COVID‑Specific Coercive Control among Emerging Adults Attending College: A Brief Note

The COVID-19 pandemic represents a “perfect storm” with regards to risk for intimate partner violence (IPV). Abusive partners may engage in novel forms of coercive control, such as pressuring their partner to engage in activities associated with COVID-19 infection risk (e.g., attend a large gathering). However, no empirical research has focused on COVIDspecific coercive control. The current study sought to evaluate the prevalence of COVID-specific coercive control in a large sample of U.S. college students, as well as its association with other forms of IPV and depression and anxiety. A total of 2,289 undergraduate students attending eight U.S. universities who were currently in a sexual/dating/romantic relationship completed an online survey in Fall 2020 about COVID-specific coercive control, other forms of IPV (psychological, physical, sexual, coercive control) and depression and anxiety symptoms. Overall, 15.5% (n = 355) of students reported experiencing COVID-specific coercive control. Individuals who experienced COVID-specific coercive control were more likely to have experienced all other forms of IPV than those who did not experience COVID-specific coercive control. Further, individuals who experienced COVID-specific coercive control had significantly greater anxiety than individuals who did not experience any form of IPV. Individuals who experienced both COVID-specific coercive control and other forms of IPV had the highest levels of depression and anxiety. COVID-specific coercive control may serve to increase depression and anxiety, particularly if it co-occurs with other forms of IPV. Future work should evaluate the prevalence and long-term impact of coercive control during the COVID-19 pandemic

Genome sequencing reveals Zika virus diversity and spread in the Americas

Although the recent Zika virus (ZIKV) epidemic in the Americas and its link to birth defects have attracted a great deal of attention, much remains unknown about ZIKV disease epidemiology and ZIKV evolution, in part owing to a lack of genomic data. Here we address this gap in knowledge by using multiple sequencing approaches to generate 110 ZIKV genomes from clinical and mosquito samples from 10 countries and territories, greatly expanding the observed viral genetic diversity from this outbreak. We analysed the timing and patterns of introductions into distinct geographic regions; our phylogenetic evidence suggests rapid expansion of the outbreak in Brazil and multiple introductions of outbreak strains into Puerto Rico, Honduras, Colombia, other Caribbean islands, and the continental United States. We find that ZIKV circulated undetected in multiple regions for many months before the first locally transmitted cases were confirmed, highlighting the importance of surveillance of viral infections. We identify mutations with possible functional implications for ZIKV biology and pathogenesis, as well as those that might be relevant to the effectiveness of diagnostic tests

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

AN EVALUATION OF WEIGHT CLASS AND MATERNAL SEXUAL HEALTH DURING PREGNANCY: THE MEDIATING ROLES OF WEIGHT BIAS AND BODY DISSATISFACTION AMONG BLACK AND WHITE WOMEN

Obesity is a national public health issue that adversely affects women of reproductive age and increases the risk for chronic issues (cardiovascular disease, type II diabetes, decreased fertility) that can cause short- and long-term consequences during pregnancy. Obesity is also related to sexual functioning, with greater BMI being linked to greater sexual problems among this population. Two potential mediators that may explain the relation between weight and sexual problems during pregnancy are internalized weight bias and body image dissatisfaction. Indeed, how a person perceives their weight and body image as it changes during pregnancy likely affects their sexual functioning and satisfaction. Importantly, little research has explored the association between these constructs among a racially diverse sample (Black, White race), thus calling for more understanding of how these variables operate among diverse groups of pregnant people. The current study sought to examine the relationship between weight class, internalized weight bias, body dissatisfaction, and sexual health (functioning, satisfaction) during pregnancy among a racially diverse sample of Black and White pregnant women. Participants were 306 pregnant individuals (0-39 weeks gestation; 40.5% Black, 51.3% White race) living within the United States who were assigned female at birth, sexually active during pregnancy, and between the ages of 18-45 years of age. Participants were drawn from a Qualtrics Panel and completed an online survey assessing obstetric characteristics, sexual activity, functioning and satisfaction, as well as weight-related constructs. Structural equation modeling was utilized to evaluate a parallel mediation model to examine the indirect effects of internalized weight bias (M1) and body dissatisfaction (M2) on the relation between weight class (pre-pregnancy BMI [X1] and gestational weight gain [X2]) and sexual health (sexual functioning [Y1] and sexual satisfaction [Y2]). Results indicated that greater BMI prior to pregnancy was associated with greater internalized weight bias while participants were pregnant, and this was in turn related to lower sexual satisfaction while pregnant. Additionally, the same trend was found with body dissatisfaction, in that the heavier an individual weighed before pregnancy was related to worse body image during pregnancy, and thus greater sexual dysfunction and lower sexual satisfaction. Further, greater weight gained during pregnancy predicted women’s sexual functioning and sexual satisfaction via body dissatisfaction, however, internalized weight bias only mediated the relationship between gestational weight gain and sexual satisfaction, similar to how internalized weight bias was not found to mediate the relationship to sexual functioning through pre-pregnancy BMI. These results indicate that BMI prior to pregnancy plays a role in sexual functioning and satisfaction during pregnancy, and that this relationship is partially explained by perceived level of internalized weight bias and body dissatisfaction. Further, gestational weight gain can also influence perceived sexual functioning during pregnancy, by way of a pregnant person’s level of body dissatisfaction. However, minimal moderation effects of race were observed. Specifically, results supported differences in strength of the relationship between pre-pregnancy BMI and internalized weight bias by race, with the relationship being stronger among White women, as hypothesized. Altogether, these findings support that future work should aim to prioritize and center Black women’s experiences with weight, stigma, and sexual health, through culturally-sensitive recruitment strategies, study methodologies, and with an ultimate goal of strengthening our measurement and assessment in order to adequately capture Black pregnant women’s experiences and better serve their healthcare needs

Gender-neutral bathrooms on campus: a multicampus study of cisgender and transgender and gender diverse college students

Objective: This study examined cisgender and transgender and gender diverse (TGD) college students’ perceptions of gender-neutral bathroom availability across eight U.S. campuses, TGD students’ fear of harassment related to (lack of) availability of gender-neutral bathrooms, and the relation between fear of harassment and TGD students’ psychological distress. Methods: Participants were 4,328 college students (4,195 cisgender, 30 binary transgender, 103 gender diverse) from eight U.S. institutions of higher education. Results: The majority (84.2%) of TGD students and 34.6% of cisgender students perceived there were too few gender-neutral bathrooms on their campus. Further, TGD students’ fear of harassment related to a lack of availability of gender-neutral bathrooms on campus was positively associated with psychological distress (i.e., symptoms of depression and anxiety). Conclusion: This study highlights the significance of increasing accessibility of gender-neutral bathrooms on campuses to help mitigate TGD students’ fear of harassment and psychological distress