certain ethics. In the context of immigration enforcement, these emotions are not self-explanatory, but they can justify the potential for violence and even deem it necessary. The emotions or affects of enforcers (as opposed to migrants) have been less addressed, and this Special Issue aims to be a novel collection. The articles pay particular attention to racism and to the understanding of institutional racism within state structures. They reveal the ways in which emotions are instrumental to the operations of state bureaucracy within the repressive migration apparatus and point to the ethics that allows individuals to conform state structures of oppression. [ABSTRACT FROM AUTHOR]

Background: It is unclear whether a hypothetical intervention targeting either psychosocial well-being or emotion-driven impulsiveness is more effective in reducing unhealthy food choices. Therefore, we aimed to compare the (separate) causal effects of psychosocial well-being and emotion-driven impulsiveness on European adolescents' sweet and fat propensity. Methods: We included 2,065 participants of the IDEFICS/I.Family cohort (mean age: 13.4) providing self-reported data on sweet propensity (score range: 0 to 68.4), fat propensity (range: 0 to 72.6), emotion-driven impulsiveness using the UPPS-P negative urgency subscale, and psychosocial well-being using the KINDLR Questionnaire. We estimated, separately, the average causal effects of psychosocial well-being and emotion-driven impulsiveness on sweet and fat propensity applying a semi-parametric doubly robust method (targeted maximum likelihood estimation). Further, we investigated a potential indirect effect of psychosocial well-being on sweet and fat propensity mediated via emotion-driven impulsiveness using a causal mediation analysis. Results: If all adolescents, hypothetically, had high levels of psychosocial well-being, compared to low levels, we estimated a decrease in average sweet propensity by 1.43 [95%-confidence interval: 0.25 to 2.61]. A smaller effect was estimated for fat propensity. Similarly, if all adolescents had high levels of emotion-driven impulsiveness, compared to low levels, average sweet propensity would be decreased by 2.07 [0.87 to 3.26] and average fat propensity by 1.85 [0.81 to 2.88]. The indirect effect of psychosocial well-being via emotion-driven impulsiveness was 0.61 [0.24 to 1.09] for average sweet propensity and 0.55 [0.13 to 0.86] for average fat propensity. Conclusions: An intervention targeting emotion-driven impulsiveness, compared to psychosocial well-being, would be marginally more effective in reducing sweet and fat propensity in adolescents. [ABSTRACT FROM AUTHOR]

Introduction: One of the main causes of anaphylaxis in Europe is Hymenoptera stings. Epidemiological data indicate that insect venom hypersensitivity concerns up to 5.0-7.5% of the population. Aim: To assess the influence of selected clinical and socio-demographic factors on the tests used in the study: WHOQOL-BREF (World Health Organization Quality of Life-Brief) and CECS (Courtauld Emotional Control Scale). Material and methods: The research was conducted among patients diagnosed with Hymenoptera venom allergy, treated with immunotherapy. The following socio-demographic and clinical factors were evaluated: gender, age, place of residence, marital status, education, professional activity, financial status, type of allergy and duration of therapy. The research was carried out in 2014-2015 in the Chair and Clinic of Allergology, Clinical Immunology and Internal Diseases, Jan Biziel University Hospital No. 2 in Bydgoszcz. The study was conducted by means of a diagnostic survey using an interview. Results: Quality of life varies significantly depending on age, education, professional activity and financial conditions. The type of allergy significantly differentiates the value of CECS in the sample. People allergic to bee venom have a higher CECS level = 53.54 compared to people allergic to wasp venom, which show a lower CECS level = 49.03. Conclusions: Quality of life varies depending on age, education, professional activity and financial conditions. A higher quality of life is found in the youngest people, with better education, professionally active and declaring good financial conditions. Patients diagnosed with a bee venom allergy have a higher level of emotional control. [ABSTRACT FROM AUTHOR]

This research investigated the effects of a single exposure to media content of a distinct valence and mass‐mediated contact with a distant minority outgroup on feelings/attitudes toward a local outgroup. Experimental Study 1 was conducted among 314 Israeli Jews. The findings of Study 1 showed the effects of a single exposure to positive and negative media items about asylum seekers in Europe on perceived threats posed by them. In this study we did not find a carry‐over effect of single‐exposure to a media item about asylum seekers in Europe on feelings toward the local outgroup—asylum seekers in Israel. Study 2 was conducted through an online survey among 1039 Israeli Jews. It showed the effect of recurring mass‐mediated contact with asylum seekers in Europe on perceived threats posed by them. Both Study 1 and Study 2 found carry‐over effects of realistic and symbolic threats from asylum seekers in Europe on feelings/attitudes toward asylum seekers in Israel. The findings of Study 2 also showed a carry‐over effect of positive mass‐mediated contact with a distant outgroup on attitudes toward a local outgroup. Based on the findings, we conclude that the positive media framing of distant outgroups may promote tolerance and acceptance of local outgroups. [ABSTRACT FROM AUTHOR]

In the article I study the emotions involved in the emergence of the homosexual liberation movement in Latin America. Marked by the radical ideas that came out of the sixties many queer organizations bowed to create a sexual revolution inside the social revolution. Because it was the first-time homosexuality came out to the public in the Latin America, at the same time in different countries, a sort of emotional community was formed. This happened thanks to the radical queer intellectual network that was formed after the Stonewall riots connecting the Americas with Europe. By sharing experiences and ideas I will argue that the Latin American homosexual liberation organizations also shared the process of what I have called coming out collectively, where things leaving shame and sadness, overcoming fear with courage, and building pride or anger were fundamental in the early years of the movement. [ABSTRACT FROM AUTHOR]

Introduction: Clinical supervisors allow trainees to fail during clinical situations when trainee learning outweighs concerns for patient safety. Trainees perceive failure as both educationally valuable and emotionally draining; however, the nuance of supervised failures has not been researched from the trainee perspective. This study explored trainees' awareness and their experience of failure and allowed failure to understand those events in‐depth. Methods: We interviewed 15 postgraduate trainees from nine teaching sites in Europe and Canada. Participants were a purposive sample, representing 1–10 years of clinical training in various specialties. Consistent with constructivist grounded theory, data collection and analysis were iterative, supporting theoretical sampling to explore themes. Results: Trainees reported that failure was a common, valuable, and emotional experience. They perceived that supervisors allowed failure, but they reported never having it explicitly confirmed or discussed. Therefore, trainees tried to make sense of these events on their own. If they interpreted a failure as allowed by the supervisor, trainees sought to ascertain supervisory intentions. They described situations where they judged supervisor's intentions to be constructive or destructive. Discussion: Our results confirm that trainees perceive their failures as valuable learning opportunities. In the absence of explicit conversations with supervisors, trainees tried to make sense of failures themselves. When trainees judge that they have been allowed to fail, their interpretation of the event is coloured by their attribution of supervisor intentions. Perceived intentions might impact the educational benefit of the experience. In order to support trainees' sense‐making, we suggest that supervisory conversations during and after failure events should use more explicit language to discuss failures and explain supervisory intentions. Residents' interpretation of being allowed to fail is shown to be colored by attributions of supervisor intention, thereby influencing what is learned from failure and emphasizing the importance of explicit conversation. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to test the psychometric properties of the Facilitative Student–Patient Relationship (FSPR) Scale in clinical practicum in hospital settings within six European countries. Design: A multi‐country, cross‐sectional survey design was applied. Methods: A convenience sample of graduating nursing students (N = 1,796) completed the FSPR Scale. Psychometric testing was carried out through explorative factor analysis and confirmatory factor analysis. Internal consistency was assessed using Cronbach's alpha. Results: Both validity and reliability of the scale were confirmed. The explorative factor analysis yielded a two‐factor construct explaining 47.7% of the total variance, identifying two sub‐scales: caring relationship and learning relationship. Confirmatory factor analysis confirmed the two‐factor structure. The Cronbach alpha coefficients (0.8–0.9) indicated acceptable reliability of the scale. [ABSTRACT FROM AUTHOR]

Background. The problem of the ageing population has resulted in attitudes towards aging in different age groups becoming a subject of increased academic interest. Objectives. To provide comparative characteristics of the prevalence of manifestations of gerontological ageism among university students in five European countries. Material and methods. The sample consisted of university students (n = 2493) aged 18–25 from Belarus (n = 827), Russia (n = 528), Poland (n = 798), Lithuania (n = 223) and Ukraine (n = 117). The prevalence of gerontological ageism among respondents was evaluated according to the Fraboni Ageism Scale. Results. The prevalence and manifestations of gerontological ageism vary depending on the country. The maximum total indicator, displaying the highest overall level of ageism, was noted among Belarusian students, the minimum – in Lithuania (p < 0.05). The final indicators of gerontological ageism were found to be the following: the level of age discrimination and negative emotional attitude towards the elderly was increased in one fifth of the respondents in all five groups. The observation found the level of ageism averaging at 60%, evenly distributed in all groups. The predominant attitudes towards older people were found to be neutral or positive (84.6%). Conclusions. The manifestations of ageism are international in nature and can explain 20% of the total variety of answers characterising the differences in ranked attributes and degree of ageism. The total indicator showed the highest degree of gerontological ageism among students in Belarus, the lowest – among those in Lithuania, with levels of gerontological ageism among students in Russia, Poland and Ukraine distributed in between. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has resulted in a health care emergency in Europe since the first wave in 2020. Several challenges have arisen for occupational therapists, as well as all the health care professionals. The aim of this study was to determine what occupational therapists have changed to adapt their therapeutic processes for this catastrophic situation. Method: An online survey was developed and sent in conjunction with the Council of Occupational Therapy for European Countries (COTEC) to European national associations of occupational therapists. Results: The study was based on a sample of 65 occupational therapists who worked with people with COVID-19. More than half of the occupational therapists (54.8%) had changed departments. The main needs patients expressed (n = 136) during hospitalization were to have social contacts (30.9%), and the main clinical complaints (n = 144) were motor impairment and fatigue (35.4%) and depression (25.7%). The most frequently reported goal (n = 141) was recovery of physical performance and fatigue management (32.6%). Among the emotions mentioned by occupational therapists, negative emotions (76%) were the most common. Conclusion: European occupational therapists demonstrated flexibility and resilience to deal with clinical and organizational challenges during the COVID-19 emergency. [ABSTRACT FROM AUTHOR]

In today's Europe, mechanisms of controlling and disciplining bodies presumably transcend the logic and costs of the painful infliction of violence. State-sanctioned practices and bureaucratic categorization offer EU citizens the chance to live as "Europeans" wherever they choose to live in the territory of a member state. However, within the framework of the neo-colonial structuring of power, Eastern European states inhabit not only a geographic border zone, but recreate the periphery of modernity on the continent. In this article I aim to problematize the violence applied to people from Eastern Europe, who are border-crossers, and to reveal the meaning of intra-European bordering practices. I bring to the fore (personal) memories of border-crossing and data from my fieldwork, exposing collective similar experiences. Today, as in the last few decades, EU citizens whose mobility is controlled or forced across Europe, are submitted to forms of displacement, eviction, and deportation, producing the un-belonging of the border-crossers. These experiences are accompanied and accounted for by numerous emotions that reveal ways in which state institutions act upon the bodies and minds of non-citizens, a way in which the state is felt, becoming present in people's lives. One of the emotions induced through state institutions and their practices is shame, an essential tool of control and a producer of un-belonging. Thus, within the nation-state, following a racist-patriarchal logic, the unaccounted dehumanization and dignity violation of "some" citizens is accommodated, rationalized, and encouraged. [ABSTRACT FROM AUTHOR]

Background older people remain underrepresented in clinical trials, and evidence generated in younger populations cannot always be generalized to older patients. Objective to identify key barriers and to discuss solutions to specific issues affecting recruitment and retention of older participants in clinical trials based on experience gained from six current European randomised controlled trials (RCTs) focusing on older people. Methods a multidisciplinary group of experts including representatives of the six RCTs held two networking conferences and compiled lists of potential barriers and solutions. Every item was subsequently allocated points by each study team according to how important it was perceived to be for their RCTs. Results the six RCTs enrolled 7,612 older patients. Key barriers to recruitment were impaired health status, comorbidities and diverse health beliefs including priorities within different cultural systems. All trials had to increase the number of recruitment sites. Other measures felt to be effective included the provision of extra time, communication training for the study staff and a re-design of patient information. Key barriers for retention included the presence of severe comorbidities and the occurrence of adverse events. Long study duration, frequent study visits and difficulties accessing the study site were also mentioned. Solutions felt to be effective included spending more time maintaining close contact with the participants, appropriate measures to show appreciation and reimbursement of travel arrangements. Conclusion recruitment and retention of older patients in trials requires special recognition and a targeted approach. Our results provide scientifically-based practical recommendations for optimizing future studies in this population. [ABSTRACT FROM AUTHOR]

Background: Despite the key role of physical activity in the management of diabetes, many individuals with diabetes do not engage in the recommended levels of physical activity. However, our knowledge of the mechanisms underlying the relationship between diabetes and physical inactivity is limited.Purpose: To investigate the associations between diabetes and the levels and evolution of physical activity across aging, and to determine whether physical, emotional, and cognitive factors mediate these associations.Methods: Data from 105,622 adults aged 50-96 years from the Survey of Health, Ageing and Retirement in Europe (SHARE) were used in adjusted linear mixed models to examine whether diabetes was associated with physical activity levels and variations across aging. The potential mediators were subjective energy, muscle strength, physical and cognitive disability, sleep problems, depressive symptoms, and cognitive functions. The variables were measured up to seven times over a 13-year period.Results: Individuals with diabetes demonstrated a lower level and a steeper decrease in physical activity across aging than individual without diabetes. Mediators explained ~53% and 94% of the association of diabetes with the level of physical activity and with the linear evolution of physical activity across aging, respectively. All mediators were significantly associated with physical activity. Physical and cognitive disability as well as depressive symptoms were the strongest mediators, while sleep was the lowest one.Conclusions: These findings suggest that the etiology of physical inactivity in individuals with diabetes can result from several physical, emotional, and cognitive changes associated with the emergence of this disease. [ABSTRACT FROM AUTHOR]