Participant recruitment into a community-based diabetes prevention trial in India: Learnings from the Kerala Diabetes Prevention Program.

Background: Data on participant recruitment into diabetes prevention trials are limited in low- and middle-income countries (LMICs). We aimed to provide a detailed analysis of participant recruitment into a community-based diabetes prevention trial in India. Methods: The Kerala Diabetes Prevention Program was conducted in 60 polling areas (electoral divisions) of the Neyyatinkara taluk (subdistrict) in Trivandrum district, Kerala state. Individuals (age 30-60 years) were screened with the Indian Diabetes Risk Score (IDRS) at their homes followed by an oral glucose tolerance test (OGTT) at community-based clinics. Individuals at high-risk of developing diabetes (IDRS score ≥60 and without diabetes on the OGTT) were recruited. Results: A total of 1007 participants (47.2% women) were recruited over nine months. Pilot testing, personal contact and telephone reminders from community volunteers, and gender matching of staff were effective recruitment strategies. The major recruitment challenges were: (1) during home visits, one-third of potential participants could not be contacted, as they were away for work; and (2) men participated less frequently in the OGTT screening than women (75.2% vs. 84.2%). For non-participation, lack of time (42.0%) was most commonly cited followed by 'I am already feeling healthy' (30.0%), personal reasons (24.0%) and 'no benefit to me or my family' (4.0%). An average of 17 h were spent to recruit one participant with a cost of US$23. The initial stage of screening and recruitment demanded higher time and costs. Conclusions: This study provides valuable information for future researchers planning to implement community-based diabetes prevention trials in India or other LMICs. Trial registration: Australia and New Zealand Clinical Trials Registry: ACTRN12611000262909

Digital Healthcare During Covid-19 Pandemic: Application and Regulatory Aspects of Telemedicine

The Indian healthcare sector faces many glitches and some of them are political and economic uncertainty, accessibility, the rising prevalence of chronic diseases and an ageing population. Owing to the skewed ratio of doctor to patient, a large part of the population is still underserved in health care. As a consequence, effective and equal delivery of health-care facilities has always been an issue. Telemedicine as an instrument for health care delivery has been developed for both convenient and specialised healthcare, especially for patients with limited access to standardised healthcare services in remote locations. Subsequently in the influx of the COVID-19 pandemic, telemedicine activities have ultimately got extreme significance in the global health situation. The Government of India has recently highlighted the problems in telemedicine by publishing effective guidelines to streamline the telemedicine practices. Similar to COVID-19, telemedicine had an influence in the past on reducing a variety of epidemic diseases such as SARS and MERS. On the other hand, there are many barriers which need to be addressed / resolved to realize its full potential. Nowadays, the challenges faced by telemedicine are no longer technological, but legal. The absence of clear laws for telemedicine registration, practise and virtual consultation in India serves as a disincentive for medical profession. Therefore, it is proposed that apart from the Telemedicine practice guidelines of India, 2020, Indian Government should introduce comprehensive medico-legal regulations to address the issues faced by telemedicine service users and providers

Differential impact of socioeconomic position across life on oral cancer risk in Kerala, India: An investigation of life-course models under a time-varying framework

Objectives The incidence of oral cancer has been rapidly increasing in India, calling for evidence contributing to a deeper understanding of its determinants. Although disadvantageous life‐course socioeconomic position (SEP) is independently associated with the risk of these cancers, the explanatory mechanisms remain unclear. Possible pathways may be better understood by testing which life‐course model most influences oral cancer risk. We estimated the association between life‐course SEP and oral cancer risk under three life‐course models: critical period, accumulation and social mobility. Methods We recruited incident oral cancer cases (N = 350) and controls (N = 371) frequency‐matched by age and sex from two main referral hospitals in Kozhikode, Kerala, India, between 2008 and 2012. We collected information on childhood (0‐16 years), early adulthood (17‐30 years) and late adulthood (above 30 years) SEP and behavioural factors along the life span using interviews and a life‐grid technique. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for the association between life‐course SEP and oral cancer risk using inverse probability weighted marginal structural models. Results Relative to an advantageous SEP in childhood and early adulthood, a disadvantageous SEP was associated with oral cancer risk [(OR = 2.76, 95% CI: 1.99, 3.81) and (OR = 1.84, 95% CI: 1.21, 2.79), respectively]. In addition, participants who were in a disadvantageous (vs advantageous) SEP during all three periods of life had an increased oral cancer risk (OR = 4.86, 95% CI: 2.61, 9.06). The childhood to early adulthood social mobility model and overall life‐course trajectories indicated strong influence of exposure to disadvantageous SEP in childhood on the risk for oral cancer. Conclusions Using novel approaches to existing methods, our study provides empirical evidence that disadvantageous childhood SEP is critical for oral cancer risk in this population from Kerala, India

Mandated Resistance, Embodied Shame: The Material and Affective Contours of a TESOL Method

This article examines how a purportedly local, postcolonial reform effort to resist center‐based methods is resisted by the students and teachers it seeks to serve. In this context, rather than take center and periphery for granted, the author attempts a processual geography of method. Drawing on data from a 19‐month ethnography in the Indian state of Kerala, the author first traces the materials production process and reifications of resistance to argue that method produces centers. Specifically, privileged actors rearranged the terms of recognition from literacy to orality to resist supposedly structural, behaviorist pedagogies but in effect mandated resistance to locally available literacy resources. Then, foregrounding the quality of classroom life (Kumaravadivelu, 2006a) under reform conditions, the author witnesses diverse regimes of shame. Kumaravadivelu (2006b) distinguishes methods (“established methods conceptualized and constructed by experts”) from methodologies (“what practicing teachers actually do in the classroom” to achieve their teaching objectives, p. 84). Because the material and affective registers of classroom life emerged as crucial domains of experience, the author attempts an intersectional analysis that foregrounds the material (Block, 2015; Ramanathan, 2008) in conjunction with that of the affective (Motha & Lin, 2013). Ethnographic attention to the “schema of agents, levels, and processes” (Ricento & Hornberger, 1996, p. 408) entailed in the production and consumption of a method illuminates the multiple and complex ways in which marginality is engendered and lived