Lymphedema is a common complication of breast cancer treatment. Yoga is a nonconventional and noninvasive intervention that is reported to show beneficial effects in patients with breast cancer-related lymphedema (BCRL). This study attempted to systematically review the effect of yoga therapy on managing lymphedema, increasing the range of motion (ROM), and quality of life (QOL) among breast cancer survivors. The review search included studies from electronic bibliographic databases, namely Medline (PubMed), Embase, and Google Scholar till June 2019. Studies which assessed the outcome variables such as QOL and management of lymphedema or related physical symptoms as effect of yoga intervention were considered for review. Two authors individually reviewed, selected according to Cochrane guidelines, and extracted the articles using Covidence software. Screening process of this review resulted in a total of seven studies. The different styles of yoga employed in the studies were Iyengar yoga ( n = 2), Satyananda yoga ( n = 2), Hatha yoga ( n = 2), and Ashtanga yoga ( n = 1). The length of intervention and post intervention analysis ranged from 8 weeks to 12 months. Four studies included home practice sessions. QOL, ROM, and musculoskeletal symptoms showed improvement in all the studies. Yoga could be a safe and feasible exercise intervention for BCRL patients. Evidence generated from these studies was of moderate strength. Further long-term clinical trials with large sample size are essential for the development and standardization of yoga intervention guidelines for BCRL patients.
ObjectivesTo determine current tobacco use in 2018/2019, quit attempts made and to explore the enablers and barriers in quitting tobacco among tobacco users identified in the Tamil Nadu Tobacco Survey (TNTS) in 2015/2016.SettingTNTS was conducted in 2015/2016 throughout the state of Tamil Nadu (TN) in India covering 111 363 individuals. Tobacco prevalence was found to be 5.2% (n=5208).ParticipantsAll tobacco users in 11 districts of TN identified by TNTS (n=2909) were tracked after 3 years by telephone. In-depth interviews (n=26) were conducted in a subsample to understand the enablers and barriers in quitting.Primary and secondary outcomesCurrent tobacco use status, any quit attempt and successful quit rate were the primary outcomes, while barriers and enablers in quitting were considered as secondary outcomes.ResultsAmong the 2909 tobacco users identified in TNTS 2015/2016, only 724 (24.9%) could be contacted by telephone, of which 555 (76.7%) consented. Of those who consented, 210 (37.8%) were currently not using tobacco (ie, successfully quit) and 337 (60.7%) continued to use any form of tobacco. Of current tobacco users, 115 (34.1%) have never made any attempt to quit and 193 (57.3.8%) have made an attempt to quit. Those using smoking form of tobacco products (adjusted relative risk (aRR)=1.2, 95% CI: 1.1 to 1.4) and exposure to smoke at home (aRR=1.2, 95% CI: 1.1 to 1.3) were found to be positively associated with continued tobacco use (failed or no quit attempt). Support from family and perceived health benefits are key enablers, while peer influence, high dependence and lack of professional help are some of the barriers to quitting.ConclusionTwo-thirds of the tobacco users continue to use tobacco in the last 3 years. While tobacco users are well aware of the ill-effects of tobacco, various intrinsic and extrinsic factors play a major role as a facilitator and lack of the same act as a barrier to quit.
This study aimed to assess the feasibility of personalized yoga therapy intervention in a private setting and its effect on quality of life (QOL), sleep quality, and symptom relief among patients with multiple sclerosis (MS). A single-group pre- and post-experimental study was conducted among 10 members of the Multiple Sclerosis Society of India between December 2017 and April 2018. At baseline and during follow-up, QOL, sleep quality, symptoms, and pain were assessed using the Multiple Sclerosis Quality of Life, Pittsburgh Sleep Quality Index, MS Symptom Checklist, and visual analogue scale, respectively. The intervention comprised 12 private customized yoga sessions of 1 hour duration and three group sessions, all spread over 3-months. Patient feedback and direct observations by the yoga therapist we re documented at each session. Ten patients (seven female, three male, age 31–52 years) were enrolled in the yoga intervention; seven completed 8–12 sessions, and three completed fewer than 5 sessions. Therapist-to-patient ratio was 1:2. All domains except sexual function showed clinically significant improvement in QOL scores. Statistically significant improvement was found in social function (p = 0.014) and change in health status (p = 0.029) scores after the intervention. Although there was improvement in pain and sleep quality, these changes were not statistically significant. Patients reported improvement in symptoms with practice of yoga alongside lifestyle changes. The study supports the feasibility of this 3-month yoga intervention for patients with MS. Studies with larger sample sizes are required to confirm our findings.
Objectives: Advanced cancer patients attending tertiary cancer centres from rural places are referred back to local physicians for symptom management. Due to lack of networking with palliative care centres (PCCs), the referred patients do not receive appropriate palliative care (PC) services. Hence, an attempt was made to map the PCCs in Tamil Nadu to make the referral system efficient. Material and Methods: PCCs in Tamil Nadu were identified from the National Health Mission directory, online sources and from morphine license annexure of drug control department. The details regarding nature of facility, PC model, service type, procedures, cost, morphine availability and type of personnel involved in their PCCs were collected from government and private centres. The data were analysed using descriptive statistics and geomapping of all the centres identified was created. Results: A total of 371 PCCs were identified, of which 32 were government headquarter hospitals (GHQH), 281 were government community centres and 58 were private. Eighty-three of the 90 centres (including GHQH and private) were active and 60 responded to the survey. More than half of the centres were hospital-based (61.7%) and 28.3% were community-based. The majority of the PCCs had in-patient (75%) and out-patient (63.3%) facilities and 63.3% had regular home visits. Forty-six centres provide PC service free of cost. Nearly 80% provide morphine for pain management, wherein 41 have obtained a license. In total, ten centres had a social worker and four had a psychologist. Conclusion: The number of PCCs is disproportionate, in which majority of the centres are clustered in urban areas. Integrating PC services into the existing health system is the way forward.
India accounts for one-quarter of the worldwide burden of cervical cancer (Ferlay et al., 2012; Institute for health metrics and evaluation , 2011) and 17% of all cancer deaths among women aged between 30 and 69 years. Cervical cancer is the second most common malignancy among women in India (Bruni et al., 2017). It is estimated that cervical cancer will occur in approximately 1 in 53 Indian women during their lifetime compared with 1 in 100 women in developed world (Institute for health metrics and evaluation, 2011). Decline in cervical cancer mortality is being noted in developed countries due to widespread screening. Coverage of cervical cancer screening in developing countries is 19%, compared to 63% in developed countries.
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