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ObjectiveTo investigate the effects of high-intensity interval training (HIIT) and sprint interval training (SIT) on fat oxidation during exercise (FatOx) and how they compare with the effects of moderate-intensity continuous training (MICT).DesignSystematic review and meta-analysis.Data sourcesAcademic Search Ultimate, CINAHL, Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, OpenDissertations, PubMed/MEDLINE, Scopus, SPORTDiscus and Web of Science.Eligibility criteria for selecting studiesStudies using a between-group design, involving adult participants who were not trained athletes, and evaluating effects of HIIT or SIT on FatOx (vs no exercise or MICT) were included.ResultsEighteen studies of fair-to-good quality were included; nine comparing HIIT or SIT with no exercise and eleven comparing HIIT or SIT with MICT. A significant pooled effect of these types of interval training on FatOx was found (mean difference in g/min (MD)=0.08; 95% confidence interval (CI) 0.04 to 0.12;pβ=0.01; 95% CI 0.00 to 0.02;p=0.003). HIIT and/or SIT were slightly more effective than MICT (MD=0.03; 95% CI 0.01 to 0.05;p=0.005). The effects on FatOx were larger among individuals with overweight/obesity.ConclusionEngaging in HIIT or SIT can improve FatOx, with larger effects expected for longer training regimens and individuals with overweight/obesity. While some effects seem small, they may be important in holistic approaches to enhance metabolic health and manage obesity.

Justification: Overuse and administration of unnecessary and inappropriate antibiotics are the leading causes for the increased antimicrobial resistance worldwide. Judicious use of antimicrobials can prevent this phenomenon. Objective: Create a collaborative outline for the use of antibiotics in the paediatric intensive care unit for various infections, based on evidence, taking into consideration local antimicrobial susceptibility patterns. Process / Methods: Under the aegis of Nepal Paediatric Society, this guideline has been developed after several meetings of paediatricians working in various hospitals in different parts of Nepal, looking into the prevalent diseases and local sensitivity patterns of antibiotics. Recommendations: This guideline will help standardize the treatment protocol in paediatric intensive care units in Nepal and help paediatricians decide the appropriate use of antibiotics promptly while managing critically ill children. Keywords: Antibiotics; antibiotic sensitivity; antimicrobial resistance; critically ill child; Paediatric Intensive Care Unit

Background:Rapidly growing coronavirus disease 2019 (COVID-19) pandemic has brought unprecedented challenges to the health system in Nepal. The main objective of this study was to explore the health system preparedness for COVID-19 and its impacts on frontline health-care workers in Nepal.Methods:Semi-structured interviews were conducted among 32 health-care workers who were involved in clinical care of COVID-19 patients and four policy-makers who were responsible for COVID-19 control and management at central and provincial level. Interviews were conducted through telephone or Internet-based tools such as Zoom and Skype. All interviews were audio-recorded, transcribed into English, and coded using inductive and deductive approaches.Results:Both health-care workers and policy-makers reported failure to initiate pre-emptive control measures at the early stages of the outbreak as the pivot in pandemic control. Although several measures were rolled out when cases started to appear, the overall health system preparedness was low. The poor governance, and coordination between three tiers of government was compounded by the inadequate personal protective equipment for health-care workers, insufficient isolation beds for patients, and poor engagement of the private sector. Frontline health-care workers experienced various degrees of stigma because of their profession and yet were able to maintain their motivation to continue serving patients.Conclusion:Preparedness for COVID-19 was affected by the poor coordination between three tiers of governance. Specifically, the lack of human resources, inadequate logistic chain management and laboratory facilities for testing COVID-19 appeared to have jeopardized the health system preparedness and escalated the pandemic in Nepal. Despite the poor preparedness, and health and safety concerns, health-care workers maintained their motivation. There is an urgent need for an effective coordination mechanism between various tiers of health structure (including private sector) in addition to incentivizing the health-care workers for the current and future pandemics.

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To evaluate the effectiveness and safety of matched targeted therapies in people with relapsed or metastatic cancer in phase I, II and III trials.

Summary: Background: Associations between endogenous estrogen exposure indicators and risk of subtypes of dementia have been unclear. Methods: Databases (PubMed, EMBASE and Web of Science) were searched electronically on 1st July and updated regularly until 12nd November 2021. Observational studies of English language were selected if reported an effect estimate [e.g., odds ratio (OR), rate ratio (RR) or hazard ratio (HR)] and 95% CI for the association between any exposure (age of menarche, age at menopause, reproductive period, estradiol level) and any endpoint variable [all-cause dementia, Alzheimer's disease (AD), vascular dementia (VD), cognitive impairment (CI)]. Random-effects models and dose-response meta-analyses were used to calculate estimates and to show the linear/nonlinear relationship. PROSPERO CRD42021274827. Findings: We included 22 studies (475 9764 women) in this analysis. We found no clear relationship between late menarche (≥14 vs

ObjectiveTo investigate the association of running participation and the dose of running with the risk of all-cause, cardiovascular and cancer mortality.DesignSystematic review and meta-analysis.Data sourcesJournal articles, conference papers and doctoral theses indexed in Academic Search Ultimate, CINAHL, Health Source: Nursing/Academic Edition, MasterFILE Complete, Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, PsycINFO, PubMed/MEDLINE, Scopus, SPORTDiscus and Web of Science.Eligibility criteria for selecting studiesProspective cohort studies on the association between running or jogging participation and the risk of all-cause, cardiovascular and/or cancer mortality in a non-clinical population of adults were included.ResultsFourteen studies from six prospective cohorts with a pooled sample of 232 149 participants were included. In total, 25 951 deaths were recorded during 5.5–35 year follow-ups. Our meta-analysis showed that running participation is associated with 27%, 30% and 23% lower risk of all-cause (pooled adjusted hazard ratio (HR)=0.73; 95% confidence interval (CI) 0.68 to 0.79), cardiovascular (HR=0.70; 95% CI 0.49 to 0.98) and cancer (HR=0.77; 95% CI 0.68 to 0.87) mortality, respectively, compared with no running. A meta-regression analysis showed no significant dose–response trends for weekly frequency, weekly duration, pace and the total volume of running.ConclusionIncreased rates of participation in running, regardless of its dose, would probably lead to substantial improvements in population health and longevity. Any amount of running, even just once a week, is better than no running, but higher doses of running may not necessarily be associated with greater mortality benefits.

Background Despite recent interest in the mental health benefits of increasing physical activity (PA) and reducing sedentary behaviour (SB), little is known about PA and SB counselling provided by mental health professionals. Therefore, the aim of this study was to explore the attitudes and practices of mental health professionals in recommending more PA and less SB to their clients. Methods Quantitative data were collected using a modified version of the Exercise in Mental Illness Questionnaire in a sample of 17 Australian mental health professionals. The collected data were reported using percentages (for categorical data) and means and standard deviations (for numerical data). Additionally, in focus group discussions, 10 mental health professionals provided in-depth information about their clinical practice, facilitators, and perceived barriers in recommending more PA and less SB. They also provided suggestions on how to potentially improve their PA and SB counselling practices. The focus groups were audio-recorded, transcribed and analysed using thematic analysis. Results Only 35.3% of participants have undergone formal training in recommending PA in the treatment of mental illness. Most participants (64.7%) ranked PA counselling among the top three types of mental health treatment. All participants reported recommending PA to their clients at least “occasionally”, while 88% of them also provided SB counselling. However, the recommendations provided were usually not specific. The most commonly reported barriers for providing PA and SB counselling were a lack of knowledge and confidence. Participants also believed that, if they were more active themselves, they would be in a better position to recommend PA to their clients, by sharing their own experience of evidence-informed strategies designed to increase PA and reduce SB. Conclusion The findings of this study indicate that mental health professionals commonly provide generic PA and SB counselling to their clients. PA and SB counselling in the mental health setting could be improved by: including training on PA and SB counselling in formal education and continued professional training for mental health professionals; implementing interventions to increase PA and reduce SB among mental health professionals themselves; and ensuring support from an exercise or PA promotion specialist as a part of a multi-disciplinary approach to mental health care.

We investigated the effects of increasing physical activity (PA) and reducing sedentary behaviour (SB) of mental health professionals on their attitudes towards and practices in recommending more PA and less SB to their clients. A 4-week pre-post intervention trial was conducted involving 17 mental health professionals. The participants who increased their own physical activity during the intervention increased the frequency of recommending more PA (p = 0.009) and less SB (p = 0.005) to their clients. A relatively simple, low-cost intervention, consisting of group behaviour change counselling, goal setting and positive feedback, may improve the practices of mental health professionals. Supplemental data for this article is available online at https://doi.org/10.1080/01612840.2021.1972189 .

Background. Understanding the burden and trend of hypertension and the associated care cascade can provide direction to the development of interventions preventing and controlling hypertension. This study aimed to assess prevalence and trends of hypertension and its awareness, treatment, and control in Nepal. Methods. We systematically searched CINAHL, Embase, ProQuest, PubMed, Web of Science, WorldCat, and government and health agency-owned websites to identify studies reporting prevalence of hypertension, awareness, treatment, and control in Nepal between 2000 and 2020. We applied the random-effects model to compute the pooled prevalence in the overall population and among subgroups in each 5-year interval period between 2000 and 2020. We used linear meta-regression analysis to predict hypertension from 2000 to 2025. Results. We identified 23 studies having a total of 84,006 participants. The pooled prevalence of hypertension, awareness, treatment, and control for 2016–2020 was 32% (95% CI: 23–40%), 50% (95% CI: 30–69%), 27% (95% CI: 19–34%), and 38% (95% CI: 28–48%), respectively. The prevalence of hypertension varied by age, gender, education, and geographical area. Hypertension increased by 6 percentage points (pp), awareness increased by 12 pp, treatment increased by 11 pp, and control increased by 3 pp over the 20 years studied. Since 2000, the rate of increment of hypertension has been 3.5 pp per decade, where 44.7% of men are expected to suffer from hypertension by 2025. Conclusion. The markedly increased prevalence of hypertension and relatively poor progress in hypertension awareness, treatment, and control in Nepal suggest that there is a need for hypertension preventive approaches as well as strategies to optimize hypertension care cascade.

BackgroundRapidly growing coronavirus disease 2019 (COVID-19) pandemic has brought unprecedented challenges to the health system in Nepal. The main objective of this study was to explore the characteristics and drivers of the health system preparedness towards COVID-19 and its impacts on frontline health care workers (HCWs) in Nepal.MethodsSemi-structured interviews (SSIs) were conducted among 32 HCWs who were involved in clinical care of COVID-19 patients and four policymakers who were responsible for COVID-19 control and management at central and provincial level. Participants were included from all seven provinces of Nepal. All SSIs were conducted through telephone or internet based tools such as Zoom and Skype. All interviews were audio-recorded, transcribed into English, and coded using inductive and deductive approaches.ResultsBoth HCWs and policymakers reported failure to initiate pre-emptive control measures at the early stages of the outbreak as the pivot in pandemic control. Although several measures were rolled out when cases started to appear, the overall health system preparedness was low. Specifically, there was inadequate personal protective equipment for HCWs, insufficient isolation beds for patients, poor coordination between the three tiers of governance, and poor engagement of the private sector. Additionally, HCWs experienced various degrees of stigma because of their profession and yet were able to maintain their motivation to continue working in the forefront.ConclusionThis study identified poor preparedness of the health system in the course of Nepal's COVID-19 response embedded in the governance. Specifically, the lack of human resources, inadequate logistic chain management and laboratory facilities for testing COVID-19 appeared to have jeopardized the health system preparedness and escalated the pandemic in Nepal. Despite the poor preparedness, and health and safety concerns, HCWs maintained their motivation. Urgent efforts are required to reform the governance and coordination mechanism in addition to incentivizing the HCWs for the current and future pandemics.

Background Untreated and uncontrolled hypertension are major challenges in the cascade of care of hypertension in Nepal. The challenge of achieving effective treatment and control of blood pressure is linked to various barriers to hypertension care at different layers of health system. Evidence is emerging globally on the effectiveness of multi-pronged hypertension control strategies. However, no systematic review of strategies of and factors associated with hypertension treatment and control in Nepal is available. Understanding country-specific factors influencing hypertension care is critical to address the gaps in the management of hypertension. This study aimed to systematically review published literature and synthesise the findings on barriers, enablers and strategies for hypertension treatment and control in Nepal. Methods Six databases namely Embase, PubMed, Web of Science, CINAHL, ProQuest and WorldCat were systematically searched for studies investigating the factors or strategies in relation to hypertension treatment and control in Nepal. The methodological quality of selected articles was assessed using Mixed Methods Appraisal Tool. Themes on barriers and enablers were generated and framed under “health system” (HS), “provider” and “patient” domains, according to the framework synthesis approach. Findings on hypertension strategies were narratively synthesised. Results We identified 14 published studies; one with mixed, three with qualitative and 10 with quantitative methods. Eight were related to barriers and enablers and six of hypertension strategies. The identified barriers associated with the HS were: lack of affordable services and lack of resources. The barriers at the provider’s level were: communication gaps and long waiting hours for appointments. Poor help-seeking behaviour, non-adherence to medication, perceived side-effects of drugs, financial hardship and lack of family support were barriers identified at patient level. The following enablers were identified: positive illness perception, free essential healthcare services and family support. Strategies implemented across the HS, provider and patient were: establishing digital health records at health centres, health worker’s capacity development, health education and yoga practice. Conclusion There is a range of barriers for hypertension treatment and control in Nepal pertaining to the health system, providers, and patients. Comprehensive interventions are needed at all three levels to further improve management and control of hypertension in Nepal.Registration: The protocol is registered in PROSPERO (registration number: CRD42020145823)

The novel coronavirus disease 2019 (COVID-19) is a highly infectious disease with human to human transmission. The COVID-19 may present with mild, moderate, or severe illness. Currently, no proven effective therapies for COVID-19 exist and no vaccine is available. Various pharmacological treatments are currently being tested for patients with COVID-19. The current living systematic review aims to examine the definition, frequency, nature, and severity of the adverse event (AE)/ adverse drug reaction (ADR) occurring in patients with COVID-19 receiving active pharmacological treatment and to compare it against control groups where available. MEDLINE, Embase, Cochrane Central databases will be searched for studies that reported COVID-19 patients receiving treatment for infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with any pharmacological drugs such as but not limited to, chloroquine, hydroxychloroquine, azithromycin, ritonavir, remdesivir, tocilizumab, pirfenidone, etc. Data pertaining to safety parameters like AEs, ADR, serious AEs, serious ADR, treatment non-response, and deterioration of illness will be captured and analysed.

Background Nepal has made significant strides towards its commitment to achieve universal health coverage in the past few decades. However, the paucity of evidence on morbidity, mortality and trends in non-communicable diseases (NCDs) has posed a significant hindrance in targeting resources for prevention, screening and treatment services. Thus, we conducted a systematic review of the existing evidence on the distribution of NCDs and their trends in Nepal from 1990 to 2017.Methods We analysed data on disability adjusted life years (DALYs), years lived with disability, years of life lost due to NCDs in Nepal and its comparator countries (Afghanistan, Bangladesh, Bhutan, India, Maldives, Pakistan and Sri Lanka) from 1990 to 2017 using all available data sources from Global Burden of Disease 2017. We also conducted supplemental analysis using data from the 2016 Nepal Demographic Health Survey (NDHS) to further elucidate the provincial level prevalence of key NCD risk factors.Results The result showed that between 1990 and 2017, life expectancy at birth increased by 14 years, from 58 years to 71 years on an average in Nepal. The three leading causes of DALYs in 2017 were cardiovascular diseases (CVDs), maternal and neonatal disorders and chronic respiratory diseases. High systolic blood pressure, smoking and high fasting plasma glucose were leading contributors to the NCD DALYs burden in 2017. At any ages ≥ 40 years, NCDs and injuries were responsible for 75–82% of total DALYs. Injuries, self-harm and violence, mental, neurological and musculoskeletal disorders superseded CVDs to become the leading causes of DALYs in young population aged 15–35 years.Conclusions CVDs were the leading causes of death in 2017 followed by chronic respiratory diseases and cancers. Data such as these are an important tool for framing a coherent policy response towards achieving the sustainable development goals, and the targets set by Nepal’s first Multi-sectoral Action plan on NCDs (2014–2020).

Background: Acute kidney injury (AKI) is common in neonates. However, early diagnosis is difficult. Different biomarkers for early diagnosis of AKI, such as NGAL, KIM-1, Cys-C, IL-18, β2-microglobulin have been proposed. But regarding premature infant, there is very little research that has been reported. Objectives: To investigate the role of urinary NGAL and Kim-1 biomarkers for early diagnosis of AKI in premature neonates. Methods: Eighty cases were divided into experimental group (60 cases) and controls group (20 cases). Of 60 cases, 24 patients met the criteria for AKI group; the remaining 36 were non-AKI group. Blood and urine samples, 1 ml each, were collected from all subjects at first day, second day, third day and seventh day of life. Urine NGAL and KIM-1 were measured by ELISA. Results: The urinary NGAL and KIM-1 are significantly higher in AKI group than Non-AKI group and normal control group in the first three days. They present earlier than classical Scr. Conclusion: Urinay NGAL and Kim-1 are beneficial biomarkers for the early diagnosis of AKI in preterm neonates.

Background The burgeoning rise of non-communicable diseases (NCDs) is posing serious challenges in resource constrained health facilities of Nepal. The main objective of this study was to assess the readiness of health facilities for cardiovascular diseases (CVDs), diabetes and chronic respiratory diseases (CRDs) services in Nepal. Methods This study utilized data from the Nepal Health Facility Survey 2015. General readiness of 940 health facilities along with disease specific readiness for CVDs, diabetes, and CRDs were assessed using the Service Availability and Readiness Assessment manual of the World Health Organization. Health facilities were categorized into public and private facilities. Results Out of a total of 940 health facilities assessed, private facilities showed higher availability of items of general service readiness except for standard precautions for infection prevention, compared to public facilities. The multivariable adjusted regression coefficients for CVDs (β = 2.87, 95%CI: 2.42–3.39), diabetes (β =3.02, 95%CI: 2.03–4.49), and CRDs (β = 15.95, 95%CI: 4.61–55.13) at private facilities were higher than the public facilities. Health facilities located in the hills had a higher readiness index for CVDs (β = 1.99, 95%CI: 1.02–1.39). Service readiness for CVDs (β = 1.13, 95%CI: 1.04–1.23) and diabetes (β = 1.78, 95%CI: 1.23–2.59) were higher in the urban municipalities than in rural municipalities. Finally, disease-related services readiness index was sub-optimal with some degree of variation at the province level in Nepal. Compared to province 1, province 2 (β = 0.83, 95%CI: 0.73–0.95) had lower, and province 4 (β =1.24, 95%CI: 1.07–1.43) and province 5 (β =1.17, 95%CI: 1.02–1.34) had higher readiness index for CVDs. Conclusion This study found sub-optimal readiness of services related to three NCDs at the public facilities in Nepal. Compared to public facilities, private facilities showed higher readiness scores for CVDs, diabetes, and CRDs. There is an urgent need for policy reform to improve the health services for NCDs, particularly in public facilities.

BACKGROUND Previous studies in Nepal noted an alarming increase in prevalence of hypertension. However, these studies were geographically sparse and coverage of population, mostly limited to single site. The current study fills this gap by examining the current status of prevalence, awareness, treatment and control of hypertension, using recently collected population-based data. METHODS We used the Nepal Demographic Health Survey 2016 data. Sample selection was based on stratified two-stage cluster sampling in rural areas and three stages in urban areas. Blood pressure was measured in all women and men aged 15 and above. RESULTS A total of 13 598 participants: 5593 men and 8005 women aged 15-69 had their blood pressures measured. Overall, 18% (95% CI 16.7-19.2) of the participants aged 15-69 years were hypertensive. Prevalence of hypertension was more among men (22%; 95% CI 21.1-23.5), aged 45-69 years (34%), with no formal education (22%), richest quintile (25%), formerly/ever married (32%), urban dwellers (19%), residents of Province 4 (24%), residents of hills (21%), and obese (41.6%). Among the total hypertensive individuals, only 38% were aware of their hypertensive status and 18% were taking antihypertensive medication. Only half of the hypertensive participants on treatment (52%) had their blood pressure under control. CONCLUSION This nationally representative survey data showed that the prevalence of hypertension is high in Nepal, whereas its awareness, treatment and control rates are low at entire population level.

Background The ever-increasing burden of non-communicable diseases (NCDs) is posing a serious health challenge for Nepal. This study examines the status of ideal cardiovascular health (ICH) and its associated determinants in Nepal using the American Heart Association (AHA) definition of ICH metrics. Methods The AHA has defined ICH as having five to seven of the ideal health metrics. A representative sample from the NCD risk factors STEPS survey 2013 were drawn to analyse the prevalence and sociodemographic determinants of ideal, intermediate and poor cardiovascular health in Nepal. Multivariable logistic regression was used to measure the determinants of ICH. Results More than half of the participants had ICH metrics (51.6%), with the 45–69 y age group having the lowest prevalence of ICH (28%) and females having better cardiovascular health compared with their male counterparts (60.6% vs 41.7%). The prevalence of low intake of fruit and vegetables, tobacco smoking and elevated blood pressure were quite high (99%, 18.8% and 31.4%, respectively). The status of ICH declined with age: individuals 15–29 y of age had 6 times (95% confidence interval [CI] 4.80–8.60) higher odds of having ICH compared with those who were 45–69 y, and it was low among urban residents (referent: rural; adjusted odds ratio 0.77 [95% CI 0.58–1.01]). Conclusions Nearly half of the participants had ICH, which declined with ageing. Further, urban residents had poor cardiovascular health. This highlights the need for a comprehensive population-based intervention targeting elderly and urban residents to improve overall cardiovascular health.

Nepal’s dual burden of undernutrition and over nutrition warrants further exploration of the population level differences in nutritional status. The study aimed to explore, for the first time in Nepal, potential geographic and socioeconomic variation in underweight and overweight and/or obesity prevalence in the country, adjusted for cluster and sample weight. Data came from 14,937 participants, including 6,172 men and 8,765 women, 15 years or older who participated in the 2016 Nepal Demography and Health Survey (NDHS). Single-level and multilevel multi-nominal logistic regression models and Lorenz curves were used to explore the inequalities in weight status. Urban residents had higher odds of being overweight and/or obese (OR: 1.89, 95% CI: 1.62–2.20) and lower odds of being underweight (OR: 0.81, 95% CI: 0.70–0.93) than rural residents. Participants from Provinces 2, and 7 were less likely to be overweight/obese and more likely to be underweight (referent: province-1). Participants from higher wealth quintile households were associated with higher odds of being overweight and/or obese (P-trend

Additional file 1: Supplementary table 1. Description of each domain (general readiness, cardiovascular diseases readiness, diabetes service readiness, and chronic respiratory diseases readiness).

Background Unhealthy behaviors, such as energy-dense food choices and a sedentary lifestyle, both of which are established risk factors for diabetes, are common and increasing among Nepalese adults. Previous studies have reported a wide variation in the prevalence of prediabetes and diabetes in Nepal, and thus a more reliable pooled estimate is needed. Furthermore, Nepal underwent federalization in 2015, and the province-specific prevalence, which is necessary for the de novo provincial government to formulate local health policies, is lacking. This study aims to provide a comprehensive summary of the current literature on various aspects of diabetes in Nepal, i.e., the prevalence of prediabetes and diabetes as well as of the awareness, treatment, and control of diabetes in Nepal. Methods This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched three electronic databases—PubMed, Scopus, and Web of Science—using a comprehensive search strategy to identify eligible studies published up to April 2, 2020. Data on prevalence estimates of prediabetes and diabetes were extracted and pooled in a meta-analysis using a random effect model. Subgroup analyses and meta-regression were conducted to assess heterogeneity across the studies. The quality of included studies was assessed using the New Castle-Ottawa scale. Results We included 14 eligible studies that comprised a total of 44,129 participants and 3517 diabetes cases. Half of the included studies had good quality. Overall, the prevalence of prediabetes and diabetes was 9.2% (95% CI 6.6–12.6%) and 8.5% (95% CI 6.9–10.4%), respectively. Among the participants with diabetes, only 52.7% (95% CI 41.7–63.4%) were aware of their diabetes status, and 45.3% (95% CI 31.6–59.8%) were taking antidiabetic medications. Nearly one-third of those under antidiabetic treatment (36.7%; 95% CI 21.3–53.3%) had their blood glucose under control. The prevalence of prediabetes and diabetes gradually increased with increasing age and was more prevalent among males and urban residents. There was a wide variation in diabetes prevalence across the provinces in Nepal, the lowest 2% in Province 6 to the highest 10% in Province 3 and Province 4. Conclusions The prevalence of prediabetes and diabetes was high in Nepal, while its awareness, treatment, and control were low. Our findings call for urgent nationwide public health action in Nepal. Electronic supplementary material The online version of this article (10.1007/s13300-020-00884-0) contains supplementary material, which is available to authorized users.

Neonatal sepsis is one of the feared cause of neonatal death in both term and preterm infants, leading up to 30% of neonatal death in developing countries. Salmonella sepsis is one of the uncommon causes of early onset neonatal sepsis. Here we present a case of early onset neonatal sepsis due to Salmonella species. Baby was delivered vaginally with good Apgar score. Within few hours of birth, baby developed respiratory distress and was admitted with empirical antibiotics. The blood culture showed the growth of Salmonella species. Child was treated with IV antibiotics and responded well to it and was discharged home without complication.

BACKGROUND: The prevalence of musculoskeletal symptoms among sedentary workers is high. Interventions that promote occupational standing or walking have been found to reduce occupational sedentary time, but it is unclear whether these interventions ameliorate musculoskeletal symptoms in sedentary workers. OBJECTIVES: To investigate the effectiveness of workplace interventions to increase standing or walking for decreasing musculoskeletal symptoms in sedentary workers. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, OSH UPDATE, PEDro, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal up to January 2019. We also screened reference lists of primary studies and contacted experts to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster-randomised controlled trials (cluster-RCTs), quasi RCTs, and controlled before-and-after (CBA) studies of interventions to reduce or break up workplace sitting by encouraging standing or walking in the workplace among workers with musculoskeletal symptoms. The primary outcome was self-reported intensity or presence of musculoskeletal symptoms by body region and the impact of musculoskeletal symptoms such as pain-related disability. We considered work performance and productivity, sickness absenteeism, and adverse events such as venous disorders or perinatal complications as secondary outcomes. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles, abstracts, and full-text articles for study eligibility. These review authors independently extracted data and assessed risk of bias. We contacted study authors to request additional data when required. We used GRADE considerations to assess the quality of evidence provided by studies that contributed to the meta-analyses. MAIN RESULTS: We found ten studies including three RCTs, five cluster RCTs, and two CBA studies with a total of 955 participants, all from high-income countries. Interventions targeted changes to the physical work environment such as provision of sit-stand or treadmill workstations (four studies), an activity tracker (two studies) for use in individual approaches, and multi-component interventions (five studies). We did not find any studies that specifically targeted only the organisational level components. Two studies assessed pain-related disability. Physical work environment There was no significant difference in the intensity of low back symptoms (standardised mean difference (SMD) -0.35, 95% confidence interval (CI) -0.80 to 0.10; 2 RCTs; low-quality evidence) nor in the intensity of upper back symptoms (SMD -0.48, 95% CI -.096 to 0.00; 2 RCTs; low-quality evidence) in the short term (less than six months) for interventions using sit-stand workstations compared to no intervention. No studies examined discomfort outcomes at medium (six to less than 12 months) or long term (12 months and more). No significant reduction in pain-related disability was noted when a sit-stand workstation was used compared to when no intervention was provided in the medium term (mean difference (MD) -0.4, 95% CI -2.70 to 1.90; 1 RCT; low-quality evidence). Individual approach There was no significant difference in the intensity or presence of low back symptoms (SMD -0.05, 95% CI -0.87 to 0.77; 2 RCTs; low-quality evidence), upper back symptoms (SMD -0.04, 95% CI -0.92 to 0.84; 2 RCTs; low-quality evidence), neck symptoms (SMD -0.05, 95% CI -0.68 to 0.78; 2 RCTs; low-quality evidence), shoulder symptoms (SMD -0.14, 95% CI -0.63 to 0.90; 2 RCTs; low-quality evidence), or elbow/wrist and hand symptoms (SMD -0.30, 95% CI -0.63 to 0.90; 2 RCTs; low-quality evidence) for interventions involving an activity tracker compared to an alternative intervention or no intervention in the short term. No studies provided outcomes at medium term, and only one study examined outcomes at long term. Organisational level No studies evaluated the effects of interventions solely targeted at the organisational level. Multi-component approach There was no significant difference in the proportion of participants reporting low back symptoms (risk ratio (RR) 0.93, 95% CI 0.69 to 1.27; 3 RCTs; low-quality evidence), neck symptoms (RR 1.00, 95% CI 0.76 to 1.32; 3 RCTs; low-quality evidence), shoulder symptoms (RR 0.83, 95% CI 0.12 to 5.80; 2 RCTs; very low-quality evidence), and upper back symptoms (RR 0.88, 95% CI 0.76 to 1.32; 3 RCTs; low-quality evidence) for interventions using a multi-component approach compared to no intervention in the short term. Only one RCT examined outcomes at medium term and found no significant difference in low back symptoms (MD -0.40, 95% CI -1.95 to 1.15; 1 RCT; low-quality evidence), upper back symptoms (MD -0.70, 95% CI -2.12 to 0.72; low-quality evidence), and leg symptoms (MD -0.80, 95% CI -2.49 to 0.89; low-quality evidence). There was no significant difference in the proportion of participants reporting low back symptoms (RR 0.89, 95% CI 0.57 to 1.40; 2 RCTs; low-quality evidence), neck symptoms (RR 0.67, 95% CI 0.41 to 1.08; two RCTs; low-quality evidence), and upper back symptoms (RR 0.52, 95% CI 0.08 to 3.29; 2 RCTs; low-quality evidence) for interventions using a multi-component approach compared to no intervention in the long term. There was a statistically significant reduction in pain-related disability following a multi-component intervention compared to no intervention in the medium term (MD -8.80, 95% CI -17.46 to -0.14; 1 RCT; low-quality evidence). AUTHORS' CONCLUSIONS: Currently available limited evidence does not show that interventions to increase standing or walking in the workplace reduced musculoskeletal symptoms among sedentary workers at short-, medium-, or long-term follow up. The quality of evidence is low or very low, largely due to study design and small sample sizes. Although the results of this review are not statistically significant, some interventions targeting the physical work environment are suggestive of an intervention effect. Therefore, in the future, larger cluster-RCTs recruiting participants with baseline musculoskeletal symptoms and long-term outcomes are needed to determine whether interventions to increase standing or walking can reduce musculoskeletal symptoms among sedentary workers and can be sustained over time.

Background Nepal's Himalayan range attracts mountaineers, climbers and tourists from all across the globe. Limited recent evidence suggests that exposure to hypoxia at a higher altitude may be a risk factor for hypertension and a protective factor for obesity. The existing urban–rural disparities in Nepal in health and economic resources may be anticipated in the burden of hypertension and obesity, two rapidly growing public health issues, but they remain largely unstudied. Therefore this study aims to assess the association of altitude and urbanization with hypertension and overweight/obesity in Nepal. Methods Data on 10 473 participants from a nationally representative survey, the 2016 Nepal Demographic and Health Survey (NDHS), was used. The NDHS assessed/measured blood pressure, height, weight, urbanization and the altitude of participants’ households by following standard procedures. Logistic and linear regression models were used to study the association of altitude (per 100 m increases) and urbanization with hypertension and obesity, or their continuous measurements (i.e. systolic and diastolic blood pressure [SBP and DBP, respectively] and body mass index [BMI]). Results The prevalence of hypertension, overweight and obesity was 25.6%, 19.6% and 4.8%, respectively. After controlling for covariates, residents of metropolitan cities had a 30% higher prevalence of overweight/obesity (adjusted prevalence ratio 1.30 [95% confidence interval {CI} 1.11 to 1.52]) than their rural counterparts. For altitude, there was a marginally increased odds of hypertension and overweight/obesity with elevation. Consistently, DBP (β = 0.18 [95% CI 0.09 to 0.27]) and BMI increased with altitude (β = 0.11 [95% CI 0.08 to 0.13]). Conclusion Urbanization was positively associated with BMI, while altitude showed a marginally positive association with hypertension and overweight/obesity. Given the role of obesity and hypertension in the aetiology of other chronic diseases and subsequently associated mortality and health care costs, residents in urban areas and at higher altitudes may benefit from weight control interventions and BP monitoring, respectively.