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A cross-sectional quantitative analysis of production and requirements of medical oxygen during the COVID-19 pandemic in Nepal

Por: Adhikari · S. K. · Aryal · Y. · Nepal · A. · Bingham · M. B. · Neupane · S. · Basnet · A. · Singh · A. K. · Prajapati · B. · Sthapit · D. · Devkota · G. · Rana · S.
Objectives

Medical oxygen supplementation is essential for treating severe illnesses and plays a critical role in managing life-threatening conditions, especially during the period of increased demand, such as the delta wave of COVID-19. The study aims to evaluate oxygen requirements and production to support effective capacity planning for future health crises.

Design and setting

Cross-sectional quantitative study. Data collection was carried out between 15 March and 19 December 2021.

Main outcome measures

The study used secondary data from Nepal’s Health Emergency Operation Centre. Regarding medical oxygen production, calculations included oxygen generated from both hospital-based oxygen plants and private companies, using their highest capacities for comparison. These production capacities were then assessed using three levels of efficiency (100%, 80% and 50%), revealing significant gaps when compared against the oxygen requirements of hospitalised COVID-19 patients, as guided by WHO recommendations. The results were communicated in terms of J-size cylinders, alongside average daily COVID-19 hospitalizations. Data was inputted and analysed using Microsoft Excel and presented in numbers and percentage.

Results

The country’s oxygen demand relies largely on the production from private enterprises, with meeting approximately 85.2% of the total requirement. Optimal production ensures that national oxygen needs will be met. The analysis highlighted that at 80% operational efficiency, 90.8% of the hospital’s requirements could be fulfilled. However, if operational efficiency drops to 50%, the fulfilment rate diminishes to 56.7%. The differences in requirement and production of oxygen are consistent across the provinces; however, a huge disparity was notable in Karnali and Sudurpaschim.

Conclusion

Continuous assessment of production capacities in both hospital and private enterprises producing oxygen is necessary to plan and address the gaps.

Socioeconomic inequalities in overweight and obesity among young adult women in Nepal between two cross-sectional surveys in 2001 and 2022

Por: Shakya · S. · Absetz · P. · Neupane · S.
Objective

To examine the socioeconomic inequalities in overweight-obesity and their changes in two decades, among young adult women aged 18–29 years in Nepal.

Design

Cross-sectional study based on Demographic and Health Surveys conducted in 2001 and 2022.

Setting

Nepal.

Participants

Data of young adult women aged 18–29 years were included for the study.

Outcome measures

Socioeconomic inequalities in education, occupation and household wealth were analysed through regression-based inequality indices: the Relative Index of Inequality, the Slope Index of Inequality and the Concentration Index. A concentration curve was constructed to evaluate whether overweight-obesity skewed towards poverty or wealth.

Results

We found an increase in the prevalence of overweight-obesity prevalence between 2001 (3.99%) and 2022 (15.45%), mostly in the oldest group (25–29 years), and among Janajati and rural residents. Socioeconomic gradients favoured wealthier, educated and employed women. A downward shift in wealth status was initially associated with a lower prevalence of overweight and obesity among women, but over time, it became linked to a higher prevalence.

Conclusions

The social gradient of overweight-obesity from 2001 to 2022 favoured women with higher socioeconomic status, and this shows a decreasing trend.

Impact of real-time glucose monitoring using FreeStyle Libre 3 on glycaemia in type 2 diabetes managed with basal insulin plus SGLT2 inhibitor and/or GLP-1 agonist: the FreeDM2 randomised controlled trial protocol

Por: Wilmot · E. G. · Ajjan · R. A. · Cheah · Y. S. · Choudhary · P. · Cranston · I. · Elliott · R. A. · Evans · M. · Iqbal · A. · Kamaruddin · S. · Barnard-Kelly · K. · Lumb · A. · Min · T. · Moore · P. · Narendran · P. · Neupane · S. · Rayman · G. · Sathyapalan · T. · Thabit · H. · Yates · T.
Introduction

Effective management of type 2 diabetes mellitus (T2DM) consists of lifestyle modification and therapy optimisation. While glycaemic monitoring can be used as a tool to guide these changes, this can be challenging with self-monitoring of blood glucose (SMBG). The FreeStyle Libre 3 (FSL3) is a real-time continuous glucose monitoring (CGM) system designed to replace SMBG. The evidence for the benefit of CGM in people with T2DM on non-intensive insulin regimens is limited. This study aims primarily to assess the glycaemic impact of FSL3 in people with suboptimally controlled T2DM treated with basal-only insulin regimens plus sodium-glucose cotransporter-2 (SGLT-2) inhibitor and/or glucagon-like peptide (GLP)-1 agonist.

Methods and analysis

This is an open-label, multicentre, parallel design, randomised (2:1) controlled trial. Recruitment has been offered across 24 clinical centres in the UK and nationally through self-referral. Adults with T2DM treated with basal-only insulin regimens plus SGLT-2 inhibitor and/or GLP-1 agonist and with screening HbA1c from ≥59 mmol/mol to ≤97 mmol/mol are included. Eligible participants will be randomised to either FSL3 (intervention) for 32 weeks or continuation of SMBG (control). The study is split into two phases, each of 16 weeks duration: phase 1 consisting of self-management with basal-insulin self-titration and phase 2 where additional therapies may be initiated. Control group participants may subsequently enter an optional extension phase to receive FSL3. The primary endpoint is the difference between treatment groups in mean change from baseline in HbA1c at 16 weeks. Secondary outcomes include HbA1c at 32 weeks, CGM-based metrics, therapy changes, physical activity levels and psychosocial measures. An economic evaluation for costs and patient outcomes will be undertaken.

Ethics and dissemination

The study was approved by the Health Research Authority, Health and Care Research Wales and the West Midlands-Edgbaston Research Ethics Committee (reference: 23/WM/0092). Study results will be disseminated in peer-reviewed journals.

Trial registration number

NCT05944432.

Secondary identifying number

Identifier assigned by the sponsor: ADC-UK-PMS-22057.

Protocol version

Revision D. Dated, 13 December 2024.

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