Navigating the Caregiving Pathway: Understanding the Contextual Influences on Sense of Coherence Among Family Caregivers.

Introduction: Family caregivers of patients with chronic conditions face challenges such as emotional and physical stress, which can lead to caregiver burden. A good sense of coherence (SOC) is crucial in promoting resilience, positive health outcomes, and coping. Caregivers with a high SOC are optimistic about their caregiving roles and finding meaning and purpose in their responsibilities.

Understanding caregiver burden and quality of life in Kerala's primary palliative care program: a mixed methods study from caregivers and providers' perspectives.

Background: Family caregivers are vital for long-term care for persons with serious health-related suffering in Kerala. Long-term caregiving and ageing may become burdensome and detrimental to patients and caregivers. We compared the caregiver burden and quality-of-life of ageing caregivers with younger caregivers.

A randomized controlled trial of medication adherence and management of risk factors for secondary prevention of stroke (MaMoRS) using a smartphone-based application.

Background: There are little data on the use of smartphone-based applications for medication adherence and risk-factor control for the secondary prevention of stroke in low-and-middle-income countries (LMICs).

Aims: The aim was to determine whether a smartphone-based app improved medication adherence, risk-factor control, and provided health education to stroke survivors for lifestyle and behavioral modifications.

Methods: An unblinded, single-center randomized controlled double arm trial with 1:1 allocation among stroke survivors was performed in South India.

Disclosure of intimate partner violence while studying positive mental health in wheelchair users: ethical dilemmas.

This case study discusses the ethical dilemmas faced by the researchers when a woman with disability voluntarily disclosed her experience of intimate partner violence during an in-depth interview on positive mental health and resilience in wheelchair users. The interviewer's role as a researcher and public health professional raised dilemmas relating to the tenets of privacy, confidentiality and nonmaleficence. Professionals working with women with disability and similar vulnerable participants should anticipate such ethical challenges around violence and discrimination that such individuals face, and strive to resolve challenges based on basic ethical tenets within a context-informed approach.

Paediatric quality of life in toddlers and children who underwent arterial switch operation beyond early neonatal period.

Objectives: The aim of this study was to evaluate the quality of life (QOL) of children who underwent the arterial switch operation (ASO) for Transposition of Great Arteries in our population and, specifically, to explore early modifiable factors and the influence of parental and socioeconomic factors on the QOL of these children.

Methods: Cross-sectional study using Paediatric Quality of Life Inventory™ 3.0 Cardiac Module was carried out on 3- to 12-year-old children who had undergone ASO between the years 2012-2018.

Factors affecting ability of TB patients to follow treatment guidelines - applying a capability approach.

Background: Negotiating anti-Tuberculosis treatment is a complicated process comprising daily consumption of multiple medications at stipulated times and dosages, as well as periodic follow-ups and investigations, may not be uniform for all Tuberculosis (TB) patients and some may perform better than others. In this context, we conducted a study in Thiruvananthapuram district, Kerala to ascertain the ability of those suffering from TB to follow treatment guidelines.

Methods: This study used an embedded mixed methods design.

Correlation Between Biomarkers and Age-Adjusted Charlson Comorbidity Index in Patients With COVID-19: A Cross-Sectional Study in a Tertiary Care Center in South India.

Background Coronaviruses, generally known to cause a mild degree of respiratory illness have in the recent past caused three serious disease outbreaks. The world is yet to be released from the grip of the most recent coronavirus disease 2019 (COVID-19) pandemic due to emerging mutant strains. Age, presence of comorbidities, clinical severity, and laboratory markers such as C-reactive protein and D-dimer are some of the factors being employed to prioritize patients for hospital care.

Baseline Predictors of Longitudinal Cognitive Outcomes in Persons with Mild Cognitive Impairment.

Introduction: The study aimed to explore longitudinal cognitive outcomes and to ascertain predictors of conversion to dementia in a hospital-based mild cognitive impairment (MCI) cohort classified according to the neuropsychological phenotype at baseline.

Materials And Methods: Subjects aged >55 years who had a clinical diagnosis of MCI at initial visit between 2010 and 2018, with at least one formal neuropsychological assessment at baseline and follow-up of a minimum of 2 years were included. The prospective study was completed based on evaluation at last follow-up to gauge conversion to dementia, quantification of performance on activities of daily living and when available, longitudinal neuropsychological test scores.

Medication-Adherence and Management of Risk Factors for Secondary Prevention of Stroke Using Smartphone-Based Application: Protocol for MAMORs-Randomized Controlled Trial.

Background: In LMICs, the medication adherence and risk factor control are suboptimal in the post-stroke follow-up period. With shortage of physicians, smartphone-based interventions can help stroke survivors in secondary stroke prevention.

Objectives: We aim to validate a digital innovative technology-based intervention to improve the awareness, medication adherence, control of risk factors through timely intervention of physician among the stroke survivors.

On conducting a study among institutionalised adolescents in Kerala, India: legal and ethical challenges.

We report the dilemmas faced by the investigators while conducting a study on the social and environmental factors for protection of the mental health of adolescents placed under State protection in Kerala, India. The proposal received counsel and directives from the Integrated Child Protection Scheme authorities, under the Social Justice Department of Kerala state and the Institutional Ethics Committee of the host institution. The investigator faced and had to reconcile conflicting directives and antithetical field realities, with respect to seeking informed consent from the study participants.

Analysis of daily COVID-19 death bulletin data during the first two waves of the COVID-19 pandemic in Thiruvananthapuram district, Kerala, India.

Context: Coronavirus disease 2019 (COVID-19) mortality trends can help discern the pattern of outbreak evolution and systemic responses.

Aim: This study aimed to explore patterns of COVID-19 deaths in Thiruvananthapuram district from 31 March 2020 to 31 December 2021.

Setting And Design: Secondary data analysis of COVID-19 deaths in Thiruvananthapuram district was performed.

Urbanization and physical activity in the global Prospective Urban and Rural Epidemiology study.

Urbanization may influence physical activity (PA) levels, although little evidence is available for low- and middle- income countries where urbanization is occurring fastest. We evaluated associations between urbanization and total PA, as well as work-, leisure-, home-, and transport-specific PA, for 138,206 adults living in 698 communities across 22 countries within the Prospective Urban and Rural Epidemiology (PURE) study. The 1-week long-form International PA Questionnaire was administered at baseline (2003-2015).

Influence of age at surgery on left ventricular strain in patients with anomalous origin of left coronary artery from pulmonary artery.

Objectives: Myocardial strain abnormalities are described after surgical repair of anomalous left coronary artery from pulmonary artery (ALCAPA) even after recovery of ventricular function. The factors that predispose to the presence of these strain abnormalities in the presence of normal ventricular function are unknown. The aim of this study was to find out whether the age at repair influences the presence of global and regional strain abnormalities on follow-up.

Mechanical Thrombectomy in Acute Ischemic Stroke: Angiographic Predictors of Outcome.

Background: In patients with acute ischemic stroke with large vessel occlusion, various angiographic features are important in patient selection and predicting outcome.

Objective: We evaluated angiographic features like collaterals, clot burden score, angiographic recanalization, number of passes, and intracranial atherosclerotic disease (ICAD) with the functional outcome at 90 days.

Materials And Methods: This was a retrospective analysis of prospectively collected data of 163 patients with acute ischemic stroke with large vessel occlusion who underwent mechanical thrombectomy within 24 hours of symptom onset.

MoCA in five Indian languages: A brief screening tool to diagnose dementia and MCI in a linguistically diverse setting.

Introduction And Objectives: Early dementia diagnosis in low and middle-income countries (LMIC) is challenging due to limited availability of brief, culturally appropriate, and psychometrically validated tests. Montreal Cognitive Assessment (MoCA) is one of the most widely used cognitive screening tests in primary and secondary care globally. In the current study, we adapted and validated MoCA in five Indian languages (Hindi, Bengali, Telugu, Kannada, and Malayalam) and determined the optimal cut-off points that correspond to screening for clinical diagnosis of dementia and MCI.

Treatment in a Stroke Unit and Risk Factor Control Reduce Recurrent Stroke Risk.

Introduction: Risk factor control is an important predictor of risk of stroke recurrence. The attributable fraction which estimates the excess risk among the exposed stroke survivors has not been studied previously. We studied the attributable fraction for stroke recurrence in consecutive incident cases of recurrent stroke.

Hypertension control in Kerala, India: A prescription-based study at primary and secondary level health care institutions.

Objective: We undertook a prescription-based study to identify the provider and institution-level factors related to achieving guideline-recommended control of hypertension and diabetes mellitus in Kerala, India.

Methods: This cross-sectional study in primary and secondary care hospitals in Kerala included both public and private institutions. One practitioner was selected from each institution.

Picture-naming test for a linguistically diverse population with cognitive impairment and dementia.

Background: Picture-naming tests (PNTs) evaluate linguistic impairment in dementia due to semantic memory impairment, impaired lexical retrieval or perceptual deficits. They also assess the decline in naming impairment at various stages of dementia and mild cognitive impairment (MCI) that occurs due to progressive cognitive impairment. With the increasing numbers of people with dementia globally, it is necessary to have validated naming tests and norms that are culturally and linguistically appropriate.

Clinical Profile and Determinants of Mortality in Patients With COVID-19: A Retrospective Analytical Cross-Sectional Study in a Tertiary Care Center in South India.

Introduction The COVID-19 pandemic gained ground in India, starting from a few cases and spreading to the whole country; eventually becoming the second-most affected country worldwide. Here, we present the clinical and laboratory profile and the risk factors associated with mortality in COVID-19. The study comes from Kerala, a region that reported the first case in India.

Factors Associated with Screening Positive for Depression among Women Caregivers of Primary Palliative Care Patients in Kerala, India.

The study encompasses findings from a prospective quantitative screening of women family caregivers for depression as part of a larger mixed methods study designed to develop and validate a caregiver burden inventory for the home-based palliative care programme in Kerala, India. We assessed the proportion of women caregivers screening positive for depression and explored the associated factors. The Primary care Screening Questionnaire for Depression (PSQ4D) was used to screen participants for depression.

ASHA-Led Community-Based Groups to Support Control of Hypertension in Rural India Are Feasible and Potentially Scalable.

To improve the control of hypertension in low- and middle-income countries, we trialed a community-based group program co-designed with local policy makers to fit within the framework of India's health system. Trained accredited social health activists (ASHAs), delivered the program, in three economically and developmentally diverse settings in rural India. We evaluated the program's implementation and scalability.

Validation of ICMR Neurocognitive Toolbox for Dementia in the Linguistically Diverse Context of India.

The growing prevalence of dementia, especially in low- and middle-income countries (LMICs), has raised the need for a unified cognitive screening tool that can aid its early detection. The linguistically and educationally diverse population in India contributes to challenges in diagnosis. The present study aimed to assess the validity and diagnostic accuracy of the Indian Council of Medical Research-Neurocognitive Toolbox (ICMR-NCTB), a comprehensive neuropsychological test battery adapted in five languages, for the diagnosis of dementia.

Relationship between Cerebral Perfusion on Arterial Spin Labeling (ASL) MRI with Brain Volumetry and Cognitive Performance in Mild Cognitive Impairment and Dementia due to Alzheimer's Disease.

Context: Cerebral blood flow (CBF) measurement using arterial spin labelling (ASL) MRI sequences has recently emerged as a prominent tool in dementia research.

Aims: To establish association between quantified regional cerebral perfusion and gray matter (GM) volumes with cognitive measures in mild cognitive impairment (MCI) and early Alzheimer's Dementia (AD), using three dimensional fast spin echo pseudo-continuous ASL MRI sequences.

Settings And Design: Hospital-based cross-sectional study.

Consumption of fruits, vegetables and salt in the context of control of type 2 diabetes and hypertension in Kerala, India.

Background: Proper diet is necessary to control hypertension and diabetes. This paper describes the combined fruit and vegetable, and salt intake of adults (>=18 years) who were detected to have hypertension or diabetes.

Methods: We analysed the data from a state-wide survey of 12012 adults using the World Health Organization STEPs for NCD risk factor surveillance.

Can occurrence of convulsive status epilepticus during video telemetry be predicted? Observations from an epilepsy monitoring unit.

Purpose: The objective of the study was to evaluate the frequency, clinical, and video-electroencephalographic (VEEG) predictors of convlusive status epilepticus (CSE) in the epilepsy-monitoring unit (EMU).

Methods: The data of all patients who had CSE in our EMU between 2008 and 2017 were reviewed. For each case, two age- and diagnosis-matched subjects who underwent VEEG and did not develop CSE were taken as internal controls.