No jab, no international travel? Linking TRA, mass media, motivation, and experience

Despite mixed emotions about COVID-19 vaccination as a precondition for international travel, COVID-19 vaccination is being advocated as one of the instruments that could facilitate safe free movement during the COVID-19 pandemic. Accordingly, the purpose of the present research is to distinguish the underlying mechanisms that could predict individuals' intentions to take the COVID-19 vaccine as a precondition for international travel. The conceptual framework was built on the extended theory of reasoned action (TRA), which incorporates mass media coverage, travel motivations, and previous travel experience. An online purposive sampling technique was utilized in this study, and 1188 responses were collected. Subsequently, structural equation modeling was utilized to test the proposed model. The originality of the present study lies with unraveling the mechanisms that affect the intention to take the COVID-19 vaccine as a precondition for international travel. In addition, the discussions are presented in subsequent sections of the paper.

ICU without walls = ICU without Data? the Covid-19 deficit

Introduction: Northern Ireland (NI) has 5.5 ICU beds/100 000 population,1 amongst the lowest in Western Europe.2 Alongside ICU bed expansion the Covid-19 response required delivery of advanced Respiratory support (Continuous Positive Airway Pressure (CPAP) and High Flow Nasal Oxygen (HFNO)) outside ICU. ICNARC provides robust data for patients within ICU but this is unavailable for those receiving 'critical care' elsewhere. Objective(s): To evaluate delivery of CPAP/HFNO outside of ICU to Covid-19 patients - focusing on demographics and outcomes including ICU admission and mortality. Method(s): Ward-CPAP for acute hypoxaemic respiratory failure (AHRF) was not previously utilised.3 It was introduced for Covid-19 to Medical wards. Data was analysed using the NI Electronic Care Record, ward electronic note system (EDAMS) and ICU system (ICCA, Koninklijke Philips N.V.). Data was compared between Wave 1 (01/03/2020 - 12/12/2020) and Wave 2 (13/12/2020 - 01/04/2021). Result(s): 215 patients received CPAP/HFNO/Invasive Mechanical Ventilation (IMV) for Covid-19: 103 in Wave 1 and 112 in Wave 2. 75 Covid-19 patients were admitted to the ICU itself (comprising 44 of the study cohort, 11 direct from ED and 20 transferred from other Trusts). Table 1 shows demographics. Fewer patients were female as seen elsewhere,4 there were more young patients in Wave 2. The majority of patients would likely have been ICU candidates pre-pandemic,3 but a subset of 25% were deemed for a ward ceiling-of-care on admission by a Consultant and the proportion of elderly patients was higher than described by ICNARC.4 Comorbidities and obesity were common. Outcomes are shown in Table 2 and Figures 1-3. Close co-operation with ICU saw 61% of patients with a documented ICU review. Overall 20% of patients were admitted to ICU, and 15% received IMV. Mortality was 37%, but 22% if patients with an admission ward ceiling-of-care decision were excluded. Mortality correlated with frailty and age (fig 2&3). Outcomes were generally better in Wave 2. Conclusion(s): This Evaluation documents the huge contribution to the critical care Covid-19 response made by our Medical teams, not captured by ICNARC. Most patients avoided ICU admission and IMV and outcomes were likely at least comparable which undoubtedly freed up vital ICU beds. We thank the teams involved and believe it is vital to evaluate the outcome of all critically ill Covid-19 patients irrespective of their location.

Single centre, cross-sectional assessment of airway hemorrhage in a cohort of patients with COVID19-associated ARDS under Venovenous extracorporeal membrane oxygenation

Objectives: Airway hemorrhage (AH) frequently complicates extracorporeal membrane oxygenation (ECMO) treatment. Inflammation, coagulopathy and antithrombotic therapy are contributing factors. Patients with COVID-19- associated ARDS (CARDS) supported with ECMO present all these features. We aim to characterize the incidence and the clinical and prognostic impact of AH. Method(s): Review of a cohort of patients with CARDS treated with ECMO support at a single ECMO centre between March 2020-February 2022 (n=92). AH was defined as a clinically significant hemorrhage fit demanded interruption of anticoagulation, transfusional support or bronchoscopy. Univariate analysis was performed using GraphPadPrism. Result(s): One third (n= 31) of patients with CARDS treated with ECMO had clinically significant AH. Patients who developed AH had significantly longer ICU length-of-stay (LoS), ECMO run and invasive mechanical ventilation (IMV) duration. Significant differences in coagulation and inflammatory markers were detected between patients with early (<72h) versus late (>9 days) onset of AH (Table 1). Mortality at day 90, demographics, comorbidities, CT scan pattern and clinical severity indexes were similar between patients with and without AH (NAH). Conclusion(s): In patients with severe CARDS treated with ECMO support, the occurrence of airway hemorrhage leads to clinically important morbidity but does not increase mortality. Distinct pathways may be involved in the development of early v. late AH. (Table Presented).

The teaching practices in History mediated by virtual platforms in the context of Social, Preventive and Compulsory Isolation during the 2020 school year. Case study

This research is mainly focused on a didactic approach, approached from the perspective of critical theory, taking into account the global context due to Covid-19. Specifically, it tries to answer the question: How does the context of social, preventive and compulsory isolation (ASPO) affect the use of virtual platforms for the development of teaching practices in the curricular space of Historia in the Ciclo Básico Común of the Escuela Normal Superior "Mariano Moreno" in Concepción del Uruguay, Entre Ríos? The main assumption that we pursue is: the dispensability of virtual platforms as mediators for the development of teaching practices in History and the non-predominance of virtuality. © 2022 Seccion Historia. Instituto Superior del Profesorado 'Eduardo Lafferriere'. All rights reserved.

Clinical characteristics and risk factors of patients with COVID-19 developing barotrauma

Background: At our hospital, people with COVID-19 (coronavirus disease 2019) had a high rate of pulmonary barotrauma. Therefore, the current study looked at barotrauma in COVID-19 patients getting invasive and non-invasive positive pressure ventilation to assess its prevalence, clinical results, and features. Methodology: Our retrospective cohort study comprised of adult COVID-19 pneumonia patients who visited our tertiary care hospital between April 2020 and September 2021 and developed barotrauma. Result(s): Sixty-eight patients were included in this study. Subcutaneous emphysema was the most frequent type of barotrauma, reported at 67.6%;pneumomediastinum, reported at 61.8%;pneumothorax, reported at 47.1%. The most frequent device associated with barotrauma was CPAP (51.5%). Among the 68 patients, 27.9% were discharged without supplemental oxygen, while 4.4% were discharged on oxygen. 76.5% of the patients expired because of COVID pneumonia and its complications. In addition, 38.2% of the patients required invasive mechanical breathing, and 77.9% of the patients were admitted to the ICU. Conclusion(s): Barotrauma in COVID-19 can pose a serious risk factor leading to mortality. Also, using CPAP was linked to a higher risk of barotrauma.Copyright © 2021 Muslim OT et al.

Remote Persons Are Closer Than They Appear: Home, Team and a Lockdown

Since 2020, worldwide COVID-19-related lockdowns have led to a rapid increase of remote collaboration, particularly in the domain of knowledge work. This has undoubtedly brought challenges (e.g., work-life boundary management, social isolation), but also opportunities. Practices that have proven successful (e.g., through increased task performance, efficiency or satisfaction) are worth retaining in future. In this qualitative empirical study, we analyzed four teams' (14 participants in total) mandatory remote collaboration over a period of several days to several months during a nationally imposed lockdown. We report results derived from questionnaires, logbooks, group interviews, and meeting recordings. We identify possible factors influencing quality of task outcome as well as subjective aspects like satisfaction, motivation, and team atmosphere. As a basis for our conclusions, we provide a scheme for categorizing effects of remote collaboration based on an exhaustive literature review on pandemic-induced mandatory remote work and collaboration. © 2023 Owner/Author.

A review of state regulations for child care: Preventing, recognizing and reporting child maltreatment.

BACKGROUND: Prior to the COVID-19 pandemic, nearly 60% of children under 5 years of age were cared for in out-of-home child care arrangements in the United States. Thus, child care provides an opportunity to identify and address potential child maltreatment. However, during the pandemic, rates of reporting child maltreatment decreased-likely because children spent less time in the presence of mandated reporters. As children return to child care, states must have regulations in place to help child care providers prevent, recognize and report child maltreatment. However, little is known about the extent to which state regulations address child maltreatment. Therefore, the purpose of this cross-sectional study was to assess state regulations related to child maltreatment and compare them to national standards. METHOD: We reviewed state regulations for all 50 states and the District of Columbia for child care centres ('centres') and family child care homes ('homes') through 31 July 2021 and compared these regulations to eight national health and safety standards on child maltreatment. We coded regulations as either not meeting, partially meeting or fully meeting each standard. RESULTS: Three states (Colorado, Utah and Washington) had regulations for centres, and one state (Washington) had regulations for homes that at least partially met all eight national standards. Nearly all states had regulations consistent with the standards requiring that caregivers and teachers are mandated reporters of child maltreatment and requiring that they be trained in preventing, recognizing and reporting child maltreatment. One state (Hawaii) did not have regulations consistent with any of the national standards for either centres or homes. CONCLUSIONS: Generally, states lacked regulations related to the prevention, recognition and reporting of child maltreatment for both centres and homes. Encouraging states to adopt regulations that meet national standards and further exploring their impact on child welfare are important next steps.

National calendar of preventive vaccinations: present and future

In the context of a pandemic of a new coronavirus infection, vaccine prophylaxis within the framework of the National Calendar of Preventive Vaccinations (NCPV) is an absolute priority in the fight against infectious diseases. The lecture presents the structure and features of the NCPV, the main directions of its improvement, information on the priority infections for vaccination. The strategy of immunization throughout life, which guarantees the creation of maximum protection against infections and preservation of the optimal level of health of people without age restrictions, is considered. Information is provided on approaches to vaccination of various patient populations against new coronavirus, pertussis, pneumococcal, and rotavirus infections. The presented lecture materials can be useful both to medical students and doctors of various specialties (infectious disease specialists, pediatricians, epidemiologists, bacteriologists).Copyright © 2022 by the authors.

Mandated media innovation impacts on knowledge dissemination in workplace training

This conceptual paper examines voluntary versus mandatory cloud-based training, generating recommendations to harmonise the complementarity of face-to-face and online media in future careers. Technological change was already accelerating when the COVID-19 pandemic response turbocharged transformations of knowledge dissemination in training, thus impacting learning and competency development for the future. The methodology applies comprehensive, structured literature review following PRISMA guidelines with development of a novel conceptual framework illuminating facets of knowledge dissemination. Exploring the context of workplace training and the future of careers with aid of NVivo it was found that altered social cues in cloud training are generating changes in learner attention span, engagement, and peer-to-peer interaction, potentially increasing contract cheating. It is hence recommended that stakeholders demarcate theoretical and practical learning outcomes to develop hybrid cloud media and face-to-face knowledge dissemination to accentuate professional accreditation requirements, engagement and etiquette in virtual spaces, and improve understanding of work-home balance.

Utility of the Brixia CXR score, C-Reactive Protein and Absolute Neutrophil Count in Predicting the Need for Invasive Mechanical Ventilation, Length of Hospital Stay, and Mortality in Moderate to Severe COVID-19 Patients

Background: The Brixia Chest X-ray (CXR) score, C-reactive protein (CRP), and the absolute neutrophil count (ANC) have been useful to predict outcomes in Coronavirus disease 2019 (COVID-19 patients). We studied the utility of the Brixia CXR score, CRP, and ANC in predicting the outcomes in terms of the need for invasive mechanical ventilation, length of stay, and mortality in moderate-severe COVID-19 patients. Material(s) and Method(s): This was a single-centre, retrospective, study on 122 COVID-19 patients. Brixia CXR score, CRP, and ANC on admission to the hospital and the fifth day of hospital stay were noted along with the need for invasive mechanical ventilation (IMV), prolonged length of stay (LOS) >= 14 days, and mortality. Result(s): 122 patients were included for analysis. The median and interquartile range (IQR) for baseline CRP was 81.50 (39-151) mg/L and 11.0 (4-30) mg/L (p < 0.001) on the fifth day. The median and IQR for baseline Brixia score was 10.0 (7-13), and on the fifth day was 7 (4-11) (p <0.001). The receiver operating characteristic curve (ROC) showed that the baseline CRP >= 52.5mg/L predicted both the need for IMV, with an area under the curve (AUC) of 0.628, and prolonged LOS with an AUC of 0.608. The ROC curve depicted that the baseline ANC >8500/muL predicted IMV requirement with an AUC of 0.657. The fifth day CRP >= 32 mg/L, ANC >= 11,000/ muL and Brixia CXR score >= 7 predicted a higher mortality in hospitalized patients. Conclusion(s): Baseline CRP (> 52.5mg/L) predicts the need for IMV and a prolonged LOS, but not mortality. Baseline ANC (> 8500/muL) predicted the need for IMV. CRP, Brixia CXR score, and ANC on the fifth day were not useful to predict LOS or mortality, though there was a significant reduction in CRP and Brixia CXR score on the fifth day compared to baseline after treatment. The fifth day CRP >= 32 mg/L, ANC >= 11,000/ muL and Brixia CXR score >= 7 predicted a higher mortality.Copyright © 2023, College of Anaesthesiologists of Sri Lanka. All rights reserved.

The impact of proning on nutritional therapy in mechanically ventilated COVID-19 patients

Introduction: Critically ill COVID-19-patients are at high risk of developing ICU-related malnutrition. This study aimed to examine the impact of proning on providing nutritional therapy for mechanically ventilated COVID-19-patients by comparing the achievement of nutritional goals and possible complications in patients who were proned vs. those who were not. Method(s): This is a single-center retrospective cohort study. We included all adult COVID-19 patients admitted to the ICU from 01/03/2020 until 31/05/2020 who required invasive mechanical ventilation (IMV), excluding those referred for ECMO. Data were extracted from electronic patient files. Weight-based nutrition targets were set in agreement with ESPEN guidelines [1]. Result(s): 32 patients were included (prone n = 16). Both groups were comparable in age, sex, comorbidities, biochemical markers and Nutrition Risk Screening on admission. Time on IMV was longer in the prone group (p = 0.032). The total time in prone position ranged from 19.5 h to 13.16 d. All patients received a NG tube, 1 proned patient received a jejunal tube. 6 received TPN (p = 0.654). Metoclopramide was used more often in the prone group (p = 0.028). The prevalence of vomiting (n = 4 vs. n = 5), large gastric residuals (n = 0 vs. n = 3) and VAP (n = 11 vs. n = 10) were comparable for the non-prone vs. prone group, resp. Table 1 shows the percentage of targets reached. These were lower in the prone group, though not statistically significant. However, when correcting for SAPS III-score, the impact of proning declined. Conclusion(s): These limited data suggest there is no significant difference in feeding COVID-19 patients on IMV that need proning vs. those who do not, except for metoclopramide use. Overall, reaching nutrition targets in these patients is challenging. This model suggests that disease impact is a greater influence on reaching nutritional goals than proning itself.

Vaccine Mandates in the COVID-19 Era: Changing Paradigm or Public Health Opportunity? Comment on "Convergence on Coercion: Functional and Political Pressures as Drivers of Global Childhood Vaccine Mandates”

The debate around vaccine mandates has flourished over the last decade, with several countries introducing or extending mandatory childhood vaccinations. In a recent study, Attwell and Hannah explore how functional and political pressures added to public health threats in selected countries, motivating governments to increase the coerciveness of their childhood vaccine regimes. In this commentary, we reflect on whether such model applies to the coronavirus disease 2019 (COVID-19) case and how the pandemic has re-shuffled the deck around vaccine mandates. We identify COVID-19 immunisation policies' distinctive aspects as we make the case of countries implementing mass immunisation programmes while relying on digital COVID-19 certificates as an indirect form of mandate to increase vaccine uptake. We conclude by acknowledging that different forms of mandatory vaccination might serve as a shortcut to protect population health in times of emergency, underlining, however, that the ultimate public health goal is to promote voluntary, informed, and responsible adherence to preventive behaviours. © 2023 The Author(s);Published by Kerman University of Medical Sciences.

Remdesivir Reduces Mortality in Hospitalized Covid-19 Patients across Variant Eras

Background: Clinical management of COVID-19 based on oxygenation requirements continues to change over time as variants of concern (VOC) evolve. We examine hospital all-cause mortality for early hospital RDV use vs. no RDV use across dominant VOC periods: pre-Delta (Dec'20-Apr'21), Delta (May-Nov'21) and Omicron (Dec'21-Apr'22). Method(s): We examined adults with a primary discharge diagnosis of COVID-19 (ICD-10: U07.1) using the Premier Healthcare Database. Patients treated with RDV in the first 2 days of admission vs. those not treated with RDV during the hospitalization were matched using a 1:1 preferential within-hospital propensity matching with replacement. Patients were excluded if discharged within 3 days of RDV initiation. Time to mortality at 14-and 28-days was examined for patients with no supplemental oxygen charges (NSOc), low-flow oxygen (LFO), high-flow oxygen/non-invasive ventilation (HFO/NIV) and invasive mechanical ventilation/ECMO (IMV/ECMO) at baseline. Baseline was defined as first 2 days of hospitalization. Result(s): 164,791 RDV-treated patients were matched to 48,473 unique non-RDV patients. Post-matching balance was achieved across groups with different baseline oxygenation levels and VOC periods. In the matched weighted cohort, 35% required NSOc, 41% LFO, 21% HFO/NIV and 3% IMV/ECMO. During the overall study period (Dec'20-Apr'22), unadjusted mortality rate was significantly lower for RDV patients across all oxygenation levels at 14 days (NSOc: 5.4% vs. 7.3%, LFO: 6.4% vs. 8.8%, HFO/NIV: 16.8% vs. 19.4%, IMV/ECMO: 27.8% vs. 35.3%) and 28 days (NSOc: 8.0% vs. 9.8%, LFO: 9.8% vs. 12.3%, HFO/ NIV: 25.8% vs. 28.3%, IMV/ECMO: 41.4% vs. 50.6%). After adjusting for baseline and clinical covariates, 14-day mortality results showed that RDV significantly lower risk compared to non-RDV across all oxygenation levels at baseline [NSO (26%), LFO (28%), HFO/NIV (17%), IMV/ ECMO (27%)]. Similarly, 28-day mortality results showed that RDV significantly lower risk compared to non-RDV across all oxygenation levels at baseline [NSO (19%), LFO (21%), HFO/NIV (12%), IMV/ECMO (26%)]. This lower mortality risk associated with RDV was consistently observed across all variant periods (Figure). Conclusion(s): Timely initiation of RDV within first two days of hospital admission demonstrated significant mortality reduction in patients hospitalized for a primary diagnosis of COVID-19 across all oxygenation levels. Remdesivir demonstrated consistent benefit across all variant periods of the pandemic to-date.

Association between pulmonary extravascular water, dead space, and clinical outcome in intubated patients with COVID ARDS

Introduction: The aim of this study was to determine whether there is an association between extravascular lung water index (EVLWi) and physiological respiratory dead space (VDphys/VT) and to determine if these factors are associated with the possibility to being discharged alive on day 28. Method(s): We analyzed a prospective cohort of patients with COVID ARDS supported with invasive mechanical ventilation (IMV) admitted in our ICU who were monitored with volumetric capnography and transpulmonary thermodilution (TPTD). First day TDTP and VDphys/VT were considered. Bohr-Enghoff formula was used to obtain VDphys/ VT. This protocol was approved by the local IRB and informed consent was waived. Result(s): 31 patients with matched TPTD and VDphys/VT during the first 24 h were analyzed in who EVLWi correlated with VDphys/VT (r = 0.599 p = 0.002), however, EVLWi did not associated with PaFi. Patients with EVLWi > 10 ml/kg had higher APACHE II and VDphys/VT. These patients had a lower cumulative incidence to be discharged alive on day 28 with aHR 7.3 [1.4-39.1] p = 0.02 (adjusted by APACHE II and VDphys/VT, Fig. 1A). Remarkably, patients with EVLWi > 10 ml/ kg + VDphys/VT > 57% had worse outcome compared to those who had EVLWi > 10 ml/kg + VDphys/VT < 57% (25% vs 75%, p = 0.032, Fig. 1B). Conclusion(s): In patients with COVID ARDS supported with IMV, VDphys/VT give prognostic data additional to EVLWi.

A Joint Analysis of Two Randomized Controlled Trials on Enoxaparin for Covid-19

Background: COVID-19 carries a high risk of vascular thrombosis. This joint analysis of two randomized-controlled trials (RCTs) aims to assess the safety and efficacy of enoxaparin at therapeutic dose compared to prophylactic dose in people hospitalized with COVID-19. Method(s): A joint analysis of two RCTs, COVID-19 HD (NCT044082359) and EMOS-COVID (NCT04646655), was performed. Both studies enrolled inpatients with COVID-19- associated respiratory compromise (as identified by respiratory rate >=25 breaths/min or arterial oxygen saturation <=93% at rest or PaO2/FiO2 <=300 mmHg for COVID-19 HD and by PaO2/FiO2 <=250 mmHg for EMOS-COVID) and/or coagulopathy (D-dimer > 2000 ng/ml for both RCTs or sepsis-Induced coagulopathy score >4 for COVIDHD). In both RCTs patients were randomly assigned to two arms: enoxaparin at prophylactic dose (standard 4.000 IU;in the EMOS-COVID 6000 IU if body weight >100 kg) and at therapeutic dose (70 U/Kg every 12 h). The primary efficacy endpoint of the joint analysis was clinical worsening, defined as the occurrence of at least one among: in-hospital death;acute myocardial infarction;symptomatic arterial or venous thromboembolism;need of either Continuous Positive Airway Pressure (Cpap) or Non-Invasive Ventilation (NIV) in patients who were in standard oxygen therapy at randomization;need for IMV in any patient. The primary outcome was assessed as time-to-event, described with hazard ratio (HR) and with Kaplan-Meier survival estimate. The primary safety endpoint was major bleeding for both trials and for the joint analysis. Result(s): COVID-19 HD enrolled 142 people between July 2, 2020 and February 15, 2022, while EMOS-COVID enrolled 141 people from July 27, 2020 to June 5, 2021, resulting in 283 patients included in this joint analysis. Two-hundredseven (73.1%) were males, with a mean age of 61.1 years (SD +/-10.7), a mean BMI of 29.7 kg/m2 (SD +/-5.0), and 115 (40.6%) were on NIV or Cpap at randomization, with no significant difference between the study groups. 21/139 people in the high dose group reached the primary endpoint compared to 32/144 in the prophylactic group (HR 0.63, 95%CI 0.36 to 1.10). Figure 1 shows the Kaplan- Meier survival estimates of clinical worsening. No major bleeding was observed during the study time. Conclusion(s): The results of this joint analysis did not highlight significant differences in clinical worsening between COVID-19 patients that received enoxaparin at therapeutic compared to prophylactic dose. (Figure Presented).

Tropical infections as occupational diseases among young volunteers in social projects.

PURPOSE: The trend of volunteering overseas has increased tremendously over the last decade. Volunteers often go to regions where they are exposed to the risk of tropical infections like malaria, dengue, typhoid fever and schistosomiasis. Health assessments have shown a high occurrence of tropical infections among young volunteers. Such tropical infections are notifiable in Germany, as they are covered by a separate branch of the social insurance system. However, there is still limited data on systematical improvement of medical prevention and health care for volunteers. METHODS: This retrospective study included 457 cases with a diagnosis for a tropical infection or typhoid fever from January 2016 to December 2019. Data sets were anonymised and then analysed with descriptive statistics first. Cases of volunteers sent abroad by "Weltwärts" were compared to cases of aid workers sent to non-industrial countries. RESULTS: A high occurrence of tropical infections as occupational diseases has been shown for volunteers compared to other (mostly older) aid workers being sent to tropical regions. The risk of acquiring a tropical infection was significantly higher in Africa compared to other tropical regions. Cases of malaria were reported significantly more often among the group of volunteers than among aid workers during the period under review. Medical check-ups after travel were rare among volunteers. CONCLUSIONS: Data imply a disproportionate risk for malaria in Africa with a higher risk of acquiring malaria tropica in Sub-Saharan regions. Region-specific risks need to be addressed in training seminars in order to raise awareness among young volunteers before travel. Medical examinations after travel should be mandatory and specific to a particular region.

A novel mathematical model for prioritization of individuals to receive vaccine considering governmental health protocols.

Infectious diseases drive countries to provide vaccines to individuals. Due to the limited supply of vaccines, individuals prioritize receiving vaccinations worldwide. Although, priority groups are formed based on age groupings due to the restricted decision-making time. Governments usually ordain different health protocols such as lockdown policy, mandatory use of face masks, and vaccination during the pandemics. Therefore, this study considers the case of COVID-19 with a SEQIR (susceptible-exposed-quarantined-infected-recovered) epidemic model and presents a novel prioritization technique to minimize the social and economic impacts of the lockdown policy. We use retail units as one of the affected parts to demonstrate how a vaccination plan may be more effective if individuals such as retailers were prioritized and age groups. In addition, we estimate the total required vaccine doses to control the epidemic disease and compute the number of vaccine doses supplied by various suppliers. The vaccine doses are determined using optimal control theory in the solution technique. In addition, we consider the effect of the mask using policy in the number of vaccine doses allocated to each priority group. The model's performance is evaluated using an illustrative scenario based on a real case.

COVID-19 vaccination hesitancy in people affected by diabetes and strategies to increase vaccine compliance: A systematic narrative review and meta-analysis

Introduction: People affected by diabetes are at higher risk for complications from certain vaccine-preventable diseases. Suboptimal vaccination coverages are reported in this population sub-group. The purpose of this study is to estimate the proportion of diabetic patients who express hesitation to the COVID-19 vaccine worldwide.Methods: Seven studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar and Scopus databases from 2020 to 2022. The following terms were used for the search strategy: (adherence OR hesitancy OR compliance OR attitude) AND (covid* OR SARS*) AND (vaccin* OR immun*) AND (diabet*).Results: The vaccine hesitation rate among persons with diabetes was 27.8 % (95 %CI = 15.6-41.9 %). In the comparison of vaccine hesitancy between sexes and educational status, the RRs were 0.90 (95 %CI = 0.71-1.15) and 0.88 (95 %CI = 0.76-1.02), respectively. The main reasons of unwillingness were lack of information, opinion that the vaccine was unsafe or not efficient, and fear of adverse events.Conclusions: In order to achieve a high vaccination coverage, multifactorial approach is needed, which requires major social, scientific and health efforts. The success of the vaccination campaign in this population depends on the capillarity and consistency of the interventions implemented.

The mandatory nature of vaccination in times of COVID-19: contextual approach and analysis from the Law and comparative policies

The most important and effective action to combat the COVID-19 pandemic, once it was verified that the initial immunity due to contagion or generalized confinements did not solve the problem in the medium term, has been vaccination. The success of vaccines is nothing new. Throughout the history of humankind, vaccines have served to reduce and even eliminate some serious communicable diseases. It is not an exaggeration to say that, together with the purification of water and penicillin, the vaccination of the population against certain diseases is one of the greatest achievements both in the fields of public health and the health of individuals. However, the success of vaccines, not only in this pandemic, but throughout history, has always been in doubt. Despite the evidence of the preventative effect of vaccines, the anti-vaccine movement has endured over time and has even grown in recent decades. Such opposition has not diminished with the efficiency and safe results that the new vaccines against Covid-19 have produced using mRNA technology;on the contrary, it has continued to expand. After the development and authorization of vaccines against covid-19 in record time, the first challenge faced by vaccination campaigns around the world was to determine the priority in access to the resource when the availability of vaccines was still scarce. The criteria followed at this point were, at least in Europe, quite uniform, prioritizing the vaccination of those most in need. That is, the elderly, who are the most prone to suffering serious illnesses. Access to vaccines was very unequal worldwide and, to avoid this, different strategies were proposed, including the suspension of patent rights or the creation of the COVAX vaccine initiative to supply countries that could not buy them. Once a greater number of vaccines were available, and prioritizing access to them was no longer the main ethical-legal issue, the debate arose in many countries about the opportunity to incorporate vaccination as a legal duty. This involved changing the majority opinion in the world;although already the subject of discussion before the pandemic, it was argued to be a moral duty to receive the recommended vaccines to preserve public health and that of others. World public opinion was very attentive to this issue of compulsory vaccination, perhaps due to the rejection that vaccines aroused in certain sectors of the population and, in particular, the vaccine against Covid-19. The discussion about the balance between the freedom of individuals and the achievement of a collective interest as important as public and individual health was resolved at the legal level by the courts of justice. Specifically, the rulings of the Supreme Court in the United States and the European Court of Human Rights in Europe established criteria that were basically convergent. Both courts understand that states have the competency to oblige the population to be vaccinated in order to safeguard their health as long as certain requirements are met: a serious risk of a pandemic, a safe and effective vaccine to combat the disease exists, and the absence of less invasive measures to achieve the same result. These rulings have served to support the specific legal measures that were adopted during the pandemic by both the different states of the United States and the member states of the Council of Europe. Necessarily different concepts have been confused in the debate, in particular those of mandatory and forced vaccination, which do not belong to the same category because they limit different fundamental rights and do so with different levels of intensity. When speaking of mandatory vaccination, reference is made to a duty whose non-compliance determines a legal consequence, be it an economic sanction or a limitation of a right. Thus, the individual who neglects the obligation to be vaccinated will be fined, have their freedom of movement restricted, their working conditions altered or their employment and salary suspended. The legal consequence is not the forced vaccination of those who resist the vaccine, but generally an economic fine. On the contrary, when it comes to forced vaccination, the individual who disregards the obligation will be legally compelled to be vaccinated, resorting even to force if necessary. In other words, the right affected directly by the measure here is the integrity of the individual. These are, therefore, two measures of different significance, from the perspective of the rights ultimately affected by the limitation, and this difference must be taken into account from the principle of proportionality. In this paper we offer an overview of the various responses adopted by different States in relation to whether or not vaccination is mandatory, which have ranged from mandatory for certain groups or even for the entire population. Among those measures of indirect persuasion for vaccination are "covid passports". Our work identifies a broad agreement in the international community on the compatibility between mandatory vaccination and the safeguarding of fundamental rights when certain conditions are met. It is also recognized that proportionality in the adoption of measures is the most effective way to achieve the desired objective of reaching high levels of vaccination in the population. In any case, it would have been desirable to have advanced formulas of persuasion that would have gone beyond information and training, without incurring in the adoption of measures that strongly restrict personal liberty, such as compulsory vaccination. Faced with this international agreement, we do not find shared criteria in other areas related to vaccines: their development and authorization, their fair distribution, or information about them. This absence of shared visions and cooperation gives rise to rivalries that reinforce the traditional clashes between powers. As the purpose of the work is to compare the legal foundations of the mandatory nature of vaccines in two territories that exert significant influence in other parts of the world, and to do so from a contextual perspective. The work has not attempted to carry out an exhaustive approach to any of the many questions raised, but rather to outline, based on some of the most accredited jurisprudential and doctrinal sources, some provisional conclusions which, at least in some cases, must be subject to successive revisions.

Integrating push–pull dynamics for understanding the association between boundary control and work outcomes in the context of mandatory work from home

PurposeMuch of what we know about work from home (WFH) is based on data collected in routine times, where WFH is applied on a partial and voluntary basis. This study leverages the conditions of mandatory WFH imposed by COVID-19 lockdowns to shed new light on factors that relate to well-being and performance among employees who WFH. Specifically, the authors explore how boundary control and push–pull factors (constraints and benefits that employees associate with WFH) interact to shape employees' exhaustion and goal setting/prioritization.Design/methodology/approachSurveys were administered in Israel and in the USA to 577 employees in "teleworkable” roles who were mandated to WFH shortly after the COVID-19 outbreak (March–April 2020).Findings(1) Boundary control is negatively related to exhaustion and positively related to goal setting/prioritization. (2) These associations are weakened by perceptions of high WFH constraints (push factors). (3) WFH benefits (pull factors) attenuate the moderating effect of WFH constraints.Practical implicationsOrganizations may benefit from identifying and boosting the saliency of WFH benefits, while considering and remedying WFH constraints.Originality/valueThe authors contribute theoretically by integrating push–pull factors into the discussion about WFH and boundary management. We also make a contextual contribution by drilling down into the specificities of nonvoluntary WFH. The expected upward trends in nonvoluntary WFH rates underscore the need to understand factors that improve outcomes among individuals who lack agency in the decision to WFH.