A Randomized controlled trial of the effect of yoga and peer support on glycaemic outcomes in women with type 2 diabetes mellitus: a feasibility study.

BACKGROUND: Type two diabetes is a complex and demanding chronic disease and its impact in a state (Kerala) which leads India in terms of the number of people with Diabetes is profound. Though the male to female ratio among the people with diabetes is roughly equal, women are uniquely and more severely affected. Management of type two Diabetes requires considerable dexterity on the part of the patient to manage drugs, diet and exercise. Therefore, in a low middle-income country like India it is necessary to look at low cost interventions that can empower the patient and build on available resources to help manage diabetes. Hence, we studied the feasibility and effect of two low cost interventions; yoga and peer support on glycaemic and other outcomes among women with type two diabetes. METHODS: An open label parallel three armed randomized control trial was conducted among 124 recruited women with Diabetes for three months. Block randomization with a block length of six was carried out with each group having at least 41 women. In the Yoga arm, sessions by an instructor, consisting of a group of postures coordinated with breathing were conducted for an hour, two days a week. In the peer support arm each peer mentor after training visited 13-14 women with diabetes every week followed by a phone call. The meeting was about applying disease management or prevention plans in daily life. RESULTS: There was a trend in decline of fasting plasma glucose in the peer and yoga group and of glycosylated haemoglobin (HbA1c) in the yoga group only, though not significant. A significant decrease was observed in diastolic blood pressure and hip circumference in the yoga group. The process indicated that most (80%) of the women in the yoga group attended classes regularly and 90% of the women in the peer group reported that peer mentoring was useful. CONCLUSION: The effect of yoga and peer support on glycaemic outcomes was incremental. Longer term studies are necessary to ascertain the benefits shown by this feasibility study. TRIAL REGISTRATION: CTRI/2011/12/002227 dated 14/12/2011.

Validation of WHOQOL-BREF in Malayalam and Determinants of Quality of Life Among People With Type 2 Diabetes in Kerala, India.

Quality of life (QOL) is an important health outcome in people with chronic conditions like diabetes and WHOQOL-BREF is a popular instrument used worldwide to assess QOL. However, QOL varies considerably from society to society depending on the culture of the person. Hence, the WHOQOL-BREF was translated to the local language, Malayalam. This article attempts to establish reliability, construct and discriminant validity of the translated WHOQOL-BREF, and determinants of QOL among people with type 2 diabetes. A cross-sectional study was undertaken among 200 patients with diabetes attending a primary care center in a rural area of Kerala, India. The translated version of WHOQOL-BREF was found to be internally consistent (Cronbach's α = .86) and demonstrated discriminant and construct validity. Education was found to be an independent determinant of QOL in the physical, psychological, and environmental domains. Thus, the translated version had good psychometric properties and education was an independent determinant of QOL in 3 of 4 domains.

Screening for breast cancer in a low middle income country: predictors in a rural area of Kerala, India.

BACKGROUND: In India, breast cancer is the leading malignancy among women in a majority of the cancer registries. Therefore it is important to understand screening practices and its predictors, including in rural areas with high female literacy and good health indices. MATERIALS AND METHODS: A cross-sectional study with multistage sampling was conducted in Vypin Block, Ernakulam district, Kerala, India. Four Panchayats (self administration units) were randomly chosen and a woman in every second household was invited to participate from the tenth ward of each. Thus a total of 809 women were interviewed. RESULTS: The majority of the repondents (82.1%) were not aware of risk factors and about a third (37.9%) were not aware of symptoms of breast cancer. About half of the population studied (46.6%) had undergone screening. Age (35-50 years), being married, health professionals as source of information and working were significant predictors of screening. Logistic regression showed that older women (35-50 yrs) were more likely to practice screening. Out of the never screened, about a third (35%) were desirous of doing it, but had not for various reasons and 53.5% were not willing to screen. The reasons identified for not screening among those desirous of doing it were grouped into knowledge 66 (43.4%), resources 23 (15.1%) and psychosocial 32(21.1%) factors. Unmarried women were significantly more likely to express factors related to all the three domains. CONCLUSIONS: This study showed that in spite of the absence of a population-based screening program, about half of the study population had undergone some type of screening. The older women (35-50 years) in particular were significantly more likely to practice screening. At this critical juncture, a high quality breast cancer awareness and screening initiative can help to consolidate the gains and tackle knowledge, resource and psychosocial barriers.