El presente trabajo, abarca un análisis de las pandemias, en especial del reciente COVID 19, cuya situación excepcional conllevó a la toma de decisiones por parte de los diferentes estados, ante el inminente colapso de los sistemas de salud; lo que originó una serie de confrontación de derechos fundamentales, colocando a los médicos en la posición de decidir a quién se le proporcionaba el escaso equipamiento médico, ante una elevada demanda de pacientes, aunado a esto, se pasaron por alto los principios bioéticos como el de dignidad humana o defensa de la vida, así como el de beneficencia, ello ante las escasas e ineficaces directrices que se dieron en algunos países, por lo que en el presente trabajo, buscamos proponer reglas biojurídicas que puedan ser aplicadas en futuras pandemias. / This document covers an analysis of pandemics, especially the recent COVID 19, this exceptional situation led the different states to make decisions, in the face of the imminent collapse of health systems; which originated a series of confrontations of fundamental rights, placing doctors in the position of deciding who was provided with scarce medical equipment, in the face of a high patient demand, added to this, bioethical principles such as human dignity or defense of life were overlooked, as well as the principle of beneficence, in front of the few and ineffective guidelines that were given in some countries, therefore in the present work, we seek to propose bio-legal rules that can be applied in future pandemics.

Yes / The COVID-19 pandemic and associated restrictions caused major disruption globally, shedding light on the unprecedented strain upon the mental health and wellbeing of individuals around the world. Poor mental health in the pandemic is reported to be greater in women, with mothers being at increased risk. It is unclear whether there are differences in the impact of mental wellbeing on some ethnic groups over others. The aim of this study was to explore the experiences of British Muslim Pakistani women with family responsibilities during the COVID-19 pandemic, two years on from the first lockdown. Methods Qualitative interviews with women were conducted via telephone using a semi-structured topic guide. The sample included 25 British Muslim Pakistani women with family responsibilities, both English and non-English speaking. Women lived in households that ranged in number and included extended family. Key themes were determined using thematic analysis. Results Results were grouped under three themes. These were (1) Community, cultural and religious contributors to poor mental wellbeing, (2) religious and cultural mediators of mental distress, and (3) perceived positive impact on lifestyle. British Muslim Pakistani women were psychologically distressed by the high rates of virus transmission and deaths in their communities and at the prospect of older members of their extended family developing the virus. The impact of restrictions on fundamental religious and cultural interactions further exacerbated poor mental wellbeing in this population. Religion, community social capital and larger household structures were all effective coping strategies for British Muslim Pakistani women. Positive impacts of the pandemic included becoming closer to family and faith, and increased work/life harmony. Conclusions An exploration of religious and cultural coping mechanisms should be used to inform future national pandemic preparedness plans, as well as effective strategies for building and maintaining social capital. This may increase adherence to physical distancing and other protective behaviours in populations. / Department of Health, United Kingdom, NIHR200166

This article is a literature review about global catastrophic risks. Its contribution is to give an overview of the research field in general and highlight the main potential catastrophic areas linked with recent studies. In many movies and TV shows, we can see our civilization collapse in various ways: Gigantic asteroids hit the earth and obliterate all life, nuclear wars emerge, artificial intelligence evolves and starts wars with humans, pandemics spread, and other kinds of catastrophic events with mass death or extinction of all life happen. Thus, even if these are extreme events and fiction, we should raise the question how likely it is that one or more of these events can occur in the near and far future. Although calculated probabilities of impact are low for the future such as tomorrow, in 10, 100 or a million years from now, this could actually be reality. Nevertheless, why should we care about the risks of these global catastrophic events today and what could be done to prevent or reduce the risk of a global catastrophe? In this paper we will discuss core content, such as different risks and ways to reduce them internationally, as well as the scientific context of the field. In fact, there are events that can be catastrophic on a global scale and happen in the near future, even if we do not know exactly when. Hence, specific risk assessment and proper mitigation strategies are necessary in order to maintain the human population. This article states that serious research is a basis for decision makers in particular, who invest funds in countermeasures.

Since the last century, many wars and violations of Human Rights were direct reasons that set the pace to develop Human Rights laws, especially after the end of World War II and the holocausts associated with it. One of the critical Human Rights is that ‘to life’, relating to the right ‘to health’, hence the fundamental accessibility to healthcare services and products. Nonetheless, the last decades have witnessed a significant growth in pharmaceutical patents leading to increased drug prices. Overshoots in prices prohibit access to medicine. Disputes between States, pharmaceutical corporations, patients, and investors have occurred, some of which were not purely related to monetary aspects but also to Human Rights, such as the right to ‘access to medicine’. These disputes are controversial. The applicable legal regimes are patent laws (e.g., the TRIPS Agreement) and International Human Rights Law (IHRL) including the European Convention on Human Rights (ECHR), European Social Charter, and more. However, it is up to the courts to decide on whether to consider IHRL in the legal decision process. The question turns to whether they consider the two regimes to be intersecting or independent. This thesis tackles the area of intersection between patent law and the right to ‘access to medicine’ in cases of pandemics such as inter alia HIV/AIDS and COVID-19. It investigates whether the right to ‘access to medicine’ exists as a human right by law, to jump to examine whether solutions like Compulsory Licenses (CLs) and patent exceptions are suitable. Then it answers the question whether there should be defragmentation of laws or not. The work analyzes available caselaw to seek a balance between patent laws and the human right to ‘access to medicine’ during pandemics. Caselaw shows that the conflict makes the overlap of laws confusing and in need of determining the set of relevant provisions in the applicable norms. The question on defragmentation in answered by focusing on Section 5 of the TRIPS Agreement and some provisions in IHRL instruments. The thesis proposes a defragmentation of applicable laws that aids in looking at previous solutions to reach the sought balance, and it sheds the light to give recommendations. The work finally recommends being proactive, for times of pandemics like the COVID-19 outbreak, and working on the realization of a unified and harmonized EU patent law to keep up to the objective of delivering quality vaccines/antivirals, on time, within budget, and with supporting applicable laws.

Introduction: Community mitigation strategies (CMS) have demonstrated to be effective in the reduction of transmission and incidence of COVID-19, especially in the population with symptoms associated with the disease. The aim of this study was to evaluate the association between the presence of COVID-19 symptoms and adherence to CMS in Latin American adults. Methods: We carried out a secondary analysis of a database developed by the University of Maryland and Facebook social network during the COVID-19 pandemic. We included Latin American adults that used the Facebook platform and participated in a survey conducted from April 23 to May 23, 2020. The principal outcome variable was reported compliance with the three main CMS (physical distancing, use of face masks, and hand washing). The exposure variable included symptoms suspicious for COVID-19 defined as the presence of three or more symptoms of an acute clinical case of COVID-19. We performed generalized linear models of the Poisson family with a logarithmic link function to evaluate the association between the presence of COVID-19 symptoms and reported compliance with CMS. We calculated crude and adjusted prevalence ratios (PR) with their 95% confidence intervals (95%CI). Results: We analyzed 1,310,690 adults from Latin America; 48.1% were male and 42.9% were under 35 years of age. The prevalence of suspicious symptoms of COVID-19 was 18.5% and reported compliance with the three CMS was 45.3%. The countries with the highest proportion of reported compliance with the three CMS were Peru, Bolivia and Panama, while those with the lowest reported compliance were Costa Rica, Nicaragua and Honduras. In the adjusted model, people with suspicious symptoms for COVID-19 had a 14% lower compliance with the three CMS (aPR = 0.86; 95%CI: 0.85–0.87; p < 0.001). Conclusions: Less than half of the participants complied with the CMS, and those presenting suspicious symptoms for COVID-19 had lower reported compliance with the three CMS. / University of Maryland / Revisión por pares

BACKGROUND: Telepresence robots provide real-time audio, video, and mobility features, allowing faculty and students to engage in learning experiences without being physically present. PROBLEM: With multiple students and faculty members needing to quarantine due to the COVID-19 pandemic, a flexible learning environment was essential. APPROACH: The telepresence robots were used as an innovative approach for both faculty and students to engage in learning experiences offered in a variety of settings. OUTCOME: Feedback was obtained from faculty and students about the use of and satisfaction with telepresence robots. The robots were easy to use and posed only a few technological challenges, which were easily overcome. CONCLUSIONS: Telepresence robots were effective tools in overcoming teaching and learning barriers caused by the COVID-19 pandemic. The telepresence robots have many applications, including use in clinical and community settings.

Increased economic growth and growing competition in the world market has led to an increased need for Supply Chain Management (SCM). SCM leads to a complex network between the parts in the entire flow chain and the complexity increases the vulnerability to external disturbances. At the end of 2020, the COVID-19 pandemic start spreading, an external disturbance, had a major impact on society. Because of the preventive measures to prevent the spread of infection, many companies' supply chains are affected. Today, it is a major challenge for companies to manage and mitigate the risk on the company through well-functioning risk management, both to work proactively and reactively, as well as structural flexibility in the supply chain. This thesis examines how a Swedish medium-sized export company is affected by COVID-19 and how they work proactively and reactively in reducing negative consequences in the supply chain as a result of COVID-19. The study was conducted with qualitative interviews at the case company and the result was compared with a literature study of existing risk management theory in the event of disastrous events. A literature survey shows that there is a clear research gap, as there is limited knowledge about COVID-19 and its impact on corporate supply chains. Previous research on the subject is not comparable to COVID-19, as all disease outbreaks are unique. The result shows that the company has comprehensive risk management through an appointed director of the group management who proactively works with risks and has prepared a crisis management plan that is used during the outbreak of COVID-19. The crisis management plan, on the other hand, does not address pandemics, but the plan has been adapted to the current situation. However, supply chain risks should be seen not only as a threat to the business, but also as opportunities. Both positive and negative consequences for the case company have been identified. The results, however, contain limitations as the pandemic during the study's time span is still going and can create further direct and indirect consequences, and a future study can follow up on the outcome of the pandemic on the case company and suggest improvements based on the company's risk management. / En ökad ekonomisk tillväxt och växande konkurrens på världsmarknaden har lett till ett ökat behov av supply chain management (SCM). SCM leder till ett komplext nätverk mellan aktörerna i hela flödeskedjan och komplexiteten ökar sårbarheten för externa störningar. I slutet av 2019 uppstod pandemin COVID-19, en extern störning, som gav stora konsekvenser på samhället. På grund av de förebyggande åtgärderna för att förhindra smittspridningen påverkas många företags supply chain. Idag är det en stor utmaning för företag att hantera och mildra risken på företaget genom en väl fungerande riskhantering, såväl att arbeta proaktivt och reaktivt, samt en strukturell flexibilitet i supply chain.   Den här studien undersöker hur ett svenskt medelstort exportföretag påverkas av COVID-19 och hur de arbetar proaktivt och reaktivt med att reducera negativa konsekvenser i supply chain till följd av COVID-19. Undersökningen genomfördes med kvalitativa intervjuer på fallföretaget och resultatet jämfördes med en litteraturstudie av befintlig teori om riskhantering vid katastrofala händelser. En litteraturundersökning visar att det finns ett tydligt forskningsgap, då det råder begränsad kännedom om COVID-19 och dess påverkan på företagets supply chain. Tidigare forskning inom ämnet är inte jämförbart med COVID-19, eftersom alla sjukdomsutbrott är unika. Resultatet visar att företaget har en övergripande riskhantering via en tillsatt direktör i koncernledningen som proaktivt arbetar med risker och har upprättat en krishanteringsplan som används under utbrottet av COVID-19. Krishanteringsplanen tar däremot inte upp pandemier, men planen har kunnat anpassats till rådande situation. Risker i supply chain ska dock endast inte ses som ett hot mot verksamheten, utan det handlar även om att se möjligheterna. Både positiva och negativa konsekvenser på fallföretaget har identifierats. Resultaten innehåller dock begränsningar då pandemin under studiens tidsspann är under spridning och kan skapa ytterligare direkta och indirekta konsekvenser, och en framtida studie kan följa upp resultatet av pandemin på fallföretaget och föreslå förbättringar utifrån företagets riskhantering.

Vitamin D insufficiency remains a costly pandemic in veterans. Treatment requires achievement of desired 25-hydroxyvitamin D [25(OH)D] concentrations. The frequency with which 25(OH)D should be measured following treatment remains speculative. A retrospective analysis of veterans with vitamin D insufficiency was conducted. The group was stratified on the basis of initial 25(OH)D and assessed for frequency of follow-up 25(OH)D concentrations. Over 3 years, 278 patients with insufficient 25(OH)D concentrations were identified. Of these, 87 (31%) patients had subsequent levels assessed in the year following initial documentation of vitamin D insufficiency. The likelihood of follow-up testing was unrelated to the initial vitamin D level. In the patients with follow-up 25(OH)D levels, 90% eventually achieved a serum level of 30 ng/mL or greater. Veterans with vitamin D insufficiency have inadequate serial monitoring of 25(OH)D concentrations.

Bakgrund: Tidigare pandemier har haft negativa konsekvenser för både människan och samhället. Pandemihanteringen behöver anpassas till den lokala kontexten och åtgärderna kräver förändringar av människornas beteenden. För att dessa ska kunna implementeras på ett fördelaktigt sätt krävs det information om människors upplevelser och uppfattningar i en pandemikontext. Syfte: Att studera erfarenheter gällande coronapandemin och dess konsekvenser hos människor som lever i en ö-värld. Metod: Studiens deltagare (n=21) rekryterades från Ålands Covidkohort (ÅCK). Datainsamlingen skedde genom fyra fokusgruppintervjuer och dessa analyserades med hjälp av systematisk textkondensering.  Resultat: Tre kategorier identifierades genom analysen. Den första kategorin handlar om både positiva och negativa förändringar gällande arbete, studier, vardag och det sociala livet. I den andra kategorin tar deltagarna upp oron för både framtiden och anhöriga, samt den psykiska påverkan som pandemin har lett till. Den sista kategorin handlar om erfarenheter kring pandemihanteringen, förvirring och frustration kopplat till denna, tilliten till myndigheter samt en gemensam strävan att stoppa pandemin. Slutsats: Ålands egenskap av ö-värld har påverkat människornas erfarenheter av pandemin. Ön är positionerad mellan två länder och pandemin har påverkat förhållandet till dessa.Litenheten har bidragit till ett socialt tryck och en ansvarskänsla. Det är viktigt att ta hänsyn till den lokala kontexten samt vilken fas pandemin befinner sig i vid framtida studier. / Background: Previous pandemics have had negative effects on both people and society. Pandemic management needs to be adapted to the local context and the measures require a behavioral change. To implement these measures in a beneficial way, information about people's experiences and perceptions in a pandemic context are required. Aim: To study experiences regarding the corona pandemic and its consequences on people living on an island. Method: The study was conducted on Åland and participants (n = 21) were recruited from Åland's Covid cohort (ÅCK). Data were collected through four focus groups interviews, and these were analyzed using systematic text condensation. Results: Three categories were identified through the analysis. The first category deals with both positive and negative changes regarding occupation, everyday life and social life. In the second category, the participants address their worry, both for the future and their relatives, as well as the psychological impact due to the pandemic. The last category deals with experiences of pandemic management, the confusion and frustration associated with it, trust in authorities and a joint effort to stop the pandemic. Conclusion: The fact that Åland is an island has affected people's experiences of the pandemic. The island is situated between two countries its relationship to these has been affected due to the pandemic. The littleness has contributed to social pressure and a sense of responsibility. It is important to consider the local context and the phase of the pandemic when conducting future studies.

The spread of pandemic influenza A (2009 H1N1 influenza) virus resulted in a global influenza pandemic in 2009. During the early stages of the pandemic, population surveillance was crucial. However, officials around the world realized that many of our surveillance and reporting systems were not prepared to respond in a coordinated, integrated way, which made informed public health decision-making very difficult. More accurate estimates of the total number of hospitalized 2009 H1N1 influenza cases were required to calculate population-based 2009 H1N1 influenza-associated mortality, morbidity and hospitalization rates. For instance, how many people were hospitalized with 2009 H1N1 influenza in Massachusetts? Of these, how many were admitted to the ICU and how many died? Compared to seasonal influenza, were some race/ethnic and age groups affected more than others, and what types of characteristics led to more severe manifestations of 2009 H1N1 influenza among these groups in Massachusetts? To address the above questions, I proposed a retrospective cohort study using data from the Hospital Discharge Database (HDD), which contains data for all inpatients discharged from 76 acute care hospitals in Massachusetts, as well as Census information to provide a measure of socioeconomic status (SES). My specific aims are as follows: 1. Develop methods to identify influenza cases precisely and describe characteristics of those hospitalized with ILI in MA between April 26-Sept 30, 2009; 2. Conduct analyses to identify race/ethnicity-related trends in reference to 2009 H1N1 influenza-related hospitalizations; 3. Conduct analyses to identify age-related trends in reference to 2009 H1N1 influenza-related hospitalizations. First, I established influenza case selection criteria using hospital discharge data. I addressed limitations in the published methods on defining cases of influenza using administrative databases, and evaluated ICD-9 codes that correspond with common and relatively serious respiratory infections and influenza using a ‘maximum’ and ‘minimum’ approach. Results confirmed that 2009 H1N1 influenza affected a younger population, and disproportionately affected racial minorities in Massachusetts. There were also higher rates of ICU admission compared to seasonal influenza. I then presented epidemiological data indicating race/ethnic disparity among 2009 H1N1 influenza cases in Massachusetts. I found that Hispanics had significantly lower odds of 2009 H1N1 influenza-related ICU stay. SES gradients calculated using five-digit zip code information did not account for these differences. Within race/ethnic strata, Hispanics Finally, I presented epidemiological data indicating differences among 2009 H1N1 influenza cases by age group in Massachusetts. I calculated measures of Diagnostic Cost Group (DxCG) comorbidity for the study population to provide a comorbidity measure at baseline. Main results indicate that although comorbidity scores were similar between the 2009 H1N1 influenza and seasonal influenza groups, 2009 H1N1 influenza caused more severe disease in younger age groups. This is the first study to report population-based statewide outcomes in all acute care centers in MA. In this dissertation I address challenges surrounding influenza surveillance to create case selection criteria within an administrative database. Using my case selection criteria, I then provide data related to fatality and severity of 2009 H1N1 influenza in Massachusetts in reference to sociodemographic variables such as racial/ethnicity and age groups, and provide evidence for patient-level interventions to those hardest hit by influenza. These findings provide valuable information about using large administrative databases to describe pandemic influenza cases and guide resource allocation to reduce disparities in relation to pandemic influenza preparedness.