Background: Vitamin K Antagonist (VKA) therapy has been extensively recommended for years to prevent thromboembolic disorders. The continued use of this treatment emphasizes its clinical importance across healthcare settings, particularly in resource-limited countries such as India. Chronic use of this therapy can impact patients’ QOL owing to treatment-related burden. Given that limited data are available related to the QOL of patients on VKA therapy at tertiary referral hospitals in the region, this study was undertaken. Methodology: This study is a cross-sectional analysis of baseline data obtained from a randomized controlled trial. These data were gathered using the QOL tool among 320 patients on VKA therapy. Results: The mean overall quality of life score was 14 ± 1.26. The highest mean scores were recorded in the social, economic, and family domains, whereas the lowest mean scores were noted in the psychological, spiritual, and health functioning domains. College/university education (β = 0.50, 95% CI: 0.10-0.90; p = 0.015) and the absence of comorbidities (β = 0.40, 95% CI: 0.11-0.69; p = 0.007) were significantly associated with better QoL. Conclusions: The findings from this single-center, cross-sectional analysis highlight the significance of considering comorbidities and education when evaluating patients on VKA therapy.
Introduction: Oral potentially malignant disorders (OPMDs) are important precursors of oral cancer and are strongly associated with tobacco use. Evidence on OPMDs among tribal populations in India remains limited. This study estimated the prevalence and clinical distribution of OPMDs among Malayali tribal tobacco users in Yelagiri Hills, Tamil Nadu, and examined associated tobacco-use characteristics. Methods: A community-based cross-sectional study was conducted among 240 current tobacco users aged ≥18 years. Data on sociodemographic characteristics and tobacco-use behaviours were collected using a structured questionnaire. Clinical oral examinations were performed according to WHO criteria for OPMD diagnosis. Factors associated with OPMD were assessed using multivariable logistic regression. Results: The mean age was 45.7 ± 18.9 years and 92.9% were male. Smoking-only tobacco use was reported by 57.9%, smokeless-tobacco use by 38.8%, and dual use by 3.3%. Overall OPMD prevalence was 60.0% (95% CI: 53.7-66.0), with oral leukoplakia being the most common lesion (37.1%). Tobacco-use duration exceeding 10 years was independently associated with OPMD presence (aOR: 8.98; 95% CI: 3.75-21.48; p<0.001). Conclusion: A high burden of OPMDs was observed among Malayali tribal tobacco users and was associated with prolonged tobacco exposure. Community-based oral cancer screening and culturally appropriate tobacco-cessation interventions are urgently needed in tribal populations.
Background: Managing caregiving complexities for palliative care patients poses significant challenges, especially within the community-based “Kerala Model” in Calicut, North Kerala, India. This qualitative study explores the lived experiences, unmet needs, coping strategies, and quality of life of family caregivers in this context. Methods: A qualitative descriptive study was conducted using purposive sampling. Three focus group discussions (FGDs) involving 24 primary family caregivers were conducted at two palliative care centres. Data were transcribed verbatim and thematically analysed using Braun and Clarke’s six-phase framework. Trustworthiness was enhanced through peer debriefing, reflexive journaling, and member checking. Results: Among 24 caregivers, 15 (62.5%) were female and 9 (37.5%) males. Spouses (10, 41.7%) and children (9, 37.5%) constituted the majority of caregivers. Six interconnected themes emerged: caregiving competencies, caregiver well-being, social and relational factors, support systems, end-of-life care, and criticism. Caregivers reported inadequate training, emotional and physical exhaustion, social isolation, financial strain, limited practical and psychological support, end-of-life decision-making challenges, and distress related to criticism. Most had provided care for 1-2 years (8, 33.3%), while 7 (29.2%) had provided care for 6 months-1 year. Conclusion: Family caregivers experience multidimensional burdens within Kerala’s community-based palliative care model. Contextually appropriate caregiver training, psychological support, financial assistance, and respite services are needed to strengthen caregiver well-being and coping.
Background: Rising use of personal listening devices and prolonged exposure to environmental noise have made hearing impairment an emerging concern among young adults, including college students. Data on its burden in this group, particularly using mobile-based screening tools, remain limited in Kerala. Objectives: To determine the prevalence and associated factors of likely hearing impairment among undiagnosed college students at a tertiary care hospital in North Kerala, and to confirm hearing loss among screen-positive individuals using Pure Tone Audiometry (PTA). Methods: This cross-sectional study enrolled 307 students from MBBS, nursing, and allied health science programs. Hearing status was assessed using the WHO-validated hearWHO application, with scores below 50 triggering referrals for ENT evaluation and PTA. Associated factors were analyzed using Chi-square tests and logistic regression. Results: Participants had a mean age of 21.26 ± 1.6 years, with females comprising 76.2% of the sample. Screening identified 5.9% with likely hearing impairment, 83.7% requiring monitoring (scores 50–75), and 10.4% with good hearing. PTA confirmed hearing loss in 1.6% (n=5) of participants. Earphone use exceeding recommended volume levels was common. Conclusion: These findings highlight a measurable burden of hearing impairment among college students, underscoring the need for periodic screening, particularly for those in the monitoring range, and awareness initiatives promoting safer listening practices and app-based screening tools.
Introduction: Diabetes mellitus represents a significant public health issue and is one of the leading noncommunicable diseases in our country. Diabetes imposes a substantial financial burden due to its chronic nature and complications. The objective was to assess the annual expenditure incurred for diabetes care among the individuals with diabetes and to compare the expenditure pattern among diabetes individuals residing in urban and rural area populations in Puducherry. Methodology: A community-based analytical cross-sectional study was conducted in the field practice areas affiliated with a medical college. A total 566 participants (283 urban and 283 rural) were selected using multistage random sampling. Data were collected using a pretested semi-structured questionnaire. Statistical analysis was performed by entering the data into Microsoft Excel and subsequently analysing it using SPSS version 22. Results: The median overall total annual cost incurred by the respondents for management of diabetes was found to be Rs. 11225 (IQR 3625-22820). Direct cost accounted for >90% of total expenditure, with medications contributing the most (median ₹10,410). Rural participants incurred higher medication and hospitalisation costs, whereas urban participants had higher investigation and indirect costs. Higher family income, longer diabetes duration, and comorbidities were significantly associated with higher direct healthcare costs. Conclusions: The median overall total annual cost incurred by the respondents for management of diabetes was found to be Rs. 11225 (IQR 3625-22820). Direct cost accounted for >90% of total expenditure. Catastrophic health expenditure was higher among rural participants (39.2%) than urban participants (27.5%; p = 0.002).
Background: Maternal health is crucial for family and community well-being, yet high-risk pregnancies are common in India. Economic hardship, limited education, and insufficient social support increase complication risk. The purpose was to estimate the prevalence of high-risk pregnancies and to assess the association of social determinants of health with high-risk pregnancy in Belagavi district Methodology: A cross-sectional investigation was carried out from April to September 2025 in Belagavi district among 456 first-trimester pregnant women. High-risk pregnancy was defined as ≥1 pre-existing maternal, obstetric, or medical risk factor. Data on sociodemographic, social determinants of health, and obstetric history were collected, and associations with high-risk pregnancy were analysed using chi-square methods and multivariable logistic regression. Results: High-risk pregnancies accounted for 52.4%; financial strain, food insecurity, unreliable transportation, and moderate perceived safety were associated with higher risk. Independent predictors included professional/administrative household-head occupation, associated with lower odds (AOR = 0.067, 95% CI: 0.005-0.943); upper middle-class status (AOR = 5.13, 95% CI: 1.43-18.43); and moderate safety perception (AOR = 1.60, 95% CI: 1.03-2.46), both associated with higher odds. Conclusions: Household head occupation, economic status, and perceived safety were associated with pregnancy risk. Financial stability, healthcare access, and safer environments may be associated with lower high-risk pregnancy.
Background: The long-term impacts of Coronavirus Disease 2019 (COVID-19) may adversely affect survivors’ quality of life (QoL), particularly in low-resource settings. The objective was to identify factors associated with quality of life among COVID-19 survivors in the Northeast of Thailand. Methods: A cross-sectional study was conducted among 1,250 COVID-19 survivors selected using multistage sampling. Data were collected using structured questionnaires assessing sociodemographic characteristics, physical activity, COVID-19 prevention behavior, health literacy, COVID-19 knowledge, stress, healthcare and social support, and QoL measured by the WHOQOL-BREF-THAI. Generalized Linear Mixed Models (GLMM) with province-level random effects were used to identify factors associated with good QoL. Results: Overall, 34.56% of participants reported good QoL. Male gender (AOR = 1.64, 95% CI: 1.18-2.29), age <35 years (AOR = 1.71, 95% CI: 1.01-2.89), bachelor’s degree education (AOR = 1.92, 95% CI: 1.08-3.43), government employment (AOR = 2.11, 95% CI: 1.18-3.79), higher income, absence of comorbidities (AOR = 1.72, 95% CI: 1.28-2.31), good physical activity (AOR = 3.42, 95% CI: 1.71-6.84), excellent health literacy (AOR = 4.38, 95% CI: 2.89-6.65), high COVID-19 knowledge (AOR = 1.78, 95% CI: 1.16-2.74), mild-to-moderate stress, and high healthcare and social support (AOR = 1.96, 95% CI: 1.19-3.23) were significantly associated with good QoL. Conclusion: QoL among COVID-19 survivors is shaped by behavioral, cognitive, and psychosocial determinants. Public health interventions should prioritize health literacy enhancement, stress reduction, and strengthening community support systems.
Background: Public health expenditure plays an important role in strengthening health-system capacity and preparedness during public health emergencies. This study examined the association between public health expenditure and COVID-19 management outcomes across Indian states. Methods: An ecological cross-sectional study was conducted using secondary data from 29 Indian states during the first wave of the COVID-19 pandemic. COVID-19 data were obtained from the MyGov India COVID-19 Dashboard, while public health expenditure and other variables were sourced from government databases. The primary exposure variable was the average share of public health expenditure in total state expenditure during 2009-2018. Pearson correlation analysis assessed associations with health infrastructure, and ordinary least squares regression examined associations with COVID-19 deaths per 100 confirmed cases and COVID-19 tests per million population, adjusting for per capita NSDP and, in separate models, population density and the proportion of the population aged 60 years and above. Results: Higher public health expenditure was associated with lower population served per public health institution and greater availability of government doctors and hospital beds. It was also significantly associated with lower COVID-19 deaths per 100 confirmed cases (β = -0.42; 95% CI: -0.83, -0.06; p = 0.04) and higher COVID-19 testing rates per million population (β = 6496; 95% CI: 511, 12481; p = 0.04). Conclusion: Sustained public investment in health may strengthen health-system preparedness and resilience during public health emergencies.
Background: Microlearning delivers content in short, focused units and is increasingly used in medical education, but consolidated quantitative evidence for undergraduate training remains limited. This systematic review and meta-analysis evaluated the impact of microlearning on knowledge, skills, and retention among undergraduate medical students. Methods: A comprehensive literature search spanning PubMed, Scopus, Web of Science, and Google Scholar were conducted from database inception through January 2025. The inclusion criteria covered experimental research comparing microlearning methods against conventional instructional techniques among undergraduate medical students. Although the review protocol lacked prospective registration, study quality was appraised using RoB 2 and ROBINS-I tools. Hedges' g standardized mean differences (SMD) were aggregated via a restricted maximum likelihood (REML) random-effects model. Results: A total of seven studies encompassing 1,674 learners comprising two randomized controlled trials and five quasi-experimental or non-randomized investigations met the selection criteria. Microlearning delivered a statistically significant enhancement in learner outcomes compared to traditional education (SMD = 0.90; 95% CI: 0.57-1.22; p <0.001), accompanied by substantial heterogeneity (I² = 82.0%). These pooled estimates remained stable across leave-one-out sensitivity evaluations and trim-and-fill procedures, which indicated zero imputed studies. Furthermore, publication bias assessments via Egger's (p = 0.76) and Begg's (p = 1.00) tests yielded non-significant outcomes. Based on GRADE criteria, the overall certainty of the evidence was rated as moderate. Conclusion: Microlearning probably enhances knowledge acquisition, skill development, and retention in undergraduate medical education. Further well-designed randomized trials are needed.
Background: Diabetic retinopathy (DR) is an avoidable cause of sight loss among adults whose type 2 diabetes mellitus (T2DM) is poorly controlled. Despite Thailand’s subsidised retinal-screening programme, uptake among rural older adults remains suboptimal. The objectives were to describe DR warning-sign awareness (WSAS) and Health Belief Model (HBM) construct scores, and to identify independent correlates of behavioural response to DR warning signs (WSBRS) after adjustment for sociodemographic covariates. Methods: This cross-sectional study enrolled 218 older adults (aged ≥60 years; HbA1c ≥7.0%) attending sub-district diabetes clinics in Mahasarakham Province, Thailand. Structured interviews assessed six HBM constructs, WSAS, and WSBRS on validated five-point Likert scales (Cronbach’s α 0.76-0.88). For regression, HBM constructs were aggregated into two composites (Health Perception, HPC; Prevention-Action, PAC). Two-block hierarchical linear regression modelled WSBRS on eight predictors. Results: Among 218 participants (mean age 67.8±6.4 years; 68.3% female), 42.7% had never undergone retinal examination. WSAS was moderate (3.42±0.58); WSBRS moderate (2.87±0.74). The full model explained 42.9% of variance (ΔR²=0.315; f²=0.751). WSAS (β=0.289), PAC (β=0.275), and HPC (β=0.215) were independently associated with WSBRS (all p≤0.001). Conclusions: Warning-sign awareness, prevention-oriented beliefs, and self-efficacy were independently associated with behavioural responses. Community nursing interventions targeting these constructs warrant prospective evaluation.
Background: Obstructive sleep apnea is a frequently overlooked sleep disorder associated with cardiovascular and metabolic morbidity that often remains underrecognized in routine clinical practice, making early risk assessment important. The objective was to assess OSA risk among adults using the STOP-BANG questionnaire (SBQ) and examine its association with selected sociodemographic and lifestyle factors. Methods: A cross-sectional study was conducted among 187 adults attending a tertiary care hospital in Eastern India, from September to November 2025. Participants were selected using systematic random sampling. OSA risk was assessed using the STOP-BANG questionnaire. Data were analyzed using descriptive statistics, Chi-square test and multivariable logistic regression. Results: The mean age of participants was 44.8 ± 17.5 years. Based on STOP-BANG scores, 14.4% were classified as high risk, 38.5% as moderate risk and 47.1% as low risk for OSA. Smoking and alcohol consumption were significantly associated with elevated OSA risk in bivariate analysis. However, after multivariable adjustment smoking remained independently associated with elevated OSA risk (AOR = 4.25; 95% CI: 2.09-8.66; p <0.001). Conclusion: More than half of the participants were identified as being at moderate to high risk for OSA using the STOP-BANG questionnaire. Further studies using representative populations and confirmatory diagnostic methods are needed.
Background: Caregivers of patients with schizophrenia experience substantial psychosocial burden and impaired Quality-of-life (QoL). Family-Based Interventions (FBIs) may improve caregiver outcomes. The objective was to examine the impact of a Family-Based Intervention on the quality of life of caregivers of patients with schizophrenia. Methods: A two-arm, parallel-group randomized controlled trial was conducted among 84 caregivers recruited from two tertiary care hospitals in Kochi, between October 2024 and March 2025. The experimental group received a Family-Based Intervention, while the control group received routine treatment and care. Caregivers’ quality of life was assessed using the Adult Carer Quality-of-life (AC-QoL) questionnaire at baseline and post-intervention. Data were analyzed using IBM SPSS Statistics version 27.0. Results: Baseline QoL scores were comparable between groups (experimental: 61.3 ± 14.8, control: 63.5 ± 12.2; p = 0.459). Post-intervention, the experimental group demonstrated significantly higher QoL than the control group (87.9 ± 9.7 vs 62.8 ± 11.5; t=10.81, p <0.001; Cohen’s d=2.36). Significant improvements were observed across all QoL domains. Although baseline differences were observed in duration of caregiving and family history of psychiatric illness, the intervention effect remained significant after adjustment for baseline QoL. Conclusion: The Family-Based Intervention significantly improved caregivers’ QoL, supporting its use as an adjunct to routine psychiatric care, while acknowledging that the large effect size reflects findings from a single district study.
Background: Cervical abrasion, a non-carious lesion typically associated with adults, is increasingly observed in adolescents due to changing oral hygiene habits. In South India, limited community-based data exist on its prevalence and determinants. Objective: To assess the prevalence of cervical abrasion and investigate independent behavioural and clinical variables among school-going adolescents in Puducherry, India. Methods: An analytical cross-sectional study was carried among 320 adolescents from grades 8 to 12 in Puducherry, India, between January to June 2025. Standardized clinical examination was done. Data on oral hygiene practices and systemic conditions were collected using a structured questionnaire. Bivariate analysis and multivariable binary logistic regression were performed. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Results: Cervical abrasion was observed in 97 participants, yielding a prevalence of 30.3%. In multivariable analysis, aggressive toothbrushing (AOR = 5.08; 95% CI: 2.76-9.35), use of abrasive toothpaste (AOR = 6.62; 95% CI: 3.35-13.08), pica (AOR = 8.93; 95% CI: 2.82-28.24), and acid-peptic disorders (AOR = 3.61; 95% CI: 1.24-10.55) were identified as independent determinants. Sex and nail-biting did not retain statistical significance. Conclusion: Early identification and targeted preventive strategies during adolescence may reduce the long-term burden of non-carious cervical lesions.
Background: Food and nutrition literacy (FNL) is an important determinant of healthy dietary behaviors among adolescents. This study examined the relationship between FNL and dietary consumption behaviors among lower secondary school students in Samut Songkhram Province, Thailand. Methods: A cross-sectional survey was conducted among 584 Grade 7-9 students selected through multistage sampling from six schools between July and November 2025. Data were collected using validated questionnaires assessing FNL (functional, interactive, and critical domains) and dietary consumption behaviors. Descriptive statistics, Pearson’s correlation, t-tests, and multiple linear regression analyses were performed. Results: Participants demonstrated a moderate overall level of FNL (mean=3.04±0.48), while dietary consumption behaviors were low (mean=2.16±0.16). Overall FNL was positively correlated with dietary behaviors (r=0.509, p<0.001). Functional (r=0.250), interactive (r=0.155), and critical literacy (r=0.206) were also significantly associated with dietary behaviors (all p<0.001). Multiple regression identified FNL (β=0.502, p<0.001) as the strongest predictor of dietary behaviors, with gender also significant (β=0.149, p<0.001). The model explained 29.7% of the variance in dietary behaviors (R²=0.297). Female students reported significantly higher FNL and healthier dietary behaviors than males. Conclusions: Food and nutrition literacy is strongly associated with healthier dietary behaviors among adolescents. Interventions strengthening nutrition literacy, particularly interactive and critical skills, may improve dietary practices.
Background: The time between marriage and the first childbirth affects population composition, fertility dynamics, maternal and child health, and population policy. This study examines distribution of FBI among Indian women considering its sociodemographic variables. The analysis employs the parameters Mode and Median to study the positive skewed outcome distributions. Statistical Methods: The distribution of FBI in the sociodemographic variables of Indian women with one child during survey was taken into consideration. The National Family Health Survey-4 is the source of the data. Using the median and mode as distributional parameters, a "Modified exponential model" was developed to assess the degree of FBI skewness across important sociodemographic variables. Log-rank test was used to check the significancy of FBI across maternal sociodemographic variables. Results: Within 32 months of marriage, 60% of women gave birth to their first child. With a mode of 10 months, the overall median FBI was 28 months. With skewed parameters Mode and Median, the proposed exponential model explained 81.7% variation in the FBI (p<0.001) using age at marriage, place of residence, religion, educational attainment, wealth index, BMI, thyroid disorder status, use of any form of contraception and history of pregnancy termination as significant predictors. Conclusion: The modified exponential model can assist health care providers and stakeholders in deciding on a treatment strategy and plan of action to start a woman's reproductive life by indicating expected FBI and skewness. This model can enhance fertility trends in certain socio-demographic, cultural, educational, and geographical female population groups in India.
Cost-effectiveness analysis (CEA), most often implemented as cost-utility analysis (CUA) using the quality-adjusted life-year (QALY), and cost-benefit analysis (CBA) are frequently presented as alternative, competing frameworks for health resource allocation, distinguished primarily by whether health outcomes are expressed in natural/utility units or monetised. This review argues that this framing, while pedagogically convenient, obscures a more important and less settled set of questions that determine whether either framework produces decision-relevant results: how the cost-effectiveness threshold (or, equivalently, the shadow price of health) should be derived; whose costs, benefits, and preferences should count; how the distribution - not merely the sum - of costs and effects across the population should be valued; and how parameter uncertainty should influence both the decision and the research agenda that follows it. After briefly establishing the conceptual core shared by CEA and CBA through the net-benefit framework, this review provides a critical synthesis of four areas of active methodological development: the opportunity-cost-based threshold debate; distributional cost-effectiveness analysis (DCEA); extended cost-effectiveness analysis (ECEA) and its cross-sectoral CBA-like extensions; and value-of-information (VOI) analysis as a link between economic evaluation and research prioritisation. Multi-criteria decision analysis (MCDA) is discussed as a complementary, non-aggregative alternative where a single threshold-based metric is contested or unavailable. Each of these developments is illustrated with a detailed published case study - the UK Bowel Cancer Screening Programme (DCEA), HPV vaccination financing in China and rotavirus vaccination in Ethiopia and India (ECEA), and the empirical re-estimation of the NICE cost-effectiveness threshold (the threshold debate) - chosen because each demonstrates a setting in which the conclusions of an evaluation change materially depending on which of these methodological extensions is applied. The review closes with practical guidance for researchers on selecting and combining these frameworks, and identifies open questions that remain unresolved in the literature.
Background: Walking is a simple, accessible form of physical activity recommended for glycemic control in type 2 diabetes mellitus (T2DM). Evidence on its immediate metabolic effects in community settings remains limited. The study was conducted to assess the immediate effects of a single walking session on anthropometric, physiological, and biochemical parameters among adults with T2DM. Methods: A community-based quasi-experimental pre–post study was conducted among 108 adults with T2DM in Puri district, Odisha, India. Participants completed a supervised 1.2-km moderate-intensity walk after overnight fasting. Body weight, blood pressure, fasting blood glucose, and lipid profile were measured before and after the intervention. Paired and independent sample t-tests were used for analysis at a 5% significance level. Results: Following walking, significant reductions were observed in body weight, systolic and diastolic blood pressure, blood glucose, total cholesterol, triglycerides, LDL, and VLDL levels, while HDL increased significantly (all p<0.05). Blood glucose declined from 180.2±45.0 to 168.6±41.8 mg/dL. Improvements were comparable across sex and age groups, with no significant between-group differences. Effect sizes were generally small, indicating modest but consistent acute benefits. Conclusions: A single session of moderate-intensity walking produced immediate improvements in glycemic, cardiovascular, and lipid parameters among adults with T2DM. Walking represents a practical, low-cost strategy that can support diabetes self-management and cardiometabolic health.
Background: Intention to quit smoking is an essential precursor to cessation. Although Protection Motivation Theory (PMT) explains smoking behavior, its link to cessation intention among Thai youth remains under-researched. This study examined university students' smoking cessation intentions and its association with PMT constructs. Methodology: A mixed-methods study was conducted among 1,493 student smokers from six universities in Northeast Thailand (August 2024 - January 2025) using multistage sampling. Data were collected via self-administered questionnaires and in-depth interviews with 15 purposively selected smokers. Quantitative data were analyzed using multivariable logistic regression, while qualitative data underwent descriptive content analysis. Results: Quantitatively, 48.9% of participants intended to quit. Stronger intentions were significantly associated with higher perceived severity, vulnerability, self-efficacy, and response efficacy. Conversely, intrinsic/extrinsic rewards and response costs were inversely associated with intention. Qualitative findings corroborated that awareness of smoking’s harm and high self-efficacy bolstered quitting confidence. However, perceived positive effects, habitual use, social exposure to smokers, and limited information on cessation services acted as significant barriers. Conclusions: PMT plays a significantly influential role in shaping quitting intentions. Consequently, these factors should be integrated into cessation interventions such as tailored educational programs to enhance service accessibility and strengthen the resolve to quit among youth.
Background: Fear of falling (FOF) is a major issue for older adults, significantly increasing their risk of falling. Few studies have explored this topic in urban areas of Thailand. This current study was aimed at assessing the prevalence of FOF and identifying factors associated with FOF among community-dwelling older adults. Methods: A cross-sectional study was conducted among 350 older adults aged ≥ 60 years in Ban Ped Sub-district, Khon Kaen, Thailand. Participants were sampled using systematic sampling. FOF was assessed using the Thai Falls Efficacy Scale-International (Thai FES-I), with FOF defined as a score ≥ 22. Univariable and multivariable logistic regression analyses were performed to identify factors associated with FOF. Results: FOF prevalence was 54% (95% CI: 48.91-59.59). High frequency items for FOF were walking on a slippery surface and walking up or down a slope. Four factors were found to be significantly associated with FOF: the female gender (AOR=2.88; 95% CI: 1.57-5.31), age ≥ 80 years (AOR=3.57; 95% CI: 1.23-10.37), a history of falls (AOR=2.10; 95% CI: 1.04-4.23), and nocturnal awakenings (AOR=3.37; 95% CI: 1.97-5.76). Conclusion: More than half of older adults experienced FOF. Female gender, advanced age, a history of falls, and nocturnal awakenings were significantly associated with FOF. Interventions should prioritize high-risk groups, particularly by addressing modifiable factors, such as nocturnal awakenings through sleep hygiene programs, nocturnal toileting management, and referral pathways to see specialist physicians for older adults with sleep disorders.
Background: Poor adherence to prescribed medication contributes to uncontrolled hypertension and increases the risk of stroke, myocardial infarction, renal failure, heart failure, and blindness, creating a major burden on healthcare systems. The objective was to estimate the prevalence of antihypertensive medication non-adherence among hypertensive patients in urban Tirupati and to identify factors associated with non-adherence. Methods: This was a community-based cross-sectional study that included 280 patients with known and diagnosed hypertension who had been on antihypertensive medication for a minimum of 6 months and resided in urban areas of Tirupati. Medication adherence was assessed through the eight-item Morisky Medication Adherence Scale (MMAS-8). Data regarding sociodemographic characteristics, health-related factors, and other psychological and social elements were collected. Results: Among 280 hypertensive patients, 4.6% showed poor adherence, 6.4% moderate adherence, and 88.9% high adherence to anti-hypertensive medication. Lack of awareness about complications increased the odds of non-adherence by 4.7 times (AOR 4.696; 95% CI 1.318-16.725), while tobacco users had 3.5 times higher odds of non-adherence (AOR 3.487; 95% CI 1.216-10.004). Conclusions: Most hypertensive patients showed high adherence to treatment, with 11.1% being non-adherent. Non-adherence was significantly higher among those unaware of complications of uncontrolled hypertension and those using tobacco.
