for the INDEPENDENT Study Group IMPORTANCE Mental health comorbidities are increasing worldwide and worsen outcomes for people with diabetes, especially when care is fragmented.OBJECTIVE To assess whether collaborative care vs usual care lowers depressive symptoms and improves cardiometabolic indices among adults with diabetes and depression. DESIGN, SETTING, AND PARTICIPANTSParallel, open-label, pragmatic randomized clinical trial conducted at 4 socioeconomically diverse clinics in India that recruited patients with type 2 diabetes; a Patient Health Questionnaire-9 score of at least 10 (range, 0-27); and hemoglobin A 1c (HbA 1c ) of at least 8%, systolic blood pressure (SBP) of at least 140 mm Hg, or low-density lipoprotein (LDL) cholesterol of at least 130 mg/dL. The first patient was enrolled on March 9, 2015, and the last was enrolled on May 31, 2016; the final follow-up visit was July 14, 2018.INTERVENTIONS Patients randomized to the intervention group (n = 196) received 12 months of self-management support from nonphysician care coordinators, decision support electronic health records facilitating physician treatment adjustments, and specialist case reviews; they were followed up for an additional 12 months without intervention. Patients in the control group (n = 208) received usual care over 24 months. MAIN OUTCOMES AND MEASURESThe primary outcome was the between-group difference in the percentage of patients at 24 months who had at least a 50% reduction in Symptom Checklist Depression Scale (SCL-20) scores (range, 0-4; higher scores indicate worse symptoms) and a reduction of at least 0.5 percentage points in HbA 1c , 5 mm Hg in SBP, or 10 mg/dL in LDL cholesterol. Prespecified secondary outcomes were percentage of patients at 12 and 24 months who met treatment targets (HbA 1c <7.0%, SBP <130 mm Hg, LDL cholesterol <100 mg/dL [<70 mg/dL if prior cardiovascular disease]) or had improvements in individual outcomes (Ն50% reduction in SCL-20 score, Ն0.5-percentage point reduction in HbA 1c , Ն5-mm Hg reduction in SBP, Ն10-mg/dL reduction in LDL cholesterol); percentage of patients who met all HbA 1c , SBP, and LDL cholesterol targets; and mean reductions in SCL-20 score, Patient Health Questionnaire-9 score, HbA 1c , SBP, and LDL cholesterol. RESULTS Among 404 patients randomized (mean [SD] age, 53 [8.6] years; 165 [40.8%] men), 378 (93.5%) completed the trial. A significantly greater percentage of patients in the intervention group vs the usual care group met the primary outcome (71.6% vs 57.4%; risk difference, 16.9% [95% CI, 8.5%-25.2%]). Of 16 prespecified secondary outcomes, there were no statistically significant between-group differences in improvements in 10 outcomes at 12 months and in 13 outcomes at 24 months. Serious adverse events in the intervention and usual care groups included cardiovascular events or hospitalizations (4 [2.0%] vs 7 [3.4%]), stroke (0 vs 3 [1.4%]), death (2 [1.0%] vs 7 [3.4%]), and severe hypoglycemia (8 [4.1%] vs 0). CONCLUSIONS AND RELEVANCE Among patients with diabetes and ...

Participation of subjects with T2DM in yoga practice for 40 days resulted in reduced BMI, improved well-being, and reduced anxiety.

Abstract:We assessed the contribution of selected built environment factors to body weight in a pilot study in urban Visakhapatnam, South India. Participants were 123 men and 60 women (age 16 to 69 years; BMI 17.3-30.5) who had lived in the area for at least 3 years. Individuals with lower BMI tended to be (a) working people (non-home based-working away from home), (b) non-vegetarians, (c) physically active (activity mostly related to work), and (d) taking afternoon siestas. Psychological stress, quality of life and wellbeing data were used from an earlier study of individuals with diabetes mellitus. The measures included were depression, anxiety, energy, positive wellbeing, satisfaction, impact, and social worry and diabetes worry (Diabetes quality of life). Guttman's Smallest Space Analysis (SSA) suggested the relationships among the psychosocial measures can be accounted for by one facet with three axial sets of variables (a) positive wellbeing and energy, (b) satisfaction, impact, and social worry and diabetes worry, and (c) anxiety and depression. SSAs on male participants suggested that fasting blood glucose and weight were most closely associated with anxiety and energy levels. In female participants, weight and fasting glucose were most closely associated with energy and to a somewhat lesser extent with anxiety. In both sexes, age was closely associated with positive wellbeing. Also in both sexes, age, weight, and fasting glucose levels were closely associated with each other. The results support the importance of understanding the impact of built environment and psychosocial factors on body weight in diabetic individuals for designing prevention strategies.

BACKGROUND Incidence of Coronary Artery Disease (CAD) is increasing day by day. Cardiac rehabilitation is an important aspect of management of Coronary Artery Disease. Anuloma Viloma Pranayama is beneficial to cardiac patients as it increases parasympathetic activity and lowers blood pressure and respiratory rate. This study was designed to assess the benefit of Anuloma Viloma Pranayama as rehabilitation therapy in post Coronary Artery Bypass Grafting (CABG) surgery patients. Parameters of pulmonary function test (PFT) were measured before and after 3 months of performing CABG. METHODS The study was carried out in the Department of Cardiothoracic and Vascular Surgery, CARE Hospital, Visakhapatnam, Andhra Pradesh, in collaboration with Department of Psychology and Parapsychology and yoga village of Andhra University. CAD patients admitted to the hospital for CABG procedure were included in the study. Thirty patients were selected for performing pranayama (cases) and 30 patients were taken as controls. The study was approved by the institutional ethics committee of Care Hospital, Visakhapatnam, Andhra Pradesh. Patients who were admitted for CABG were advised to practice pranayama for 3 months along with normal rehabilitative steps from 3rd postoperative day. Pulmonary function test was measured by spirometry. Parameters like Forced Expiratory Volume in 1 second (FEV1), Forced Vital Capacity (FVC), FEV1 : FVC ratio, Peak Expiratory Flow Rate (PEFR) and Maximum Voluntary Ventilation (MVV) were measured. A comparison of pulmonary parameters was done between groups and statistically analysed using SPSS 20 software. P Valve < 0.05 was considered as significant. RESULTS Results of the study were analysed and compared between cases and controls. All the parameters of PFT improved significantly in pranayama group 3 months after CABG when compared with their preoperative values. There was also statistically significant improvement of all PFT parameters when compared between pranayama group (cases) and the control group. CONCLUSIONS Anuloma Viloma Pranayama is beneficial to postoperative CABG patients. It helps in reducing air way inflammation, air way collapse, and increases chest expansion, air way oxygenation along with improvement of pulmonary function tests. KEYWORDS Anuloma Viloma Pranayama, PFT, CABG

In an effort to arrest the spread of coronavirus (COVID-19) infection, a nationwide lockdown was declared in India in March 2020. To assess how personal built environments affected the citizens in the first few weeks, an explorative online survey was conducted, eliciting responses about work habits before the lockdown, psychological wellbeing, time spent in various activities, characteristics of those who worked from home, and food and sleep patterns. We received 121 (76 male and 45 female) responses with an average age of 35.5 years [max: 70 years, min: 18 years, standard deviation (SD): 12.9 years]. The major difference caused by the lockdown was a reduction in the time taken and distance travelled of the commute to workplaces, which was an average of 30 minutes and 9.5 km, respectively. In terms of diet, subjects who were vegetarian did not experience any difference, unlike those who were non-vegetarians (p < 0.05). The results show an association of the dependent variable of ‘feeling in general’ with predictor variables of ‘energy, pep, vitality’ and ‘feel healthy to work’ during the pandemic, whereas the predictor variables of ‘energy, pep, vitality’, ‘happy and satisfied personal life’, ‘feel healthy to work’ show an association with the dependent variable of ‘feeling in general’ before the lockdown with a significance of p < 0.02 and R2 = 0.51 and R2 = 0.60, respectively. Among those who worked from home in constrained environments, people found spaces and seemed to adapt reasonably well to the built environment with employees showing a preference for working from bedrooms and students for working from ‘sit-out’ (outside) spaces (p < 0.05). There was no change in the quality or quantity of sleep during the lockdown. This study in the early weeks of the lockdown documents the way in which individuals lived through it in terms of the built environment at home.