Dispositional optimism has been linked in previous studies to better health outcomes. We sought to examine the independent associations of dispositional optimism and depressive symptoms with physical and mental functioning in a cohort of healthy middle-aged and older men. The study was conducted among 659 subjects in the Veterans Administration (VA) Normative Aging Study. Dispositional optimism and depressive symptomatology were measured in 1991 and 1990, respectively, by the Life Orientation Test and the Center for Epidemiologic Studies--Depression Scale (CES-D). The dependent variables, functioning and well-being, were measured in 1992 by the Medical Outcomes Study Short-Form Health Survey (SF-36). In multivariate regression models, optimism was associated with higher levels of general health perceptions, vitality, and mental health, and lower levels of bodily pain, but not to physical functioning, social functioning, or role limitations due to physical or emotional problems. Depressive symptomatology was associated with reduced levels of functioning across all SF-36 domains. The findings for optimism and depression were statistically significant after mutual adjustment in multivariate regression models. Optimism and depression are independent predictors of functional status among aging men.

Background Continuous positive airway pressure (CPAP) is the most widely prescribed treatment for obstructive sleep apnoea syndrome (OSAS). Although it has been shown to improve the symptoms of OSAS, many patients have difficulty adhering to this treatment. The purpose of this study was to investigate the effectiveness of an automated telemedicine intervention to improve adherence to CPAP. Methods A randomised clinical trial was undertaken in 250 patients being started on CPAP therapy for OSAS. Patients were randomly assigned to use a theory-driven interactive voice response system designed to improve CPAP adherence (telephone-linked communications for CPAP (TLC-CPAP), n¼124) or to an attention placebo control (n¼126) for 12 months. TLC-CPAP monitors patients' self-reported behaviour and CPAP-related symptoms and provides feedback and counselling through a structured dialogue to enhance motivation to use CPAP. A Sleep Symptoms Checklist, the Functional Outcomes of Sleep Questionnaire, the Center for Epidemiological Studies Depression Scale and the Psychomotor Vigilance Task were administered at study entry and at 6-month and 12-month follow-up. Hours of CPAP usage at effective mask pressure were measured by the CPAP device stored in its memory and retrieved at each visit. Results Median observed CPAP use in patients randomised to TLC-CPAP was approximately 1 h/night higher than in the control subjects at 6 months and 2 h/night higher at 12 months. Using generalised estimating equation modelling, the intervention had a significant effect on CPAP adherence. For secondary analysis, the effect of CPAP adherence on the secondary outcomes was analysed. CPAP adherence was significantly associated with a greater reduction in sleep apnoea symptoms and depressive symptoms and a greater improvement in functional status. No significant association was observed between CPAP adherence and reaction time. Conclusions The TLC-CPAP intervention resulted in improved CPAP adherence, which was associated with improved functional status and fewer depressive symptoms. Clinical trial.gov: NCT00232544.

This computer-based telecommunications exercise intervention led to improvements in participants' strength, balance, and depressive symptoms. Because of their low cost and easy accessibility, computer-based interventions may be a cost-effective way of promoting exercise in the home.

This pilot study suggests that patients with OSAS started on CPAP and a concurrently administered automated education and counseling system had better CPAP adherence and better control of OSAS symptoms.

Because of the important role of peripheral airways inflammation in the pathogenesis of asthma and COPD and because of the known anti-inflammatory actions of corticosteroids, we hypothesized that endogenous cortisol may influence the rate of decline of pulmonary function with aging. We examined the basal plasma cortisol concentration and serial spirometric measurements of 86 healthy men participating in the Normative Aging Study. Subjects selected for this study were free of any chronic illnesses and denied chronic use of any medications. Blood for cortisol determination was obtained with the subject in the supine position at 8:00 A.M. Two consecutive spirometric examinations that took place an average of 4.7 yr apart were employed in the analysis. Cross-sectional analysis revealed a weak (p = 0.08) direct relationship between the basal plasma cortisol concentration and FEV1. The cortisol concentration and FVC appeared unrelated. Longitudinal analysis revealed a significant (p = 0.008) relationship between the plasma cortisol concentration and the rate of decline of FEV1 over the follow-up interval after adjustment for age, height, smoking status, and initial FEV1 in a multivariate regression model. This multivariate model predicts that subjects with cortisol concentration 1 standard deviation (23.3 ng/ml) below the mean would experience FEV1 decline 71.6 ml/yr greater than subjects with cortisol concentration 1 standard deviation above the mean. This difference was comparable to the estimated 69.5 ml/yr difference between current and never smokers. Cortisol concentration was unrelated to the rate of decline of FVC. The data suggest that physiologic concentrations of cortisol may modulate the process responsible for the deterioration of ventilatory function with aging.