Patricia P. Katz

Objective: To examine self‐management behaviors used to cope with 5 rheumatoid arthritis (RA)‐related stressors (pain, fatigue, physical limitations, joint changes, and symptom unpredictability) and the relationship between use of self‐management behaviors and ability to perform life activities.Methods: Data were from telephone interviews of 511 persons with RA. Participants were presented with lists of self‐management behaviors for each stressor and asked to indicate which they had used in the past year. Performance of life activities was assessed concurrently (baseline) and 1 year later (followup). The number of activities affected (difficulty performing or unable to perform) and the number that individuals were completely unable to perform were calculated. Multiple regression analyses were used to examine the association of perceived stressor impact and arthritis education with strategy use and the association of self‐management behaviors with performance of life activities.Results: Four self‐management strategies were identified: accommodation, active remediation, social, and perseverance. Greater perceived impact of stressors was associated with use of more self‐management strategies in total for each stressor (β = 0.43–0.73, all P < 0.0001) and with use of accommodation (β = 0.26–0.29, P < 0.0001), social (β = 0.23–0.43, P < 0.0001), and perseverance (β = 0.29–0.46, P < 0.0001) strategies. Greater use of accommodation strategies at baseline was associated with an increase in the number of activities affected at followup (β = 0.11, P < 0.05); greater use of perseverance strategies was associated with a decrease in activities unable to perform (β = −0.13, P < 0.01).Conclusion: Self‐management behaviors are commonly used and may help prevent loss of the ability to perform life activities.

Background: The Rhinosinusitis Disability Index (RSDI) is a validated measure of health-related quality of life (HRQL) in rhinitis. Responsiveness of the RSDI to changes in health status over time has not been described. Methods: We studied adults with a self-reported physician diagnosis of rhinitis identified through a national telephone survey. HRQL was assessed at baseline and at 24 months using the RSDI. Symptom severity, physical health status (SF-12 PCS), psychological mood (CES-D), and perceived control of symptoms were also assessed at the time of each interview. In addition, we ascertained specific health outcomes attributed to rhinitis, including days of restricted activity, job effectiveness, number of physician visits, and medication costs. Results: Of 109 subjects interviewed at baseline, 69 (63%) were re-interviewed 24 months later. RSDI scores improved by = 0.5 standardized response mean in 13 (19%) subjects and worsened in 17 (25%). Change in the RSDI over time correlated with changes in symptom severity (r = 0.38, p = 0.001), physical health (r = -0.39, p = 0.001), mood (r = 0.37, p = 0.002) and perceived control of symptoms (r = -0.37, p = 0.01). In multivariate analyses adjusted for baseline health status, improvement in RSDI was associated with less restricted activity (p = 0.01), increased job effectiveness (p = 0.03), and decreased medication costs (p = 0.05), but was not associated with change in the number of physician visits from baseline (p = 0.45). Conclusion: The RSDI is responsive to changes in health status and predicts rhinitis-specific health outcomes.

We examined the link between functioning and psychological status among persons with chronic obstructive pulmonary disease (COPD), using measures of both general functional status and performance of life activities. 334 persons with COPD were interviewed by telephone. Functioning was assessed with two measures of difficulty with specific types of activities (self-care, recreational activities/hobbies) and a general measure of functional status (SF-12 Physical Component Score (PCS)). About 16.2% of the sample had SF-12 Mental Component Score (MCS) scores indicative of psychological distress (MCS < 35). In separate regression models, difficulty with self-care and recreational activities was associated with an increased likelihood of distress (self-care: OR=2.9, 95%CI 1.3, 6.6; recreation: OR=7.5 [2.4, 23.7]), while PCS scores were not. In a model including all three predictors, difficulty with recreation was strongly associated with distress (OR=7.7 [2.1, 29.2]), difficulty with self-care was less strongly associated with distress (OR=2.1 [0.8, 5.5]), and PCS did not contribute significantly to the predictive ability of the model. However, low functioning as measured by the PCS was a significant risk factor for difficulty performing activities. Measures of activity difficulty were independent predictors of psychological distress, while general physical function was not. Poor general physical function was a risk factor for activity difficulties, suggesting an indirect relationship between low PCS and psychological distress, with activity difficulties as the intermediate variable.

Background: Exposure to environmental tobacco smoke (ETS), which contains potent respiratory irritants, may lead to chronic airway inflammation and obstruction. Although ETS exposure appears to cause asthma in children and adults, its role in causing COPD has received limited attention in epidemiologic studies.Methods: Using data from a population-based sample of 2,113 U.S. adults aged 55 to 75 years, we examined the association between lifetime ETS exposure and the risk of developing COPD.Participants were recruited from all 48 contiguous U.S. states by random digit dialing. Lifetime ETS exposure was ascertained by structured telephone interview. We used a standard epidemiologic approach to define COPD based on a self-reported physician diagnosis of chronic bronchitis, emphysema, or COPD.Results: Higher cumulative lifetime home and work exposure were associated with a greater risk of COPD. The highest quartile of lifetime home ETS exposure was associated with a greater risk of COPD, controlling for age, sex, race, personal smoking history, educational attainment, marital status, and occupational exposure to vapors, gas, dusts, or fumes during the longest held job (OR 1.55; 95% CI 1.09 to 2.21). The highest quartile of lifetime workplace ETS exposure was also related to a greater risk of COPD (OR 1.36; 95% CI 1.002 to 1.84). The population attributable fraction was 11% for the highest quartile of home ETS exposure and 7% for work exposure.Conclusion: ETS exposure may be an important cause of COPD. Consequently, public policies aimed at preventing public smoking may reduce the burden of COPD-related death and disability, both by reducing direct smoking and ETS exposure.

Objective: To examine the impact of instrumental and emotional support on valued life activity (VLA) disability and depressive symptoms. Instrumental support was expected to affect VLA disability; emotional support was expected to be associated with depressive symptoms and moderate the impact of VLA disability on depressive symptoms.Methods: Data were collected over 3 years through interviews with the University of California, San Francisco, Rheumatoid Arthritis Panel. Analyses assessed whether instrumental support predicted later VLA disability and whether emotional support predicted both concurrent and later depressive symptoms.Results: Receiving adequate instrumental support was associated with less subsequent VLA disability. Strong associations were noted between both VLA disability and emotional support with concurrent depressive symptoms. No relationship was found between emotional support and later depression. No evidence was found for the hypothesis that emotional support moderated the impact of VLA disability on depressive symptoms.Conclusion: Results highlight the need to assess different types of support and their unique impact on critical outcomes. Instrumental support is beneficial to the maintenance of valued activities, a critical factor in the psychological adjustment of individuals living with rheumatoid arthritis. Emotional support has a significant short‐term impact on depression, although it may not buffer the impact of VLA disability on future depression.