<div>The papain-like protease (PLP) domain of nonstructural protein 3 (nsp3) of the coronavirus (CoV) genome promotes viral replication by processing the CoV polyprotein (protease) and also antagonize innate immune responses by deubiquitinating (DUB) and deISGylating (deISG) host substrates. Selectively removing the DUB/deISG activities of PLP while keeping the protease activity intact is a potential strategy for designing a live attenuated virus. However, it is unclear in the literature the precise mechanism by which PLPs support CoV evasion of the innate immune system. Deciphering the substrate specificity of PLPs for host ubiquitin (Ub) and interferon stimulated gene 15 (ISG15) can therefore help in the design of PLP mutants that selectively lack one activity for evaluating the DUB and deISG mechanism in CoV pathogenesis and replication. </div><div> In this dissertation, we investigate the structure and function of the single PLP (PLpro) from beta-CoVs, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), which are dangerous viral pathogens that emerged from a zoonotic source to cause infectious disease in the human population. Additionally, we translate the knowledge gained to the equivalent PLP2 from alpha-CoV porcine epidemic diarrhea virus (PEDV) and feline infectious peritonitis virus (FIPV), which cause fatal disease in suckling piglets on industrial pork farms and household cats, respectively. The primary objective of this work is to rationally design PLP mutants across beta- and alpha-CoVs to help attenuate CoV infection, as no antiviral or vaccine exist for human CoVs and the efficacy of PEDV vaccines are an ongoing research topic. </div><div><br></div><div>In Chapter 1, different human, animal, and the bat origin CoV strains are introduced. The CoV life-cycle and virion structure are outlined, along with the replicase complex for viral replication. The multidomain nsp3 from alpha- and beta-CoV genomes are also described with a focus on the PLP domain and its proposed cleavage sites of the viral polyprotein. The discovery of the first viral protease DUB and the multiple activities of PLPs are defined, which includes a proposed model of how DUB versus deISG activities may act in the innate immune response. This leads into the therapeutic potential of PLP for an antiviral or live attenuated vaccine, which is followed by the introduction of live attenuated vaccines and the reverse genetics system. Next, proof of concept studies on PLP2 mutants are described and the introduction is concluded by stating the ultimate goal for the design of PLP mutants.</div><div><br></div><div>In Chapter 2, we hypothesize that the flanking ubiquitin-like (Ubl2) domain of MERS-CoV PLpro is not required for its enzymatic function. We characterize the specific activity, kinetics, substrate specificity, and inhibition of the PLpro enzyme with and without the Ubl2 domain and reveal that the Ubl2 domain does not significantly alter PLpro function. We determine the structure of the core PLpro, smallest catalytic unit to 1.9 Å resolution and observed no structural changes compared to the wild-type. Additionally, we demonstrate that a purported MERS-CoV PLpro inhibitor is nonselective in non-reducing conditions and should not be pursed for therapeutic use. We show that the core PLpro enzyme i.e. without the Ubl2 domain is a stable and robust construct for crystallization and is also thermally stable based on thermal melting studies with utility for structure-based drug design. </div><div><br></div><div>In Chapter 3, we shed light on the specificity of SARS-CoV PLpro towards Ub versus ISG15 by characterizing the specific activity and kinetic parameters of SARS-CoV PLpro mutants. In addition, the structure of SARS-CoV PLpro in complex with the C-terminal domain of ISG15 is determined and compared with the Ub-bound structure. Based on the structure and kinetic results, the altered specificities of SARS-CoV PLpro mutants Arg167Glu, Met209Ala, and Gln233Glu are compared with the wild-type. Arg167Glu mutant exhibits DUB hyperactivity and is expected to adopt a more favorable interaction with the Arg42 of Ub. At the same time, ARG167GLU contains a shorter side-chain that hinders interaction with the unique Trp123 of ISG15 for deISG activity compared to the wild-type. These results aid in the development of SARS-CoV PLpro mutants that have directed shifts in substrate specificity for Ub versus ISG15. </div><div><br></div><div>In Chapter 4, the process and antiviral activity of ISGylation is reviewed and how viruses can modulate host-derived versus virus-derived machineries to counteract ISGylation for viral infection. MERS-CoV PLpro is cross-reactive for Ub, but less is known about its specificity towards ISG15. In this study, we determine the structure of MERS-CoV PLpro bound with ISG15 to 2.3 Å resolution and reveal a small hydrophobic pocket of ISG15 that consists of P130 and W123, which differs from Ub hydrophobic patch. We design and determine the kinetic parameters for 13 PLpro mutants and reveal that MERS-CoV PLpro only has a single ubiquitin recognition (SUb1) site. Kinetic studies show that removing the charge of the R1649 greatly enhances DUB/protease activity while mutating in an Arg near R42 of Ub or ISG15 hydrophobic region is detrimental to both DUB/deISG activities. Kinetic experiments and probe-reactivity assays showed that Val1691Arg, Val1691Lys, and His1652Arg mutants are drastically reduced DUB/deISG activities compared to the wild-type. Overall, MERS-CoV PLpro mutants with alter kinetic profiles will be useful for discovery tools and DUB/deISG deficient mutants are great candidates for removing host cell antagonism activity by PLpro for live attenuated vaccines.</div><div><br></div><div>In Chapter 5, the goal is to translate the knowledge gained in Chapters 2-4 on beta-CoVs PLpro and evaluate the substrate specificity of alpha-CoVs FIPV and PEDV PLP2 for mutagenesis experiments. First, we design and purify the core PLP2 enzymes for kinetics. PLP2s are efficient DUBs that prefer Ub to ISG15 in vitro, and this preference is conserved in beta-CoV MHV PLP2 as well as alpha-CoV NL63 PLP2. We determine the structure of alpha-CoV PEDV PLP2 to 1.95 Å resolution and reveal the unique Zn-finger coordinating Cys3-His arrangement of the alpha-CoV genus that differs from past beta-CoV PLP crystal structures. To determine residues of the SUb1 site, we generate a homology model of FIPV PLP2 and overlay our PLP2 structures with MERS-CoV PLpro bound with Ub. In addition, we create electrostatic surface maps across coronaviral PLP subfamilies to evaluate the charge distribution of the SUb1 for the rational design of several FIPV and PEDV PLP2 mutants. We evaluate the turnover of PLP mutants for FRET-based substrates and reveal that His101ArgFIPV and Asn101ArgPEDV are drastically reduced in Ub-AMC activity while their peptide activities are within 2-fold of the wild-type. These mutants show delayed reactivity for Ub probes and no longer cleave Ub-chains displaying isopeptide bonds compared to the wild-type. Results from this study reveal a hot spot in both alpha- and beta-CoVs that can be used to selectively remove DUB activity of PLPs for generating a DUB deficient PLP enzyme. </div><div><br></div><div>In this dissertation, we investigate the substrate specificity of PLPs across alpha- and beta-CoVs and develop a fingerprint for Ub and also shed light on ISG15 recognition. Specifically, hot spots were identified in the SUb1 site of different PLPs, which recognize R42 and hydrophobic Ile44 of Ub. Position 97-98 of PLPs can be used to remove DUB activity by substituting an Arg, but usually effect protease function. Substituting an Arg at position 101 and 136 of coronaviral PLPs serve as the best strategy to remove DUB function while not hindering active site functionality. The DUB/deISG deficient mutants described will be useful for inhibiting the ability of PLPs to function in the innate immune response. Ultimately, this work provides a guide for identifying attenuating mutants in existing CoVs for live attenuated vaccines and also a blueprint for engineering PLPs from new emerging CoVs. </div>

El virus SARS-CoV-2 sigue reproduciéndose velozmente y muestra variantes más infecciosas. La segunda ola de la enfermedad va apaciguándose en Europa y Estados Unidos de América del Norte, menos en América del Sur. En el Perú, las cifras de fallecidos han sido sinceradas a más del doble, encontrándose mayor mortandad en los hombres y en los mayores de 70 años. Se ha corroborado en el mundo que la gestante sufre una enfermedad más severa -a veces con un proceso similar a la preeclampsia-, con más posibilidad de muerte que la mujer no gestante y mayor muerte fetal y prematuridad. Las vacunas iniciales elaboradas en los EE UU y Europa están siendo efectivas en disminuir las infecciones, hospitalizaciones y muertes en los países donde la vacunación ha avanzado más rápido. Está siendo administrada en gestantes sin efectos secundarios mayores, recomendándoseles se vacunen para evitar la infección severa. Mientras tanto, no se conoce la duración de la inmunidad dada por la infección COVID-19 y por la vacuna. Se está considerando una tercera dosis de refuerzo y el cambio de marca en los vacunados. Y se está en espera de una tercera ola de infecciones debido a la aparición de las variantes brasilera e india (delta). / The SARS-CoV-2 virus continues to reproduce rapidly and is showing more infectious variants. The second wave of the pandemic is subsiding in Europe and the United States of North America, but not in South America. In Peru, the number of deaths has more than doubled, with a higher mortality rate in men and in those over 70 years of age. It has been corroborated worldwide that pregnant women suffer a more severe disease -sometimes with a process similar to preeclampsia- with a greater possibility of death than non-pregnant women and greater fetal death and prematurity. Initial vaccines developed in the USA and Europe are proving effective in reducing infections, hospitalizations and deaths in countries where vaccination has advanced more rapidly. It is being administered in pregnant women without major side effects, and they are recommended to be vaccinated to avoid severe infection. As of now, the duration of immunity given by COVID-19 infection and by the vaccine is not known. A third booster dose and rebranding of vaccinees is being considered. And a third wave of infe ergence of the Brazilian and Indian (Delta) variants.

Bakgrund: Den pågående pandemin COVID-19 orsakas av viruset SARS-CoV-2. Sedan december 2020 har nya varianter av viruset med betydande genetiska förändringar upptäckts, gemensamt benämnt varianter av särskild betydelse eller variants of concern (VOC). Just nu är det tre VOC som bevakas särskilt; B.1.1.7 (först upptäckt i Storbritannien), B.1.351 (först upptäckt i Sydafrika) respektive P.1 (först upptäckt i Brasilien). Den tidigaste statistiken från Folkhälsomyndigheten om förekomsten av VOC i Region Dalarna är från februari 2021. Förekomsten av VOC innan dess är fortfarande okänd. I regionen delas analysering av prover vid misstanke om COVID-19 in i de olika kategorierna patienter, vårdpersonal, smittspårning och allmänhet. Befintlig statistik om förekomsten av VOC grundar sig nästan enbart på förekomsten bland allmänhetens prover. Syfte: Syftet med denna studie var att undersöka förekomsten av SARS-CoV-2 varianter av särskild betydelse i prover tagna från patienter, vårdpersonal och smittspårningar under december 2020-januari 2021 i Region Dalarna. Studien syftade också till att undersöka när spridningen av respektive VOC kan ha startat i regionen. Metod: Provmaterialet bestod av SARS-CoV-2 positiva prov tagna inom analyskategorierna under tidsperioden. Prover analyserades med RT-PCR och smältkurvsanalys för detektion av VOC-karaktäristiska mutationer. Resultat: Ett fåtal fall av B.1.1.7 detekterades redan i december och en stigande andel av B.1.1.7 påvisades inom analyskategorierna under januari, som tecken på att en regional spridning kan ha startat vid tidpunkten. Endast ett fåtal fall av B.1.351 och/eller P.1 detekterades inom analyskategorierna under tidsperioden, vilket tyder på att en regional spridning av dessa ännu inte hade startat i januari. / Background: The ongoing pandemic COVID-19 is caused by the virus SARS-CoV-2. Since December 2020 new variants of the virus with significant mutations have been discovered, referred to as variants of concern (VOC). At the point, the occurrence of three VOC is especially monitored; B.1.1.7 (discovered in UK), B.1.351 (discovered in South Africa) and P.1 (discovered in Brazil). The earliest statistics about the occurrence of VOC in Region Dalarna, Sweden, is from February 2021 and the occurrence before that is still unknown. In the region analysis of specimen in case of suspected COVID-19 is divided into the different categories patients, healthcare-staff, infection tracing and public. Existing statistics is based almost exclusively on the occurrence of VOC in specimen from the public. Aim: The aim of this study was to examine the occurrence of SARS-CoV-2 VOC among specimens collected from patients, healthcare staff and infection tracing in Region Dalarna during December 2020-January 2021. The study also aimed to examine when the spread of each VOC started in the region. Method: SARS-CoV-2 positive specimen collected within the categories during the time was analyzed with RT-PCR and melting curve analysis for detection of VOC-characteristic mutations. Results: A few cases of B.1.1.7 was detected already in December and an increased percentage of B.1.1.7 was detected within the categories during January, suggesting that a regional spread started at the time. Only a few cases of B.1.351 and/or P.1 was detected within the categories, suggesting that a regional spread of these had not yet started in January.

I mars 2020 drabbades världen av en pandemi kopplat till viruset Covid-19 (SARS-CoV-2). I Sverige som i resten av världen har sjukvårdspersonalen varit tvungna att jobba under hög belastning i stressiga arbetssituationer som resultat av denna pandemi. Syftet med studien var att undersöka vilka faktorer som spelade roll för att vårdpersonalen skulle orka med det stressiga jobbet under en ovanlig situation som covid-19 pandemin. Till denna studie valdes kvalitativ design med en tematisk induktiv analys. Resultatet visade att kollegornas stöd, tydliga instruktioner från närmaste chefer, känslan av stolthet för att kunna klara av situationen tillsammans med andra samt personliga strategier var positiva faktorer som hjälpte vårdpersonalen att kunna klara av arbetet. Medan sjukvårdspersonalen upplevde att stöd från högre ledningen och samhällets ansvar inte var tillräckligt. / In March 2020, the world was hit by a pandemic linked to the Covid-19 (SARS-CoV-2) virus. In Sweden, as in the rest of the world, healthcare professionals had to work under high load in stressful work situations as a result of this pandemic. The purpose of this study was to investigate what factors played a role in the care staff being able to cope with the stressful job during an unusual situation such as the pandemic. For this study, qualitative design with a thematic inductive analysis was chosen. The results showed that the colleagues' support, clear instructions from immediate managers, the feeling of pride in being able to cope with the situation together with others and personal strategies were positive factors that helped the care staff to cope with the work load. While the health care staff felt that support from senior management and the responsibility of society was not enough.

La composition chimique des particules submicroniques (PM₁) a été suivie pendant plus d'un an ( juillet 2013- septembre 2014), à résolution temporelle fine (< 30 min.), à l'aide d'un analyseur ACSM pour la fraction non-réfractaire (organiques, sulfates, nitrates, ammoniums et chlorures) et d'un aethalomètre (carbone suie), complétés par une observation micro-météorologique. Une campagne intensive (juillet 2014) a enrichi le jeu de données avec le suivi de composés organiques volatils par analyse PTR-ToFMS. Le site de mesure est de type urbain de fond, sous l'influence d'une large zone industrielle et portuaire. La composition chimique des aérosols a été analysée de manière globale, saisonnière et selon 4 secteurs de vent. L'étude de la conversion SO₂-SO₄ dans le secteur industriel a montré que ce processus est favorisé à humidité relative élevée (> 70%), faible turbulence verticale (σw : 0-0.5 m sˉ¹) et faible vitesse de vent (0-2 m sˉ¹). À l'aide d'un modèle source récepteur PMF (Positive Matrix Factorization), trois sources primaires d'espèces organiques, liées au trafic, à la combustion de biomasse et à la cuisson domestique, ont été identifiées, ainsi qu'une source secondaire. Les analyses PMF saisonnière et par secteur, avec et sans contraintes, ont permis d'identifier 2 facteurs supplémentaires en secteurs marin et industriel. Quelques cas (brises de mer, épisodes de pollution et passages de bateaux) ont été étudiés, permettant dans le dernier cas d'extraire un spectre de masse moyen lié aux émissions des navires, ShOA (Ship-like Organic Aerosol). Ce facteur contribue en moyenne pour seulement 0.5% à la fraction organique particulaire mais jusqu'à plus de 90% sur de courtes périodes. / The chemical composition of submicron particles (PM₁) was monitored for over one year (July 2013-September 2014), at high temporal resolution (< 30 min), using an Aerosol Chemical Speciation Monitor (ACSM) for the non-refractory fraction (NR-PM₁ : organic, sulfate, nitrate, ammonium and chloride) and an aethalometer for black carbon (BC), together with micrometeorology parameters. An intensive campaign (July 2014) completed the data set including the monitoring of volatile organic compounds by PTR-TOFMS. The chosen site has an urban background typology, under the influence of a large area with industrial and harbor activities. The chemical composition of aerosols was analyzed globally, seasonally and using four wind sectors. A study of the SO₂-to-SO₄ conversion in the industrial sector has shown that this process is favored at high relative humidity (> 70%), low vertical turbulence (σw : 0-0.5 m sˉ¹) and low wind speed (0-2 m sˉ¹). Using PMF (Positive Matrix factorization) source receptor modeling, three primary sources of organic species, relatied to traffic, combustion of biomass and domestic cooking, have been identified, as well as a secondary source. The seasonal and sector PMF analyses, with and without constraints, helped to identify two additional factors in the marine and industrial sectors. Some specific events (sea breezes, high pollution events and nearby ship movements) were studied, allowing to extract an average mass spectrum associated with ship emissions for the latter, ShOA (Ship-like organic aerosol). This factor only contributes to 0.5% of the particulate organic fraction on average but up to more than 90% over short periods.

Les études de séroprévalence portant sur les infections au SRAS-CoV-2 doivent souvent composer avec des échantillons non-aléatoires et non-représentatifs, limitant ainsi parfois la validité externe de leurs résultats lorsque ceux-ci sont appliqués à la population générale. Dans le cadre de ce mémoire, il s’agit d’investiguer la représentativité d’une cohorte pédiatrique d’une étude longitudinale de séroprévalence (Enfants et COVID-19 : Étude de séroprévalence) et d’évaluer dans quelle mesure ses estimations de séroprévalence peuvent s’appliquer à la population pédiatrique montréalaise en général. 1 632 enfants ont fourni au point de départ un échantillon sanguin afin de déterminer leur séropositivité aux anticorps contre le SRAS-CoV-2. À l’aide d’une modélisation par régression logistique et d’un procédé de « standardisation marginale », une pondération post-stratification calculée à partir des données du recensement canadien de 2016 a été appliquée à la population d’étude. Les variations dans les estimations de séroprévalence ont finalement été évaluées. D’importantes différences dans la distribution de certaines caractéristiques sociodémographiques peuvent être observées lorsqu’on compare la population d’étude et la population générale en se basant sur les données du recensement canadien de 2016. En comparaison des estimations non-pondérées, les estimations de séroprévalence générées à partir du procédé de « standardisation marginale » montrent une variation de plusieurs points de pourcentage, allant de -0,4% à +3,2%. La pondération n’a pas induit de changement dans l’estimation de mesures relatives comme les ratios de séroprévalence. Lorsque la population d’étude est non-représentative de la population-cible, il est nécessaire de pondérer les caractéristiques sociodémographiques associées à l’issue si l’on veut appliquer les résultats plus généralement. / Prevalence studies on SARS-CoV-2 infections have often based on study populations with non-random and non-representative samples, which limits the external validity of their results when applied to the general population. The aim of this thesis was to investigate the representativeness of a pediatric cohort of a longitudinal seroprevalence study (Children and COVID-19: Seroprevalence study) and to assess to what extent its baseline estimates of seroprevalence can be applied to the Montreal pediatric population. There were 1 632 children participants who provided a blood sample at baseline, which was used to determine their seropositivity to SARS-CoV-2 antibodies. Using logistic regression modeling and a "marginal standardization" method, post-stratification weights calculated from 2016 Canadian census data were applied to the study population. Variations in seroprevalence estimates were then assessed. Significant differences in the distribution of certain sociodemographic characteristics were observed when comparing the study population and the target population based on 2016 Canadian census data. Seroprevalence estimates were generated from the “marginal standardization” approach which differed to that of the non-standardized estimates, and the differences ranges from -0,4% to +3,2%. Weighting did not change relative measures estimates, such as seroprevalence ratios. When the study population is not representative of the target population, it is necessary to weight the sociodemographic characteristics associated with the prevalence estimates, if the results will be applied more broadly.

Inledning: God vårdhygien är ett centralt begrepp inom all hälso- och sjukvård för att förhindra spridning av sjukdomsframkallande mikroorganismer, vilka kan ge upphov till vårdrelaterade infektioner. Tandvården ska därför följa Hälso- och sjukvårdslagen (1982:763) och Socialstyrelsens föreskrifter om basala hygienrutiner. I samband med Covid-19 pandemin aktualiserades vikten av vårdhygien ytterligare för att förhindra smittspridning av Covid-19 inom tandvården. Munhålan utgör en stor potentiell risk för överföring av SARS-CoV-2, men även andra mikroorganismer, särskilt vid aerosolgenererande procedurer.  Ett tidigare mastersarbete vid Odontologiska fakulteten, Malmö Universitet, påvisade brister i följsamheten med basala hygienrutiner bland tandläkarstudenter. En uppföljning har inte genomförts, vilket uppmärksammades i samband med pandemin och frågeställningen om Covid-19 syn på betydelsen av aseptik och vårdhygien väcktes.  Syfte: Undersöka tandläkarstudenters syn på vårdhygien och självbedömd följsamhet med hygienriktlinjer under Covid-19.  Material och metod: En anonym webbenkät skickades till samtliga tandläkarstudenter på kurs 4–10 vid Odontologiska fakulteten, Malmö Universitet.  Resultat: Den totala svarsfrekvensen var 54%. Resultat visade att samtliga studenter ansåg sig ha tillräckliga kunskaper om hygienrutinerna, men trots detta bröt 20% medvetet mot hygienrutinerna och 4% uppgav att de aldrig följde hygienrutinerna.  Slutsats: Den självbedömda kunskapen om hygienriktlinjer är hög, trots det är inte följsamheten med hygienriktlinjerna optimal, vilket innebär att det finns risk för spridning av vårdrelaterade infektioner. / Introduction: Good hygiene is imperative to prevent the spread of health care associated infections. Dental care must therefore comply with the Health and Medical Services Act (1982: 763) and the National Board of Health and Welfare's regulations on basic hygiene guidelines. In conjunction with the Covid-19 pandemic, the importance of hygiene measures was further emphasized to prevent the spread of Covid-19 in dentistry. The oral cavity poses a high potential risk for transmission of SARS-CoV-2, in addition to other microorganisms, especially in aerosol-generating procedures.  A previous master's thesis at the Faculty of Odontology, Malmö University, showed a deficiency in compliance with hygiene guidelines among dental students. The question if Covid-19 view of the importance of aseptic techniques and hygiene measures in dentistry was therefore raised.  Aim: Investigate dental students' views of healthcare hygiene and self-assessed aseptic measures during Covid-19.  Materials and method: An anonymous web survey was sent to all dental students in courses 4–10 at the Faculty of Odontology, Malmö University.  Results: The overall response rate was 54%. Results showed that all students considered themselves to have sufficient knowledge of the hygiene routines, but despite this, 20% of students deliberately broke the hygiene routines and 4% stated that they never followed the hygiene routines.  Conclusion: The self-assessed awareness of hygiene guidelines and aseptic techniques is high among the students, still the compliance with hygiene protocols is not optimal, meaning there is a risk of spread of healthcare associated infections.

Objetivo: Identificar los factores influyentes en la postura ante la inmunización SARSCoV-2 en estudiantes de medicina de una universidad de Lambayeque en el año 2021. Materiales y métodos: Se realizó un estudio tipo observacional transversal analítico. Se tomó a toda la población elegible,que constó de aproximadamente 160 estudiantes y se distribuyó con un muestreo probabilístico tipo estratificado. El cuestionario elaborado se basó en la encuesta online de la Organización de Consumidores y Usuarios (OCU) titulada “Encuesta OCU: los españoles y la vacuna” que fue realizada en España. Para el análisis estadístico se empleó la herramienta estadística IBM SPSS Statistics 25.0.0.0. Se tabularon las variables categóricas para la distribución de frecuencia y porcentajes, y se realizó un análisis bivariado entre las variables de interés y las variables de desenlace, mediante la prueba exacta de Fisher. Resultados: Se encuestó a 155 de 160 universitarios, el 94,8% fueron jóvenes (18-25 años). El semestre académico que representó mayor porcentaje fue octavo ciclo. La mayoría de los ítems del cuestionario obtuvieron el puntaje de 3 puntos según la escala de Likert. El 96,8% de universitarios manifestaron que sí se vacunarían tan pronto como pudieran. Se obtuvo que el factor influyente en la postura ante la inmunización SARS-CoV-2 fue el de la efectividad de la vacuna reduciendo la mortalidad por COVID – 19. Conclusiones: Se concluye que la mayoría de los estudiantes se encontraron a favor de la vacunación. Además, la efectividad de la vacuna reduciendo la mortalidad por COVID-19, fue el único factor influyente. / Objective: To identify the influential factors in the posture before SARS-CoV-2 immunization in medical students of a Lambayeque university in the year 2021. Materials and methods: An analytical cross-sectional observational study was carried out. The entire eligible population was taken, which consisted of approximately 160 college students and was distributed with a stratified probabilistic sampling. The questionnaire prepared was based on the online survey of the Organization of Consumers and Users (OCU) entitled "OCU Survey: Spaniards and the vaccine" that was carried out in Spain. For the statistical analysis, the statistical tool IBM SPSS Statistics 25.0.0.0 was used. Categorical variables were tabulated for frequency distribution and percentages, and a bivariate analysis was performed between the variables of interest and the outcome variables, using Fisher's exact test. Results: 155 of 160 university students were surveyed, 94.8% were young (18-25 years). The semester of studies that represented the highest percentage was eighth cycle. Most of the ítems in the questionnaire obtained a score of 3 points according to the Likert scale. 96.8% of university students stated that they would get vaccinated as soon as they could. It was found that the influential factor in the posture before SARS-CoV-2 immunization was the effectiveness of the vaccine in reducing mortality from COVID-19. Conclusions: It is concluded that the majority of students were in favor of vaccination. Also, the effectiveness of the vaccine in reducing mortality from COVID-19 was the only influential factor.

Bakgrund, de restriktioner och rekommendationer som människor fått förhålla sig till under COVID-19 pandemin har inneburit en annorlunda och förändrad vardag. En grupp som blivit drabbad är högskole- och universitetsstudenter som bland annat fått byta de fysiska klassrummen mot diverse online plattformar. Tidigare forskning har utförts, men hur aktivitetsmönstret har förändrats är dock mindre utforskat. Syftet med studien var att kartlägga förändring i aktivitetsmönstret hos högskole- och universitetsstudenter under COVID-19 pandemin. Metoden som användes hade en kvantitativ design i form av tvärsnittsstudie. Ett bekvämlighetsurval användes och respondenter rekryterades via sociala medier (Facebook). Populationen bestod av 49 studenter. Deskriptiv statistik användes för att beskriva insamlade data. Resultatet visade på en förändring i studenternas aktivitetsmönster och en koppling mellan förlust av meningsfulla aktiviteter, nöjdhet gällande sin aktivitetsfördelning samt upplevd vardagsbalans kunde urskiljas. Slutsats, övergripande hade förändringarna i studenternas aktivitetsmönster påverkats till det negativa. Författarna till föreliggande studie har en förhoppning om att studien ska leda till ökad förståelse gällande människors aktivitetsmönster som relaterar till den hälsoproblematik som kan uppstå under situationer som den rådande COVID-19 pandemin. / Background, this thesis describes the restrictions and recommendations that people have had to follow during the COVID-19 pandemic, and how these have led to a different and altered everyday life. College- and University students are one group that have been affected, especially since they had to switch from in-person learning to online platforms. There have been prior studies regarding the health of students and how their health has been affected during the pandemic, however the extent to which the occupational pattern of students has changed has been less explored. The purpose of this study was to investigate the change in student’s occupational patterns during the COVID-19 pandemic. The method that was used was a quantitative design. A convenience sample was used, and the respondents were recruited through social media platforms (Facebook). The population included 49 students. Descriptive statistics were used to describe the data that was collected from the survey. Results, the study showed a change in student’s occupational patterns during the COVID-19 pandemic and a connection was seen between loss of meaningful activities, satisfaction regarding their activity distribution, and perceived everyday balance. In conclusion, the overall changes in student’s occupational patterns had a negative effect. The authors expect that this study will lead to a higher understanding of the occupational patterns that relate to the health problems that can occur during situations such as the COVID-19 pandemic.

Bakgrund: Covid-19 pandemin som orsakades av Sars-Cov-2-viruset innebar en betydande utmaning för världen. I synnerhet påverkades hälso- och sjukvården av dess framfart. Sjuksköterskor som arbetade inom slutenvården under denna tid var särskilt utsatta och föremål för en rad olika upplevelser både positiva och negativa. Dessa erfarenheter är värdefulla att analysera för att bättre kunna hantera kommande pandemier. Syfte: Att undersöka sjuksköterskors upplevelser inom slutenvården under covid-19 pandemin. Metod: Litteraturöversikt genomförd i enlighet med Fribergs metod. Elva kvalitativa originalartiklar valdes från databaserna PubMed och Cinahl Complete för analys. Resultat: Tre huvudteman identifierades vilka var: Rädsla, Osäkerhet och Sjuksköterskans upplevelser rörande yrkesrollen. Slutsats: Rädsla var en dominerande upplevelse bland sjuksköterskor och antog ett flertal olika former. Sjuksköterskor upplevde även osäkerhet relaterat till det oklara kunskapsläget, föränderlig information, den egna kompetensen samt brist på material och personal. Sjuksköterskor upplevde både positiva och negativa känslor relaterade till yrkesrollen. Förberedelse i form av utbildning av sjuksköterskor och allmänhet, genomtänkta rutiner och riktlinjer samt förbättrad lagerhållning av skyddsmaterial är viktigt för att minska negativa effekter under kommande pandemier. / Background: The Covid-19-pandemic caused by the Sars-Cov-2-virus constituted a significant challenge for the world. In particular the healthcare systems were affected during its course. Nurses working within inpatient care were especially vulnerable and might have had several different experiences, which could be either negative or positive. These experiences are valuable and worth analyzing in order to be better prepared for forthcoming pandemics. Aim: To analyze nurses´experiences in inpatient care during the Covid-19 pandemic. Method: A literary overview conducted in accordance with the method of Friberg. Eleven qualitative original articles were selected from the databases PubMed and Cinahl Complete and analyzed. Results: Three main themes were identified which were: Fear, uncertainty and nurses experiences related to the profession. Conclusions: Fear was a dominant experience among nurses and took a variety of forms. Nurses also experience uncertainty related to the unclear state of knowledge, changing information, their own competence and due to a shortage of materials and other staff. Nurses experienced both positive and negative emotions in relation to their profession. Preparation in the form of eduaction for both nurses and the general public, well-thought-out routines and guidelines as well as improved stockpiling of protective equipment is essential to reduce the negative effects of future pandemics.