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Many chronically ill older patients in the Netherlands have a combination of more than one chronic disease. There is therefore a need for self-management programs that address general management problems, rather than the problems related to a specific disease. The Chronic Disease Self-Management Program (CDSMP) seems to be very suitable for this purpose. In evaluations of the program that have been carried out in the United States and China, positive effects were found on self-management behaviour and health status. However, the program has not yet been evaluated in the Netherlands. Therefore, the aim of this study was to evaluate the short-term and longer-term effects of the program among chronically ill older people in the Netherlands. One hundred and thirty-nine people aged 59 or older, with a lung disease, a heart disease, diabetes, or arthritis were randomly assigned to an intervention group (CDSMP) or a control group (care-as-usual). Demographic data and data on self-efficacy, self-management behaviour and health status were collected at three measurement moments (baseline, after 6 weeks, and after 6 months). The patients who participated rated the program with a mean of 8.5 points (range 0-10), and only one dropped out. However, our study did not yield any evidence for the effectiveness of the CDSMP on self-efficacy, self-management behaviour or health status of older patients in the Netherlands. Because the patients who participated were very enthusiastic, which was also indicated by very high mean attendance (5.6 out of 6 sessions) and only one dropout, it seems too early to conclude that the program is not beneficial for these patients. Keywords: Self management; Elderly; Chronic disease; Randomized trial; The Netherlands

The present longitudinal study aims to explain emotional and social loneliness experienced by older adults (N = 99) during two-and-a-half years of widowhood. Utilization of multilevel analysis and a 'visual' cluster analysis with prescribed classification criteria enabled us to search for average adaptational developments as well as individual variability in the adjustment process. Results were interpreted within the theory of mental incongruity.

Using data on 32 actors and ties among them drawn from available court files, we combine analytical sociology with statistical models for networks in order to analyse a case of a counterfeit alcohol distribution network from the Czech Republic. We formulate a theory of action and identify relational mechanisms which could explain how the structure of the network emerged and describe. We use the exponential random graph model to test these mechanisms. The analysis reveals that the two actors capable of manufacturing the poisonous mixture were considerably though not optimally proximate to others enabling fast distribution of the mixture. Our model results that the structure was formed by mechanisms of triadic closure, negative tendency to concentrate ties, and tie translation of pre-existing ties into operational ties. We conclude with the discussion of the implications our approach for the study of criminal networks. [ABSTRACT FROM AUTHOR]

This longitudinal study aims to explain loneliness in newly bereaved older adults, taking into account personal and circumstantial conditions surrounding the partner's death. A distinction is made between emotional and social loneliness. Data were gathered both before and after partner loss. Results were interpreted within the framework of the Theory of Mental Incongruity. The findings reveal that being unable to anticipate the partner's death is related to higher levels of emotional loneliness. Standards of instrumental support, measured indirectly by poor physical condition, lead to stronger emotional as well as social loneliness. Standards measured directly by importance attached to support or contacts result in higher emotional loneliness but, unexpectedly, in lower social loneliness. Furthermore, difficulties with establishing personal contacts, caused, for instance, by social anxiety, add to loneliness. It is concluded that circumstances related to the partner's illness may contribute to emotional loneliness after bereavement. Moreover, the results highlight the importance of taking coping attitudes into consideration for a better understanding of how newly bereaved older adults adapt to the loss of a partner. KEY WORDS - longitudinal, bereavement, widowhood, loneliness, older adults.