Effect of lockdown on activities of daily living in the built environment and wellbeing.

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.

Effect of a Collaborative Care Model on Depressive Symptoms and Glycated Hemoglobin, Blood Pressure, and Serum Cholesterol Among Patients With Depression and Diabetes in India: The INDEPENDENT Randomized Clinical Trial.

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 Participants: Parallel, 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 A1c (HbA1c) 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 Measures: The 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 HbA1c, 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 (HbA1c <7.0%, SBP <130 mm Hg, LDL cholesterol <100 mg/dL [<70 mg/dL if prior cardiovascular disease]) or had improvements in individual outcomes (≥50% reduction in SCL-20 score, ≥0.5-percentage point reduction in HbA1c, ≥5-mm Hg reduction in SBP, ≥10-mg/dL reduction in LDL cholesterol); percentage of patients who met all HbA1c, SBP, and LDL cholesterol targets; and mean reductions in SCL-20 score, Patient Health Questionnaire-9 score, HbA1c, 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 depression in India, a 12-month collaborative care intervention, compared with usual care, resulted in statistically significant improvements in a composite measure of depressive symptoms and cardiometabolic indices at 24 months. Further research is needed to understand the generalizability of the findings to other low- and middle-income health care settings. Trial Registration: ClinicalTrials.gov Identifier: NCT02022111.

Yoga practice in diabetes improves physical and psychological outcomes.

BACKGROUND: The aim of this study was to examine the effect of yoga practice on clinical and psychological outcomes in subjects with type 2 diabetes mellitus (T2DM). METHODS: In a 40-day yoga camp at the Institute of Yoga and Consciousness, ambulatory subjects with T2DM not having significant complications (n = 35) participated in a 40-day yoga camp, where yogic practices were overseen by trained yoga teachers. Clinical, biochemical, and psychological well-being were studied at baseline and at the end of the camp. RESULTS: At the end of the study, there was a reduction of body mass index (BMI) (26.514 +/- 3.355 to 25.771 +/- 3.40; P < 0.001) and anxiety (6.20 +/- 3.72 to 4.29 +/- 4.46; P < 0.05) and an improvement in total general well-being (48.6 +/- 11.13 to 52.66 +/- 52.66 +/- 12.87; P < 0.05). CONCLUSIONS: Participation of subjects with T2DM in yoga practice for 40 days resulted in reduced BMI, improved well-being, and reduced anxiety.