Study of Emotion Regulation Based on Yogic Personality Using Implicit, Explicit, and Eye Tracking Techniques.

Context: Emotion regulation (ER) is vital for well-being. Yogic personality traits, gunas, influence the expression of ER. Aims: To investigate the expression of ER based on guna-related personality traits employing explicit, implicit, and objective eye-tracking techniques. Settings and Design: Quota sampling was used, with a cross-sectional design with three groups, sattva, rajas, and tamas. Three hundred and ninety-four female students were screened and finally, 30 from sattva, 34 from rajas, and 36 from tamas were analyzed. Methods: Participants were given State and Trait Mindfulness Scales, Gita Inventory, Social Desirability Scale, state-trait anxiety inventory, Adult Attachment Scale, and Emotional Regulation Questionnaire. ER-Implicit Association Test (ER-IAT) and Eye Tracker were also used to evaluate the participants. Statistical Analysis Used: One-way repeated-measures analysis of variance was used to examine differences between sattva, rajas, and tamas. Results: Sattva group adopted a higher level of regulation strategy, ER-IAT scores were positive for sattva, negative for rajas and tamas. Mindfulness was highest and anxiety was least in sattva. In the eye tracker, within the non-emotional areas of interest (eAOI) regions of pleasant condition, and eAOI regions of unpleasant condition, sattva group had considerably higher dwell time. Pupil dilation was lowest in sattva for all the conditions, both within and outside eAOIs. Conclusions: Sattva guna was found to foster healthy ER, and other psychological attributes. Conscious cultivation of sattva is needed for healthy emotional life.

A Prospective Study on Type-2 Diabetic Complications and Efficacy of Integrated Yoga: A Pan India 2017.

BACKGROUND: Type 2 diabetes (T2DM) contributes to high mortality and morbidity because of its major complications related to kidney, heart, brain, and eyes. It also poses a high risk for mortality because of COVID-19. Studies suggest the possible implications of Yoga in delaying or attenuating such complications. METHODOLOGY: This was a pan-India multi centered cluster-randomized (4 level) two-armed trial in the rural and urban population of all populous states of India. Data were obtained using mobile app in all adults in the household of the selected clusters. RESULTS: We report the diabetes related complications in 16623 adults (48% males, 52% females) from 65 districts (1 in 10 districts, 2011 census) of 29 (out of 35) states and Union Territories of India; mean age was 48.2 ± 12.46 years. Out of this 40% lived in rural and 62% in urban locations. In high risk diabetes individuals (scored ≥ 60 points on Indian diabetes risk score key), 18.0% had self-reported history of (peripheral neuropathy, 6.1% had h/o major strokes, 5.5% had minor strokes (transient ischemic episodes), 18.1% had lower limb claudication, 20.5% leg ulcers, 4.4% had h/o cardiac surgery, 4.8% angioplasty, and 15.1% had diabetes retinopathy. Complications were higher in rural than in urban areas, higher in people with extended duration of diabetes. Integrated yoga module for three months (one hour daily) showed significantly better reduction in symptoms related to complications as compared to control group (P < .001). CONCLUSION: The alarming high prevalence of complications in diabetes population calls for urgent action, where yoga may show the benefits in reduction of symptoms of complications.

Prospective Study of Different Staple Diets of Diabetic Indian Population.

Background: Diabetes is a metabolic disorder characterized by chronic hyperglycemia. Its prevention and regulation depends on dietary pattern and lifestyle. There are numerous studies which have been conducted to elucidate the relationship between type of diet consumption and sugar levels. The objective of this study was to enumerate the distribution of the staple food consumed in seven zones across India and their association with sugar levels. Methods: A pan-India multicentered screening, covering the 63 districts, 29 states, and 4 union territories per populations, was undertaken. A specially designed questionnaire was administered for data collection, which comprised specific questions for diet 17,280 sample was analyzed across seven zones of India. Statistical Package for the Social Sciences (SPSS; 21.0) software was used to analyze the data. Results: The survey suggested that rice and wheat are the major staple food consumed across different regions of India. In Jammu, North, East, South, and central zones, consumption of rice was more than wheat. However, in North and West zones, consumption of wheat was observed to be more than rice. Mean values of fasting blood sugar (FBS), postprandial blood sugar (PPBS) were high in the group consuming Bajra (128.3 & 160.5). Similarly, FBS mean was less in group consuming rice (114.6), and PPBS was low in group consuming ragi (149.2). Conclusion: Staple food has significant effect on FBS, PPBS and glycated haemoglobin cholesterol levels and anthropometric measurements.

Perceptions of benefits and barriers to Yoga practice across rural and urban India: Implications for workplace Yoga.

BACKGROUND: Even though Yoga is useful for prevention of obesity, diabetes and hypertension it is not universally practiced. The purpose of the study was to determine the benefits and barriers confronted by the community members while incorporating Yoga into routine practice and at workplace. OBJECTIVE: This study explored the motivators and barriers to Yoga practice by estimating how these elements can be useful for development and incorporation of Yoga as a workplace activity and as a profession. METHODS: A nationwide multi-centered prospective study was conducted recruiting individuals of different age groups and geographical zones in India. Participants of Yoga intervention group were administered a questionnaire with 19 items on benefits (YBS) and 18 items on barriers for Yoga practice (BFYS). Data was analyzed using SPSS v21 software. RESULTS: Majority of the participants perceived Yoga improves "physical fitness", "relaxes mind and body", improves "stamina", across age groups. "Lifestyle", "Family commitments", "Physical over-exertion", "No Encouragement from family", "Occupational commitments" and "Few places to do Yoga" were perceived barriers across various geographical zones. Despite knowing the benefits of Yoga, these barriers prevented individuals from integrating it into their daily routine. CONCLUSIONS: The present study may be considered as a starting point for development of Yoga as a workplace activity and a profession based on the perceptions of its various benefits and barriers faced by a large study population spanning an entire nation.

A composite of BMI and waist circumference may be a better obesity metric in Indians with high risk for type 2 diabetes: An analysis of NMB-2017, a nationwide cross-sectional study.

AIMS: Obesity measurement is a vital component of most type 2 diabetes screening tests; while studies had shown that waist circumference (WC) is a better predictor in South Asians, there is evidence that BMI is also effective. Our objective was to evaluate the efficacy of BMIWC, a composite measure, against BMI and WC. METHODS: Using data from a nationwide randomized cluster sample survey (NMB-2017), we analyzed 7496 adults at high risk for type 2 diabetes. WC, BMI, and BMIWC were evaluated using Odds Ratio (OR), and Classification scores (Sensitivity, Specificity, and Accuracy). These were validated using Indian Diabetes Risk Score (IDRS) by replacing WC with BMI and BMIWC, and calculating Sensitivity, Specificity, and Accuracy. RESULTS: BMIWC had higher OR (2·300) compared to WC (1·87) and BMI (2·26). WC, BMI, and BMIWC were all highly Sensitive (0·75, 0·81, 0·70 resp.). But BMIWC had significantly higher Specificity (0.36) when compared to WC and BMI (0.27 each). IDRSWC, IDRSBMI, and IDRSBMIWC were all highly Sensitive (0·87, 0·88, 0·82 resp.). But IDRSBMIWC had significantly higher Specificity (0·39) compared to IDRSWC and IDRSBMI (0·30, 0·31 resp.). CONCLUSIONS: Both WC and BMI are good predictors of risk for T2DM, but BMIWC is a better predictor, with higher Specificity; this may indicate that Indians with high values of both central (high WC) and general (BMI > 23) obesity carry higher risk for type 2 diabetes than either one in isolation. Using BMIWC in IDRS improves its performance on Accuracy and Specificity.

Is the Indian Dietary Pattern Associated WithType 2 Diabetes? A Pan-India Randomized Cluster Sample Study.

BACKGROUND: Diabetes is associated strongly with many neurodegenerative diseases and is also a lifestyle disorder. A good glycemic status depends on diet management and physical activity. There are several studies available on the relationship between diet habits and impact on diabetes. PURPOSE: The objective of this study was to check the association of different dietary factors with glucose levels and lipid values in type 2 diabetes from a part of a large nationwide trial. METHODS: This was the data fromapan-India multicentered cluster randomized controlled study covering 60 states and 4 union territories; 17,285 individuals were surveyed for dietary factors. Amongst them, data of 12,500 individuals were analyzed.Males were 54% and 60% individuals were from urban areas. RESULTS: The analysis of the results showed that consumption (usual/often) of milk(odds ratio, OR = 7.180), meat (OR = 6.81), less fiber (OR = 17.77), and less fruits (OR = 14.71) was strongly and positively associated with fasting blood glucose (P<.001). The postprandial blood glucose (PPBG) in diabetes individuals also had a strong positive association (P<.001) with consumption (usual/often) of meat (OR = 22.82) and milk (OR = 17.19). In prediabetes individuals, milk was significantly (P<.001) associated with fasting blood glucose (OR = 2.74). In nondiabetes individuals also, milk was significantly associated with postprandial blood glucose (OR = 2.56). Consumption of meat was associated with high cholesterol (OR = 1.465).Consumption of junk food was associated significantly (P <.001)with the status of known diabetes (OR = 1.345) and known hypertension (OR = 1.247). CONCLUSION: Consumption of milk, meat, less vegetables, less fruits, and junk food has a significant effect on the glycemic status and cholesterol levels, and also on the status of known diabetes and hypertension.

Sleep Disorders in Individuals With High Risk for Diabetes in Indian Population.

BACKGROUND: Sleep restores physiology and neurochemical components of our body and is essential for physical and mental health. Sleep disorders (SDs) are associated with insulin resistance and metabolic disorders. The association between SDs and diabetes needs to be understood in the Indian population. PURPOSE: The purpose was to investigate the association between SD and diabetes in the Indian population. METHODS: As a part of nationwide Niyantrita Madhumeha Bharata Abhiyaan-2017 (NMB-2017), a cross-sectional study was conducted and data was collected from seven zones of India, after screening through the Indian Diabetes Risk Score (IDRS). The sleep quality was assessed on a scale of 1 to 4 (very good = 1, very bad = 4). The time taken to fall asleep (sleep latency) was assessed on a scale of 0 to 5 ("0" = nil and "5" = >1.5 h). Stress was assessed by the perceived stress scale. RESULTS: Bad sleep quality was positively (odds ratio 1.055, CI [1.001, 1.113], and P < .01) associated with self-reported known diabetes. Increased time taken to fall in sleep (sleep latency) was associated significantly with IDRS high risk (odds ratio 1.085, CI [1.008, 1.168], and P = .01), with an average sleep latency /time takes to fall in sleep (maximum range 5 [>1.5 h], mode 2 [10 to 30 min]) minutes. Moderate stress was significantly associated with bad sleep quality (odds ratio 1.659). CONCLUSION: A positive association of bad sleep quality and stress with diabetes, and an increased sleep latency in the IDRS high-risk population point to the role of modifiable risk factors. Behavioral modification and stress reduction by using yoga may be beneficial in the better management of diabetes.

Depression in High-Risk Type 2 Diabetes Adults.

BACKGROUND: Patients suffering from diabetes mellitus are two to three times more vulnerable to develop depressive symptomatology. PURPOSE: To report the association between depression and high-risk diabetes in India. METHODS: A total of 1,606 adults were recruited for the study. A patient health questionnaire was used to determine the depression on the basis of score. A statistical analysis was done using analysis of covariance (ANCOVA) and binary logistic regression to determine the association between diabetes categories and four degrees of depression. RESULTS: Out of 1,606 participants, 52.6% were males and 47.4% were females, 56.4% belonged to the urban area and 43.6% to the rural area. However, 19.5% (314) had diabetes; 29.1% of diabetes individuals had minimal depression, 38.7% had mild, 17.2% moderate, 12.0% moderately severe, and 3.1% had severe depression. In the self-reported diabetic participant group (N = 142), there was a significantly higher degree of severe depression (3.3%) in the uncontrolled group (HbA1c >7%) as compared to the well-controlled diabetes group (HbA1c <7%). ANCOVA in gender differences in the uncontrolled diabetes group showed that male gender had significantly (P = -.02) higher mean scores of depression. CONCLUSION: This study found that there is a positive association between depression and uncontrolled diabetes in male gender.

Niyantrita Madhumeha Bharata 2017, Methodology for a Nationwide Diabetes Prevalence Estimate: Part 1.

BACKGROUND: Type 2 Diabetes Mellitus (T2DM) poses an ever-increasing threat to people's health worldwide. India has reported high rates of incidence of T2DM. The dangers make accurate assessment of its burden and intervention of lifestyle change, an urgent necessity. AIMS AND OBJECTIVES: The aim of the study was to estimate the nationwide prevalence of prediabetes and diabetes, followed by a translational lifestyle trial. METHODOLOGY: The Indian Yoga Association was commissioned in 2016-2017 by the Government of India to conduct this study which was undertaken in two phases: Phase 1 was to estimate the prevalence of prediabetes and diabetes across the country, and Phase 2 was to conduct a randomized controlled trial using a validated yoga lifestyle protocol. This paper highlights the unique methodology of Phase 1 of the study. The first stage was screening (February to April 2017) for adults (>20 years) with high risk for diabetes on Indian diabetes risk score (IDRS) on mobile app, using a random cluster sampling survey method. All households in the rural (4 villages with about 500 adult population/village) and urban (2 census enumeration blocks [CEBs] of about 1000 adult population/block) sectors of 65 districts (one per ten districts in the entire country) from 29 out of 35 states of India were approached. In the second stage, detailed assessments (sociodemographic, clinical details, A1c, lipid profile, body mass index, stress, and tobacco) were carried out on those with high risk on IDRS and on all self-reported diabetes individuals. RESULTS: In the first stage of door-to-door visit, 240,968 adults in all households of the selected clusters of villages and CEBs were approached. Of these, 162,330 responded. The respondents in the second stage for detailed assessments in the selected cohort were 50,199 (48% rural and 52% urban) adults. Of these, 7472 were self-reported known diabetes adults and the remaining were 42,737. Prevalence estimates for the country will follow in the future publications. CONCLUSION: This rapid survey completed within 3 months in the entire country using trained volunteers offers the methodology to obtain a quick estimate of diabetes and high-risk population to implement any lifestyle program.

Methodology of Niyantrita Madhumeha Bharata Abhiyaan-2017, a Nationwide Multicentric Trial on the Effect of a Validated Culturally Acceptable Lifestyle Intervention for Primary Prevention of Diabetes: Part 2.

BACKGROUND: The rapidly increasing diabetes burden, reaching epidemic proportions despite decades of efforts, reflects our failure to translate the proven evidence for prevention of diabetes. Yoga, with its holistic approach, alters the habituated patterns of lifestyles and behaviour. Motivated by the accumulating evidence, the Government of India funded a large randomized controlled trial. AIMS AND OBJECTIVES: The twin objectives were: (a) estimate the prevalence of prediabetes and diabetes through a parallel multisite stratified cluster sampling method and (b) implement NMB 2017 (niyantrita madhumeha bharata abhiyaan), a randomized control trial using yoga based lifestyle program. MATERIALS AND METHODS: Screening for Indian Diabetes Risk score(IDRS) was conducted in randomly selected clusters in all 7 zones (65 districts from 29 states/union territories) of India. This was followed by detailed assessments in those with known diabetes and high risk (≥60) on IDRS. Those who satisfied the selection criteria and consented were recruited for the two armed waitlisted randomized control trial. A validated remedial diabetesspecific integrated yoga lifestyle module was taught to the experimental arm by certified volunteers of Indian Yoga Association. Followup assessments were done after 3 months in both groups. In this article, we report the methodology of the trial. RESULTS: Response to door to door visits (n-240,968 adults >20yrs) in randomly selected urban and rural households for screening was 162,330; detailed assessments (A1c, lipid profile, BMI, stress, tobacco etc) were performed on 50,199 individuals. Of these 12466 (6531 yoga 5935 control) consented and for the RCT; 52% females, 48% males; 38% rural, 62% urban; BMI 21.1 ± 3.8; waist circumference 91.7 ± 11.9. A1c in diabetes subjects in yoga group was 7.63 ± 2.17 and 7.86 ± 2.13 in control group. CONCLUSION: This unique methodology provides the evidence to implement a validated yoga life style module using yoga volunteers in all parts of the country which is an urgent need to prevent India from becoming the global capital for diabetes.

Spiritual Well-Being and Its Relationship with Mindfulness, Self-Compassion and Satisfaction with Life in Baccalaureate Nursing Students: A Correlation Study.

The present study aimed to explore the correlates and predictors of spiritual well-being among nursing students. One hundred and forty-five BSc nursing students were recruited from three nursing colleges in Bangalore, Karnataka, India. Data were collected using SHALOM, FMI, SCS-SF and SWLS questionnaires and analysed by the Pearson correlation test and multiple regression analysis. The results of our study revealed a significant correlation between variables, and a considerable amount of variance was explained by self-compassion, mindfulness and satisfaction with life on personal, communal, environmental and transcendental domains of spiritual well-being.

Immediate Effects of Yoga Breathing with Intermittent Breath Holding on Response Inhibition among Healthy Volunteers.

BACKGROUND: There is very little evidence available on the effects of yoga-based breathing practices on response inhibition. The current study used stop-signal paradigm to assess the effects of yoga breathing with intermittent breath holding (YBH) on response inhibition among healthy volunteers. MATERIALS AND METHODS: Thirty-six healthy volunteers (17 males + 19 females), with mean age of 20.31 ± 3.48 years from a university, were recruited in a within-subject repeated measures (RM) design. The recordings for stop signal task were performed on three different days for baseline, post-YBH, and post yogic breath awareness (YBA) sessions. Stop-signal reaction time (SSRT), mean reaction time to go stimuli (go RT), and the probability of responding on-stop signal trials (p [r/s]) were analyzed for 36 volunteers using RM analysis of variance. RESULTS: SSRT reduced significantly in both YBH (218.33 ± 38.38) and YBA (213.15 ± 37.29) groups when compared to baseline (231.98 ± 29.54). No significant changes were observed in go RT and p (r/s). Further, the changes in SSRT were not significantly different among YBH and YBA groups. CONCLUSION: Both YBH and YBA groups were found to enhance response inhibition in the stop-signal paradigm. YBH could be further evaluated in clinical settings for conditions where response inhibition is altered.

Prevalence of positional sleep apnea in patients undergoing polysomnography.

STUDY OBJECTIVES: The primary aim of this study was to determine the prevalence of positional obstructive sleep apnea using a functional definition. Positional sleep apnea was defined as a total apnea-hypopnea index (AHI) > or = 5 with a > 50% reduction in the AHI between the supine and nonsupine postures, and an AHI that normalizes (AHI < 5) in the nonsupine posture. A secondary aim was to determine if positional sleep apnea can be diagnosed accurately during a split-night study. DESIGN: Retrospective chart review. SETTING: Two sleep centers in Buffalo, NY, one a Veterans Affairs Western New York Healthcare System Sleep Center (VAWNY) and the other a freestanding ambulatory center (Associated Sleep Center [ASC]). PATIENTS: Three hundred twenty-six patients from the VAWNY, including 57 patients who underwent a split-night study and 242 patients from the ASC who underwent polysomnography. INTERVENTIONS: None. MEASUREMENTS: Patient characteristics and sleep study results. RESULTS: Positional sleep apnea was seen in 49 of 99 patients (49.5%) with mild sleep apnea (AHI, 5 to 15/h), 14 of 72 patients (19.4%) with moderate sleep apnea (AHI, 15 to 30/h), and 5 of 77 patients (6.5%) with severe sleep apnea (AHI > 30/h). Sufficient sleep (> 15 min) in both postures was not seen in 104 of 269 patients (38.7%) and 80 of 242 overnight studies (33.1%) at the VAWNY and ASC, respectively, and was not seen in 47 of 57 split-night studies (82.5%). The percentage of studies with insufficient sleep in both postures was significantly greater for split-night studies (p < 0.0001). CONCLUSIONS: Positional sleep apnea is common particularly in patients with mild disease. Positional sleep apnea cannot usually be assessed during a split-night study.