Relationship between Ayurvedic way of life and wellness in Indo-Canadians with and without Cancer
اسلاید 1: www.tabaye.ir
اسلاید 2: Relationship between Ayurvedic way of life and wellness in Indo-Canadians with and without Cancer.Presented by – Ushasri Nannapaneni15th June 2007.NET Trainee Day
اسلاید 3: Rationale / BackgroundObjectivesBrief Literature Review - AyurvedaMethodologya. Quantitative Approach5. Results6. Next Steps a. Qualitative Approach b. Time Line for CompletionPresentation Outline
اسلاید 4: I. Background /RationaleSince the 1960s Immigration has increased greatly to Canada, more so from the Asian sub-continent. Indo-Canadians are the second largest Ethnic group among immigrants in Canada after the Chinese.1There are disparities in health and health outcomes among immigrants compared to the Canadians. We need to understand the health beliefs and various health related practices to understand how and why the “healthy immigrant effect” is lost over a period of time. Current research would help bridge the gap that exists in this learning and help cater to immigrants’ needs accordingly. II. ObjectivesTo examine, to what extent the Ayurvedic way of life is associated with Self Rated Health (wellness) among Indo-Canadians with cancer, compared to non-Indo-Canadians with cancer, using the CCHS 2.1To compare how Indo-Canadians with and without cancer rely on Ayurvedic way of life to achieve wellness, using CCHS 2.1To better understand the perspectives of Ayurvedic way of life in Indo-Canadian cancer patients, and its contribution to their own wellness.
اسلاید 5: III. Brief Literature Review - AyurvedaAyurveda is whole system of healthcare that originated in India around 3000 B.C.2Ayurveda, is an ancient practice, and is a nature based philosophy that stresses the integration of body, mind and spirit and has its roots in the spiritual Hindu culture. 3‘Ayu’ – means life or longevity and ‘Veda’ – means knowledge.4 The underlying beliefs and principles are built on five elements of nature – Earth, Fire, Water, Air and Vacuum or Space. 5Ayurvedic philosophy believes that all the factors in life such as diet, exercise, weather, emotions, family dynamics, are much like the waves of the sea, which constantly are out of sync throw us out of a healthy balance. 2,6The balance has to be actively regained and maintained through the 7 broad areas of health of Ayurveda. 7
اسلاید 6: III. Brief Literature Review – Ayurveda Contd…Ayurvedic practitioners identify a persons’ constitution or “dosha” (psycho-physiological governing factors that have lost balance), as the basis for health and treatment along with treating the illness.63 Types of Doshas – “Pitha”, “Vatha” and “Kapha.”7Disease is seen as loss of dynamic balance and to not only heal disease but to re-establish balance to prevent disease from re-occurring of disease and promote positive health. To achieve balance there are 7 broad areas in Ayurveda: 7 1. Diet 2. Detoxification 3. Physical Activity 4. Relaxation Techniques 5. Oral Health 6. Rejuvenation Techniques 7. Religion and Spirituality
اسلاید 7: Mediating Factors that may be CatalystsMediating Factors that may be BarriersConceptual Framework - Model Proposed for the study Source: Spector RE. Cultural diversity in health and illness 1985; Oxford University Press Inc. Components of Ayurvedic philosophy/ Indo-Canadian way of lifeDiet(Fruit and Veg. consumption)Detoxification(Food Choices)Physical Exercise(Physical activities)Relaxation Technique(Leisure activities)Rejuvenation Techniques(Dietary Supplement use) (Changes made to improve healthReligion/SpiritualityOral Health(Dental visits)ReligionSocializationCultureEthnicityWellness(SRH)Length of Stay in Canada
اسلاید 8: 1. Diet (Total Fruit and Vegetable Consumption); 2. Detoxification (chooses / Avoids foods for health Reasons); 3. Physical Activity ( Freq. Physical Activity); 4. Relaxation Techniques (Sedentary Activities); 5. Oral Health (# of times one brushes teeth); 6. Rejuvenation Techniques (Dietary Supplement use); 7. Religion and Spirituality (Religion and Spirituality).Variables chosen from the CCHS (2.1) Survey to operationalize the Ayurvedic way of life
اسلاید 9: IV MethodologyPart 1 - Quantitative
اسلاید 10: CCHS – 146 Health Regions (HRs) participated in the study.Sample – 135,573 un-weighted cases (respondents) from all the HRs answered the survey. Age – 12 and above participated.The Survey is divided into 2 sections – a. Main Modules b. Optional ModulesEach question under these modules (sections) is treated as a variable and some of the questions from each of these sections have been selected to be the proxies for Ayurvedic way of life (ref. model for the study).All the variables were selected based on the review of the Ayurvedic literature.After the questions to use have been selected, some of the variables were re-coded for the purpose of analysis.The Canadian Community Health Survey (CCHS - cycle 2.1)
اسلاید 11: Outcome Variable – Self Rated Health (Wellness).Independent Variables – Total Fruit and Vegetable Consumption; Chooses/Avoids foods for health reasons; Physical activity; Sedentary activities; Freq. of brushing teeth.Demographic Variables / potential Confounders – Age; Gender, Education, Income, Marital Status; Satisfaction with life.Variables used for the Study
اسلاید 12: Table 1 Main Modules in the Survey CCHS (2.1)
اسلاید 13: Optional Modules No. of Health Regions that selected the moduleFrequenciesRejuvenation Techniques(Changes to improve health) (Dietary Supplements)414Valid N 134,433Missing 1,140Valid N 3,948Missing 131,625Oral health (Freq. of Brushing teeth)66Valid N 41,918Missing 93,655Detoxification (Chooses /Avoids foods)85Valid N 101,268Missing 34,305Relaxation Techniques(Sedentary/Leisure Activities)48Valid N 58,169Missing 77,404Satisfaction with life8Valid N 132,279Missing 3,294 Self Esteem7Valid N 8,927Missing 126,646Mastery –Scale6Valid N 1,423Missing 134,150Table 1 Optional Modules in the Survey CCHS (2.1) Contd…
اسلاید 14: Table 1 Optional Modules in the Survey CCHS (2.1) Contd…
اسلاید 15: Table 2 Recoded Variables
اسلاید 16: Table 2 Recoded Variables Contd…
اسلاید 17: Analytical FrameworkAyurvedic way of life1. Fruit and veg. Consumption(Representing diet in Auyrveda)2. Food Choices(Representing Detoxification)3. Physical Activities(Representing Physical activities)4. Leisure Activities(Representing Relaxation Techniques)5. Dietary Supplement Use andChanges made to improve health(Representing Rejuvenation techniques)6. Spirituality(Representing Religion and Spirituality)7. Dental Visits and oral health(Representing Oral Health)Demographics(Age, Gender, Marital Status)Length of StaySocial SupportSatisfaction with lifeUse of CAMSES/ Language(Income, Education)Perceived Control Over Life (mastery)SRH(Wellness)
اسلاید 18: V Results Part 1 Quantitative
اسلاید 19: VariableNon - Indo-Canadians with Cancer n (%)Indo-Canadians With Cancern (%)Indo-Canadians without Cancern (%)Age>6544-6512-44206,142 (47.1)165,690 (37.9)66,576 (15.0)1,672 (26.3)3,506 (55.2)1,170 (18.4)61,423 (6.8)214,120 (23.6)632,882 (69.7)GenderMale Female202,047 (46.2)235,361 (53.8)1,102 (17.4)5,246 (82.6)488,388 (53.8)420,087 (46.2)Marital StatusSingleNot Single105,045 (24.0)290,598 (66.4)1,521 (24.0)3,838 (60.5)67,768 (7.5)571,259 (62.9)Education< than Secondary gradSecondary gradOther-post-sec/ univ. graduate84,133 (19.2)54,381 (12.4)272,377 (62.3)411 (6.5)126 (2.0)5,811 (91.5)46,926 (5.2)97,651 (10.7)695,223 (76.5)Income Low IncomeMiddle or High36,373 (8.3)335,811 (76.8)983 (15.5)5,336 (84.1)100,973 (11.1)684,686 (75.4) Table 1 – Demographics of the groups being compared
اسلاید 20: Table 2 - Cancer cases by EthnicityIndo –Canadiansn (%)Non-Indo- Canadiansn (%)Without cancer910,810 (99.30%)24,664,260 (98.26%)With cancer6,348 (0.69%)435,913 (1.76%)Total917,15825,100,173Indo-Candians with cancern (%)Indo-Canadians without cancern (%)Non-Indo-Canadians with cancern (%)Poor health 575 (9.1)374,118 (41.2)270,003 (61.7)Good health3,286 (51.8)516,464 (56.9)88,305 (20.2)Total3861 (60.8)890583 (98.0)358308 (81.9)Table 3 -– Self rated health by sub-groups of interest
اسلاید 21: Univariate and bivariate AnalysesObjective 1 To examine, to what extent the Ayurvedic way of life is associated with Self Rated Health (wellness) among Indo-Canadians with cancer, compared to non-Indo-Canadians with cancer, using the CCHS 2.1
اسلاید 22: Table 4: Ethnicity and Ayurvedic principles (Independent variables and potential confounders) Independent Variables(Ayurvedic Components)Indo-Canadians with Cancer (%)Non-Indo-Canadians with Cancer (%)Diet < 55-10 Times>1027.554.617.954.142.63.3Chooses/AvoidsFoods for Health reasonsYesNo75.424.666.233.8Physical ActivityRegularOccasionalInfrequent46.19.744.258.112.429.5Sedentary Activities≤ 14 hrs/wk15-29 hrs/wk≥ 30 hrs/wk51.737.810.421.452.825.8* All cancer cases were selected to perform the chi square test.
اسلاید 23: Independent VariablesIndo-Canadians with Cancer (%)Non-Indo-Canadians with Cancer (%)Age12-18 yrs19-29 yrs30-50 yrs51-70 yrs> 70 yrs---72.52.6---45.532.4SexMaleFemale17.482.646.253.8Marital statusSingleNot single66.633.460.539.5Education< Sec gradeSec gradeOther post-secPost-sec-grad6.52.01.889.720.513.26.559.8IncomeLowMediumHigh15.646.737.810.164.925.0Table 4: Ethnicity and Ayurvedic principles (Independent variables and potential confounders) Contd…
اسلاید 24: Table 4 Ethnicity and Ayurvedic principles (Independent variables and potential confounders) Contd…Independent VariablesIndo-Canadians with Cancer (%)Non-Indo-Canadians with Cancer (%)Length of stay in Canada0-20 yrs> 20 yrs39.160.916.283.8Satisfaction with lifeSatisfiedNeither satis/DissatisfiedDissatisfied--6.8--8.5CAM useYesNo16.183.912.387.7* All cancer cases were selected to perform the chi square test.
اسلاید 25: Table 5: Self-rated health by Ayurvedic principles VariableIndo-Canadians with cancer (%)Indo-Canadians with cancer (%)Non-Indo-Canadians with cancer (%)Non-Indo-Canadians with cancer (%)PoorGoodPoorGoodDiet< 55-10 Times>1061.435.82.856.339.64.262.334.63.156.139.44.5Chooses/AvoidsFoods for Health reasonsYesNo54.645.452.547.556.743.356.843.2Physical ActivityRegularOccasionalInfrequent54.612.133.361.313.824.857.317.425.371.915.412.7Sedentary Activities≤ 14 hrs/wk15-29 hrs/wk≥ 30 hrs/wk46.742.710.644.944.410.730.750.319.036.548.614.9Oral health≥ twice/dayOnce/day<Once/day/wk80.218.51.284.915.10.080.617.91.585.713.40.9* All Indo-Canadian cases are selected
اسلاید 26: VariableIndo-Canadians with cancer (%)Indo-Canadians with cancer (%)Non-Indo-Canadians with cancer (%)Non-Indo-Canadians with cancer (%)PoorGoodPoorGoodAge12-18 yrs19-29 yrs30-50 yrs51-70 yrs> 70 yrs8.220.339.325.46.812.632.243.010.31.98.914.331.930.014.913.322.138.720.85.4SexMaleFemale48.551.557.242.849.952.149.950.1Marital statusSingleNot single30.769.342.058.041.458.642.157.9Education< Sec gradeSec gradeOther post-secPost-sec-grad6.914.33.875.04.59.47.079.115.214.36.963.56.111.36.276.4IncomeLowMediumHigh18.758.322.99.057.733.312.559.128.46.450.642.9Table 5: Self-rated health by Ayurvedic principles Contd…
اسلاید 27: *All Indo-Canadian cases are selectedTable 5: Self-rated health by Ayurvedic principles Contd… VariableIndo-Canadians with cancer (%)Indo-Canadians with cancer (%)Non- Indo-Canadians with cancer (%)Non- Indo-Canadians with cancer (%)PoorGoodPoorGoodLength of stay in Canada0-20 yrs> 20 yrs68.731.377.722.341.258.850.949.1Satisfaction with lifeSatisfiedNeither satisfied/DissatisfiedDissatisfied81.510.77.894.63.61.885.59.05.595.53.31.2CAM useYesNo7.192.99.590.511.888.213.186.9
اسلاید 28: Final model following Logistic RegressionObjective 1
اسلاید 29: VariableCrude OR95 % CISig.BetaS.E.Adjusted OR95 % CISig.Age 44-65Age >651.1331.1251.108-1.1591.099-1.151.000.000-.276-.123.016.0101.3181.1661.277-1.3611.130-1.202.000.000Gender-Male1.0861.070-1.103.000-.166.0101.181.1.158-1.204.000Marital Stat –Single1.0981.079-1.118.000-.272.0121.3121.282-1.342.000Post sec /Univ EduHigh school or less1.577.8681.545-1.610.841-.895.000.000.343-.456.013.0201.409.6331.373-1.445.609-.658.000.000Phy_Act InfrequentPhy_Act Occasional2.3572.2462.307-2.4072.184-2.310.000.000-.751-.003.013.0142.1182.1132.065-2.1732.044-2.184.000.000Fruit & Veg <5 timesFruit & Veg 5-101.0271.312.983-1.0741.255-1.371.234.000-.001.260.027.027.9991.297.948-1.0541.229-1.368.978.000Satisfied with lifeNeither Satis/Dissati4.8611.6264.568-5.1741.511-1.749.000.000.999-.053.036.0432.716.9492.534-2.913.871-1.033.000.226Middle / High Income1.4011.360-1.444.000.136.0191.1451.103-1.190.000Ethnicity1.0971.092-1.101.000.477.0501.6121.461-1.778.000Table 6 Crude and Adjusted Estimates of Ayurvedic way of life of Cancer Cases on Self Rated Health Note: All Cancer cases were selected.Reference Categories- Age: 12-44; Gender: Female; Marital Status: not Single; Education <than high school; Physical Activity: Regular; Fruit and Vegetable Use: >10times; Satisfaction with life: Dissatisfied; Income: Low Income; Ethnicity: Indo-Canadians; Self Rated Health: Good
اسلاید 30: Univariate and bivariate AnalysisObjective 2To compare how Indo-Canadians with and without cancer rely on Ayurvedic way of life to achieve wellness, using CCHS 2.1
اسلاید 31: VariableIndo-Canadian (%)Indo-Canadian (%)PoorGoodDiet < 55-10 Times>1061.435.82.856.339.64.2Chooses/AvoidsFoods for Health reasonsYesNo54.645.452.547.5Physical ActivityRegularOccasionalInfrequent54.612.133.361.313.824.8Sedentary Activities≤ 14 hrs/wk15-29 hrs/wk≥ 30 hrs/wk46.742.710.644.944.410.7Oral health≥ twice/dayOnce/day<Once/day/wk80.218.51.284.915.10.0Table 7 Self Rated health of Indo-Canadians on Ayurvedic Principles*All Indo-Canadian Cases are selected.
اسلاید 32: VariableIndo-Canadians (%)Indo-Canadians (%)PoorGoodAge12-18 yrs19-29 yrs30-50 yrs51-70 yrs> 70 yrs8.220.339.325.46.812.632.243.010.31.9SexMaleFemale48.551.557.242.8Marital statusSingleNot single30.769.342.058.0Education< Sec gradeSec gradeOther post-secPost-sec-grad6.914.33.875.04.59.47.079.1IncomeLowMediumHigh18.758.322.99.057.733.3*All Indo-Canadian Cases are selected.Table 7 Self Rated health of Indo-Canadians on Ayurvedic Principles Contd…
اسلاید 33: VariableIndo-Canadians (%)Indo-Canadians (%)PoorGoodLength of stay in Canada0-20 yrs> 20 yrs68.731.377.722.3Satisfaction with lifeSatisfiedNeither Satisfied/DissatisfiedDissatisfied81.510.77.894.63.61.8CAM useYesNo7.192.99.590.5Table 7 Self Rated health of Indo-Canadians on Ayurvedic Principles Contd…*All Indo-Canadian Cases are selected.
اسلاید 34: Table 8 Comparing Indo-Canadians with and without Cancer on using Ayurvedic way of lifeVariableIndo-Canadians with Cancer (%)Indo-Canadians without Cancer (%)Diet< 55-10 Times>1027.554.617.958.737.83.5Chooses/AvoidsFoods for Health reasonsYesNo75.424.653.146.9Physical ActivityRegularOccasionalInfrequent46.19.744.258.613.128.3Sedentary Activities≤ 14 hrs/wk15-29 hrs/wk≥ 30 hrs/wk51.737.810.445.643.710.7
اسلاید 35: VariableIndo-Canadians with Cancer (%)Indo-Canadians without Cancer (%)Age12-18 yrs19-29 yrs30-50 yrs51-70 yrs> 70 yrs---72.52.6---16.44.0SexMaleFemale17.482.653.846.2Marital statusSingleNot single66.633.462.937.1Education< Sec gradeSec gradeOther post-secPost-sec-grad6.52.01.889.75.611.65.677.2IncomeLowMediumHigh15.646.737.813.158.128.8Table 8 Comparing Indo-Canadians with and without Cancer on using Ayurvedic way of life Contd…
اسلاید 36: VariableIndo-Canadians with Cancer (%)Indo-Canadians without Cancer (%)Length of stay in Canada0-20 yrs> 20 yrs39.160.973.826.2Satisfaction with lifeSatisfiedNeither Satisfied/DissatisfiedDissatisfied--6.8--7.9CAM useYesNo16.183.98.491.6Table 8 Comparing Indo-Canadians with and without Cancer on using Ayurvedic way of life Contd…*All Indo-Canadian Cases are selected
اسلاید 37: Final model following Logistic RegressionObjective 2
اسلاید 38: Table 9 Crude and Adjusted Estimates of Ayurvedic way of life on Self-rated health –Indo-CanadiansVariableCrude OR95 % CISig.BetaS.E.Adjusted OR95 % CISig.Age 12-44Age 45-655.6132.5475.505-5.7232.495-2.600.000.0001.518.613.014.0144.5621.8474.442-4.6861.797-1.897.000.000Fruit & Veg <5 timesFruit & Veg 5-10.628.770.613-.643.751-.789.000.000-.329-.135.013.0131.9052.0251.834-1.9781.949-2.105.000.000Gender -Female1.398.1.386-1.410.000-.508.0071.6621.640-1.683.000Cancer-No.127.116-.391.000-1.951.051.142.129-.152.000Marital Status – not Single1.1871.166-1.205.000-.849.012.428.418-.438.000PhyAct InfrequentPhyAct Occasional.672.986.666-.679.973-.999.000.035.144.480.007.0101.1541.6151.138-1.1711.583-1.648.000.000Choose/Avoids Foods -Yes.942.934-.951.000.082.0071.0851.071-1.100.000Satisfied with lifeNeither Satis/Dissat3.6761.0653.585-3.7691.033-1.098.000.0001.380.1681.380.1683.9751.1833.834-4.1211.132-1.236.000.000Post-Sec/Univ EduHigh school or less1.650.9891.619-1.681.967-1.011.000.313.614-.143.013.0161.847.8661.800-1.896.840-.894.000.000Middle /High Inc2.3112.280-2.343.000.697.0102.0071.969-2.047.000Note: All Indo-Canadian Cases are selected.Reference Categories- Age: > 65; Fruit & Vegetable Use: >10 times; Gender: male; Cancer: Yes; Marital Status: Single; Physical Activity :Regular; Chooses and Avoids food: No; Satisfaction with life: Dissatisfied; Education: < than sec grad; Income: Low income; Self-Rated-health: Good
اسلاید 39: Summary of findings so farEthnicity plays a role in how one rates his/her health.Compared to Indo-Canadians, non-Indo-Canadians with cancer have 61% more chances of rating their health as poor. Conversely, Indo-Canadians with cancer have 39% less chances of rating their health as poor compared to non-Indo-Canadians with cancer.Among the Indo-Canadians, non-cancer respondents have 86% less chance of rating their health as poor. Conversely, having cancer would increase the chance of rating their health as poor by about 14%. In other words, having a chronic condition is associated with how Indo-Canadians rate their health.Age is the biggest predictor of Self-rated health for all the 3 groups being compared namely, Indo-Canadians with and without cancer, and non-Indo-Canadians with cancer.There may be an interaction between age and satisfaction with life among both the ethnic groups. This will be explored further in the qualitative enquiry.
اسلاید 40: Major limitation was the use of CCHS survey to operationalize the Ayurvedic way of life, as the survey was not designed to suit the purpose of the study.Some of the variables chosen could not be used as there were very few respondents who answered the questions from those modules of the survey, and the variables had to be removed from the analysis.Having no data center in Saskatchewan, the analysis took too long, and I had to rely on Statistics Canada to run the analysis on the Master files and send the results through e-mail.Limitations
اسلاید 41: VI Next StepsMethodology – Qualitative ApproachTime Line for Completion
اسلاید 42: a. Methodology - QualitativeThe variables used in the Quantitative study from the CCHS Survey (Cycle2.1) will be explored in a qualitative enquiry.20 in-depth interviews in an ethnographic format will be conducted in Vancouver and in Saskatoon.For the interviews purposive sampling will be used following the below mentioned criteria:At least 60% will be females; age group will be 44-65 yrs; From middle or high income group; marital Status – married and born outside Canada.4. If recruitment becomes difficult, snowball technique will be used to recruit a convenience sample.5. Advertisement will be made in the temple asking participants to self select fro the interview. An announcement with regard to the study will also be made on the local radio.6. Data Analysis: Data will be analyzed using Nudist software after all the transcripts have been transcribed.
اسلاید 43: Questions for the InterviewWhat measures do you take to promote your health?Did you use any alternative health care measure to promote health?Do you have any experience with using Ayurveda?What are your perspectives on Ayurveda?What are your perspectives on how it helped you in achieving better health?
اسلاید 44: b. Time Line for completionCommittee meeting is scheduled for the 22nd of June 2007 and an approval for the Qualitative Study will be obtained.Discussions with Dr. Maria-Christina Barroetavena with regard to the qualitative study.Ethics application will be submitted by the end of July to the Ethics Board at the University of Saskatchewan.First draft of the dissertation will be written and submitted to the committee members to review by December 2007.Results will be presented at the Departmental seminar as part of the requirement at the University of Saskatchewan.
اسلاید 45: Selected ReferencesCitizenship and Immigration Canada. Facts and Figures- Immigration Overview. Ottawa. ON, 2002. Shanbhag V. A beginner’s introduction to Ayurvedic medicine: The science of natural healing and prevention through individual therapies. 1994; Keats Publishing Inc, New Canaan, Connecticut.Mishra LC, Singh BB, Dagenais S. Healthcare and disease management in Ayurveda. Alt Ther Health and Med 2001; 7(2):44-51.Robert E Svaboda. Prakriti Your Ayurvedic constitution. 1998; Lotus Press, Twin Lakes, WI.Rhyner H. Ayurveda: The gentle Health System. 1994. New York. NY: Sterling Publishing.Lad V. An introduction to Ayurveda. altern Iner Health Med 1995; 7(3):57-63.Mishra LC, Singh BB, Dagenais S. Ayurveda : Historical perspective and principles of the traditional healthcare system in India. Alternative Therapies 2001; 7(2).Spector RE. Cultural diversity in health and illness 1985; Oxford University Press Inc.
اسلاید 46: AcknowledgementsFunding from the Canadian Institutes for Health Research (CIHR), Palliative Care in Cross-Cultural Context – New Emerging Team (NET) for Equitable and Quality Cancer Care for Culturally Diverse Populations is gratefully acknowledged
اسلاید 47: Thank YouQuestions?
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