Sex differences in innate anti-viral immune responses to respiratory viruses and in their clinical outcomes in a birth cohort study.

The mechanisms explaining excess morbidity and mortality in respiratory infections among males are poorly understood. Innate immune responses are critical in protection against respiratory virus infections. We hypothesised that innate immune responses to respiratory viruses may be deficient in males. We stimulated peripheral blood mononuclear cells from 345 participants at age 16 years in a population-based birth cohort with three live respiratory viruses (rhinoviruses A16 and A1, and respiratory syncytial virus) and two viral mimics (R848 and CpG-A, to mimic responses to SARS-CoV-2) and investigated sex differences in interferon (IFN) responses. IFN-α responses to all viruses and stimuli were 1.34-2.06-fold lower in males than females (P = 0.018 - < 0.001). IFN-ß, IFN-γ and IFN-induced chemokines were also deficient in males across all stimuli/viruses. Healthcare records revealed 12.1% of males and 6.6% of females were hospitalized with respiratory infections in infancy (P = 0.017). In conclusion, impaired innate anti-viral immunity in males likely results in high male morbidity and mortality from respiratory virus infections.

Racial and Ethnic Disparities in Health-Related Socioeconomic Risks During the Early COVID-19 Pandemic: A National Survey of U.S. Women.

Background: Nearly half of U.S. women experienced new or worsening health-related socioeconomic risks (HRSRs) (food, housing, utilities and transportation difficulties, and interpersonal violence) early in the COVID-19 pandemic. We sought to examine racial/ethnic disparities in pandemic-related changes in HRSRs among women. Materials and Methods: We conducted a cross-sectional survey (04/2020) of 3200 women. Pre- and early pandemic HRSRs were described by race/ethnicity. Weighted, multivariable logistic regression models generated odds of incident and worsening HRSRs by race/ethnicity. Results: The majority of Black, East or Southeast (E/SE) Asian, and Hispanic women reported ≥1 prepandemic HRSR (51%-56% vs. 38% of White women, p < 0.001). By April 2020, 68% of Black, E/SE Asian, and Hispanic women and 55% of White women had ≥1 HRSR (p < 0.001). For most HRSRs, the odds of an incident or worsening condition were similar across racial/ethnic groups, except Black, E/SE Asian and Hispanic women had 2-3.6 times the odds of incident transportation difficulties compared with White women. E/SE Asian women also had higher odds of worsening transportation difficulties compared with White women (adjusted odds ratios = 2.5, 95% confidence interval 1.1-5.6). In the early pandemic, 1/19 Hispanic, 1/28 E/SE Asian, 1/36 Black and 1/100 White women had all 5 HRSRs (extreme health-related socioeconomic vulnerability). Conclusions: Prepandemic racial/ethnic disparities in HRSRs persisted and prevalence rates increased for all groups early in the pandemic. Disparities in transportation difficulties widened. White women were much less likely than others to experience extreme health-related socioeconomic vulnerability. An equitable COVID-19 response requires attention to persistent and widening racial/ethnic disparities in HRSRs among women.

Change in Health-Related Socioeconomic Risk Factors and Mental Health During the Early Phase of the COVID-19 Pandemic: A National Survey of U.S. Women.

Background: During a pandemic, women may be especially vulnerable to secondary health problems driven by its social and economic effects. We examined the relationship between changes in health-related socioeconomic risks (HRSRs) and mental health. Materials and Methods: A cross-sectional survey of 3,200 women aged 18-90 years was conducted in April 2020 using a quota-based sample from a national panel (88% cooperation rate). Patterns of change in HRSRs (food insecurity, housing instability, interpersonal violence, and difficulties with utilities and transportation) were described. Weighted, multivariate logistic regression was used to model the odds of depression, anxiety, and traumatic stress symptoms among those with and without incident or worsening HRSRs. Results: More than 40% of women had one or more prepandemic HRSRs. In the early pandemic phase, 49% of all women, including 29% with no prepandemic HRSRs, had experienced incident or worsening HRSRs. By April 2020, the rates of depression and anxiety were twice that of prepandemic benchmarks (29%); 17% of women had symptoms of traumatic stress. The odds of depression, anxiety, and posttraumatic stress symptoms were two to three times higher among women who reported at least one incident or worsening HRSR; this finding was similar for women with and without prepandemic HRSRs. Conclusions: Increased health-related socioeconomic vulnerability among U.S. women early in the coronavirus disease 2019 (COVID-19) pandemic was prevalent and associated with alarmingly high rates of mental health problems. Pandemic-related mental health needs are likely to be much greater than currently available resources, especially for vulnerable women.

Optimizing Access to Preventive Reproductive Health Care: Meeting Patients Where They Are At

PREVENTIVE REPRODUCTIVE HEALTH CARE BARRIERS Today, we hear ourselves repeating this wise attending's words while working in our hospital's family planning clinic in response to a question we sometimes hear from learners: "Why do you think she waited so long to have her abortion?" Patients seeking abortion care and those pursuing preventive reproductive health care describe many of the same psychosocial, interpersonal, and structural barriers to obtaining care.1,2 Notable psychosocial challenges to obtaining care include medical mistrust and not prioritizing one's personal health amid competing demands;interpersonal barriers include parenting and caregiving for adult family members;and structural barriers include instability around insurance, transportation, and childcare.1 Although many barriers to seeking abortion and preventive reproductive health care coincide, those seeking abortion care face additional challenges, including stigma and antiabortion legal restrictions. The Turnaway Study was a landmark five-year longitudinal study that followed individuals who presented for abortion just before or after the gestational age limits at 30 abortion clinics across the United States.2 Participants who presented after the clinics' gestational age limits and were unable to obtain a desired abortion were more likely to experience economic hardship and report being in fair or poor health years later, compared with those who presented in time to obtain their desired abortion.2,3 Furthermore, what is often called the "wellwoman visit," which we refer to as the "preventive reproductive health visit" in recognition that not all individuals assigned female at birth identify as women, is an important opportunity to provide health screening, counseling, immunizations, contraception, and preconception care to help address individual and population-level reproductive health disparities.1 INNOVATIVE APPROACHES TO OVERCOMING BARRIERS Given the myriad interacting barriers individuals face in obtaining reproductive health care, innovative strategies to engage people in reproductive health care must prioritize meeting people where they are, figuratively and sometimes literally, to help them overcome their own context-specific barriers. [...]they implemented a program offering colocation of contraceptive services to mothers presenting for their young infants' well-baby visits. Importantly, preventive reproductive health care offers many potential health benefits but remains a downstream intervention that cannot fully mitigate long-standing, underlying structural and environmental factors that negatively affect individuals' reproductive health and contribute to population-level reproductive health disparities.