Objetivo: Describir las características demográficas, clínicas, laboratoriales y de tratamiento de pacientes hospitalizados por la COVID-19 y determinar los factores de riesgo de mortalidad hospitalaria. Materiales y métodos: Estudio de cohorte retrospectivo de pacientes adultos hospitalizados por la COVID-19. Se extrajeron datos demográficos, clínicos, laboratoriales y de tratamiento de las historias clínicas de pacientes que ingresaron al Hospital III Daniel Alcides Carrión de Tacna. Para el análisis de supervivencia se empleó el modelo de riesgos proporcionales de Cox y se calcularon los cocientes de riesgo instantáneos (HR) crudos y ajustados con sus respectivos intervalos de confianza al 95% (IC 95%). Resultados: Se evaluó a 351 pacientes, el 74,1% eran hombres; las comorbilidades más comunes fueron obesidad (31,6%), hipertensión (27,1%) y diabetes mellitus (24,5%). La mediana de tiempo de hospitalización fue 8 días (RIC: 4-15). El 32,9% falleció durante el seguimiento. El análisis multivariado mostró un aumento del riesgo de morir asociado a la edad ≥65 años, HR = 3,55 (IC 95%: 1,70-7,40); al incremento de lactato deshidrogenasa >720 U/L, HR = 2,08 (IC 95%: 1,34-3,22); y a la saturación de oxígeno por debajo del 90%, principalmente cuando fue menor al 80%, HR = 4,07 (IC 95%: 2,10-7,88). Además, el uso de colchicina en el tratamiento tuvo un efecto protector, HR = 0,46 (IC 95%: 0,23-0,91). Conclusiones: Los factores de riesgo de muerte por la COVID-19 incluyeron ser mayor de 65 años, tener saturación de oxígeno menor de 90% y elevación del lactato deshidrogenasa >720 U/L; el tratamiento con colchicina podría mejorar el pronóstico de los pacientes.

Title: Distance form of teaching physical education during the pandemic SARS- CoV-2. Aims: The aim of this work was to determine the course and provision of physical education in the time of the SARS-CoV-2 pandemic from 1 January 2020 to 31 December 2020. Methods: An online questionnaire was used to write the work, which was shared with teachers via social networks and via email. CAWI method was used for data collection. The data were subsequently processed using MS Excel 2013. Results: The results show that in the spring the teaching of physical education took place much less and less often than in the autumn. In the spring, the teachers did not yet have such technical equipment compared to the autumn, and the teaching took place mainly in an offline form. In the autumn, more teachers taught online, focusing mainly on motivating children to move. In the spring part, the teaching was more theoretically focused. Respondents agreed that a failure in physical education will have a major impact on children's development in the future. Keywords: SARS-CoV-2, distance learning, physical education, government measures, pandemic

Background: The epidemiology of SARS-CoV-2 infection in the pediatric population, with a focus on racial and ethnic disparities and impact of societal public health measures, remains poorly understood. Methods: This large observational study used electronically abstracted data from pediatric (≤ 19 years of age) patients who received a molecular test for SARS-CoV-2 at a UMass Memorial Health Care (UMMHC) site between March 8, 2020 and April 3, 2021 which was further supplemented by manual chart review of a subset of pediatric SARS-CoV-2 cases. Multivariable logistic regression models with interaction terms were used to identify risk factors for SARS-CoV-2 infection. Segmented regression analysis using Poisson models was used to estimate the effect of public health measures on the weekly incidence of SARS-CoV-2 infection. Results: A total of 25,426 unique pediatric patients were tested for SARS-CoV-2 among whom 2,920 (11.5%) tested positive. The average age of those who tested positive was 10.8 years (SD: 5.8) and 48.1% were female. In the subset analysis, nearly three-quarters (75.9%) of SARS-CoV-2 diagnoses occurred through a telephone encounter, meaning that the child was not physically examined by a provider prior diagnosis and only 2.0% were admitted for inpatient care at diagnosis. Results of multivariable regression revealed that children or parents who self-reported Black race, Hispanic ethnicity, and non-English primary language were associated with approximately twice the odds of testing positive in comparison with White or English-speaking patients. Furthermore, increasing age was associated with increased odds of testing positive for SARS-CoV-2 (aOR: 1.1 (1-4 years), 1.2 (5-9 years), 1.4 (10-14 years), 1.6 (15-17 years), 1.7 (18-19 years)). However, this association between age and positivity rate, varies by race/ethnicity and primary language such that Non-Hispanic Black, Hispanic, and non-English speaking children had markedly greater odds of testing positive during adolescence in comparison to Non-Hispanic White and English-speaking counterparts. Results from segmented regression analysis demonstrated a decline in weekly incidence of cases 9.9% (95% CI: 7.8 – 11.9) after the Massachusetts state mask mandate was implemented. During the winter holidays, the rate of increase in the weekly incidence of cases was 12.1% (95% CI: 11.9 – 12.3) in this pediatric population. Conclusions: Many SARS-CoV-2 cases have been diagnosed at UMMHC sites and notable racial/ethnic disparities exist that vary based on patient age. Public health measures are effective at preventing transmission of SARS-CoV-2 among children.

During the past two years, the pandemic of the SARS-CoV-2 virus has impacted where a big share of the world’s employees conducts their work. Governments around the world have encouraged people to stay at home as much as possible, in the hope of slowing down the infection rate of the virus. Companies around the world have therefore encouraged their employees to work from home. The change has been rapid and unusual for a lot of people. The purpose of this thesis is to examine what the effects of working from home has had on employees and what parameters may make it sustainable long-term. When investigating this matter further, a set of sub-questions has been identified in hope to obtain a deeper understanding of the topic and to answer the question of How can working from home be sustainable long-term? This paper is a qualitative research that follows an inductive approach. The literature review provides relevant theoretical background, which has then been the foundation for the analysis and conclusion. The theories provided covers leadership, motivation, efficiency, gender equality, government support, and internationalization. The conceptual framework then provides a deeper understanding of how each of these theories relates to the main question and its sub-questions. The authors have then examined secondary data such as articles from trusted journals as well as government records in a systematic literature review. An analysis of the findings in the systematic literature review in correlation to the theories has then been made to each sub-question. The concluding chapter then ties the thesis by answering the main question of this subject.

As a global phenomenon, the outbreak of SARS-CoV-2 has impacted the socio-economic and political life like no other event of the recent past. With over 600,000 fatalities in its member-states, an unprecedented economic recession and damage to the Single Market, the European Union has been hit unexpectedly hard by COVID-19. Through the lens of Securitisation, and more precisely, Collective Securitisation, this thesis has the purpose to examine how the EU and its institutions have responded to the threat that is the spread of SARS-CoV-2, asking ‘Has SARS-CoV-2 been successfully securitised in the European Union?’. By applying a qualitative content analysis to speeches of the European Commission published between January and May 2020 as well as to a European Parliament Plenary debate following the speech of Commission President von der Leyen on April 16th, 2020, the thesis establishes that securitising moves have taken place in the examined timeframe and that they have been accepted by the European Parliament. In accordance with the Copenhagen School framework of Securitisation and Sperling and Webber’s Collective Securitisation model, the thesis concludes that COVID-19 was therefore successfully securitised.

Introduktion COVID-19 orsakas av viruset SARS-CoV-2. 3-chymotrypsin-liknande cysteinproteaset (3CLpro) är ett enzym som styr coronavirus replikation och är viktigt för viruset livscykel. Därför 3CL pro är en viktig måltavla för att hämma SARS-CoV-2. Syfte Syftet med detta projekt är att undersöka om proteashämmare kan vara en framkomlig väg för att ta fram antivirala läkemedel mot COVID-19. Metod Arbetet är en litteraturstudie och databasen PubMed har använts för att hitta vetenskapliga artiklar med hjälp av olika sökord, såsom SARS-CoV 2 and protease inhibitors, SARS-CoV-2 and 3CL-pro, MERS-CoV and 3CLpro inhibitors och SARS-CoV and 3CLpro. Totalt valdes 10 vetenskapliga artiklar ut som grund för att undersöka om några proteashämmare finns rapporterade och hur de utvärderats, dvs i prekliniska studier eller kliniska studier. Resultat  Peptidomimetiska alfa-ketoamider är effektiva bredspektrum hämmare för att hämma 3CL pro i SARS-CoV-2 och enterovirus, t.ex. alfa-ketoamiderna (13a och 13b) som även visade goda farmakokinetiska egenskaper i prekliniska studier. Även läkemedelskandidater (11a och 11b) har utvärderats i prekliniska studier och både visade hög SARS-CoV-2 3CL-pro hämmande aktivitet. Två nya studier visade att genomsekvensen för SARS-CoV-2 3CLpro är mycket lik den för SARS-CoV-1 än MERS-CoV. Herbacetin, rhoifolin pectolinarin och Biflavonoid amentoflavon 9 visade en effektiv hämning av SARS-CoV-1 3CL pro. Herbacetin, isobavachalcone, quercetin 3 ‐ β ‐ d ‐ glukosid, helikrysetin och enterovirushämmare (6b, 6c och 6d) visat sig ha hämmande aktivitet och kunde hämma den enzymatiska aktiviteten hos MERS-CoV 3CL pro. De redan framtagna HIV-proteashämmarna lopinavir och ritonavir har utvärderats i kliniska prövningar och både visade ingen skillnad mot standardbehandling samt minskade inte dödlighet. Slutsats Slutsatsen som kan dras av studien är att det finns flera proteashämmare i preklinisk fas mot SARS-COV-2 3CL-pro samt finns flera proteashämmare mot SARS-CoV-1 och MERS-CoV. Proteashämmare kan vara ett möjligt läkemedel mot COVID-19 i framtiden, men det tar lång tid för att utveckla ett nytt läkemedel.

Following the detection of SARS-CoV-2 RNA fragments in wastewater in March 2020, the use of wastewater-based epidemiology is rapidly emerging as a non-invasive approach to assessing community wide COVID-19 prevalence. Wastewater-based epidemiology is promoted as a complement to clinical testing in terms of improving public health authorities’ preparedness and supporting them in taking required interventions to protect the public health.  To utilize the occurrence of SARS-CoV-2 in wastewater in a public health context and evaluate trends in viral prevalence on a community level, robust data interpretation is required. This master's thesis work examines what is currently known about the factors that influence the concentrations of SARS-CoV-2 in wastewater, as well as the impact of alternative normalization approaches on the relationship between viral wastewater data and clinical case numbers. The work is divided into two parts where this report provides a state-of-the-art review as well as an overview of key findings in the accompanied scientific paper.  The study involved collection of wastewater samples from two different sized wastewater treatment plants (WWTPs) in Luleå municipality, between January and March 2021.  Concentrations of SARS-CoV-2 RNA were quantified in each sample as well as concentrations of total nitrogen (TN), total phosphorus (TP) and pepper mild mottle virus (PMMoV). Average daily WWTP flow and environmental data (precipitation and temperature) were continuously measured over the sampling period. The population size was estimated based on mass loads of TN and TP and literature values of the domestic contribution of these parameters to the sewer system. The viral wastewater data was normalized using the estimations of population size, census data, WWTP flow and PMMoV. The impact of the alternative normalization approaches was evaluated using statistical analyses to explore the relationship to clinical case numbers.  The result showed that the strength of the correlation between the different normalization approaches and clinical case data differed between the WWTPs. However, within each WWTP the differences in correlation between the different normalization approaches and clinical cases were not significant. Moreover, normalization using WWTP flow (i.e., viral loads) showed a stronger correlation to clinical cases compared to population and PMMoV normalized viral loads. However, when comparing wastewater data between the two catchment areas, the normalization approaches utilizing population (either census or TN and TP estimated population) or PMMoV better reflect the number of clinical cases. Additionally, according to time-shifted analysis, wastewater data of SARS-CoV-2 RNA predated an increase in clinical cases by 0-2 and 5-8 days, respectively, for the larger and smaller WWTPs.

Introduction: The coronavirus is an RNA virus with a lipid envelope. The initially known coronaviruses are (MERS-CoV and SARS-CoV) which caused fatal endemics in 2002 and 2012. At the end of 2019, a new variant of coronavirus called SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) was discovered in Wuhan in China. SARS-CoV-2 has caused serious diseases especially in the older groups with millions of infections and deaths. The World Health Organization (WHO) identified Covid-19 as a global health emergency on 30 January 2020 and classified it as a pandemic on March 11, 2020. Several companies started developing a vaccine to stop the spread of SARS-CoV-2. Several vaccination programs have been approved and are currently used against Covid-19. Objectives: The work aimed to investigate the safety and efficacy of the approved mRNA-based vaccines against SARS-CoV-2. Method: The work was based on reviewing published, scientific articles that examined safety and efficacy of mRNA-based vaccines (Pfizer BionTech BNT162b and mRNA-1273 Modern). In total there were five clinical trials selected from Pubmed. Two studies examined the safety and efficacy of mRNA-1273 Moderna and three other studies examined the safety and effectiveness of the Pfizer BionTech BNT162b. Results: Both vaccines have shown good safety and efficacy and were well tolerated in patients in different ages. mRNA-based vaccines have shown mild to moderate symptoms that were higher after dose 2 and disappeared after a few days. Both Pfizer BionTech and Modern mRNA-1273 have shown efficiencies over 90%.

Background: Vaccination against SARS-CoV-2 significantly reduces the transmissibility of the virus and the likelihood of a severe course of COVID-19, and is thus a critical component in overcoming the current pandemic. The factors associated with adverse reactions after vaccination against SARS-CoV-2 have not yet been sufficiently evaluated. Methods: We used the Disease Analyzer database (IQVIA) to identify 531,468 individuals who received a total of 908,869 SARS-CoV-2 vaccinations in 827 general practices in Germany between April and September 2021. Cox regression models were used to analyze the frequency of vaccination-related side effects reported within 14 days after SARS-CoV-2 vaccination, as well as subjects’ demographic characteristics and comorbidities. Results: The total number of side effects documented was 28,287 (3.1% of all vaccinations). Pain in the limb (24.3%), fatigue (21.0%), dizziness (17.9%), joint pain (15.7%), fever (9.5%), nausea (7.5%), and myalgia (6.4%) were the most common side effects documented among the 12,575 vaccinations with definite side effects. In the multivariate regression analysis, young age was associated with much higher odds of reported side effects (OR18–30 years: 4.45, OR31–40 years: 3.50, OR41–50 years: 2.89). In addition, pre-existing comorbidities such as dementia (OR: 1.54), somatoform disorder (OR: 1.53), anxiety disorder (OR: 1.43), depression (OR: 1.37), chronic respiratory tract disease (OR: 1.27), hypertension (OR: 1.20), and obesity (1.14) significantly increased the odds of side effects. Finally, the male sex was associated with increased odds of reported side effects (OR: 1.17). Conclusion: Our study, based on a large outpatient database from Germany, identified young age, male sex, and pre-existing comorbidities such as dementia, somatoform disorders, anxiety disorders, and depression as factors associated with vaccine-related adverse events diagnosed in GP practices. These data could help to identify subgroups needing particular advice and care in the context of SARS-CoV-2 vaccinations.

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