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COVID-19 outbreak is global disease that impact most of industries in the world. Tourism is one of industry shocked by COVID-19. Curfew policy and social distance caused most of tourism sector such as tourism, hotel, and restaurant were closed. The purpose of this study is to analyze financial statement of tourism industries in Indonesia and Türkiye using financial ratio analysis. We employ financial analysis of credit (risk) analysis and profitability analysis during lockdown. We employ 27 financial statements of tourism firms in both countries in 2020. Based on the result, we found that profitability ratio that have significant differences in both countries such as ROA, ROE, and net margin. Although other measurement such as, current asset ratio, quick ratio, asset turn over, debt to equity ratio, and short term debt to equity ratio have no significant. The result informs that tourism of listed firms in Indonesia and Türkiye have significantly difference in profitability ratio. However, capability of managing liquidity, utilizing asset and managing capital structure and solvency has no significant difference. The result implies that tourism industries both in Indonesia and Türkiye have similar issues in liquidity, utilizing asset, and solvency, because they have to face diminishing income during COVID-19. Hence, it will effect on the liquidity.

The COVID-19 pandemic has exposed the vulnerability of ethnic minorities again. Health inequity within ethnic minorities has been explained by factors such as higher prevalence of underlying disease, restricted access to care, and lower vaccination rates. In this study, we investigated the effect of cultural tailoring of communicators and media outlets, respectively, on vaccine willingness in an influenza vaccination campaign in the Netherlands. A total of 1226 participants were recruited from two culturally non-tailored media outlets (Dutch newspaper and Facebook), and one media outlet tailored to a large community in the Netherlands with Indian ancestry. The participants from all three media outlets were randomly exposed to a vaccination awareness video delivered by a physician with an Indian or Dutch background, followed by an online survey. Cultural tailoring compared to cultural non-tailoring of communicators showed no difference in improvement of vaccine willingness (13.9% vs. 20.7% increment, respectively, p = 0.083). However, the media outlet tailored to the community with Indian ancestry, resulted in a higher improvement of vaccine willingness compared to non-tailored media outlets (46.7% vs. 14.7% increment, respectively, p < 0.001, unadjusted OR = 5.096). These results suggest that cultural tailoring of media outlets may be critical to effectively reach out to ethnic minorities to help optimize vaccination rates and improve general health. Funder: Sanofi; doi: http://dx.doi.org/10.13039/100004339

The original article [1] contained the following errors with their respective amendments: 1) Abstract, lines 48 and 49: “Median TDI score on SST was 26.8 (IQR 23.6-29.3) in the placebo group and 28.8 (IQR 24.0-30.9) in the prednisolone group, with a median difference of 2.0 (95% CI 0.75 to 1.5).” to “Median TDI score on SST was 26.8 (IQR 23.6-29.3) in the placebo group and 28.8 (IQR 24.0-30.9) in the prednisolone group, with a median difference of - 1.5 (-3.0 to 0.25).” 2) Outcome, line 233-235: “Median TDI score was 26.8 (IQR 23.6- 29.3) in the placebo group and 28.8 (IQR 24.0- 30.9) in the prednisolone group, with a median difference of 2.0 (95% CI 0.75 to 1.5, p = 0.10).” to “Median TDI score was 26.8 (IQR 23.6- 29.3) in the placebo group and 28.8 (IQR 24.0- 30.9) in the prednisolone group, with a median difference of - 1.5 (-3.0 to 0.25).” 3) Line 237-238: "Self-reported smell function on VAS-score was 3.2 (IQR 1.8- 6.5) in the placebo group and 3.6 (IQR 1.0- 5.8) in the prednisolone group with a median difference of 0.45 (95% CI 1.1 to -1.2, p = 0.53)." to "Self-reported smell function on VAS-score was 3.2 (IQR 1.8- 6.5) in the placebo group and 3.6 (IQR 1.0- 5.8) in the prednisolone group with a median difference of 0.3 (95% CI -0.9 to -1.3, p = 0.53)." 4) Line 240-242: “Self-reported taste function on VAS-score was 5.6 (IQR 2.3- 7.6) in the placebo group and 5.0 (IQR 2.0- 7.8) in the prednisolone group with a median difference of 0.25 (95% CI 0.1 to -0.2, p = 0.80).” to “Self-reported taste function on VAS-score was 5.6 (IQR 2.3- 7.6) in the placebo group and 5.0 (IQR 2.0- 7.8) in the prednisolone group with a median difference of 0.1 (95% CI -1.0 to 1.3, p = 0.80)”.

Abstract Background Recruiting participants for lifestyle programmes is known to be challenging. Insights into recruitment strategies, enrolment rates and costs are valuable but rarely reported. We provide insight into the costs and results of used recruitment strategies, baseline characteristics and feasibility of at-home cardiometabolic measurements as part of the Supreme Nudge trial investigating healthy lifestyle behaviours. This trial was conducted during the COVID-19 pandemic, requiring a largely remote data collection approach. Potential sociodemographic differences were explored between participants recruited through various strategies and for at-home measurement completion rates. Methods Participants were recruited from socially disadvantaged areas around participating study supermarkets (n = 12 supermarkets) across the Netherlands, aged 30–80 years, and regular shoppers of the participating supermarkets. Recruitment strategies, costs and yields were logged, together with completion rates of at-home measurements of cardiometabolic markers. Descriptive statistics are reported on recruitment yield per used method and baseline characteristics. We used linear and logistic multilevel models to assess the potential sociodemographic differences. Results Of 783 recruited, 602 were eligible to participate, and 421 completed informed consent. Most included participants were recruited via letters/flyers at home (75%), but this strategy was very costly per included participant (89 Euros). Of paid strategies, supermarket flyers were the cheapest (12 Euros) and the least time-invasive (< 1 h). Participants who completed baseline measurements (n = 391) were on average 57.6 (SD 11.0) years, 72% were female and 41% had high educational attainment, and they often completed the at-home measurements successfully (lipid profile 88%, HbA1c 94%, waist circumference 99%). Multilevel models suggested that males tended to be recruited more often via word-of-mouth (ORfemales 0.51 (95%CI 0.22; 1.21)). Those who failed the first attempt at completing the at-home blood measurement were older (β 3.89 years (95% CI 1.28; 6.49), whilst the non-completers of the HbA1c (β − 8.92 years (95% CI − 13.62; − 4.28)) and LDL (β − 3.19 years (95% CI − 6.53; 0.09)) were younger. Conclusions Supermarket flyers were the most cost-effective paid strategy, whereas mailings to home addresses recruited the most participants but were very costly. At-home cardiometabolic measurements were feasible and may be useful in geographically widespread groups or when face to face contact is not possible. Trial registration Dutch Trial Register ID NL7064, 30 May 2018, https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7302

Abstract Background Between 2019 and 2021, the first Irish health system performance assessment (HSPA) framework was developed. As routinely collected health data are necessary to continuously populate indicators of an HSPA framework, a purpose-driven assessment of the health information system (HIS) in Ireland and its fitness to support the implementation of an HSPA framework was conducted. This study reports on the status of the Irish HIS through a multimethod assessment based on continuous broad stakeholder involvement. Methods Between May and November 2020, over 50 informants were engaged in individual and group interviews and stakeholder consultation workshops as part of the HIS assessment process. Descriptive themes and high-level data availability heatmaps were derived from interview and workshop data using thematic analysis. Indicator “passports” for the HSPA framework were populated during stakeholder consultation workshops and analysed using univariate descriptive statistics. Results The HIS in Ireland was able to provide administrative, survey and registry-based data for public sector acute care services, focusing on structure, process and output metrics. Significant data availability gaps, most notably from primary care, private hospitals and community care, were reported, with little availability of electronic health record and people-reported data. Data on outcome metrics were mostly missing, as were linkage possibilities across datasets for care pathway monitoring. The COVID-19 pandemic highlighted the national HIS’s shortcomings but also the capacity for rapid development and improvement. Conclusions A tailor-made assessment of the HIS in Ireland, involving a broad set of relevant stakeholders, revealed strengths, weaknesses and areas for improvement in the Irish health data landscape. It also contributed to the development of a national HSPA framework and momentum to further strengthen data infrastructure and governance, while working towards a more data-driven and person-centred healthcare system. This work demonstrates the utility of an inclusive HIS assessment process and is applicable beyond Ireland, where this case study was conducted.

Abstract Objective: to analyze nurses’ discourse about the potentialities in using information technologies as organizational support for the COVID-19 coping actions in Primary Health Care. Method: a qualitative and exploratory study conducted in the Family Health Strategy units from the city of João Pessoa, Paraíba, Brazil. Data collection was carried out from September to November 2021 with 26 nurses selected through the snowball technique, resorting to a semi-structured interview script. The empirical material was organized in the Atlas.ti 9 software and grounded on the theoretical-methodological contribution of Discourse Analysis, French Line. Results: three discursive blocks were evidenced: innovation based on social media; health education actions; resoluteness in organizational actions, presenting the relevance of the WhatsApp®, Instagram® and Facebook® apps as strategic resources, in order to collaborate in the Primary Health Care are with the organization of health actions against COVID-19 by nurses. Conclusion: health units have the potential to strengthen the assistance provided through digital organizational devices; however, they need political support that invests in the structure and strategies to enhance organization of the health actions. Resumo Objetivo: analisar o discurso de enfermeiros acerca das potencialidades na utilização das tecnologias da informação como apoio organizacional das ações de enfrentamento da COVID-19 na Atenção Primária à Saúde. Método: estudo qualitativo e exploratório, realizado nas unidades da Estratégia Saúde da Família, na cidade de João Pessoa, Paraíba, Brasil. A coleta de dados foi realizada de setembro a novembro de 2021 com 26 enfermeiros selecionados por meio da snowball technique, utilizando-se de roteiro de entrevista semiestruturado. O material empírico foi organizado no software Atlas.ti 9 e fundamentado com base no aporte teórico-metodológico da Análise do Discurso de linha francesa. Resultados: evidenciaram-se três blocos discursivos: inovação a partir das mídias sociais; ações de educação em saúde; resolutividade nas ações organizacionais, apresentando a relevância dos aplicativos WhatsApp®, Instagram® e Facebook® como recursos estratégicos, de forma a colaborar para a área de Atenção Primária à Saúde com a organização das ações de saúde frente à COVID-19 por enfermeiros. Conclusão: as unidades de saúde possuem potencial para fortalecer a assistência por meio dos dispositivos organizacionais digitais, no entanto, necessitam de apoio político que invista na estrutura e em estratégias para potencializar a organização das ações de saúde. Resumen Objetivo: analizar el discurso de los enfermeros sobre el potencial que tienen las tecnologías de la información como apoyo organizacional a las acciones en la lucha contra el COVID-19 en la Atención Primaria de Salud. Método: estudio cualitativo y exploratorio, realizado en unidades de la Estrategia Salud de la Familia, en la ciudad de João Pessoa, Paraíba, Brasil. La recolección de datos se realizó de septiembre a noviembre de 2021 con 26 enfermeros seleccionados mediante la técnica de bola de nieve, utilizando un formulario de entrevista semiestructurada. El material empírico fue organizado en el software Atlas.ti 9 y se basó en el aporte teórico-metodológico del Análisis del Discurso de la escuela francesa. Resultados: se observaron tres bloques discursivos: innovación desde las redes sociales; acciones de educación para la salud; resolutividad en las acciones organizacionales, que muestran la importancia de las aplicaciones WhatsApp®, Instagram® y Facebook® como recursos estratégicos, que colaboran en el área de Atención Primaria de Salud con la organización de las acciones de salud contra el COVID-19 que llevan a cabo los enfermeros. Conclusión: las unidades de salud tienen potencial para fortalecer la atención a través de dispositivos organizacionales digitales, pero necesitan apoyo político que invierta en la estructura y en estrategias para mejorar la organización de las acciones de salud.

AbstractHuman milk contains SARS-CoV-2-specific antibodies after COVID-19 vaccination. These milk antibodies decrease several months post-vaccination. Whether booster immunization restores human milk antibody levels, potentially offering prolonged passive immunity for the infant, remains unknown. In this prospective follow-up study, we investigated the longitudinal SARS-CoV-2-specific antibody response in human milk of 26 lactating women who received a COVID-19 booster dose of an mRNA-based vaccine. Moreover, we evaluated whether the booster-induced human milk antibody response differs for participants who received a similar or different vaccine type in their primary vaccination series. All participants (100%) who received a homologous booster vaccination showed SARS-CoV-2-specific immunoglobulin A (IgA) and immunoglobulin G (IgG) in their milk. Heterologous booster vaccination resulted in milk conversion for 9 (69%) and 13 (100%) participants for IgA and IgG respectively. Findings of this study indicate that both homologous and heterologous boosting schedules have the potential to enhance SARS-CoV-2-specific IgA and IgG in human milk.

Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic disorder caused by the accumulation of monoclonal immunoglobulin secreting cells in the bone marrow. The main clinical implication of MGUS is that it’s the precursor of multiple myeloma (MM) and related disorders. Current guidelines recommend indefinite follow-up of individuals with MGUS in order to detect MGUS progression. The benefits of this follow-up and of detecting MGUS have not been sufficiently studied but recent evidence has suggested that the detection of MGUS provides opportunities of early treatment in MM and related disorder at an asymptomatic stage and that such early treatment can significantly improve outcomes. Systematic screening may provide a means to vastly expand the availability of early treatment but has not been sufficiently studied. MGUS may also have other clinical significance with multiple studies associating the asymptomatic disorder with a wide range of non-malignant disorders. However, previous studies have been heavily afflicted by bias and the extent of these associations and their clinical relevance is not clear. The aim of this thesis is to further clarify the clinical significance of MGUS with an emphasis on the association of MGUS and non-malignant disease and to demonstrate methodologies that can significantly improve our understanding of this asymptomatic precursor disorder and its clinical significance. Four papers are presented. The first two papers apply alternative study designs and statistical methods to registry-based data on MGUS from Sweden to study the relationship between MGUS and peripheral neuropathy (PN) and fractures. The latter two papers pertain to the Iceland screens, treats, or prevents multiple myeloma study (iStopMM), a population-based screening study with the aim of gathering a population- based cohort of individuals screened for MGUS and to assess the benefits and harms of such screening in a clinical trial. The study is described in detail in paper three and the fourth paper demonstrates the opportunities to found in studying MGUS disease associations within the screened cohort of iStopMM by assessing the relationship of MGUS and coronavirus disease 2019 (COVID-19). In paper I and II, MGUS was found to be associated with PN and fractures. Based on the findings we hypothesized that PN is one of, at least, three causes of fractures in MGUS alongside undetected MM bone disease and MGUS inherent bone disease. In paper III, the recruitment of iStopMM is described with around 54% of eligible Icelanders (n=80,759) signing up to participate in the study. In paper IV, MGUS was unexpectedly not found to be associated with increased incidence or severity of COVID-19. v In conclusion, MGUS has clinical significance by being the precursor of MM and related disorders and by leading to non-malignant complications. The findings of this thesis confirm that previous studies have been afflicted by significant bias. Further studies, particularly within screened cohorts like that of iStopMM, are needed to further clarify the clinical significance of MGUS and to focus and improve care of individuals with MGUS. Á Góðkynja einstofna mótefnahækkun (e. monoclonal gammopathy of undetermined significance, MGUS) er einkennalaust ástand orsakað af uppsöfnun einstofna mótefnaframleiðandi frumna í beinmerg. Klínískt mikilvægi MGUS felst fyrst og fremst í því að það er forstig mergæxlis og skyldra sjúkdóma. Núgildandi leiðbeininagar ráðleggja eftirfylgd með einstaklingum með MGUS til að greina þróun þess yfir í illkynja sjúkdóma. Gagnsemi þessarar eftirfylgdar og þess að greina MGUS hefur þó ekki verið að fullu sönnuð en talsverðar vísbendingar eru um að með því að greina þróun MGUS yfir í illkynja sjúkdóma snemma megi grípa fyrr inn í og þannig bæta horfur í þeim sjúkdómum talsvert. Kerfisbundin skimun fyrir MGUS gæti verið leið til að auka aðgengi að slíkri snemmbúinni meðferð en ekki liggja fyrir neinar rannsóknir á slíkri skimun. Til viðbótar við að vera forstig illkynja sjúkdóma hefur MGUS verið tengt fjölda annarra sjúkdóma. Fyrri rannsóknir eru þó líklega nokkuð bjagaðar og enn er því óljóst hvaða sjúkdóma MGUS tengist raunverulega og hvaða klínísku þýðingu þær sjúkdómstengingar hafa. Markmið þessarar ritgerðar er að skýra klínískt mikilvægi MGUS, einkum með tilliti til sjúkdóma sem ekki eru illkynja. Ætlunin er að nota nýja aðferðarfræðilega nálgun sem getur stórbætt skilning okkar á MGUS og sjúkdómum sem því tengjast. Rigerðin byggir á fjórum greinum. Í grein I og II eru tengsl MGUS við úttaugamein og beinbrot skoðuð í sænskum gagnagrunni og öðruvísi aðferðarfræðilegri nálgun beitt á það gagnasett en áður hefur verið gert. Seinni tvær greinarnar byggja á rannsókninni Blóðskimun til bjargar. Rannsóknin er lýðgrunduð skimunarrannsókn fyrir MGUS og slembiröðuð rannsókn á eftirfylgd með það að markmiði að kanna gagnsemi og skaðsemi þess að skima fyrir MGUS. Rannsókninni og hönnun hennar er ítarlega lýst í grein III. Í grein IV eru gögn rannsóknarinnar notuð til að rannsaka tengsl MGUS og COVID-19 í því óbjagaða þýði einstaklinga með MGUS sem greinast með skimun í Blóðskimun til bjargar. Í grein I og II sýna niðurstöðurnar að MGUS tengist úttaugameini og beinbrotum. Auk þess benda niðurstöðurnar til þess að úttaugamein sé ein af a.m.k. þremur orsökum beinbrota í MGUS samhliða ógreindum mergæxlis beinasjúkdómi og MGUS beinasjúkdómi. Í grein III er öflun þátttakenda í Blóðskimun til bjargar lýst en alls skráðu 80,759 Íslendingar sig í rannsóknina. Í grein IV sáust nokkuð óvænt engin tengsl milli MGUS og tíðni eða alvarleika COVID-19. Niðurstöðurnar benda til að MGUS hafi klínískt mikilvægi. Það er bæði forstig illkynja sjúkdóma og tengist líklega öðrum sjúkdómum líka. Einnig staðfesta niðurstöðurnar fyrri grun um að eldri rannsóknir hafi byggt á bjöguðum þýðum sem hafa gefið okkur skakka mynd af umfangi tengsla MGUS við sjúkdóma og sýna glögglega mikilvægi þessi að rannsaka þessi tengsl innan skimaðra þýða eins og í Blóðskimun til bjargar. Slíkar rannsóknir eru nauðsynlegar til að skýra raunverulegt klínískt mikilvægi MGUS og með því betrumbæta eftirfylgd einstaklinga með MGUS og þannig vonandi horfur þeirra.

The lockdown policy deals a severe blow to the economy and greatly reduces the nitrogen oxides (NOx) emission in China when the coronavirus 2019 spreads widely in early 2020. Here we use satellite observations from Tropospheric Monitoring Instrument to study the year-round variation of the nitrogen dioxide (NO2) tropospheric vertical column density (TVCD) in 2020. The NO2 TVCD reveals a sharp drop, followed by a stable fluctuation and then a strong rebound when compared to 2019. By the end of 2020, the annual average NO2 TVCD declines by only 3.4% in China mainland, much less than the reduction of 24.1% in the lockdown period. On the basis of quantitative analysis, we find the rebound of NO2 TVCD is mainly caused by the rapid recovery of economy especially in the fourth quarter, when contribution of industry and power plant on NO2 TVCD continues to rise. This revenge bounce of NO2 indicates the emission reduction of NOx in lockdown period is basically offset by the recovery of economy, revealing the fact that China's economic development and NOx emissions are still not decoupled. More efforts are still required to stimulate low-pollution development.