Short-Term Effects of a School-Based Comprehensive Sexuality Education Intervention Among Very Young Adolescents in Three Urban Indonesian Settings: A Quasi-Experimental Study.

PURPOSE: To evaluate the effects of a comprehensive sexuality education (CSE) intervention on short-term psychosocial outcomes related to healthy sexuality among very young adolescents in urban Indonesia. METHODS: A quasi-experimental study was conducted between 2018 and 2021 with students aged 10-14 years at 18 schools in Indonesia (Lampung, Denpasar, Semarang). Three schools per site were purposefully selected to receive the SEmangaT duniA RemajA intervention, a two-year, rights-based teacher-led CSE intervention delivered in classrooms (or online after the 2020 COVID-19 outbreak); and matched with three control schools. Surveys were completed by 3,825 students at pre- and posttest (82% retention). The final analytical sample included 1852 intervention and 1483 control students (N = 3,335). Difference-in-difference analysis was conducted to examine the intervention effect on healthy sexuality competencies (knowledge, skills, and attitudes) and personal sexual well-being. RESULTS: Baseline characteristics for intervention and control groups were similar in terms of sex (57% female) and age (mean 12 years). Students receiving SEmangaT duniA RemajA demonstrated significantly greater increase in competencies, including greater pregnancy knowledge, more gender equal attitudes, and communication about sexual and reproductive health and rights, compared to controls. There was no intervention effect on personal sexual well-being, except for self-efficacy to prevent pregnancy. Subgroup analysis indicated more significant effects among females and students in Semarang and Denpasar, than males or students in Lampung. DISCUSSION: While findings demonstrate the potential for CSE programs to improve healthy sexuality competencies in early adolescence, the effect appears to be highly contextualized which may be due to varying levels of implementation quality, especially since the COVID-19 outbreak.

The impact of COVID-19 on psychiatric clinical encounters among low-income racially-diverse children.

BACKGROUND: There is a lack of longitudinal data to examine the impact of COVID-19 on all types of clinical encounters among United States, underrepresented BIPOC (Black, Indigenous, and people of color), children. This study aims to examine the changes in all the outpatient clinical encounters during the pandemic compared to the baseline, with particular attention to psychiatric encounters and diagnoses. METHOD: This study analyzed 3-year (January 2019 to December 2021) longitudinal clinical encounter data from 3,394 children in the Boston Birth Cohort, a US urban, predominantly low-income, Black and Hispanic children. Outcomes of interest were completed outpatient clinical encounters and their modalities (telemedicine vs. in person), including psychiatric care and diagnoses, primary care, emergency department (ED), and developmental and behavioral pediatrics (DBP). RESULTS: The study children's mean (SD) age is 13.9 (4.0) years. Compared to 2019, psychiatric encounters increased by 38% in 2020, most notably for diagnoses of adjustment disorders, depression, and post-traumatic stress disorders (PTSD). In contrast, primary care encounters decreased by 33%, ED encounters decreased by 55%, and DBP care decreased by 16% in 2020. Telemedicine was utilized the most for psychiatric and DBP encounters and the least for primary care encounters in 2020. A remarkable change in 2021 was the return of primary care encounters to the 2019 level, but psychiatric encounters fluctuated with spikes in COVID-19 case numbers. CONCLUSIONS: Among this sample of US BIPOC children, compared to the 2019 baseline, psychiatric encounters increased by 38% during 2020, most notably for the new diagnoses of adjustment disorder, depression, and PTSD. The 2021 data showed a full recovery of primary care encounters to the baseline level but psychiatric encounters remained sensitive to the pandemic spikes. The long-term impact of the pandemic on children's mental health warrants further investigation.

Assessing the health, social, educational and economic impact of the COVID-19 pandemic on adolescents in low- and middle-income countries: a rapid review of the literature.

COVID-19 has caused profound health, social, educational and economic devastation around the world, especially among the lives of adolescents in low- and middle-income countries. This paper looks at a wide array of outcomes impacting adolescents' daily lives including health (mental, physical, sexual and reproductive health, vaccine perceptions and overlap between these topics), social relationships (family and peer), education and socio-economic disparities. Both scientific and grey literature between December 2019 and February 2022 were sought from PubMed, Google Scholar and organisations conducting research among adolescents, and coded. A total of 89 articles were included, 73% of which were peer-reviewed; 37% of the articles were from WHO's Western Pacific region; 62% of the articles were cross-sectional; 75% were quantitative. Three major topics emerged in more than half the articles: mental health (72%), education (61%) and socio-economic ramifications (55%). However, there were regional differences in topics and many of them overlapped. The results indicate that, where there has been research, almost all findings have been linked to worse mental health during the pandemic. Overall, remote education was seen as a negative experience. The ramification of school closures on future aspirations, in particular early school leaving, highlights the importance of prioritising education during future pandemics based on the situation within the country. Gender and other disparities have made marginalised adolescents vulnerable to the economic ramifications of containment measures. Given the risks identified, there is a pressing need to put adolescents at the centre of establishing priorities for their health agenda for post-pandemic recovery.

Genome-wide association study of SARS-CoV-2 infection in Chinese population.

Coronavirus disease 2019 (COVID-19) is a global public health concern. The purpose of this study was to investigate the association between genetic variants and SARS-CoV-2 infection and the COVID-19 severity in Chinese population. A total of 256 individuals including 87 symptomatic patients (tested positive for SARS-CoV-2), 84 asymptomatic cases, and 85 close contacts of confirmed patients (tested negative for SARS-CoV-2) were recruited from February 2020 to May 2020. We carried out the whole exome genome sequencing between the individuals and conducted a genetic association study for SARS-CoV-2 infection and the COVID-19 severity. In total, we analyzed more than 100,000 single-nucleotide polymorphisms. The genome-wide association study suggested potential correlation between genetic variability in POLR2A, ANKRD27, MAN1A2, and ERAP1 genes and SARS-CoV-2 infection susceptibility. The most significant gene locus associated with SARS-CoV-2 infection was located in POLR2A (p = 5.71 × 10-6). Furthermore, genetic variants in PCNX2, CD200R1L, ZMAT3, PLCL2, NEIL3, and LINC00700 genes (p < 1 × 10-5) were closely associated with the COVID-19 severity in Chinese population. Our study confirmed that new genetic variant loci had significant association with SARS-CoV-2 infection and the COVID-19 severity in Chinese population, which provided new clues for the studies on the susceptibility of SARS-CoV-2 infection and the COVID-19 severity. These findings may give a better understanding on the molecular pathogenesis of COVID-19 and genetic basis of heterogeneous susceptibility, with potential impact on new therapeutic options.

COVID-19 Experiences and Health-Related Implications: Results From a Mixed-Method Longitudinal Study of Urban Poor Adolescents in Shanghai.

PURPOSE: This analysis aimed to investigate gender differences in adolescents' concerns and the health implications of COVID-19. METHODS: We used two rounds of the Global Early Adolescent Study (GEAS) collected in Shanghai in 2018 and 2020. We analyzed data from 621 adolescents, comparing boys' and girls' concerns about COVID-19 and examining trends in general health and mental health by sex between the pre-COVID-19 and COVID-19 periods. Changes in health indicators over time were assessed using generalized estimating equation (GEE) models. RESULTS: Adolescent girls reported more health concerns (52.0% vs. 42.7%) and educational concerns (61.0% vs. 46.3%) than boys, whereas boys expressed more worries about the economic consequences of COVID-19 (32.9% vs. 25.4%). Changes in health-related outcomes during the pandemic compared to the prepandemic era differed by sex and varied by COVID-related experiences. Boys reported improved overall health (OR: 1.54, 95% CI: 1.00, 2.35) in the COVID-19 period relative to the pre-COVID-19 period. Such improvements were only observed among boys who reported no family economic hardships (OR: 2.10, 95% CI: 1.24, 3.58). We found no significant change for girls (OR: 1.14, 95% CI: 0.83, 1.55), regardless of COVID-19 economic impacts. In contrast, girls reported increased anxiety (OR: 1.63, 95% CI: 1.09, 2.45), especially among those who were concerned about their academic performance (OR: 1.85, 95% CI: 1.16, 2.97). Boys experienced no such increase (OR: 0.92, 95% CI: 0.55, 1.54), regardless of their education concerns. DISCUSSION: Adolescents' COVID-19 experiences are highly gendered and result in increased health inequalities, with greater mental health implications for girls.

Elevated Exhaustion Levels of NK and CD8+ T Cells as Indicators for Progression and Prognosis of COVID-19 Disease.

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) induced Coronavirus Disease 2019 (COVID-19) has posed a global threat to public health. The immune system is crucial in defending and eliminating the virus and infected cells. However, immune dysregulation may result in the rapid progression of COVID-19. Here, we evaluated the subsets, phenotypic and functional characteristics of natural killer (NK) and T cells in patients with COVID-19 and their associations with disease severity. Methods: Demographic and clinical data of COVID-19 patients enrolled in Wuhan Union Hospital from February 25 to February 27, 2020, were collected and analyzed. The phenotypic and functional characteristics of NK cells and T cells subsets in circulating blood and serum levels of cytokines were analyzed via flow cytometry. Then the LASSO logistic regression model was employed to predict risk factors for the severity of COVID-19. Results: The counts and percentages of NK cells, CD4+ T cells, CD8+ T cells and NKT cells were significantly reduced in patients with severe symptoms. The cytotoxic CD3-CD56dimCD16+ cell population significantly decreased, while the CD3-CD56dimCD16- part significantly increased in severe COVID-19 patients. More importantly, elevated expression of regulatory molecules, such as CD244 and programmed death-1 (PD-1), on NK cells and T cells, as well as decreased serum cytotoxic effector molecules including perforin and granzyme A, were detected in patients with COVID-19. The serum IL-6, IL-10, and TNF-α were significantly increased in severe patients. Moreover, the CD3-CD56dimCD16- cells were screened out as an influential factor in severe cases by LASSO logistic regression. Conclusions: The functional exhaustion and other subset alteration of NK and T cells may contribute to the progression and improve the prognosis of COVID-19. Surveillance of lymphocyte subsets may in the future enable early screening for signs of critical illness and understanding the pathogenesis of this disease.

Study on the variation of air pollutant concentration and its formation mechanism during the COVID-19 period in Wuhan.

To prevent the spread of COVID-19 (2019 novel coronavirus), from January 23 to April 8 in 2020, the highest Class 1 Response was ordered in Wuhan, requiring all residents to stay at home unless absolutely necessary. This action was implemented to cut down all unnecessary human activities, including industry, agriculture and transportation. Reducing these activities to a very low level during these hard times meant that some unprecedented naturally occurring measures of controlling emissions were executed. Ironically, however, after these measures were implemented, ozone levels increased by 43.9%. Also worthy of note, PM2.5 decreased 31.7%, which was found by comparing the observation data in Wuhan during the epidemic from 8th Feb. to 8th Apr. in 2020 with the same periods in 2019. Utilizing CMAQ (The Community Multiscale Air Quality modeling system), this article investigated the reason for these phenomena based on four sets of numerical simulations with different schemes of emission reduction. Comparing the four sets of simulations with observation, it was deduced that the emissions should decrease to approximately 20% from the typical industrial output, and 10% from agriculture and transportation sources, attributed to the COVID-19 lockdown in Wuhan. More importantly, through the CMAQ process analysis, this study quantitatively analyzed differences of the physical and chemical processes that were affected by the COVID-19 lockdown. It then examined the differences of the COVID-19 lockdown impact and determined the physical and chemical processes between when the pollution increased and decreased, determining the most affected period of the day. As a result, this paper found that (1) PM2.5 decreased mainly due to the reduction of emission and the contrary contribution of aerosol processes. The North-East wind was also in favor of the decreasing of PM2.5. (2) O3 increased mainly due to the slowing down of chemical consumption processes, which made the concentration change of O3 pollution higher at about 4 p.m.-7 p.m. of the day, while increasing the concentration of O3 at night during the COVID-19 lockdown in Wuhan. The higher O3 concentration in the North-East of the main urban area also contributed to the increasing of O3 with unfavorable wind direction.

Drivers for the poor air quality conditions in North China Plain during the COVID-19 outbreak.

China's lockdown to control COVID-19 brought significant declines in air pollutant emissions, but haze was still a serious problem in North China Plain (NCP) during late-January to mid-February of 2020. We seek the potential causes for the poor air quality in NCP combining satellite data, ground measurements and model analyses. Efforts to constrain COVID-19 result in a drop-off of primary gaseous pollutants, e.g., -42.4% for surface nitrogen dioxide (NO2) and -38.9% for tropospheric NO2 column, but fine particulate matter (PM25) still remains high and ozone (O3) even increases sharply (+84.1%). Stagnant weather during COVID-19 outbreak, e.g., persistent low wind speed, frequent temperature inversion and wind convergence, is one of the major drivers for the poor air quality in NCP. The surface PM2.5 levels vary between -12.9~+15.1% in NCP driven by the varying climate conditions between the years 2000 and 2020. Besides, the persistent PM2.5 pollution might be maintained by the still intensive industrial and residential emissions (primary PM2.5), and increased atmospheric oxidants (+26.1% for ozone and +29.4% for hydroxyl radical) in response to the NO2 decline (secondary PM2.5). Further understanding the nonlinear response between atmospheric secondary aerosols and NOx emissions is meaningful to cope with the emerging air pollution problems in China.

The SARS-CoV-2 receptor ACE2 expression of maternal-fetal interface and fetal organs by single-cell transcriptome study.

The new type of pneumonia caused by the SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) has been declared as a global public health concern by WHO. As of April 3, 2020, more than 1,000,000 human infections have been diagnosed around the world, which exhibited apparent person-to-person transmission characteristics of this virus. The capacity of vertical transmission in SARS-CoV-2 remains controversial recently. Angiotensin-converting enzyme 2 (ACE2) is now confirmed as the receptor of SARS-CoV-2 and plays essential roles in human infection and transmission. In present study, we collected the online available single-cell RNA sequencing (scRNA-seq) data to evaluate the cell specific expression of ACE2 in maternal-fetal interface as well as in multiple fetal organs. Our results revealed that ACE2 was highly expressed in maternal-fetal interface cells including stromal cells and perivascular cells of decidua, and cytotrophoblast and syncytiotrophoblast in placenta. Meanwhile, ACE2 was also expressed in specific cell types of human fetal heart, liver and lung, but not in kidney. And in a study containing series fetal and post-natal mouse lung, we observed ACE2 was dynamically changed over the time, and ACE2 was extremely high in neonatal mice at post-natal day 1~3. In summary, this study revealed that the SARS-CoV-2 receptor was widely spread in specific cell types of maternal-fetal interface and fetal organs. And thus, both the vertical transmission and the placenta dysfunction/abortion caused by SARS-CoV-2 need to be further carefully investigated in clinical practice.