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Determining whether the incidence of suicidal behavior during the COVID-19 pandemic changed for those with severe mental disorders is essential to ensure the provision of suicide preventive initiatives in the case of future health crises.
Methods
Using population-based registers, quarterly cohorts from the first quarter of 2018 (2018Q1) to 2021Q4 were formed including all Swedish-residents >10 years old. Interrupted time series and generalized estimating equations analyses were used to evaluate changes in Incidence Rates (IR) of specialised healthcare use for suicide attempt and death by suicide per 10 000 person-years for individuals with or without specific severe mental disorders (SMDs) during, compared to before the pandemic.
Results
The IR (95% Confidence interval, CI) of suicide in individuals with SMDs decreased from 16.0 (15.0–17.1) in 2018Q1 to 11.6 (10.8–12.5) in 2020Q1 (i.e. the quarter before the start of the pandemic), after which it dropped further to 6.7 (6.3–7.2) in 2021Q2. In contrast, IRs of suicide attempt in SMDs showed more stable trends, as did the trends regarding suicide and suicide attempt for individuals without SMD. These discrepancies were most evident for individuals with substance use disorder and ASD/ADHD. Changes in IRs of suicide v. suicide attempt for one quarter during the pandemic for substance misuse were 11.2% v. 3.6% respectively. These changes for ASD/ADHD were 10.7% v. 3.6%.
Conclusions
The study shows pronounced decreases in suicide rates in individuals with SMDs during the pandemic. Further studies aiming to understand mechanisms behind these trends are warranted to consult future suicide prevention strategies.
During the global COVID-19 pandemic, many countries have expanded the level and coverage of current social insurance and social assistance programs as well as implemented new programs. Based on three separate datasets, V-Dem V-Party dataset; fourteen structured expert interviews; and a dataset of 114 social security measures, we study the link between the welfare regime, pandemic-related social policy measures, and incumbents’ ideological stand. Does the pandemic-related social policy measures mirror the political attitudes of the incumbents? What role did the welfare regime play? We scrutinise eight OECD countries (Denmark, Finland, Germany, Netherlands, Norway, Sweden, UK, and the US) representing three different welfare regimes: corporatist-conservative countries, liberal countries, and socio-democratic countries. The key findings of this article show that the pandemic-related social policy measures did not mirror the political attitudes of the incumbents.
Trade secrets raise three primary issues. First, if an entity is forced to share trade secrets to expedite development and to expand the supply of needed products, must or should the government compensate the rights holder? Although this chapter addresses this question, it is largely unnecessary to answer it. This is because compensation is not required under international law, and because reasonable compensation should normally be provided for compelled trade secret sharing. Second, does international law prohibit governments from compelling the sharing of trade secrets, including by compulsory licensing? The short answer is no. Third, what authorities currently exist or could be adopted for governments to compel the sharing of trade secrets? The chapter provides general overview of a range of existing authorities, as well as a framework for addressing the latter two questions and for understanding the complexity of the first question.
This chapter identifies three distinct reasons why China took a middle-of-the-road position in the debate on the COVID-19 TRIPS waiver at the WTO. It also recounts the country’s more assertive position in the run-up to the adoption of the Ministerial Decision on the waiver. Drawing eight lessons from the international debate on the waiver and the subsequent Ministerial Decision, the chapter offers insights into the future role China can or will play in future international policy debates at the intersection of intellectual property and public health, including during the next pandemic.
As has been the case outsideAfrica, African countries have experienced multiple consequences from the COVID-19 pandemic that extend beyond its immediate impact on human health. In Africa, much like elsewhere in the world, the pandemic has had a significant economic impact, leading to profound global economic distress. African countries have also experienced consequences that are unlike those of much of the rest of the world. For example, the pandemic has contributed to a sovereign debt crisis that led to sovereign defaults by Zambia in late 2020, Mali in early 2022, and Ghana in late 2022, and might lead to additional defaults. Travel bans and COVID-19 vaccine exclusion are key policies that have also had a particular impact in Africa. These and other COVID-19 policies in African contexts reflect patterns of exclusion that are at least in part a consequence of continuing colonial hangover.
The chapter begins with the genesis of relevant regulatory protections and their general parameters before discussing their prevalence among countries. It then turns to discussion of proposed and actual modification of TRIPS requirements for COVID and how that intersects with these regulatory barriers. The chapter concludes with recommendations.
For many years, some lawmakers, scholars, and activists have argued that firms located in each developing country (or each regional set of developing countries) should produce more of the drugs that the residents there need. They contend that local production would benefit the residents of those countries in two ways. The chapter first discusses some recent developments that have altered the relative strength of these competing considerations, sharply increasing the likelihood that fostering local production in developing countries would be socially beneficial.It then proposes five legal reforms and economic initiatives that could help build local pharmaceutical production capacity and thereby save lives.
At the outset of the COVID-19 pandemic, numerous observers recognized the potential for patents and other intellectual property (IP) rights to hinder the development and dissemination of medical equipment and products responsive to the virus. Concerns over the impact of IP rights on pandemic response led to a range of national and international governmental interventions. Yet these concerns also spurred voluntary, private action by IP rights holders. This chapter discusses and assesses these private initiatives, with a focus on the Open Covid Pledge (OCP), an initiative that the author helped to organize. The OCP eventually led to the voluntary commitment of an estimated 500,000 patents to the COVID-19 response, was endorsed by Universities Allied for Essential Medicines (UAEM) and adopted by the WHO’s Covid Technology Access Pool (C-TAP) as a recommended mechanism for making technology available in the COVID-19 response.
The COVID-19 pandemic unquestionably disrupted established norms and procedures. Climate networks in Sweden and the associated actors had to adapt to and navigate this dramatic and unpredictable situation. The chapter provides initial insights into how the pandemic affected a business network, a government-led multi-stakeholder platform and a social movement. Arguing that COVID-19 can constitute both an opportunity and a risk for non-state climate action, we investigate whether or not the pandemic created a window of opportunity for non-state actors to achieve their voluntary pledges or push the state to adopt more ambitious action, and whether or not the state has been able to mobilize non-state actors, or if it has made it harder for them for them to mobilize. Our findings indicate that thus far, the pandemic has not led to deeper changes, either in the climate debate in Sweden or in the climate work of individual actors. The members of climate networks have changed their working procedures and modified their communication strategies when it comes to climate action. However, the pandemic affected the ability of social movements to carry out their main activity, at least in the short term, that is, to go out on the streets and demonstrate.
The COVID pandemic has had deleterious effects on the mental health of the global population. Parents of children with CHD were particularly vulnerable to negative mental health outcomes such as depression, anxiety, and perceived stress. A better understanding of the CHD parent experiences, needs, and concerns while navigating the healthcare system during a pandemic is needed.
Methods:
Online survey responses from 71 parents of young children with CHD representing families across the United States of America and Canada were analysed. Qualitative data were collected one year into the COVID pandemic. Thematic analysis was used to examine responses to the open-ended question “What would you like healthcare professionals (doctors, nurses) to know about your experience of being a parent with a child with CHD during the COVID-19 pandemic?.”
Results:
Two major themes with subthemes and an umbrella theme emerged from the parents’ responses (1) Pandemic Parenting: The Emotional Toll of Hospital Visitation Restrictions, Dealing with Social Distancing, Feeling Isolated, Decision Making in Uncertainty, and Playing it Safe versus Returning to Normal and (2) Unmet Expectations of Care: Needing Information, Wanting Empathy, Requesting Respect, Questioning Care Quality, and the umbrella theme of: Our Lives were Turned Upside Down.
Conclusion:
CHD parents describe a negative impact of healthcare-related challenges during the COVID pandemic. These findings may offer insight to how healthcare professionals can better support the mental health and care burden of CHD parents during future pandemics.
The concurrent challenges of the COVID-19 pandemic and a significant earthquake in Izmir on October 30, 2020, presented a unique scenario for disaster management and response. This study focuses on the impact of the earthquake, which resulted in 117 fatalities, including 1 due to drowning, and injured 1034 individuals, alongside widespread structural damage including to the Izmir Democracy University Buca Seyfi Demirsoy Training and Research Hospital. The objective is to assess the activation and implementation of the hospital disaster plan amidst the ongoing pandemic. Through a retrospective evaluation of all actions undertaken as per the Hospital Disaster Emergency Plan within the Disaster Management cycle, this study examines the decision-making process for the hospital evacuation on October 30, 2020, the evacuation of COVID-19 patients, and the strategies employed to increase hospital capacity. Of 216 patients hospitalized at the time of the earthquake, 65 were transferred to other facilities under COVID-19 protocols. The prolonged nature of pandemics and the likelihood of secondary disasters underscore the importance of comprehensive risk assessments and dynamic disaster planning, considering simultaneous multiple hazards. This study suggests the inclusion of multi hazard scenarios and diverse evacuation methods by using types of ambulances, such as ground, helicopter, and boat.
This retrospective study provides insights on linguistic development in exceptional circumstances assessing 378 children (between 2;6 and 3;6) who lived their first years during the COVID-19 pandemic and comparing it with normative data collected before this period (CDI-III-PT; Cadime et al., 2021). It investigates the extent to which linguistic development was modulated by a complex set of factors, including sex, maternal education, book reading, language-promoting practices, COVID-19 infection, parental stress and sleeping problems, considering three periods (during lockdowns, out of lockdowns and at present). The results show a substantial negative effect of the pandemic on both lexical and syntactic development. Considering individual variation, structural equation modelling unveiled a complex scenario in which age, sex, book reading, language-promoting practices, sleeping problems and COVID-19 infection showed a direct effect on linguistic development. Maternal education and parental stress had an indirect effect on children’s language, mediated by book reading and sleeping problems, respectively.
I investigate why some countries were more successful in containing the death toll than others during the COVID-19 pandemic. I focus on the role of socialism and on the existence of long-term regime-driven legacies that may have had an impact on the containment of COVID-related deaths. I claim that countries that went through successful socialist revolutions have specific features that equip them with better resources to cope with public challenges such as pandemics. Furthermore, these features remain even after the demise of the socialist regime. I find a positive effect of socialist revolutions over COVID-19 containment at the country level. I investigate three possible causal mechanisms for this relationship: authoritarianism, state capacity, and mass mobilization. Through mediation analysis, I find the socialist legacy seems to be channeled through higher levels of mobilization and also more authoritarian institutions.
Social policies convey normative assumptions about how households should make ends meet and organise care, but how do these ideals withstand crises such as the coronavirus disease 2019 (COVID-19) pandemic? Previous research shows continuity of welfare state models in the crisis, but mostly looked at single policy fields and produced mixed findings regarding the role of pre-crisis reform trajectories. This paper contributes a detailed analysis of assumptions about the ‘standard productive household’ in terms of three dimensions: labour market participation, coverage of economic needs and coverage of care needs. Drawing on original policy documents enacted in 2020 in Germany – which had dismantled many of its institutional strongholds for the male-breadwinner model before the crisis – we provide two novel insights. First, social policy responses to the pandemic were relatively coherent regarding assumptions about labour market participation, but expectations towards households’ abilities to make ends meet and parents’ care involvement were less coherent. In addition to relaxing conditions on stable employment and income, policy responses normalised patchwork incomes and relied on parents to compress paid and unpaid work. Second, we propose that crises may slow down reform processes that are already underway by reverting to ideas that were dominant in the past.
This chapter begins the last section, a section that explores how the police power can be used to address modern social problems. We look at a number of these wicked problems, including housing, transportation, environmental degradation, and other predicaments, and connect our conception of the police power as described earlier in this book to the use of this power proactively to confront these especially difficult problems.
This chapter looks at how the police power has evolved in judicial interpretations and legislative enactments to the present day. It begins by exploring how the shifting approaches to regulatory governance more generally and also various state constitutional developments in the past two centuries affected thinking about the overall structure and purpose of state regulatory authority. It then turns to a number of critical areas in which the police power was used as a tool of protecting health, safety, welfare, and the common good. It begins with morals, a linchpin of traditional police power regulation, and then proceeds to discuss urban blight, occupational licensing, and public health emergencies
The grief of relatives of patients who died of COVID-19 in an intensive care unit (ICU) has exacted an enormous toll worldwide.
Aims
To determine the prevalence of probable prolonged grief disorder (PGD) at 12 months post-loss and beyond. We also sought to examine circumstances of the death during the COVID-19 pandemic that might pose a heightened risk of PGD, and the associations between probable PGD diagnosis, quality of life and social disconnection.
Method
We conducted an observational, cross-sectional multicentre study of the next of kin of those who died of COVID-19 between March 2020 and December 2021. Participants were recruited from ICUs in South-East London. The Prolonged Grief Disorder Scale (PG-13-R), Quality-of-Life Scale (QOLS) and Oxford Grief-Social Disconnection Scale (OG-SD) were used.
Results
A total of 73 relatives were recruited and assessed, all of them over a year after their loss. Twenty-five (34.2%; 95% CI 23.1–45.4%) relatives of patients who died in the ICU met the criteria for PGD. Those who met the criteria had significantly worse quality of life (QOLS score mean difference 26; 95% CI 17–34; P < 0.001) and endorsed greater social disconnection (OG-SD score means difference 41; 95% CI 27–54; P < 0.001).
Conclusions
The findings suggest that rates of PGD are elevated among relatives of patients who died of COVID-19 in the ICU. This, coupled with worse quality of life and greater social disconnection experienced by those meeting the criteria, suggests the need to attend to the social deprivations and social dysfunctions of this population group.
The COVID-19 pandemic introduced unique stressors that posed significant threats to adolescent mental health. However, limited research has examined the impact of trauma exposure on vulnerability to subsequent stressor-related mental health outcomes in adolescents. Furthermore, it is unclear whether there are protective factors that promote resilience against the negative impacts of COVID-19 stressors in adolescents with prior trauma exposure. This preregistered study aimed to investigate the impact of trauma on COVID-19 stressor-related mental health difficulties in adolescents, in addition to the role of protective factors.
Methods
Aims were investigated in a sample of 9696 adolescents (mean age 12.85 ± 0.88 years) from the Adolescent Brain Cognitive Development Study. Linear mixed-effects models were employed to examine (a) the associations of early trauma exposure (exposed v. non-exposed), COVID-19 stressors, and perceived stress, sadness, and positive affect levels during the pandemic period in the US, and (b) the role of protective factors (physical activity, parental support, and improvements in family and peer relationships) in these associations.
Results
There was a positive association between COVID-19 stressors and sadness, which was enhanced in trauma-exposed adolescents. Improvements in family and peer relationships mitigated the association between COVID-19 stressors and poor mental health outcomes, regardless of prior traumatic experience.
Conclusions
These findings support the hypothesis that prior trauma elevates risk of mental health difficulties in the face of future stressors. Results underscore the protective role of enhanced social relationships as targets for early prevention and intervention in those experiencing acute stressors, regardless of prior traumatic experiences.
The COVID-19 pandemic destabilised the political, social, and economic life of countries as it spread around the world. It posed multiple threats to individuals, societies, and across different domains of life, highlighting their intersectionality and uneven impacts. The paper focuses on the UK and South Korea, countries which took very different paths in framing and addressing the crisis. It draws on secondary data and an integrated critical human security and state capacity approach to compare how state responses, institutional capacity, and the mobilisation of policy instruments themselves construct constellations of insecurity which intersect with human security and vulnerability. It will demonstrate the structural constraints that have continued to shape vulnerability and the dynamics of human security and insecurity in turbulent times.
To explore the lived experience of informal dementia caregivers during the COVID-19 pandemic.
Methods:
Interpretative Phenomenological Analysis (IPA) was employed. Eight primary informal caregivers were recruited from a community mental health service for older people when attending in their role as caregiver of a service-user. Semi-structured interviews were conducted at home or in the clinic based on the participants’ convenience and preference. IPA was completed following Smith and colleagues framework for analysis.
Results:
Six group experiential themes, each with a number of subthemes, emerged from the cross-case interpretative analysis: the ambivalent experience of caregiving (subtheme: those complex emotional experiences); navigating lockdown: lived challenges and opportunities (subthemes: the pervasive fear, intensification of existing struggles, being prevented from caring for a loved one, and lockdown as a time for opportunity); transitioning out of lockdown (subthemes: regaining freedom, but restricted freedom after all and being in a lockdown of one’s own); the present with COVID-19, but mostly with dementia (subthemes: dementia, a disease that does not pause, and ‘takeaways’ from the journey); looking into the future (subthemes: embracing COVID-19 and the true needs); and a word on coping (subtheme: managing it all as best one can).
Conclusion:
Findings demonstrate the significance of the meaning caregivers ascribed to their experiences on their wellbeing and ability to cope in times of COVID-19 and thereafter. Gaining an understanding of the caregivers’ unique experiences is crucial to appreciate how to best support them.