Loneliness among parents whose adult children have migrated abroad is associated with higher psychological distress, difficulties in regulating emotions and problematic series watching, an exploratory study by researchers from NIMHANS has found.

The findings assume relevance on World Mental Health Day, observed on October 10, which draws attention to mental health and the need to address psychological well-being. The study highlights the emotional challenges that parents may experience when their children settle abroad and everyday family interactions become less frequent.

Why do some people feel lonely even when they are loved?

64 ‘empty-nest’ parents

Published in BMC Research Notes, the study examined 64 ‘empty-nest’ parents aged between 45 and 65, whose adult children had emigrated and lived away from home for at least two years. The sample comprised 30 fathers and 34 mothers from different families in Karnataka, Haryana and Punjab. Most belonged to middle socioeconomic backgrounds and nuclear families, and more than half had been in the empty-nest phase for over five years.

Rajesh Kumar, associate professor in the department of clinical psychology at NIMHANS and the corresponding author of the study, said the findings highlighted the relationship between loneliness and emotional well-being among parents adjusting to life without their children at home.

“We found a significant association between loneliness and psychological distress. Loneliness was also associated with difficulties in emotion regulation and problematic series watching, which refers to excessive or difficult-to-control viewing that interferes with everyday functioning. This also resulted in the risk of developing non-communicable diseases (NCDs),” he said.

Loneliness significantly predicted psychological distress even after accounting for age and gender. Of the 64 participants, 22 (34.3%) were classified as having higher levels of loneliness, while 42 (65.7%) fell into the lower-loneliness group. Those reporting higher loneliness also reported greater psychological distress, more difficulties in regulating emotions and higher levels of problematic series watching, Mr. Kumar said.

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Social changes

Manoj Kumar Sharma, professor in the department of clinical psychology at NIMHANS and head of its SHUT Clinic, said the findings needed to be understood in the context of the emotional and social changes that parents may experience when their children settle abroad.

Dr. Sharma, who is one of the authors, cautioned that the study did not establish that loneliness causes psychological distress or excessive series watching. As it was cross-sectional, it could identify associations but not determine the direction of the relationships, he said.

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Mothers reported greater loneliness

Women in the study reported significantly higher levels of loneliness and psychological distress than men.

The researchers said that this was consistent with earlier research suggesting that mothers may experience greater emotional difficulties during the empty-nest phase, potentially reflecting their involvement in caregiving and emotional relationships with their children.

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Possible coping mechanism

The researchers said digital media and streaming services could provide an easily accessible form of solitary leisure for parents experiencing less day-to-day interaction with their children.

However, the study did not examine why participants watched series or whether they used viewing deliberately to cope with loneliness or negative emotions. The researchers cautioned against assuming that excessive viewing was necessarily a coping response.

Other factors that could influence media use include social support, physical mobility, retirement, living arrangements, marital relationships, the frequency and quality of communication with adult children, and access to technology.

The loneliness epidemic

Social and psychological support

The findings underline the need to pay greater attention to the emotional well-being of parents whose children migrate abroad, as changing family structures and international migration can reduce opportunities for regular face-to-face interaction, Dr. Sharma said.

The authors said interventions to strengthen social connectedness, promote adaptive emotion-regulation strategies and encourage healthier technology use could potentially help parents navigate the empty-nest transition.

There were days when Dr. Koyyala Ruth John Paul struggled to find food. Estranged from her family after coming out as a transgender woman, she spent years trying to make ends meet, searching for jobs while refusing to give up on her dream of becoming a doctor. When the path to postgraduate medical education was blocked by the absence of clear admission procedures for transgender candidates, she turned to the courts.

On Saturday (October 10, 2026) her perseverance culminated in a milestone. Dr. Ruth John Paul cleared all subjects in the recently announced MD/MS examination results, completing her postgraduate degree in Emergency Medicine at the ESIC Medical College and Hospital in Sanathnagar, Hyderabad, where she studied during the 2023-26 academic session. She has become the first transgender person in India to complete a postgraduate medical course. “I am feeling very happy. It is a matter of pride for me and my community. It is a great achievement in my life,” she said.

A childhood marked by loss

The youngest of three siblings, Dr. Ruth John Paul hails from Khammam district and grew up in a family with limited financial means. She lost her father when she was eight years old and was raised by her mother. She completed her schooling and intermediate education in her native district before clearing the National Eligibility-cum-Entrance Test (NEET) and pursuing undergraduate medical education. She came out as a transgender woman during her undergraduate years. This led to her family rejecting her, leaving her separated from them for nearly six years.

The period that followed was marked by financial insecurity and the struggle to survive independently. “There were times when I did not even have food. I struggled to survive and looked for jobs,” she said.

In 2021, she found part-time work at Mitr Clinic (now Sabrang Clinic), which is India’s first transgender clinic. She worked there for around two years while continuing to prepare for postgraduate medical entrance examinations.

A legal battle to pursue her dream

Clearing the entrance examination was not the end of her struggle. Dr. Ruth John Paul said she encountered difficulties during postgraduate medical counselling because there were no clear protocols for accommodating transgender candidates.

With the assistance of transgender rights activist Vyjayanti Vasanta Mogli, she approached the Telangana High Court seeking relief. The legal proceedings continued for nearly two years. An interim order from the High Court eventually enabled her to proceed with admission. In 2023, she secured a seat in Emergency Medicine at ESIC Medical College and Hospital in Sanathnagar.

Her admission marked a turning point, but the challenges did not end there. She said she continued to encounter stigma and apprehension from people who were unfamiliar with transgender individuals.

From apprehension to acceptance

Working in a clinical environment brought its own challenges. As an emergency medicine trainee, she had to interact with patients during some of their most vulnerable moments, while also navigating the prejudices that transgender people can face. She recalled how some people were initially hesitant or uncomfortable around her. “Initially, some people were scared and did not know how to respond. But when I interacted with patients and treated them with care, they began to appreciate me. People who were initially apprehensive have now become comfortable with me,” she said.

A doctor with a larger purpose

Now that she has completed her postgraduate course, Dr. Ruth John Paul wants to use her medical training to help people in need, particularly transgender individuals who require emergency and critical care. “I want to serve everyone, especially transgender people who face critical medical emergencies. I want to provide care without discrimination based on gender identity or sexuality,” she said.

Food safety inspections in Kozhikode district have resulted in fines over ₹16 lakh against eateries over the past three months, with officials detecting violations including unhygienic food preparation, storage of stale ingredients and failure to follow basic hygiene requirements.

The aggressive inspections mostly covered hotels, bakeries, wayside eateries and other local food establishments. The action comes amid directions from the Food Safety Department requiring food handlers to wear gloves and hair caps while preparing and serving food.

Officials have also exposed food being prepared in unhygienic vessels and with corroded equipment, as well as food sold in areas where contaminated water accumulates. Poor handling practices have also been found to increase the risk of contamination by bacteria such as E. coli and Salmonella, which can cause serious illness.

“A recent inspection at a food establishment near Malabar Christian College in the city found food items that had reportedly been stored for several days. The items included stale curries, spices, spice mixes, fruits, vegetables, bread and chapatis,” said an official who was part of the inspection. He said similar violations were detected during recent inspections at the Beach Food Street in which one outlet was ordered to shut down, while six others were served notices.

According to the Food Safety Department squads, the inspections are being conducted as part of ‘Operation Thelima’, a special drive launched by the State government across the State. Six mobile squads have been deployed for checking violation on a regular basis and initiate instant action.

Officials make it clear that under the Food Safety and Standards Act, penalties vary according to the nature of the violation. The reported provisions include fines of ₹1 lakh to ₹5 lakh for supplying food that does not meet prescribed standards and penalties for unhygienic food preparation, misleading advertisements, adulteration and operating without a valid licence or registration. More serious offences involving food poisoning or death may attract imprisonment and fines, depending on the circumstances and applicable provisions, they warn.

Priya (name changed), 32, from Kerala, had been struggling with recurring episodes of depression that affected her ability to carry out everyday activities. Despite taking medication for several weeks, she continued to experience symptoms. With her symptoms persisting, she sought further medical advice and is now undergoing repetitive transcranial magnetic stimulation (rTMS). This non-invasive procedure uses magnetic pulses to stimulate specific areas of the brain.

Priya’s experience reveals a challenge in managing depression, say experts. While antidepressants help many people, some continue to experience symptoms despite treatment, requiring doctors to reassess the diagnosis and consider other interventions.

Karnataka has urged the Centre to extend price-control measures beyond cancer medicines to other high-cost, life-saving drugs used to treat cardiac and kidney diseases, following the National Pharmaceutical Pricing Authority’s (NPPA) in-principle approval to cap trade margins on certain non-scheduled anti-cancer medicines at 30% of their maximum retail price (MRP).

Addressing presspersons in Bengaluru, Health Minister U.T. Khader said price rationalisation should translate into direct savings for patients, and urged the Union government to extend similar measures to other essential medicines where high treatment costs place a burden on patients.

Cancer, kidney, AIDS drugs sold at up to 70 times procurement cost: Karnataka Health Minister

At its meeting on October 8, the NPPA gave in-principle approval to rationalise trade margins on non-scheduled anti-cancer medicines identified under Paragraph 19 of the Drugs (Prices Control) Order, 2013. The measure is subject to finalisation of the list of medicines to be covered.

The Ministry of Health and Family Welfare has been asked to constitute an expert committee under the Directorate General of Health Services to recommend the anti-cancer medicines to be brought under price control. The committee is expected to submit its report by October 14.

The Centre estimates that the measure could reduce the MRP of several anti-cancer medicines by 20% to 70%, potentially saving patients around ₹2,500 crore. “The financial strain of cancer treatment often pushes families into debt, making it inevitable for them to exhaust their savings and sell assets to meet medical expenses,” Mr. Khader said.

Citing examples, the Minister said a cancer drug/injection costing around ₹3,250 was reportedly priced at ₹23,347. Medicines with a landing cost of about ₹3,000 are being sold at a cost of ₹27,000. Under the 30% trade-margin cap, the maximum price of a medicine would depend on its applicable pricing base and can substantially reduce out-of-pocket expenditure for patients, he explained.

Also Read: Bitter pills: on Court’s intervention, drug pricing

Karnataka’s representation to the Centre

In a letter dated September 23 to Union Health Minister J.P. Nadda, the Karnataka government had sought national-level action after inspections in the State found substantial differences between the procurement costs of medicines and the prices charged to patients. The State identified pricing concerns involving 253 medicines and consumables with mark-ups.

Karnataka had sought the inclusion of advanced chemotherapy, targeted therapy and other expensive cancer medicines under the ambit of the Drugs (Prices Control) Order, along with a comprehensive cap on trade margins for high-cost and life-saving medicines.

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The State had also called for expanding the NPPA’s price-control oversight and strengthening enforcement against excessive charging and profiteering.

Disclosure of medicine costs in hospital bills

The State has also sought greater transparency in the prices charged to patients. A circular issued on October 1 asked healthcare institutions to disclose both the purchase or landing cost and the MRP of medicines in patient bills. The instructions are advisory in nature and are proposed to take effect from November 1.

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Karnataka’s call follows observations by the Supreme Court questioning why the MRP of essential medicines, including cancer drugs, could not be capped at 16% above the price to retailers, as is applicable to scheduled medicines under the Drugs (Prices Control) Order, 2013.

The State said the proposed 30% trade-margin cap on non-scheduled anti-cancer medicines should be followed by wider action to cover other essential, high-cost medicines, including those used in cardiac and kidney treatment, so that the benefits of price rationalisation reach patients directly.

During my 10+ years of clinical experience in various States and with numerous patient populations, I have seen that dental anxiety is a constant challenge. I have seen this phenomenon in children clutching their parents’ hands before their first cleaning and in accomplished professionals quietly cancelling appointment after appointment in the hope that the problem will somehow resolve itself.

It doesn’t.

In my experience, the longer you leave a fear unchecked, the greater the clinical and human cost becomes. Dental anxiety is not a moral failing. This is a well-documented psychological response—and one with important, measurable public health consequences.

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How severe is it?

Roughly a third of people have significant dental anxiety, and roughly a tenth have a clinical phobia. That’s not a little footnote. That means a lot of the population is actively avoiding or delaying care that could prevent serious disease. The downstream consequences of this avoidance are visible daily in my clinical work: infections tolerated for months, decay advanced far beyond what early intervention would have required, and patients presenting with pain that could have been prevented years ago.

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Knowing where it starts

Dental anxiety typically has a definite source. A painful or poorly done procedure in childhood can be a source of dental anxiety. A provider who was in a hurry or didn’t tell the patient what was happening. The specific sensory environment of a dental office—the sounds, the smells, and the physical vulnerability of lying back with your mouth open—can leave powerful imprints, especially in young patients. That memory is not just wiped out; it impacts behaviour for decades. For some, it’s not just one event but an accumulation. Years of avoidance layered on top of embarrassment about how their teeth look now, and a fear of judgment prevents them from asking for help. This cycle of shame avoidance is one of the hardest patterns I see clinically. When these patients do come in, they need much more intervention than if they had come in sooner, and this becomes an instance of the very fear that kept them away.

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The health price of avoidance

Research literature teaches us, that oral health is not an island. Untreated dental disease is a chronic inflammatory load on the body. It has been linked to cardiovascular risk, dysregulated blood sugar, and impaired immune function. When a patient avoids dental care for years, it is not just their smile that is at risk; they are carrying a preventable health load that will rise elsewhere in time.

In addition to the system effects, the impact on quality of life is immediate and real. A toothache interferes with sleep. It impacts nutrition, concentration, and the ability to speak with confidence. These are not trivial consequences; they affect how people show up in their professional and personal lives every day.

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What works in practice

The most significant change I’ve made in my practice is making communication a priority before any procedure begins. When patients feel informed and in control, it greatly reduces their dental anxiety. A stop signal—a raised hand that stops everything instantly—can alter the psychological dynamic in the room. It shifts the patient from passive recipient to active participant, and that shift matters enormously. I also allow extra time for anxious patients. The problem is not that procedures take longer, but that rushing them increases anxiety. I explain everything before it happens, check in frequently, and never minimise what a patient is feeling. These should not be luxury accommodations; they should be routine parts of effective care.

For patients with more severe anxiety, pharmacological support is appropriate. Nitrous oxide is safe, effective, and rapidly reversible. There are also oral sedation choices if needed. These are clinical tools, not last resorts, and patients should feel comfortable asking about them.

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A message to patients

If fear has kept you from the dentist, remember you are not alone, and you are not too far gone to be helped. What I ask of patients in this situation is one small step—not a treatment plan, not a procedure, simply a conversation. Come in and tell us about your nervousness. A good provider is a good listener and will start there. There is no need to be afraid of the dental chair. With the right approach, it can be a place where you take difficult things and make them manageable—and where the relief on the other side is worth it.

(Dr. Sowjanya Gunukula is a U.S.-licensed dentist with international training who focuses on preventive and evidence-based oral healthcare and contributes to advancing community and public health dentistry. sowji.gunukula@gmail.com)

A cluster of Shigella infections linked to a temple festival has put health authorities in Thrissur on alert, with 10 cases reported in the district in the first nine days of October. Seven of the cases, including that of a seven-month-old child, were reported from Tholur among people who had attended a festival at a temple there.

The suspected source of the infection has been traced to a well at the temple, from which water was drawn for rituals. The well has since been chlorinated, District Medical Officer M. Sujatha said.

“The seven Shigella cases reported from Tholur were among people who attended a festival at a temple in Tholur. The source of infection has been identified as the temple well from which water was taken for rituals. The well has been chlorinated,” Dr. Sujatha said.

Health teams are closely monitoring the situation, while hospitals have been instructed to respond immediately if any further cases are detected. Awareness campaigns have also been conducted in the area, with people advised to seek medical attention promptly if they develop symptoms, she said.

All those who tested positive for Shigella have sought treatment, and most have recovered. The remaining patients are also recovering, according to the DMO.

The other three Shigella cases reported during the nine-day period were from Wadakkanchery, Arimbur and Adat.

The Shigella cluster comes amid a wider surge in fever cases in the district. As many as 4,914 people sought treatment for fever between October 1 and 9. During the period, 39 dengue cases and four cases of leptospirosis were also confirmed.

Dengue cases have been reported from several parts of the district, including Kodakara, Mattathur, Meloor, Thrissur Corporation, Avinissery, Chalakudy municipality, Kaiparamba, Kodassery, Pananchery, Puthukkad, Adat, Alur, Puthur, Mullurkara, Pariyaram, Tholur, Orumanayur, Thalikulam and Choondal.

Leptospirosis cases were reported from Pananchery, Pazhayannur, Porkulam and Kuzhur.

Dengue cases

The DMO said a significant number of dengue cases had been detected in migrant labour camps and among their contacts. “Most of the dengue cases have been reported from migrant labour camps and their contacts. We are keeping a close watch on them and monitoring the situation,” she said.

Health authorities have stepped up surveillance and preventive measures across the district. The DMO urged people with fever to take adequate rest, drink sufficient water and consume nutritious food, while vulnerable people, particularly those with compromised immunity, should take extra precautions and seek medical care when necessary.

With Shigella cases emerging in connection with a common gathering and dengue continuing to surface across multiple locations, health officials are keeping a close watch on possible further transmission and urging the public to maintain strict hygiene and food and water safety.

In a bid to make cancer treatment more affordable and reduce patients’ out-of-pocket expenditure, the Union government has decided to cap trade margins at 30% of the maximum retail price (MRP) for all non-scheduled anti-cancer drugs.

Also read | Bitter pills: on Court’s intervention, drug pricing

The measure will cover branded and generic drugs, domestically manufactured and imported medicines, and patented and non-patented products. An expert committee under the Directorate General of Health Services (DGHS) will finalise the list of medicines to be brought under the measure.

Current mark-ups up to 700%

The National Pharmaceutical Pricing Authority (NPPA), which analysed market data, found that the average trade mark-up on non-scheduled anti-cancer medicines was around 170%, with mark-ups reaching up to 700% in some cases. It also found substantial differences between prices charged through retail, hospital, and online pharmacies.

Why India needs a smarter healthcare margin policy

The government said the decision was prompted by the high financial burden of cancer treatment. Around 75% of cancer treatment expenditure is estimated to be borne out of pocket.

The anti-cancer medicines market comprises around 225 drugs and 500 formulations, with an annual turnover of approximately ₹12,500 crore. Scheduled cancer medicines account for about ₹2,250 crore.

Massive savings

A senior official said that the government is drawing on the experience of a similar intervention in 2019, when the NPPA capped trade margins on 42 selected non-scheduled anti-cancer drugs by invoking its extraordinary powers under Paragraph 19 of the Drug Price Control Order, 2013. The exercise had reportedly resulted in price reductions of up to 91%, with annual savings of ₹984 crore across 526 brands.

The latest intervention is expected to result in price reductions of up to 70% of MRP and annual savings of around ₹2,500 crore, the government said.

‘Production must be maintained’

Under the new framework, the trade margin will be capped at 30% of MRP, equivalent to 42.86% of the price to stockist.

“To ensure availability, manufacturers will be required to maintain their existing production level,” said the official. 

The government said the measure would regulate trade margins rather than manufacturers’ selling prices or revenue, with the intervention aimed at reducing the margins retained across the distribution chain.

A large randomised controlled trial among heart failure patients in India led by the Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) in Kerala, has found that hospitalisation episodes and all-cause mortality among heart failure patients can be significantly reduced if patients are systematically followed-up by a nurse, with the help of a mobile health application.

The two-year Telemonitoring and Integrated Multidisciplinary care for Heart Failure (TIME-HF) trial found that heart failure patients with reduced ejection fraction (HFrEF) who received nurse-led collaborative care had a 22% lower risk of death than those receiving usual care. They were also more likely to remain alive without hospitalisation during the two-year follow-up.

The trial results were published in the American Heart Association’s Journal, Circulation, on August 30, 2026.

What makes the trial relevant is that it addresses critical gaps in heart failure care: in Keralam, heart failure registries have reported high mortality post-discharge — 82.7% mortality over 10 years, alongside the fact fact that only 25.4% of the patients with heart failure receive guideline-based therapies. It also holds lessons for the rest of the country: with nearly 27% of all deaths in India being due to heart disease, and 62% of all deaths due to cardiovascular disease occurring between the ages of 40 and 69 years, there is an urgent need for quality, post-discharge care.

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What the trial did

The TIME-HF trial involved 1,507 adults at 22 government and private hospitals in Keralam and neighbouring States, with 755 patients assigned to the intervention and 752 to usual care. The mean age was 61.9 years; 77.6% were men, 57.3% lived in rural areas and 70% had relatively low educational attainment. Ischaemic heart disease was the predominant cause of heart failure, accounting for 77.4% of cases.

Results indicated that nurse-led intervention substantially improved prescription of the four major components of guideline-directed medical therapy for heart failure — renin-angiotensin system inhibition/ARNI, beta-blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors.

“Our heart failure patients receive sub-optimal care, as most of them do not adhere to therapies or follow up with the doctor on time. There is also the issue of physician inertia. HF Registry evidence indicates that the median survival after diagnosis of heart failure is just 3.7 years. This collaborative care model is proof that survival and quality of life of these patients can be improved if we systematically address the gaps in care so that proven therapies for heart failure become part of routine care,” said lead researcher and additional professor at SCTIMST P. Jeemon.

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Centring nursing care

The model put a trained nurse at the centre of the care pathway, who would closely monitor heart failure patients after discharge, educate the patient and family about heart-failure self-care, lifestyle modification and encourage medication adherence.

Nurses reviewed the patients’ medication regimen at discharge to ensure that there was no deviation from the guideline-mediated therapies. This was again reviewed at every follow-up visit with the help of a mobile-health app. The m-health app helped the nurses monitor all physical parameters of the patient real time and to identify warning signs of worsening disease, communicate and connect with patients and physicians so that timely hospitalisation was possible.

All participants underwent scheduled follow-up visits every three months for two years. Adherence to all four guideline-directed medical therapies was only 22.1% in the usual-care group, while it was 37.3% in the intervention group at two years.

“The health system engaging with the patient regularly was the key here. The m-health app gave the patient updates in real time to the nurse. Oxygen saturation levels, weight gain, weight loss, drop in blood pressure or respiratory rate comes as alerts, and then were escalated to the physician,” Dr. Jeemon points out.

The TIME-HF trial thus helped address one of the health system’s persistent weaknesses: that of proper follow-up care of patients with chronic diseases. The model is suited for strengthening chronic disease management and reducing the burden of hospitalisation and mortality in resource-limited settings across the country, experts said.

India’s leprosy programme is falling short of several projections set for 2025-26. The country reported 91,783 new leprosy cases in 2025-26, 41.2% higher than the projected 65,000. New cases among children were 91.6% above the projection while the rate of Grade 2 Disability (G2D) among new cases was 1.34 per million, against a projected one per million.

India’s national prevalence rate was 0.56 cases per 10,000 population at the end of March 2026, below the elimination target of a prevalence rate below one case per 10,000.

But the burden remains concentrated geographically. Chhattisgarh had the highest prevalence among States/UTs at 1.66 cases per 10,000 population, followed by Jharkhand (1.51), Chandigarh (1.49), Odisha (1.25) and Maharashtra (1.14).

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At the district level, 14.8% of districts had a prevalence rate above one case per 10,000 in 2025-26, down from 18.6% in 2013-14 but 114 districts still remained above the programme’s elimination target. Moreover, only 148 districts have provisionally achieved interruption of transmission, against a projected 300.

G2D was also concentrated in a few States/UTs. Chandigarh, Delhi, Chhattisgarh, Jharkhand and Odisha together accounted for 42.5% of the 1,945 G2D cases reported in 2025-26. Chandigarh recorded the highest rate at 13.54 per million, followed by Delhi (11.53) and Chhattisgarh (7.87).

Single-Dose Rifampicin Post-Exposure Prophylaxis (SDR PEP), a preventive dose given to people who have been in contact with a leprosy patient, was administered to 91.2% of the 16.94 lakh eligible contacts in 2025-26, up from 71.4% of the 6.48 lakh in 2019-20.

Source: National Leprosy Eradication Programme (2025-26) and National Strategic Plan and Roadmap for Leprosy 2023-2027