Examining relationships between participation, glycemic control, and quality of life

Title: Examining relationships between participation, glycemic control, and quality of life Type of submission: Research paper Purpose: Persons with chronic medical conditions are prescribed self-management regimens with the goal of maintaining physical health, often measured through biological markers. However, self-management regimens are complex and time-consuming; as such, they may interfere with or limit participation in meaningful occupations, which in turn may negatively influence quality of life (e.g. Pyatak, 2011). Therefore, using an occupational science lens (Wilcock, 2007; Durocher, Rappolt, & Gibson, 2014), we examined the relationship between occupational engagement and multiple domains of health using baseline data from the Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) study, a randomized controlled trial of an occupation-based diabetes management intervention. Our presentation focuses on young adults with diabetes and the associations between participation, glycemic control, and quality of life. Methods: The REAL Diabetes study included 81 young adults diagnosed with type 1 or type 2 diabetes from low socioeconomic status and minority backgrounds (Pyatak et al., 2016). We assessed the following: (1) objective participation: frequency of participation across five domains of activities: household activities, productive activities, transportation, leisure, and social activities and (2) subjective participation, calculated by multiplying participants’ ratings of personal importance of individual activities by satisfaction with their frequency of participation in those activities, both measured by the Participation Objective, Participation Subjective scale (POPS) (Brown et al., 2004); (3) glycemic control, as measured by Hemoglobin A1c (HbA1c); and (4) diabetes-related quality of life, as measured by the Audit of Diabetes Dependent Quality of Life. We examined the associations of both domains of participation with HbA1c and diabetes-related quality of life using nonparametric statistical methods, then examined these associations for potential effect modification. Results: Subjective participation was negatively associated with HbA1c (r=-0.23, p=0.04). Diabetes type was an effect modifier for this association (p for interaction=0.03); subjective participation was associated with lower HbA1c in people with type 1 diabetes (p=0.004) but not type 2 diabetes (p=0.22). In addition, subjective participation was positively associated with diabetes-related quality of life among all participants (r=0.24, p=0.03). There were no significant associations between objective participation and HbA1c or diabetes-related quality of life. Implications for Occupational Science: Our findings suggest that satisfaction with, but not frequency of, participation is associated with both physical health and disease-related quality of life. These findings substantiate the link between occupation and health and provide insight that different dimensions of participation (objective versus subjective) make different contributions to well-being. Discussion Questions/Objectives for Discussion: How can healthcare providers and systems incorporate knowledge about subjective participation within approaches to chronic disease management? How does occupational science incorporate objective and subjective domains of participation when examining the relationship between occupation and health? How can occupational scientists engage with other communities to translate research findings about the link between occupation and health into practical applications for health promotion? Three key words: Chronic disease, Self-management, Participatio

The California Breast Cancer Survivorship Consortium (CBCSC): prognostic factors associated with racial/ethnic differences in breast cancer survival

Racial/ethnic disparities in mortality among US breast cancer patients are well-documented. Our knowledge of the contribution of lifestyle factors to disease prognosis is based primarily on non-Latina Whites and is limited for Latina, African American and Asian American women. To address this knowledge gap, the California Breast Cancer Survivorship Consortium (CBCSC) harmonized and pooled interview information (e.g., demographics, family history of breast cancer, parity, smoking, alcohol consumption) from six California-based breast cancer studies and assembled corresponding cancer registry data (clinical characteristics, mortality), resulting in 12,210 patients (6,501 non-Latina Whites, 2,060 African Americans, 2,032 Latinas, 1,505 Asian Americans, 112 other race/ethnicity) diagnosed with primary invasive breast cancer between 1993 and 2007. In total, 3,047 deaths (1,570 breast cancer-specific) were observed with a mean (SD) follow-up of 8.3 (3.5) years. Cox-proportional hazards regression models were fit to data to estimate hazards ratios (HR) and 95% confidence intervals (CI) for overall and breast cancer-specific mortality. Compared with non-Latina Whites, the HR of breast cancer-specific mortality was 1.13 (95% CI, 0.97-1.33) for African Americans, 0.84 (95% CI, 0.70-1.00) for Latinas, and 0.60 (95% CI, 0.37-0.97) for Asian Americans after adjustment for age, tumor characteristics, and select lifestyle factors. The CBCSC represents a large and racially/ethnically diverse cohort of breast cancer patients from California. This cohort will enable analyses to jointly consider a variety of clinical, lifestyle, and contextual factors in attempting to explain the long-standing disparities in breast cancer outcomes