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ObjectiveTo assess the beneficial and harmful effects of adding exercise to usual care for people with hypertension, type 2 diabetes mellitus and/or cardiovascular disease.DesignSystematic review with meta-analysis and trial sequential analysis of randomised clinical trials.Data sourcesThe CENTRAL, MEDLINE, EMBASE, Science Citation Index Expanded on Web of Science and BIOSIS searched from inception to July 2020.Eligibility criteria for selecting studiesWe included all randomised clinical trials adding any form of trialist defined exercise to usual care versus usual care in participants with either hypertension, type 2 diabetes or cardiovascular disease irrespective of setting, publication status, year and language.Outcome and measuresThe primary outcomes were all-cause mortality, serious adverse events and quality of life.Data extraction and synthesisFive independent reviewers extracted data and assessed risk of bias in pairs. Our methodology was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Grading of Recommendations Assessment, Development and Evaluation and Cochrane Risk of Bias-version 1.ResultsWe included 950 trials, of which 248 trials randomising 21 633 participants reported on our predefined outcomes. All included trials were at high risk of bias. The major types of exercise reported were dynamic aerobic exercise (126/248 trials), dynamic resistance exercise (25/248 trials), and combined aerobic and resistance exercise (58/248 trials). The study participants were included due to cardiovascular diseases (189/248 trials), type 2 diabetes (41/248 trials) or hypertension (16/248 trials). The median intervention period was 3 months (IQR: 2–4 months) and the median follow-up period was 6 months (IQR: 3–8 months) after randomisation. Meta-analyses and trial sequential analyses showed evidence of a beneficial effect of adding exercise to usual care when assessing all-cause mortality (risk ratio (RR) 0.82; 95% CI 0.73 to 0.93; I2=0%, moderate certainty of evidence) and serious adverse events (RR 0.79; 95% CI 0.71 to 0.88; I2=0%, moderate certainty of evidence). We did not find evidence of a difference between trials from different economic regions, type of participants, type of exercise or duration of follow-up. Quality of life was assessed using several different tools, but the results generally showed that exercise improved quality of life, but the effect sizes were below our predefined minimal important difference.ConclusionsA short duration of any type of exercise seems to reduce the risk of all-cause mortality and serious adverse events in patients with either hypertension, type 2 diabetes or cardiovascular diseases. Exercise seems to have statistically significant effects on quality of life, but the effect sizes seem minimal.PROSPERO registration numberCRD42019142313.

Background: Chronic cough is a common respiratory complaint among the general population, causing substantial physical, social, and psychological burden. This study aims to estimate the prevalence of chronic cough and its risk factors among Nepalese adults.Methods: It is a community-based cross-sectional study among 1438 adults aged >=40 years from a semi-urban area of the Pokhara Metropolitan City of Western Nepal. Chronic cough was defined as daily coughing for at least three months duration during the preceding two years. We assessed the prevalence and associated risk factors of chronic cough.Results: Majority (54 were female and the average age (SD) was 56(10) years. The prevalence of chronic cough was 5%. Logistic regression analysis resulted in higher odds of chronic cough among aged gt;60 years (OR: 4.7; 95 2.5 textendash 8.9), COPD patients (OR:18.5; 95 11.2 textendash 30.6), biomass fuel smoke exposure (OR: 1.7; 95 1.1 textendash 2.7), and absence of kitchen chimney (OR: 2.9; 95 1.5 textendash 5.6). Similarly, chronic coughing is associated with among those who exposed to secondhand smoke (OR: 3.1; 95 1.9 textendash 4.9), former smokers (OR: 3.0; 95 1.6 textendash 5.4), current smokers (OR: 5.8; 95 3.2 textendash 10.3) and history of childhood lung infection (OR: 2.5; 95 1.3 textendash 5.0). However, there was no statistically significant association observed with sex, cardiovascular comorbidities, and tuberculosis history.Conclusions: Considering the significant impact of chronic cough on quality of life, it is important to design and implement programs and strategies to reduce modifiable risk factors like smoking, biomass fuel exposure, and preventing childhood lung infection.FootnotesCite this article as: European Respiratory Journal 2021; 58: Suppl. 65, PA3510.This abstract was presented at the 2021 ERS International Congress, in session textquotedblleftPrediction of exacerbations in patients with COPDtextquotedblright.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).

Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality in Nepal. It is a progressive lung disease and has a significant impact on the quality of life of patients. Health‐related quality of life (HRQOL) reflects the health‐ and disease‐related facets of quality of life. Limited studies have assessed the impact of COPD on HRQOL and associated factors in Nepal. This study is based on a cross-sectional household survey data from a semiurban area of Western Nepal. A validated Nepali version of St George’s Respiratory Questionnaire (SGRQ) was used to measure the HRQOL. COPD was defined together with post-bronchodilator airflow obstruction and the presence of respiratory symptoms. Post-bronchodilator airflow obstruction was defined as Forced Expiratory Volume in 1st second (FEV1) to Forced Vital Capacity (FVC) ratio < 0.70. COPD was diagnosed in 122 participants, and their median (IQR) total score of HRQOL was 40 (26 − 69); the score of symptoms, activity, and impact area were 53 (37 − 74), 57 (36 − 86), and 26 (13 − 62), respectively. The overall HRQOL was significantly different in terms of age, occupational status, physical activity, and comorbidities. Disease severity and the presence of respiratory symptoms had a significant difference in HRQOL (p = 0.0001). Appropriate measures to improve conditions and addressing the associated factors like respiratory symptoms and enhancing physical activity are necessary and important.

High salt (sodium chloride) intake raises blood pressure and increases the risk of developing hypertension, a major risk factor for cardiovascular disease. Little is known about salt intake in Nepal, and no study has estimated salt consumption from 24-hour urinary sodium excretion. Participants (n = 451) were recruited from the Community-Based Management of Non-Communicable Diseases in Nepal (COBIN) cohort in 2018. Salt intake was estimated by analyzing 24-hour urinary sodium excretion. Multivariate linear regression was used to estimate differences in salt intake. The mean (±SD) age and salt intake were 49.6 (±9.8) years and 13.3 (±4.7) g/person/d, respectively. Higher salt intake was significantly associated with male gender (β for female = −2.4; 95% CI: −3.3, −1.4) and younger age (β10 years = −1.4; 95% CI: −1.4, −0.5) and higher BMI (β = 0.1; 95% CI: 0.0, 0.2). A significant association was also found between increase in systolic blood pressure and higher salt intake (β = 0.3; 95% CI: 0.0, 0.7). While 55% reported that they consumed just the right amount of salt, 98% were consuming more than the WHO recommended salt amount (

Unwanted and mistimed pregnancies impose threats on the health and well-being of the mother and child and limit the acquisition of optimal sexual and reproductive health services, especially in resource-constrained settings like the Democratic Republic of Congo (DRC). This study aimed to determine the prevalence and correlates of mistimed and unwanted pregnancies among women in the DRC. Data were drawn from the 2013–14 DRC Demographic Health Survey (EDS-RDC II). Bivariate and multivariate logistic regression analysis was performed to identify correlates of mistimed and unwanted pregnancies. Sequential logistic regression modelling including distal (place of residence), intermediate (socio-demographic and socioeconomic factors) and proximal (reproductive health and family planning) factors was performed using multivariate analysis. More than a quarter (28%) of pregnancies were reported as unintended (23% mistimed and 5% unwanted). Women who wanted no more children (aOR 1.21; CI: 1.01, 1.44) had less than 24 months of birth spacing (aOR 2.14; CI: 1.80, 2.54) and those who intended to use a family planning method (aOR 1.24; CI: 1.01, 1.52) reported more often that their last pregnancy was mistimed. Women with five or more children (aOR 2.13; CI: 1.30, 3.49), those wanting no more children (aOR 13.07; CI: 9.59, 17.81) and those with more than 48 months of birth spacing (aOR 2.31; CI: 1.26, 4.23) were more likely to report their last pregnancy as unwanted. The high rate of unintended pregnancies in the DRC shows the urgency to act on the fertility behaviour of women. The associated intermediate factors for mistimed and unwanted pregnancy indicate the need to accelerate family planning programmes, particularly for women of high parity and those who want no more children. Likewise, health promotion measures at the grassroots level to ensure women’s empowerment and increase women’s autonomy in health care are necessary to address the social factors associated with mistimed pregnancy.

High salt/sodium intake is associated with an increased risk of hypertension, which is a major risk factor for cardiovascular diseases. This paper aims to examine the association between salt consumption and salt-related knowledge, attitudes, and practices (KAP) in Nepal. The cross-sectional data used in this study were collected as part of the community-based management of non-communicable diseases project (COBIN) to understand the amount and KAP related to salt consumption in Nepal. Multivariate hierarchical logistic regression was performed to assess the association of salt-related KAP and determinants of high salt consumption in Nepal. The mean per capita salt intake was 8.0 (±3.7) g/day, with 81.6% of the population reporting higher intake than the WHO recommendation of

Additional file 1: PRISMA-P 2015 Checklist for this protocol.

Anupa Rijal,Tara Ballav Adhikari,Arja R Aro Unit for Health Promotion Research, Faculty of Health Sciences, University of Southern Denmark, Esbjerg, Denmark Abstract: Sex trafficking, where individuals are traded for sex purposes and abused sexually, physically, mentally, and economically leading to repercussions in individual liberty, social life, and health and well-being, is one of the worst forms of infringement of human rights. Despite the growing global concern against sex trafficking, thousands of individuals, mostly girls and women, are trafficked annually, especially from low- and middle-income countries like Nepal. This article discusses the public health issues related to sex trafficking and the different ethical approaches – libertarianism, paternalism, stewardship, and virtue ethics – on perspectives concerning combating sex trafficking in Nepal. Along with the legal standpoint, awareness-raising activities, transit monitoring, and limited rehabilitative programs, Nepal also needs to enhance its stewardship approaches by addressing the gender-sensitive nature of the problem through empowerment and livelihood programs for girls and women from vulnerable communities to combat sex trafficking effectively. Keywords: women, exploitation, public health, libertarianism, paternalism, stewardship, Nepal

Objectives:The aim of the study was to examine the association of salt related knowledge, attitudes and practices with salt consumption and determinants of high salt intake among people of Lekhnath municipality of Western Nepal.Methods:The secondary analysis of Community-Based Intervention for blood