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The study explores the perspectives of college students on the pedagogical shift as well as frequent transitions between online and offline learning modes during the COVID-19 pandemic in Kerala, the most literate state in India.

A descriptive cross-sectional study was conducted among 1,366 college students in Kerala during December 2021. A pre-tested questionnaire was sent using Google Forms to students of arts and science colleges. The authors analyzed quantitative data using descriptive statistics and qualitative data using thematic content analysis.

The reported advantages of online learning were increased technical skill, flexibility in study time, effectiveness in bridging the gap of the missed academic period and provision of attending more educational webinars. Students expressed concerns of increased workload, difficulty in concentration due to family circumstances, academic incompetency, uncleared doubts and addiction to mobile phones and social media during the online classes. The main advantages reported for switching to an offline learning mode were enhanced social interaction, effective learning, better concentration and reduced stress. The reported challenges of offline classes were fear of getting the disease, concern of maintaining social distancing and difficulty in wearing masks during the classes. The shift in offline to online learning and vice versa was perceived as a difficult process for the students as it took a considerable time for them to adjust to the switching process of learning.

Students' concerns regarding transition between different learning modes provide important information to educators to better understand and support the needs of students during the pandemic situations.

Recent public health policy emphasizes the achievement of healthy aging as average life expectancy increases worldwide. Evidence for healthy aging from low- and middle-income countries (LMIC) is limited. The purpose of this paper is to assess the prospects of healthy aging and its associated factors in the Indian context.

The study was based on a national-level panel survey, the Indian Human Development Survey (IHDS) conducted in 2004-05 and 2011-12. The analytical sample consists of 10,218 elderly individuals who were 60 years old and above at the baseline. Change in health status was assessed based on disability and disease incidence at the follow-up. A generalized estimating equation (GEE) model was performed to assess health status change.

Increasing age was a risk factor for all dimensions of health outcomes. Elderly from the lowest wealth quintiles were more likely to lose health due to short-term morbidity, whereas the highest wealth quintiles were more likely to lose health due to long-term and multi-morbidity, indicating evidence for the presence of the “disease of affluence”. Social capital, such as living in a joint family acted as a protective factor against health risks.

With the results showing the evidence of the “disease of affluence” and “disease of poverty” in different health outcomes, there should be a health policy focus that copes with undergoing epidemiological transition. It is also important to pay attention to health-protecting factors such as social and familial support to achieve healthy aging.

The substantial increase in non-communicable diseases (NCDs) is considered a major threat to developing countries. According to various international organizations and researchers, Kerala is reputed to have the best health system in India. However, many economists and health-care experts have discussed the risks embedded in the asymmetrical developmental pattern of the state, considering its high health-care and human development index and low economic growth. This study, a scoping review, aims to explore four major health economic issues related to the Kerala health system.

A systematic review of the literature was performed using PRISMA to facilitate selection, sampling and analysis. Qualitative data were collected for thematic content analysis.

Chronic diseases in a significant proportion of the population, low compliance with emergency medical systems, high health-care costs and poor health insurance coverage were observed in the Kerala community.

The present study was undertaken to determine the scope for future research on Kerala's health system. Based on the study findings, a structured health economic survey is being conducted and is scheduled to be completed by 2021. In addition, the scope for future research on Kerala's health system includes: (1) research on pathways to address root causes of NCDs in the state, (2) determine socio-economic and health system factors that shape health-seeking behavior of the Kerala community, (3) evaluation of regional differences in health system performance within the state, (4) causes of high out-of-pocket expenditure within the state.

Given the internationally recognized standard of Kerala's vital statistics and health system, this review paper highlights some of the challenges encountered to elicit future research that contributes to the continuous development of health systems in Kerala.