human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective . To examine the effects of yoga versus an educational film program on sleep , mood , perceived stress , and sympathetic activation in older women with RLS . Methods . Participants were drawn from a larger trial regarding the effects of yoga on cardiovascular disease risk profiles in overweight , sedentary postmenopausal women . Seventy-five women were r and omized to receive either an 8-week yoga ( n = 38 ) or educational film ( n = 37 ) program . All 75 participants completed an RLS screening question naire . The 20 women who met all four diagnostic criteria for RLS ( n = 10 yoga , 10 film group ) comprised the population for this nested study . Main outcomes assessed pre- and post-treatment included : sleep ( Pittsburgh Sleep Quality Index ) , stress ( Perceived Stress Scale ) , mood ( Profile of Mood States , State-Trait Anxiety Inventory ) , blood pressure , and heart rate . Results . The yoga group demonstrated significantly greater improvements than controls in multiple domains of sleep quality and mood , and significantly greater reductions in insomnia prevalence , anxiety , perceived stress , and blood pressure ( all P's≤0.05 ) . Adjusted intergroup effect sizes for psychosocial variables were large , ranging from 1.9 for state anxiety to 2.6 for sleep quality . Conclusions . These preliminary findings suggest yoga may offer an effective intervention for improving sleep , mood , perceived stress , and blood pressure in older women with RLS This is the first in vivo demonstration of an association between endogenous neurotransmitter release and conscious experience . Using 11C-raclopride PET we demonstrated increased endogenous dopamine release in the ventral striatum during Yoga Nidra meditation . Yoga Nidra is characterized by a depressed level of desire for action , associated with decreased blood flow in prefrontal , cerebellar and subcortical regions , structures thought to be organized in open loops subserving executive control . In the striatum , dopamine modulates excitatory glutamatergic synapses of the projections from the frontal cortex to striatal neurons , which in turn project back to the frontal cortex via the pallidum and ventral thalamus . The present study was design ed to investigate whether endogenous dopamine release increases during loss of executive control in meditation . Participants underwent  two 11C-raclopride PET scans : one while attending to speech with eyes closed , and one during active meditation .  The tracer competes with endogenous dopamine for access to dopamine D2 receptors predominantly found in the basal ganglia . During meditation , 11C-raclopride binding in ventral striatum decreased by 7.9 % . This corresponds to a 65 % increase in endogenous dopamine release . The reduced raclopride binding correlated significantly with a concomitant increase in EEG theta activity , a characteristic feature of meditation . All participants reported a decreased desire for action during meditation , along with heightened sensory imagery . The level of gratification and the depth of relaxation did not differ between the attention and meditation conditions . Here we show increased striatal dopamine release during meditation associated with the experience of reduced readiness for action . It is suggested that being in the conscious state of meditation causes a suppression of cortico-striatal glutamatergic transmission . To our knowledge this is the first time in vivo evidence has been provided for regulation of conscious states at a synaptic level Type 2 diabetes is a global public health crisis that threatens the economies of all nations , particularly developing countries . Fueled by rapid urbanization , nutrition transition , and increasingly sedentary lifestyles , the epidemic has grown in parallel with the worldwide rise in obesity . Asia 's large population and rapid economic development have made it an epicenter of the epidemic . Asian population s tend to develop diabetes at younger ages and lower BMI levels than Caucasians . Several factors contribute to accelerated diabetes epidemic in Asians , including the “ normal-weight metabolically obese ” phenotype ; high prevalence of smoking and heavy alcohol use ; high intake of refined carbohydrates ( e.g. , white rice ) ; and dramatically decreased physical activity levels . Poor nutrition in utero and in early life combined with overnutrition in later life may also play a role in Asia 's diabetes epidemic . Recent advances in genome-wide association studies have contributed substantially to our underst and ing of diabetes pathophysiology , but currently identified genetic loci are insufficient to explain ethnic differences in diabetes risk . Nonetheless , interactions between Westernized diet and lifestyle and genetic background may accelerate the growth of diabetes in the context of rapid nutrition transition . Epidemiologic studies and r and omized clinical trials show that type 2 diabetes is largely preventable through diet and lifestyle modifications . Translating these findings into practice , however , requires fundamental changes in public policies , the food and built environments , and health systems . To curb the escalating diabetes epidemic , primary prevention through promotion of a healthy diet and lifestyle should be a global public policy priority OBJECTIVES Yoga and exercise have beneficial effects on  mood and anxiety .  γ-Aminobutyric acid (GABA)-ergic activity is reduced in mood and anxiety disorders . The practice of yoga postures is associated with increased brain GABA levels . This study addresses the question of whether changes in mood , anxiety , and GABA levels are specific to yoga or related to physical activity . METHODS Healthy subjects with no significant medical/psychiatric disorders were r and omized to yoga or a metabolically matched walking intervention for 60 minutes 3 times a week for 12 weeks . Mood and anxiety scales were taken at weeks 0 , 4 , 8 , 12 , and before each magnetic resonance spectroscopy scan . Scan 1 was at baseline . Scan 2 , obtained after the 12-week intervention , was followed by a 60-minute yoga or walking intervention , which was immediately followed by Scan 3 . RESULTS The  yoga subjects ( n = 19 ) reported greater improvement in mood and greater decreases in anxiety than the walking group ( n = 15 ) . There were positive correlations between improved mood and decreased anxiety and thalamic GABA levels . The yoga group had positive correlations between changes in mood scales and changes in GABA levels . CONCLUSIONS The 12-week yoga intervention was associated with greater improvements in mood and anxiety than a metabolically matched walking exercise . This is the first study to demonstrate that increased thalamic GABA levels are associated with improved mood and decreased anxiety . It is also the first time that a behavioral intervention ( i.e. , yoga postures ) has been associated with a positive correlation between acute increases in thalamic GABA levels and improvements in mood and anxiety scales . Given that pharmacologic agents that increase the activity of the GABA system are prescribed to improve mood and decrease anxiety , the reported correlations are in the expected direction . The possible role of GABA in mediating the beneficial effects of yoga  on mood and anxiety warrants further study BACKGROUND This study examined the effects of brief daily yogic meditation on mental health , cognitive functioning , and immune cell telomerase activity in family dementia caregivers with mild depressive symptoms . METHODS Thirty-nine family dementia caregivers ( mean age 60.3 years old ( SD = 10.2 ) ) were r and omized to practicing Kirtan Kriya or listening to relaxation music for 12 min per day for 8 weeks . The severity of depressive symptoms , mental and cognitive functioning were assessed at baseline and follow-up . Telomerase activity in peripheral blood mononuclear cells ( PMBC ) was examined in peripheral P BMC pre-intervention and post-intervention . RESULTS The meditation group showed significantly lower levels of depressive symptoms and greater improvement in mental health and cognitive functioning compared with the relaxation group . In the meditation group , 65.2 % showed 50 % improvement on the Hamilton Depression Rating scale and 52 % of the participants showed 50 % improvement on the Mental Health Composite Summary score of the Short Form-36 scale compared with 31.2 % and 19 % , respectively , in the relaxation group ( p < 0.05 ) . The meditation group showed 43 % improvement in telomerase activity compared with 3.7 % in the relaxation group ( p = 0.05 ) . CONCLUSION This pilot study found that brief daily meditation practice s by family dementia caregivers can lead to improved mental and cognitive functioning and lower levels of depressive symptoms . This improvement is accompanied by an increase in telomerase activity suggesting improvement in stress-induced cellular aging . These results need to be confirmed in a larger sample PURPOSE Recent evidence suggests that depression is linked to increased mortality among patients with diabetes . This study examines the association of depression with all-cause and cause-specific mortality in diabetes . METHODS We conducted a prospect i ve cohort study of primary care patients with type 2 diabetes at Group Health Cooperative in Washington state . We used the Patient Health Question naire ( PHQ-9 ) to assess depression at baseline and review ed medical records supplemented by the Washington state mortality registry to ascertain the causes of death . RESULTS Among a cohort of 4,184 patients , 581 patients died during the follow-up period .  Deaths occurred among 428 ( 12.9 % ) patients with no depression , among 88 ( 17.8 % ) patients with major depression , and among 65 ( 18.2 % ) patients with minor depression . Causes of death were grouped as cardiovascular disease , 42.7 % ; cancer , 26.9 % ; and deaths that were not due to cardiovascular disease or cancer , 30.5 % . Infections , dementia , renal failure , and chronic obstructive pulmonary disease were the most frequent causes in the latter group . Adjusting for demographic characteristics , baseline major depression ( relative to no depression ) was significantly associated with all-cause mortality ( hazard ratio [HR]=2.26 , 95 % confidence interval [ CI ] , 1.79–2.85 ) , with cardiovascular mortality ( HR = 2.00 ; 95 % CI , 1.37–2.94 ) , and with noncardiovascular , noncancer mortality ( HR = 3.35 ; 95 % CI , 2.30–4.89 ) . After additional adjustment for baseline clinical characteristics and health habits , major depression was significantly associated only with all-cause mortality ( HR = 1.52 ; 95 % CI , 1.19–1.95 ) and with death not caused by cancer or atherosclerotic cardiovascular disease ( HR = 2.15 ; 95 % CI , 1.43–3.24 ) . Minor depression showed similar but nonsignificant associations . CONCLUSIONS Patients with diabetes and coexisting depression face substantially elevated mortality risks beyond cardiovascular deaths OBJECTIVE Cross-sectional and longitudinal associations among regimen  distress  ( RD ) , self-management , and glycemic control were undertaken to explore mechanisms of operation among these variables . RESEARCH DESIGN AND METHODS In a behavioral r and omized control trial ( RCT ) to reduce RD , 392 adults with type 2 diabetes were assessed for  RD , diet , exercise , medication adherence , and HbA1c at baseline and at 4 and 12 months . Associations among RD , self-management , and HbA1c were examined in cross-sectional analyses at baseline , in prospect i ve analyses using baseline values to predict change over time , and in time-varying analyses . RESULTS At baseline , greater RD and poorer medication adherence were independently associated with higher HbA1c ( P = 0.05 and P < 0.001 , respectively ) , and greater RD was associated with poorer medication adherence ( P = 0.03 ) . No consistent pattern of significant prospect i ve associations was found . Significant time-varying findings showed that decreases in RD were associated with improvements in medication adherence ( P < 0.01 ) , physical activity ( P < 0.001 ) , and HbA1c ( P = 0.02 ) over time following intervention . Changes in self-management were not associated with changes in HbA1c over time . CONCLUSIONS In the context of an RCT to reduce distress , RD , self-management , and HbA1c were interrelated in cross-sectional and time-varying analyses . Decreases in RD were associated with improvements in both self-management and HbA1c over 12 months . Findings point to the complex and likely multifaceted pathways of association among these key constructs , with results indicating significant linkages between RD and both self-management and glycemic control over time OBJECTIVE There is conflicting evidence regarding the utility of stress management training in the treatment of diabetes . The few studies that have shown a therapeutic effect of stress management have used time-intensive individual therapy . Unfortunately , widespread use of such interventions is not practical . The aim of the present investigation is to determine whether a cost-effective , group-based stress management training program can improve glucose metabolism in patients with type 2 diabetes and to determine whether a particular subset of patients is more likely to get positive results . RESEARCH DESIGN AND METHODS Patients with type 2 diabetes were r and omized to undergo a five-session group diabetes education program with or without stress management training .  Participants ( n = 108 ) were followed for 1 year , during which HbA(1c ) tests and question naires assessing perceived stress , anxiety , and psychological health were administered at regular intervals to evaluate treatment 
    Output:
    
agent
Collectively , findings suggest that yogic practice s may promote significant improvements in several indices of importance in DM2 management , including glycemic control , lipid levels , and body composition .
More limited data suggest that yoga may also lower oxidative stress and blood pressure ; enhance pulmonary and autonomic function , mood , sleep , and quality of life ; and reduce medication use in adults with DM2 .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective . To examine the effects of yoga versus an educational film program on sleep , mood , perceived stress , and sympathetic activation in older women with RLS . Methods . Participants were drawn from a larger trial regarding the effects of yoga on cardiovascular disease risk profiles in overweight , sedentary postmenopausal women . Seventy-five women were r and omized to receive either an 8-week yoga ( n = 38 ) or educational film ( n = 37 ) program . All 75 participants completed an RLS screening question naire . The 20 women who met all four diagnostic criteria for RLS ( n = 10 yoga , 10 film group ) comprised the population for this nested study . Main outcomes assessed pre- and post-treatment included : sleep ( Pittsburgh Sleep Quality Index ) , stress ( Perceived Stress Scale ) , mood ( Profile of Mood States , State-Trait Anxiety Inventory ) , blood pressure , and heart rate . Results . The yoga group demonstrated significantly greater improvements than controls in multiple domains of sleep quality and mood , and significantly greater reductions in insomnia prevalence , anxiety , perceived stress , and blood pressure ( all P's≤0.05 ) . Adjusted intergroup effect sizes for psychosocial variables were large , ranging from 1.9 for state anxiety to 2.6 for sleep quality . Conclusions . These preliminary findings suggest yoga may offer an effective intervention for improving sleep , mood , perceived stress , and blood pressure in older women with RLS This is the first in vivo demonstration of an association between endogenous neurotransmitter release and conscious experience . Using 11C-raclopride PET we demonstrated increased endogenous dopamine release in the ventral striatum during Yoga Nidra meditation . Yoga Nidra is characterized by a depressed level of desire for action , associated with decreased blood flow in prefrontal , cerebellar and subcortical regions , structures thought to be organized in open loops subserving executive control . In the striatum , dopamine modulates excitatory glutamatergic synapses of the projections from the frontal cortex to striatal neurons , which in turn project back to the frontal cortex via the pallidum and ventral thalamus . The present study was design ed to investigate whether endogenous dopamine release increases during loss of executive control in meditation . Participants underwent  two 11C-raclopride PET scans : one while attending to speech with eyes closed , and one during active meditation .  The tracer competes with endogenous dopamine for access to dopamine D2 receptors predominantly found in the basal ganglia . During meditation , 11C-raclopride binding in ventral striatum decreased by 7.9 % . This corresponds to a 65 % increase in endogenous dopamine release . The reduced raclopride binding correlated significantly with a concomitant increase in EEG theta activity , a characteristic feature of meditation . All participants reported a decreased desire for action during meditation , along with heightened sensory imagery . The level of gratification and the depth of relaxation did not differ between the attention and meditation conditions . Here we show increased striatal dopamine release during meditation associated with the experience of reduced readiness for action . It is suggested that being in the conscious state of meditation causes a suppression of cortico-striatal glutamatergic transmission . To our knowledge this is the first time in vivo evidence has been provided for regulation of conscious states at a synaptic level Type 2 diabetes is a global public health crisis that threatens the economies of all nations , particularly developing countries . Fueled by rapid urbanization , nutrition transition , and increasingly sedentary lifestyles , the epidemic has grown in parallel with the worldwide rise in obesity . Asia 's large population and rapid economic development have made it an epicenter of the epidemic . Asian population s tend to develop diabetes at younger ages and lower BMI levels than Caucasians . Several factors contribute to accelerated diabetes epidemic in Asians , including the “ normal-weight metabolically obese ” phenotype ; high prevalence of smoking and heavy alcohol use ; high intake of refined carbohydrates ( e.g. , white rice ) ; and dramatically decreased physical activity levels . Poor nutrition in utero and in early life combined with overnutrition in later life may also play a role in Asia 's diabetes epidemic . Recent advances in genome-wide association studies have contributed substantially to our underst and ing of diabetes pathophysiology , but currently identified genetic loci are insufficient to explain ethnic differences in diabetes risk . Nonetheless , interactions between Westernized diet and lifestyle and genetic background may accelerate the growth of diabetes in the context of rapid nutrition transition . Epidemiologic studies and r and omized clinical trials show that type 2 diabetes is largely preventable through diet and lifestyle modifications . Translating these findings into practice , however , requires fundamental changes in public policies , the food and built environments , and health systems . To curb the escalating diabetes epidemic , primary prevention through promotion of a healthy diet and lifestyle should be a global public policy priority OBJECTIVES Yoga and exercise have beneficial effects on  mood and anxiety .  γ-Aminobutyric acid (GABA)-ergic activity is reduced in mood and anxiety disorders . The practice of yoga postures is associated with increased brain GABA levels . This study addresses the question of whether changes in mood , anxiety , and GABA levels are specific to yoga or related to physical activity . METHODS Healthy subjects with no significant medical/psychiatric disorders were r and omized to yoga or a metabolically matched walking intervention for 60 minutes 3 times a week for 12 weeks . Mood and anxiety scales were taken at weeks 0 , 4 , 8 , 12 , and before each magnetic resonance spectroscopy scan . Scan 1 was at baseline . Scan 2 , obtained after the 12-week intervention , was followed by a 60-minute yoga or walking intervention , which was immediately followed by Scan 3 . RESULTS The  yoga subjects ( n = 19 ) reported greater improvement in mood and greater decreases in anxiety than the walking group ( n = 15 ) . There were positive correlations between improved mood and decreased anxiety and thalamic GABA levels . The yoga group had positive correlations between changes in mood scales and changes in GABA levels . CONCLUSIONS The 12-week yoga intervention was associated with greater improvements in mood and anxiety than a metabolically matched walking exercise . This is the first study to demonstrate that increased thalamic GABA levels are associated with improved mood and decreased anxiety . It is also the first time that a behavioral intervention ( i.e. , yoga postures ) has been associated with a positive correlation between acute increases in thalamic GABA levels and improvements in mood and anxiety scales . Given that pharmacologic agents that increase the activity of the GABA system are prescribed to improve mood and decrease anxiety , the reported correlations are in the expected direction . The possible role of GABA in mediating the beneficial effects of yoga  on mood and anxiety warrants further study BACKGROUND This study examined the effects of brief daily yogic meditation on mental health , cognitive functioning , and immune cell telomerase activity in family dementia caregivers with mild depressive symptoms . METHODS Thirty-nine family dementia caregivers ( mean age 60.3 years old ( SD = 10.2 ) ) were r and omized to practicing Kirtan Kriya or listening to relaxation music for 12 min per day for 8 weeks . The severity of depressive symptoms , mental and cognitive functioning were assessed at baseline and follow-up . Telomerase activity in peripheral blood mononuclear cells ( PMBC ) was examined in peripheral P BMC pre-intervention and post-intervention . RESULTS The meditation group showed significantly lower levels of depressive symptoms and greater improvement in mental health and cognitive functioning compared with the relaxation group . In the meditation group , 65.2 % showed 50 % improvement on the Hamilton Depression Rating scale and 52 % of the participants showed 50 % improvement on the Mental Health Composite Summary score of the Short Form-36 scale compared with 31.2 % and 19 % , respectively , in the relaxation group ( p < 0.05 ) . The meditation group showed 43 % improvement in telomerase activity compared with 3.7 % in the relaxation group ( p = 0.05 ) . CONCLUSION This pilot study found that brief daily meditation practice s by family dementia caregivers can lead to improved mental and cognitive functioning and lower levels of depressive symptoms . This improvement is accompanied by an increase in telomerase activity suggesting improvement in stress-induced cellular aging . These results need to be confirmed in a larger sample PURPOSE Recent evidence suggests that depression is linked to increased mortality among patients with diabetes . This study examines the association of depression with all-cause and cause-specific mortality in diabetes . METHODS We conducted a prospect i ve cohort study of primary care patients with type 2 diabetes at Group Health Cooperative in Washington state . We used the Patient Health Question naire ( PHQ-9 ) to assess depression at baseline and review ed medical records supplemented by the Washington state mortality registry to ascertain the causes of death . RESULTS Among a cohort of 4,184 patients , 581 patients died during the follow-up period .  Deaths occurred among 428 ( 12.9 % ) patients with no depression , among 88 ( 17.8 % ) patients with major depression , and among 65 ( 18.2 % ) patients with minor depression . Causes of death were grouped as cardiovascular disease , 42.7 % ; cancer , 26.9 % ; and deaths that were not due to cardiovascular disease or cancer , 30.5 % . Infections , dementia , renal failure , and chronic obstructive pulmonary disease were the most frequent causes in the latter group . Adjusting for demographic characteristics , baseline major depression ( relative to no depression ) was significantly associated with all-cause mortality ( hazard ratio [HR]=2.26 , 95 % confidence interval [ CI ] , 1.79–2.85 ) , with cardiovascular mortality ( HR = 2.00 ; 95 % CI , 1.37–2.94 ) , and with noncardiovascular , noncancer mortality ( HR = 3.35 ; 95 % CI , 2.30–4.89 ) . After additional adjustment for baseline clinical characteristics and health habits , major depression was significantly associated only with all-cause mortality ( HR = 1.52 ; 95 % CI , 1.19–1.95 ) and with death not caused by cancer or atherosclerotic cardiovascular disease ( HR = 2.15 ; 95 % CI , 1.43–3.24 ) . Minor depression showed similar but nonsignificant associations . CONCLUSIONS Patients with diabetes and coexisting depression face substantially elevated mortality risks beyond cardiovascular deaths OBJECTIVE Cross-sectional and longitudinal associations among regimen  distress  ( RD ) , self-management , and glycemic control were undertaken to explore mechanisms of operation among these variables . RESEARCH DESIGN AND METHODS In a behavioral r and omized control trial ( RCT ) to reduce RD , 392 adults with type 2 diabetes were assessed for  RD , diet , exercise , medication adherence , and HbA1c at baseline and at 4 and 12 months . Associations among RD , self-management , and HbA1c were examined in cross-sectional analyses at baseline , in prospect i ve analyses using baseline values to predict change over time , and in time-varying analyses . RESULTS At baseline , greater RD and poorer medication adherence were independently associated with higher HbA1c ( P = 0.05 and P < 0.001 , respectively ) , and greater RD was associated with poorer medication adherence ( P = 0.03 ) . No consistent pattern of significant prospect i ve associations was found . Significant time-varying findings showed that decreases in RD were associated with improvements in medication adherence ( P < 0.01 ) , physical activity ( P < 0.001 ) , and HbA1c ( P = 0.02 ) over time following intervention . Changes in self-management were not associated with changes in HbA1c over time . CONCLUSIONS In the context of an RCT to reduce distress , RD , self-management , and HbA1c were interrelated in cross-sectional and time-varying analyses . Decreases in RD were associated with improvements in both self-management and HbA1c over 12 months . Findings point to the complex and likely multifaceted pathways of association among these key constructs , with results indicating significant linkages between RD and both self-management and glycemic control over time OBJECTIVE There is conflicting evidence regarding the utility of stress management training in the treatment of diabetes . The few studies that have shown a therapeutic effect of stress management have used time-intensive individual therapy . Unfortunately , widespread use of such interventions is not practical . The aim of the present investigation is to determine whether a cost-effective , group-based stress management training program can improve glucose metabolism in patients with type 2 diabetes and to determine whether a particular subset of patients is more likely to get positive results . RESEARCH DESIGN AND METHODS Patients with type 2 diabetes were r and omized to undergo a five-session group diabetes education program with or without stress management training .  Participants ( n = 108 ) were followed for 1 year , during which HbA(1c ) tests and question naires assessing perceived stress , anxiety , and psychological health were administered at regular intervals to evaluate treatment 
    Output:
    