Adam Burke

A yoga intervention for type 2 diabetes risk reduction: a pilot randomized controlled trial

BackgroundType 2 diabetes is a major health problem in many countries including India. Yoga may be an effective type 2 diabetes prevention strategy in India, particularly given its cultural familiarity.MethodsThis was a parallel, randomized controlled pilot study to collect feasibility and preliminary efficacy data on yoga for diabetes risk factors among people at high risk of diabetes. Primary outcomes included: changes in BMI, waist circumference, fasting blood glucose, postprandial blood glucose, insulin, insulin resistance, blood pressure, and cholesterol. We also looked at measures of psychological well-being including changes in depression, anxiety, positive and negative affect and perceived stress. Forty-one participants with elevated fasting blood glucose in Bangalore, India were randomized to either yoga (n = 21) or a walking control (n = 20). Participants were asked to either attend yoga classes or complete monitored walking 3–6 days per week for eight weeks. Randomization and allocation was performed using computer-generated random numbers and group assignments delivered in sealed, opaque envelopes generated by off-site study staff. Data were analyzed based on intention to treat.ResultsThis study was feasible in terms of recruitment, retention and adherence. In addition, yoga participants had significantly greater reductions in weight, waist circumference and BMI versus control (weight −0.8 ± 2.1 vs. 1.4 ± 3.6, p = 0.02; waist circumference −4.2 ± 4.8 vs. 0.7 ± 4.2, p < 0.01; BMI −0.2 ± 0.8 vs. 0.6 ± 1.6, p = 0.05). There were no between group differences in fasting blood glucose, postprandial blood glucose, insulin resistance or any other factors related to diabetes risk or psychological well-being. There were significant reductions in systolic and diastolic blood pressure, total cholesterol, anxiety, depression, negative affect and perceived stress in both the yoga intervention and walking control over the course of the study.ConclusionAmong Indians with elevated fasting blood glucose, we found that participation in an 8-week yoga intervention was feasible and resulted in greater weight loss and reduction in waist circumference when compared to a walking control. Yoga offers a promising lifestyle intervention for decreasing weight-related type 2 diabetes risk factors and potentially increasing psychological well-being.Trial registrationClinicalTrials.gov Identified NCT00090506.

Traditional Medicine in China Today: Implications for Indigenous Health Systems in a Modern World

In the United States, traditional Chinese medicine (TCM) is recognized by the National Institutes of Health as an effective complementary and alternative medicine modality, widely used by consumers and growing as a profession.1–3 Ironically, while TCM is expanding in the United States, it may be contracting in China as a result of dramatic health care reforms and changing cultural values. There is, however, little information in Western literature explicitly delineating the impacts of these forces on TCM. The purpose of this inquiry was to interview a sample of select respondents, particularly individuals from a major Chinese college of traditional medicine, regarding their perceptions of the field. The results provided insight into the survival and assimilation of indigenous health systems in a modern world. In the late 1970s, Deng Xiao Ping introduced elements of the market economy into China. During the 1990s, significant health care reforms were also initiated. These reforms placed a new emphasis on profitability, economic autonomy for health facilities, and decentralization of public health services and contributed to the demise of the rural cooperative medical system.4–6 These reforms also produced fundamental changes in health care financing, including replacing free universal health care with fee-for-service and private insurance strategies.4,7 This has contributed to increased medical care costs, higher out-of-pocket expenses, growing inequity in access, a reduction of prevention programs in poor areas, and pricing policies that encourage overprescribing drugs and high-tech services.4,7,8–10 As a significant percentage of all health care delivered in China is in the form of traditional treatments,11 such reforms will invariably affect this ancient healing system as well.

Re-examining religiosity as a protective factor: comparing alcohol use by self-identified religious, spiritual, and secular college students.

Religiosity has been found to be associated with lower alcohol use by college students. The majority of studies on this topic, however, fail to differentiate religiosity and spirituality. This is potentially problematic due to the changing face of religion in America today. A study was conducted to explore similarities and differences between self-identified religious and spiritual college students. A modified version of the Core Alcohol and Drug Survey was administered online with a sample of 2,312 students. As hypothesized, self-identified religious and spiritual students differed significantly on key variables related to religious practices, alcohol consumption, and postmodern social values.

Exploring the Prevalence of Ayurveda Use Among Asian Indians

OBJECTIVE Despite a growing body of literature on complementary and alternative medicine, there is still limited information on the use of Ayurveda in the United States. Because Ayurveda is one of the worlds major traditional medical systems, knowledge of its use is important. In particular, information on utilization by Asian Indians living in the United States is needed due to increased immigration from India and related regions. Recent reports of heavy metal contamination of some imported Ayurveda products underscore this need. For this reason, an exploratory survey was conducted. DESIGN A semistructured 21-item questionnaire was administered using face-to-face interviews. PARTICIPANTS AND SETTING The study comprised a convenience sample of 64 Asian Indians living in Northern California. OUTCOME MEASURES Main outcome measures included sociodemographic variables, questions on awareness, knowledge and use of Ayurvedic products or services, use of other nutritional/herbal products, and reasons for use. RESULTS In the sample, 95% of the participants were aware of Ayurveda, 78% had knowledge of Ayurvedic products or treatments, and about 59% had used or were currently using Ayurveda. Only 18% of those using Ayurveda had informed their Western medical doctors. CONCLUSIONS Given its common use in the United States by Asian Indians, its cultural relevance, potential therapeutic value, and possible safety concerns, physician and consumer education along with more empirical research is warranted.

Limited Health Knowledge as a Reason for Non-Use of Four Common Complementary Health Practices

Background Complementary health practices are an important element of health/healthcare seeking behavior among adults in the United States. Reasons for use include medical need, prevention and wellness promotion, and cultural relevance. Survey studies published over the past several decades have provided important information on the use of complementary health practices, such as acupuncture and yoga. A review of the literature, however, reveals an absence of studies looking specifically at who does not use these approaches, and why not. Methods To explore this issue two samples were created using data from the 2007 National Health Interview Survey Complementary and Alternative Medicine supplement. Of particular interest was the relationship between lack of health knowledge, as a reason for non-use, and key independent variables. The first sample was comprised of individuals who had never used any of four common complementary health practices -- acupuncture, chiropractic, natural products, and yoga. The second was a subset of those same non-users who had also reported low back pain, the most frequently cited health concern related to use of complementary therapies. Results A hypothesized association between lack of health knowledge, lower educational attainment, and other key socioeconomic indicators was supported in the findings. Although it was hypothesized that low back pain would be associated with greater information seeking, regardless of level of education, that hypothesis was not supported. Conclusion Lack of knowledge was found to affect utilization of common complementary health practices, regardless of the potentially motivating presence of back pain. Disparities in the utilization of complementary medicine, related to educational attainment and other socioeconomic factors, may negatively affect quality of care for many Americans. Creative approaches are needed to help reduce inequities in understanding and improve access to care for underserved populations.

Comparing Individual Preferences for Four Meditation Techniques: Zen, Vipassana (Mindfulness), Qigong, and Mantra

CONTEXT A significant number of studies have been published examining the mind-body effects of meditation and its clinical efficacy. There are very few studies, however, which directly compare different meditation methods with each other to explore potentially distinct mechanisms and effects, and no studies comparing individual preferences for different methods. As preference is seen as an important factor in consumer healthcare decision making, greater understanding of this aspect is needed as meditation becomes a more widely used therapeutic modality. OBJECTIVES For this reason a pilot study was conducted to compare four meditation techniques for personal preference. DESIGN A within-subjects comparison design was employed. PARTICIPANTS A convenience sample of 247 undergraduate university students participated in the study. INTERVENTION Participants learned two open observing meditation techniques-Vipassana (Mindfulness) and Zen, and two focused attention techniques-Mantra and Qigong Visualization, practicing one method per week. At the end of a six-week training period participants ranked the four meditation methods in order of personal preference. OUTCOME MEASURES Ranking of subjective preference of meditations practiced. RESULTS A within subjects comparison revealed that significantly more participants chose Vipassana or Mantra meditation as their preferred techniques compared with Qigong Visualization and Zen. CONCLUSION This study provides information on differences in preference for type of meditation. As the benefits of meditation accrue over time, selecting a method that motivates sustained practice is a critical objective if therapeutic effects are to be achieved.

Colorectal Cancer Screening and Chinese Americans: Efficacy of Lay Health Worker Outreach and Print Materials

INTRODUCTION Chinese Americans have low colorectal cancer (CRC) screening rates. Evidence-based interventions to increase CRC screening in this population are lacking. This study aims to compare the efficacy of two interventions in increasing CRC screening among Chinese Americans. DESIGN Cluster randomized comparative trial. SETTING/PARTICIPANTS From 2010 to 2014, a community-academic team conducted this study in San Francisco, CA with Chinese Americans aged 50-75 years who spoke English, Cantonese, or Mandarin. INTERVENTION Lay health worker (LHW) intervention plus in-language brochure (LHW+Print) versus brochure (Print). LHWs in the LHW+Print arm were trained to teach participants about CRC in two small group sessions and two telephone calls. MAIN OUTCOME MEASURES Change in self-reports of ever having had CRC screening and being up to date for CRC screening from baseline to 6 months post-intervention. Statistical analysis was performed from 2014 to 2015. RESULTS This study recruited 58 LHWs, who in turn recruited 725 participants. The average age of the participants was 62.2 years, with 81.1% women and 99.4% foreign born. Knowledge increase was significant (p<0.002) for nine measures in the LHW+Print group and six in the Print group. Both groups had increases in having ever been screened for CRC (LHW+Print, 73.9%-88.3%, p<0.0001; Print, 72.3%-79.5%, p=0.0003) and being up to date for CRC screening (LHW+Print, 60.0%-78.1%, p<0.0001; Print, 58.1%-64.1%, p=0.0003). In multivariable analyses, the intervention OR for LHW+Print versus Print was 1.94 (95% CI=1.34, 2.79) for ever screening and 2.02 (95% CI=1.40, 2.90) for being up to date. CONCLUSIONS Both in-language print materials and LHW outreach plus print materials increased CRC screening among Chinese Americans. The combination of LHW+Print was more effective than Print alone. These findings can guide clinicians and policymakers in choosing appropriate interventions to increase CRC screening among Chinese American immigrants. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT00947206.

Teaching patients how to talk with biomedical providers about their complementary and alternative medicine use.

OBJECTIVE The goal was to examine the feasibility and impact of a face-to-face communication skills training intervention based on a current public health campaign to encourage patients to talk about complementary and alternative medicine (CAM) with their biomedical health providers. METHODS Current CAM users were invited to complete a survey about current/past CAM use and communication with biomedical providers before beginning a communication skills training workshop. In the 6-month period following the training, participants were asked to record information on any CAM conversations with those providers. RESULTS Of the 38 participants who received training, 32 finished the entire study. Over half of those participants reported discussing CAM in post-training visits with biomedical providers. Participants initiated the conversation in most cases, and were more likely to disclose CAM use than they were to ask questions about CAM. Participants who talked about CAM were significantly more likely to perceive CAM as relevant to their visit, compared with individuals who did not talk about CAM. CONCLUSIONS Participants positively evaluated this patient communication workshop. Consistent with previous research, most CAM conversations were patient-initiated. PRACTICE IMPLICATIONS These findings reinforce the importance of patient education interventions for improving patient-provider communication in general, and CAM communication specifically.

An International Comparison of Attitudes Toward Traditional and Modern Medicine in a Chinese and an American Clinic Setting

Introduction. International comparative research on traditional medicine (TM) offers a useful method for examining differences in patient characteristics and can provide insight into: (i) more universal characteristics which may cross cultures and international borders; (ii) unique characteristics influenced by regional/national factors; and (iii) cultural values of immigrant populations. To explore these issues TM patients from the United States and China were compared. Methods. Data collection took place at two TM college clinics. A convenience sample of 128 patients in China and 127 patients in the United States completed a 28-item questionnaire. Results. There was a marked similarity between the two patient groups in terms of the biological characteristics of age and gender. Musculoskeletal issues were the most common presenting complaints in the United States; while in China TM was used for a more diverse array of conditions. The majority of patients in both countries had initially used allopathic medicine (AM); significantly, more of the United States respondents stopped allopathic treatment after beginning traditional treatment. In comparing the two countries, patients in China were significantly more satisfied with AM and American patients significantly more satisfied with TM. In comparing the two medicines, the patient samples in both countries were significantly more satisfied with TM than AM. Discussion. Although treatment often originated with allopathic providers, many patients sought alternatives presumably to find the best solution to their problems. This tendency toward self-assignment suggests that a pluralistic healthcare system may provide the greatest satisfaction resulting from personal choice and improved outcomes.

Engaging Traditional Medicine Providers in Colorectal Cancer Screening Education in a Chinese American Community: A Pilot Study

Introduction Although colorectal cancer (CRC) screening is effective in preventing colon cancer, it remains underused by Asian Americans. Because Chinese Americans often use traditional Chinese medicine (TCM), we conducted a pilot study to explore the feasibility and acceptability of having TCM providers deliver education about CRC screening. Methods Four TCM providers (2 herbalists and 2 acupuncturists) were trained to deliver small-group educational sessions to promote CRC screening. Each provider recruited 15 participants aged 50 to 75. Participants completed a baseline survey on CRC-related knowledge, attitudes, and behaviors and then attended one 2-hour educational session delivered by the providers in Cantonese or Mandarin. Three months later, participants completed a postintervention survey. Results Sixty participants were recruited from the San Francisco Chinatown neighborhood. The average age was 62.4 years. Most participants had limited English proficiency (96.7%), annual household income less than