Assessing conflict and intimacy for understanding and treating couple distress

It has become increasingly apparent that the topic of marital conflict has been given special status within the published literature on issues of marriage (Bradbury, Rogge, & Lawrence, 2001; Fincham, 2003). The question has been raised as to whether or not there are other constructs that deserve comparable attention. The present study argues for a closer look at an additional emerging construct, emotional intimacy, and its role in couples relationships. Much of the literature on overt conflict and emotional intimacy fails to make an adequate distinction between these two constructs. The present study proposed to derive two factor scales from the Marital Satisfaction Inventory-Revised, Disaffection and Disharmony. Basic psychometric properties of these scales were examined using multiple data sets. Implications were examined for understanding underlying components of relationship distress in both community and clinic couples, and results provided support for the use of the revised factor scales in both clinical and research applications

Assessing conflict and intimacy for understanding and treating couple distress

It has become increasingly apparent that the topic of marital conflict has been given special status within the published literature on issues of marriage (Bradbury, Rogge, & Lawrence, 2001; Fincham, 2003). The question has been raised as to whether or not there are other constructs that deserve comparable attention. The present study argues for a closer look at an additional emerging construct, emotional intimacy, and its role in couples relationships. Much of the literature on overt conflict and emotional intimacy fails to make an adequate distinction between these two constructs. The present study proposed to derive two factor scales from the Marital Satisfaction Inventory-Revised, Disaffection and Disharmony. Basic psychometric properties of these scales were examined using multiple data sets. Implications were examined for understanding underlying components of relationship distress in both community and clinic couples, and results provided support for the use of the revised factor scales in both clinical and research applications

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