ObjectiveTo understand the structures and strategies that helped Kerala in fighting the COVID-19 pandemic, the challenges faced by the state and how it was tackled.DesignQualitative descriptive study using focus group discussions and in-depth interviews.SettingState of Kerala, India.Participants29 participants: four focus group discussions and eight in-depth interviews. Participants were chosen purposively based on their involvement in decision-making and implementation of COVID-19 control activities, from the department of health and family welfare, police, revenue, local self-government and community-based organisations. Districts, panchayats (local bodies) and primary health centres (PHCs) were selected based on epidemiological features of the area like the intensity of disease transmission and preventive/containment activities carried out in that particular area to capture the wide range of activities undertaken in the state.ResultsThe study identified five major themes that can inform best practices viz social capital, robust public health system, participation and volunteerism, health system preparedness, and challenges. This study was a real-time exploration of the intricacies of COVID-19 management in a low/middle-income country and the model can serve as an example for other states and nations to emulate or adjust accordingly.ConclusionThe study shows the impact of synergy of these themes towards more effective solutions; however, further research is much needed in examining the relationship between these factors and their relevance in policy decisions.
The term sarcopenia is derived from the Greek meaning 'poverty of flesh' and is characterized by the progressive loss of skeletal muscle mass, muscle strength, and physical performance. This term was first coined by I.H. Rosenberg to denote "ageing related loss of skeletal muscle mass and strength" 1. Sarcopenia has a biological component with the genes involved in skeletal muscle mitochondrial function, oxidative capacity, and glucose uptake showing reduced expression with ageing 2. It affects women and men equally, starting from the fourth decade and accelerating from the 6 th decade 3. It was originally described in the elderly population, and is often now defined as a geriatric syndrome associated with functional impairment, increased risk of falls, fractures, and reduced survival. Sarcopenia has been found to be a predictor of chronic disease progression, poorer functional outcomes, and postoperative complications (both infections and noninfectious complications) 4. Standardization of sarcopenia assessment, especially in diagnosis of low muscle mass, will be crucial for clinical practice and interventions in the future. Dual energy X-ray absorptiometry (DEXA), bioelectrical impedance analysis Abstract Objective: To estimate the proportion of radiologically significant (LSMI) sarcopenia and the factors associated with it among patients undergoing Computerized Tomography scan. Methods: A Cross sectional study was conducted among 152 patients underwent CT scan in the radiology department of Government medical college Thiruvananthapuram. Sarcopenia was estimated based on lumbar skeletal muscle index obtained using cross sectional areas of various abdominal muscles by CT scan. The proportion of sarcopenia was estimated and associated factors studied. Binary logistic regression model was used to adjust the confounders. Results: Out of 152 individuals, sarcopenia was present in a total of 82 (53.95%) individuals. Male gender (Adjusted OR= 8.42, 3.64-19.52 (95% CI)) was a risk factor for and a body mass index more than 25Kg/m 2 (Adjusted OR= 0.36, 0.15-0.67 (95% CI)) was a protective factor against sarcopenia. Conclusion: The burden of sarcopenia is found to be high and considering the double burden of sarcopenia and obesity in the Kerala community, newer strategies for health promotion and early detection need to be developed.
Background In the context of the largest dengue outbreak in the state of Kerala, India in 2017, along with global evidence of changing epidemiology of dengue virus and its distribution, this study was planned to understand the epidemiological pattern of dengue infection and contemplate the clinical presentations of different serotypes. Methods This cross-sectional study was conducted in the Thiruvananthapuram and Kollam districts of Kerala, India, spanning 3 y from 2017 to 2019. We recruited adult patients based on the World Health Organization case definition of probable dengue fever to study their virological, spatial and clinical characteristics. Results Dengue infection was identified in 113 (33.9%) of the 333 probable dengue patients recruited. Dengue virus 1 (DENV1), along with its combinations (59.09%), was the predominant serotype during 2017, followed by DENV2. There was a marked increase in the proportion of DENV4 cases (34.56%) and concurrent infections (26%) in 2019. DENV3 infections were more likely to present with warning signs (adjusted relative risk 6.14 [95% confidence interval 1.3 to 29.4]) and a significantly lower platelet count (p=0.02). Conclusions The results highlight the hyperendemicity of dengue infection in the state and the changing pattern of dengue virus predominance along with redominance. The rise in DENV4 and concurrent infections put forth the possibility of a more severe future outbreak.
Background: Screen time (ST) is the time spent in sedentary behaviors involving screen based media (SBM) like watching television, playing games, using computers and mobile phones. This situation is a matter of concern because excessive screen time is associated with the risk of excess weight gain, hypertension, metabolic syndrome, low cardiorespiratory fitness. In a study conducted in urban resettlement in New Delhi, 68% of adolescents engage in using SBM for more than 2 hours. This study aimed to estimate the prevalence of excess screen time and factors associated with it among school going adolescents in Kerala.Methods: A cross sectional study was conducted among 130 students of age group 12-15 years studying in schools located in urban area of Thiruvananthapuram district from August 2019 to October 2019. Stratified sampling technique was used. A semi-structured self-administered questionnaire was used for data collection. Data was entered in MS Excel and was analyzed using appropriate statistical software.Results: The proportion of students who had high screen time was 87.7%. Mobile phones were the most frequently used gadget. Male gender OR-8.3 (95% CI- 1.7-40.3), less duration of sleep OR-0.34 (95% CI- 0.15-3.12), and low socio-economic status OR-0.21 (95% CI- 0.21-0.96) were found to be associated with high screen time among high school students in Kerala.Conclusions: The study observed that 87.7% of high school students engage in using Screen based media for more than 2 hours. In this study male gender and short sleep duration were found to be associated with excess screen time.
Introduction The impact of SARS-CoV-2 is not only on physical health but also on mental health. This pandemic raised concerns of fear, anxiety, and stress among patients affected with the disease. Quarantine and home isolation might have created psychological distress and helplessness in patients due to social and economic reasons. This study aimed in assessing the level of perceived stress and factors associated with it among SARS-CoV-2-affected young adults who were under home isolation. Methodology A cross-sectional study was conducted among 147 SARS-CoV-2-affected young adults who were under home isolation during June 2021 to August 2021. A semi-structured proforma was created using KoBo Toolbox for humanitarian response for data collection. Perceived Stress Scale (PSS-10) was used for measurement of stress among COVID-19 patients. The questionnaire was shared in online platform. Data was analyzed using Statistical Package for Social Sciences version 23.0. Significance of association was tested using chi square test and independent sample t test. Logistic regression was done to predict the factors associated with perceived stress. Results Out of the 147 study participants, 56.5% were females and 43.5% were males. Symptoms were present in 94 (63.9%) of patients. The mean age of the study participants was 26 (10.5) years. The mean PSS score was 17.5 (6.4). Among the cases under home isolation, 24.5% had low stress levels, 68% had moderate stress levels, and 7.5% had severe stress levels. Feeling of loneliness during home isolation (odds ratio [OR]: 4.7, 95% confidence interval [CI] [1.9-11.63], P = .008), presence of elderly or under-5 children in the same house (OR: 15.45, 95% CI [2.03-117.5], P = .001), and presence of cough ( P = .05) were found to be significantly associated with higher PSS scores. Age and sleep were negatively correlated with stress score. Conclusion One-third of the study participants had moderate to severe levels of perceived stress. Age, sleep hours, presence of cough, presence of under-5 children or elderly in the same house, and feeling of loneliness during home isolation were found to be significantly associated with high perceived stress level scores.
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