General Hospital, Ernakulam is a state owned hospital in Kochi, India. It is managed as part of the public health system of the government of Kerala. It was founded by the King of the Kochi princely state in 1845 and was handed over to the government of Kerala following independence of India and the following state restructuring. Like any other hospital part of the public health system in India the Ernakulam General Hospital too is funded solely by the state government, and all the services are highly subsidised. Treatment for citizens classified under the Below Poverty Line category is fully subsidised. Most of the government spending on health care schemes are dispensed through the public health system, and for the area under the jurisdiction of the corporation of Kochi, the General Hospital is the prime dispensing outlet for these schemes..
AIMS:Underestimated cardiovascular (CV) risk may lead to inadequate control of blood pressure (BP), LDL cholesterol, and glycated haemoglobin. This study investigated CV risk assessment and BP, LDL cholesterol, and glycated haemoglobin control among patients with hypertension in routine clinical practice. METHODS AND RESULTS:In the observational, cross-sectional, epidemiological SNAPSHOT study (conducted in Bulgaria, Croatia, Georgia, Romania, Serbia, and Spain), CV risk was assessed in adults with hypertension according to the physician clinical practices, guidelines, and the risk assessment models valid when the study was performed (SCORE1 and SCORE2/SCORE2-OP). Blood pressure, LDL cholesterol, and glycated haemoglobin control rates were also assessed. Of 9307 patients (aged 65.8 ± 10.5 years, 43.1% male), most (91.3%) had ≥1 additional CV risk factor; 7610 (81.8%) had dyslipidaemia and 3097 (33.3%) had type 2 diabetes (T2D). Compared with guideline recommendations, assessment of patient CV risk by physicians, relative to the risk obtained using SCORE1 and SCORE2/SCORE2-OP, was accurate in only 38.0 and 26.7% of patients, respectively, and was underestimated in 54.3 and 71.8% of patients. Control rates of BP, LDL cholesterol, and glycated haemoglobin were suboptimal [<25%, <12% (in those with comorbid dyslipidaemia), and <50% (in those with comorbid T2D), respectively]. CONCLUSION:Physicians from six European countries tended to overestimate control rates of BP and LDL cholesterol, while underestimating CV risk in their patients with hypertension. Overall, BP, LDL cholesterol, and glycated haemoglobin control rates were low. Better implementation of clinical guideline recommendations is needed.
Background: Domestic squalor (DS) is related to physical problems, living alone, family and neighbourhood problems and mental illnesses, especially dementia. However, methods to detect and treat older adults with DS remain unclear. We aimed to clarify the methods of appropriate intervention for older adults with DS. Methods: The Initial-phase Intensive Support Team for Dementia (IPIST) is a multidisciplinary outreach team in Japan that provides intensive support to people living at home with suspected dementia. We distributed a questionnaire to 50 IPISTs, specifically requesting the submission of 'two complex cases that were difficult to manage' regarding medical or long-term care. The questionnaire included sociodemographic characteristics, diagnosis, referral sources, and reasons for complexity. We compared cases with and without DS (DS+ vs. DS-), and DS cases living alone and those living with family (DS+ living alone vs. DS+ living with family). Results: We received responses from 33 IPISTs and collected data from 70 complex cases. DS was selected as the reason for complexity in 24 cases, 14 of which were people living alone. Significantly fewer DS+ cases were referred by family (8.3% vs. 54.3%), while significantly more were referred by others (87.5% vs. 41.3%). The most common referral sources were neighbours and social workers. DS+ cases had significantly higher rates of self-neglect (87.5% vs. 13.0%). Those living alone were significantly younger (median (interquartile range): 78.5 (76.8-82.8) years) than those living with family (85.0 (78.8-89.8) years). Family members living with DS+ cases also had issues, including mental illness or maltreatment. Conclusions: In this study sample, many older adults with DS exhibited self-neglect and had limited family support. Our findings suggest that a comprehensive approach to both older adults with DS and their families is crucial for appropriate intervention. Therefore, IPISTs that have a multidisciplinary team with an outreach function may be effective.
Introduction: Stock market volatility plays a vital role in financial markets and economic stability, drawing considerable academic attention over the past two decades. However, a comprehensive review of the literature examining the landscape of stock market volatility research has been lacking.Objective: This study aims to fill that gap by conducting a systematic bibliometric analysis to identify key authors, journals, documents, contributing countries, and collaborative networks, while mapping thematic trends in stock market volatility research.Method: The analysis employs VOS Viewer and the Bibliometrix R-package to examine 1,418 articles published between 2005 and 2022, retrieved from the Scopus database. The study utilizes keyword co-occurrence analysis and bibliographic coupling to map research themes and collaborative networks.Results: Findings reveal a significant rise in research output after 2015, with a notable surge during the COVID-19 pandemic. The top 10 most-cited papers amassed over 4,700 citations, with crisis-related studies demonstrating substantial influence. Key contributors include Gupta R., Ma F., and Zhang Y., while the USA, China, and the UK emerge as the leading publishing countries. Four main research streams are identified: volatility measurement and forecasting, crisis and contagion effects, macroeconomic influences, and spillover effects across markets. "Realized volatility" and "GARCH" emerge as dominant themes driving the field.Conclusions: This study offers a foundational overview of stock market volatility research, supporting scholars in identifying trends and research gaps, and providing practitioners with a structured understanding of the domain's evolution.
Renal rehabilitation, particularly exercise therapy, plays a vital role in maintaining physical function and improving outcomes in patients undergoing hemodialysis. In April 2022, Japan introduced an insurance reimbursement policy for exercise instruction during hemodialysis. However, the clinical association with outcomes and broader impact of this policy remain unclear. This study aims to elucidate the real-world association between the implementation of renal rehabilitation, especially exercise therapy during dialysis, on clinical outcomes, including mortality and hospitalization, in Japanese patients undergoing hemodialysis. It also assesses secondary outcomes such as frailty, physical function, and nutritional status. A retrospective cohort study was conducted using data from 10 dialysis facilities across Japan between January 2021 and January 2024. Adult patients receiving outpatient hemodialysis were included. The exercise group received regular intradialytic exercise therapy, while a matched control group did not. Primary outcomes included death and hospitalization. Secondary outcomes included changes in physical function (e.g., grip strength, gait speed), serum albumin/creatinine levels, frailty scores, and care needs. Subgroup analyses were performed on the basis of the presence of reimbursement claims for exercise instruction. This multicenter study will provide the first large-scale real-world evaluation of exercise therapy during hemodialysis following the 2022 reimbursement policy. It will elucidate the association between the implementation clinical outcomes. The eventual findings from this study may clarify the role of structured exercise programs in dialysis care and have the potential to inform future health policy decisions in Japan and globally. These results could also help guide best practices in renal rehabilitation and optimize patient-oriented outcomes.
In sub-Saharan Africa, approximately 85% of the population uses polluting cooking fuels (e.g. wood, charcoal). Incomplete combustion of these fuels generates household air pollution (HAP), containing fine particulate matter (PM2.5 ) and carbon monoxide (CO). Due to large spatial variability, increased quantification of HAP levels is needed to improve exposure assessment in sub-Saharan Africa. The CLEAN-Air(Africa) study included 24-h monitoring of PM2.5 and CO kitchen concentrations (npm2.5 = 248/nCO = 207) and female primary cook exposures (npm2.5 = 245/nCO = 222) in peri-urban households in Obuasi (Ghana), Mbalmayo (Cameroon) and Eldoret (Kenya). HAP measurements were combined with survey data on cooking patterns, socioeconomic characteristics and ambient exposure proxies (e.g. walking time to nearest road) in separate PM2.5 and CO mixed-effect log-linear regression models. Model coefficients were applied to a larger study population (n = 937) with only survey data to quantitatively scale up PM2.5 and CO exposures. The final models moderately explained variation in mean 24-h PM2.5 (R2 = 0.40) and CO (R2 = 0.26) kitchen concentration measurements, and PM2.5 (R2 = 0.27) and CO (R2 = 0.14) female cook exposures. Primary/secondary cooking fuel type was the only significant predictor in all four models. Other significant predictors of PM2.5 and CO kitchen concentrations were cooking location and household size; household financial security and rental status were only predictive of PM2.5 concentrations. Cooking location, household financial security and proxies of ambient air pollution exposure were significant predictors of PM2.5 cook exposures. Including objective cooking time measurements (from temperature sensors) from (n = 143) households substantially improved (by 52%) the explained variability of the CO kitchen concentration model, but not the PM2.5 model. Socioeconomic characteristics and markers of ambient air pollution exposure were strongly associated with mean PM2.5 measurements, while cooking environment variables were more predictive of mean CO levels.
