Associations of the glycaemic index and the glycaemic load with risk of type 2 diabetes in 127 594 people from 20 countries (PURE): a prospective cohort study.

BACKGROUND: The association between the glycaemic index and the glycaemic load with type 2 diabetes incidence is controversial. We aimed to evaluate this association in an international cohort with diverse glycaemic index and glycaemic load diets. METHODS: The PURE study is a prospective cohort study of 127 594 adults aged 35-70 years from 20 high-income, middle-income, and low-income countries. Diet was assessed at baseline using country-specific validated food frequency questionnaires. The glycaemic index and the glycaemic load were estimated on the basis of the intake of seven categories of carbohydrate-containing foods. Participants were categorised into quintiles of glycaemic index and glycaemic load. The primary outcome was incident type 2 diabetes. Multivariable Cox Frailty models with random intercepts for study centre were used to calculate hazard ratios (HRs). FINDINGS: During a median follow-up of 11·8 years (IQR 9·0-13·0), 7326 (5·7%) incident cases of type 2 diabetes occurred. In multivariable adjusted analyses, a diet with a higher glycaemic index was significantly associated with a higher risk of diabetes (quintile 5 vs quintile 1; HR 1·15 [95% CI 1·03-1·29]). Participants in the highest quintile of the glycaemic load had a higher risk of incident type 2 diabetes compared with those in the lowest quintile (HR 1·21, 95% CI 1·06-1·37). The glycaemic index was more strongly associated with diabetes among individuals with a higher BMI (quintile 5 vs quintile 1; HR 1·23 [95% CI 1·08-1·41]) than those with a lower BMI (quintile 5 vs quintile 1; 1·10 [0·87-1·39]; p interaction=0·030). INTERPRETATION: Diets with a high glycaemic index and a high glycaemic load were associated with a higher risk of incident type 2 diabetes in a multinational cohort spanning five continents. Our findings suggest that consuming low glycaemic index and low glycaemic load diets might prevent the development of type 2 diabetes. FUNDING: Full funding sources are listed at the end of the Article.

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. Materials and Methods: Mortality data were obtained from the district COVID-19 control room, and deaths in the first and second waves of COVID-19 were compared. Statistical Analysis: We summarised data as proportions and medians with the inter-quartile range (IQR) and performed Chi-square tests to make comparisons wherever applicable. Results: As on 31 December 2021, 4587 COVID-19 deaths were reported in Thiruvananthapuram district, with a case fatality rate of 0.91%. We observed high mortality among older persons (66.7%) and men (56.6%). The leading cause of death was bronchopneumonia (60.6%). The majority (88.5%) had co-morbidities, commonly diabetes mellitus (54.9%). The median interval from diagnosis to hospitalisation was 4 days (IQR 2-7), and that from hospitalisation to death was 2 days (IQR 0-6). The deaths reported during the second wave were four times higher than those of the first wave with a higher proportion of deaths in the absence of co-morbidities (p < 0.001). The majority of the deceased were unvaccinated. Ecological analysis with vaccine coverage data indicated 5.4 times higher mortality among unvaccinated than those who received two vaccine doses. Conclusions: The presence of co-morbidities, an unvaccinated status, and delay in hospitalisation were important reasons for COVID-19 deaths. Primary level health providers can potentially help sustaining vaccination, expeditious referral, and monitoring of COVID-19 patients.

Psychosocial Intervention Model of Kerala, India During Pandemic COVID-19: "Ottakkalla Oppamundu (You're not alone, we're with you)".

Globally, the coronavirus disease 2019 (COVID-19) pandemic has resulted in several psychosocial manifestations across all socioeconomic strata. This study attempted to explore the details of a psychosocial support system implemented in Kerala, India, to address psychosocial issues during this pandemic. It employed a descriptive approach using qualitative and quantitative methods. The results can be summarized into 4 overarching themes: (1) process of implementation, (2) issues addressed, (3) experiences, and (4) success stories. This intervention targeted the whole population, with a specific focus on quarantined/isolated individuals and selected vulnerable groups. COVID pandemic has sowed several negative emotions, such as anxiety; and stigma and fearful thoughts, including suicidal ideations; trepidation regarding family members; and misinfodemics in general. Social and religious corollaries of the pandemic have intensified the psychological agony. The study provides an overview of the psychosocial intervention adopted by the state during the pandemic, which has helped both the beneficiaries and the providers. It has also helped to promote positive thinking and change the attitude toward the disease among the beneficiaries. It is highly commendable that timely intervention could obviate quite a few psychiatric emergencies, including suicides and aggressive behaviors. Considering its efficiency, flexibility, and sustainability, this model can be replicated in any setting.

Functioning of Arogyakiranam programme in Kerala: A qualitative study.

CONTEXT: Arogyakiranam program, a state-run health entitlement scheme, caters to health care needs of 0 to 18-year-old children, in government hospitals of Kerala. Very few studies have been conducted in this regard. AIM: An interim analysis of the functioning of this program through stakeholder perspective facilitates understanding the mode in which the program is currently progressing, thereby paving way for bettering it further. METHODS AND MATERIAL: A qualitative study in three purposively selected districts of Kerala consisting of in-depth interviews was conducted across different levels of stakeholders including officials from different health care levels and beneficiary caretakers who bring their wards to these centers. RESULTS: The functioning of the scheme with regard to implementation, fund flow, monitoring, documenting, reporting etc., was found to be following a fine structure. The scheme provides financial risk protection to the beneficiaries' families. Perceived challenges were lesser public awareness of the scheme, the requirement of an updated guideline, funds, the need for the availability of specialists and other amenities. Complete electronic hospital proceedings, a separate account for the scheme, staff reorientation/training, more reviews, and appraisals were emphasized. The overall functioning of the scheme is found to be streamlined and highly fruitful in terms of catering to the child population in the state. CONCLUSION: Arogyakiranam program has proven to be a boon to its beneficiaries with nil out-of-pocket expenditure, providing an array of health care amenities, ensuring equity thereby relentlessly working towards universal health coverage.

Risk Factors for Fall-Related Injuries Leading to Hospitalization Among Community-Dwelling Older Persons: A Hospital-Based Case-Control Study in Thiruvananthapuram, Kerala, India.

This study intended to identify the risk factors for injurious falls that led to hospitalization of older persons living in the community. A hospital-based unmatched incident case-control study was done among 251 cases and 250 controls admitted at a tertiary care centre in Kerala. Mean age of cases was 71.6 ± 9.13 years and that of controls was 67.02 ± 6.17 years. Hip fractures were the predominant injury following falls. Falls were mostly a result of intrinsic causes. After adjusting for other variabes, the risk factors for all injuries were age above 70 years (odds ratio [OR] = 2.25; 95% confidence interval [CI] = 1.46-3.46), previous fall history (OR = 2.76; 95% CI = 1.08-7.08), impaired vision (OR = 4.49; 95% CI = 2.77-7.30), not living with spouse (OR = 1.97; 95% CI = 1.31-2.97), door thresholds (OR = 1.52; 95% CI = 1.01-2.29), and slippery floor (OR = 2.37; 95% CI = 1.31-4.32). The risk factors for hip fractures and other injuries were identified separately. Fall prevention strategies among older persons are warranted in Kerala.