Effects of the Covid-19 pandemic on the continuity of sexual and reproductive health care in the maternity ward of a health and social promotion centre in Burkina Faso: a qualitative study (preprint)

The COVID-19 pandemic has significantly impacted the continuity of maternity care in Burkina Faso. This study aimed to compare the volumes of in-person visits and explore the experiences of healthcare providers and users regarding the continuity of healthcare in the maternity ward of a Health and Social Promotion Center (HSPC) before, during, and after the lockdown during the COVID-19 pandemic in Ouagadougou, Burkina Faso. Methods We conducted a multimethod, cross-sectional exploratory study with a phenomenological approach. Monthly health administrative data regarding family planning visits, antenatal visits, deliveries, and postnatal care before, during, and after COVID-19 were collected and compared. Qualitative data were collected through semi-structured interviews with family healthcare providers and users and thematically analyzed. Results The study found that the pandemic led to a decline in the demand for healthcare, as people were afraid of contracting COVID-19. This was particularly true for pregnant women who had recently given birth. The study also found that the pandemic disrupted the supply of essential medicines and medical supplies, which made it difficult for healthcare providers to provide quality care. The qualitative analysis allowed us to highlight three themes: the representation of respondents on COVID-19, their perception of the effectiveness of barrier measures and their analysis of the continuity of care in times of COVID-19: the picture of respondents on COVID-19, their perception of the efficacy of barrier measures and their analysis of the continuity of care in times of COVID-19. Despite these challenges, the study found that healthcare providers and users could find ways to maintain continuity of care. Conclusion The study concludes that the COVID-19 pandemic has significantly impacted the continuity of maternity care in Burkina Faso. However, healthcare providers and users have found ways to maintain continuity of care, and the study provides recommendations for improving continuity of care in the future.

Exploring Key Challenges for Healthcare Providers and Stakeholders in delivering adolescent sexual and Reproductive Health Services and information during the COVID-19 Pandemic in Malawi, Zambia and Zimbabwe: A Qualitative Study (preprint)

Introduction: This study aimed to explore the direct and indirect influences of COVID-19-related restrictions on adolescents and young people's SRHR in Malawi, Zambia, and Zimbabwe, with a focus on teenage pregnancy and access to and utilization of HIV testing and counselling services. Methods: A qualitative case study in a larger mixed-methods study design was used. Thirty-four interviews and four group discussions were conducted with relevant stakeholders in Malawi, Zambia and Zimbabwe. In Zambia, adolescents and young people were included and asked to describe their experience/perceptions of the impact of COVID-19 on their SRHR. Content and thematic analysis were used to analyze the data, Results: Priority shifts resulted in the focus of service provision to the COVID-19 response, shortages of already insufficient human resources due to infection and/or isolation, supply chain disruptions leading to shortages of important SRH-related commodities and supplies, compromised quality of services such as counselling for HIV and overall limited AYP’s access to SRH information. Suggestions for interventions to improve SRH services include the need for a disaster preparedness strategy, increased funding for ASRHR, the use of community health workers and community-based ASRHR strategies, and the use of technology and social media platforms such as mhealth. Conclusion:Disruption of SRH services for AYP due to pandemic related-restrictions, and diversion of resources/funding has had a ripple effect that may have long-term consequences for AYP throughout the East and Southern African region. This calls for further investment in AYP’s access to SRHR services as progress made may have been deterred.

Sexual behaviours among MSM during the first COVID-19 lockdown not associated with risk of COVID-19 infection (preprint)

Background: The social distancing measures associated with the COVID-19 pandemic had far reaching effects on sexual behavior worldwide. However, it remains unclear whether sexual contact with non-steady partners was a contributor to the spread of SARS-CoV-2. The aim of this study was to (i) assess whether the SARS-CoV-2 seropositivity after the first pandemic wave among people using HIV Pre-Exposure Prophylaxis (PrEP) in Zurich, Switzerland differed from that of a demographic matched population level comparison group, (ii) describe risk factors for SARS-CoV-2 seropositivity in this population, and (iii) determine whether sexual contact with non-steady partners was associated with SARS-CoV-2 seropositivity. Methods: The study was conducted between July 2020 and October 2020 as a nested cross-sectional study within two ongoing cohort studies, SwissPrEPared (all eligible PrEP users in Switzerland ≥18 years old) and Corona Immunitas (a series of cross-sectional and longitudinal studies measuring the SARS-CoV-2 seroprevalence across Switzerland, beginning in April 2020). All SwissPrEPared participants were recruited from Checkpoint Zurich (the main PrEP clinic in Zurich). Data were collected on participants’ SARS-CoV-2 antibody status, social characteristics and behavioral data after the first wave of the corona pandemic in Switzerland, and seroprevalence was compared with a propensity score-matched sample from the general Zurich population. Results: Of the 218 participants enrolled, 8.7% (n=19, 95% CI: 5.5-13.5%) were seropositive for SARS-CoV-2 during the first pandemic wave, higher than that of the general male population in Zurich aged 20-65 (5.5%, 95% CI: 3.8–8.2%). Participants on average reduced their social outings, but the seronegative were more socially active before, during, and after the first lockdown period. In a logistic model, increasing mean sexual partner count was not associated with seropositivity (OR: 0.9, 95% CI: 0.8, 1.0), but increasing number of trips abroad was associated with higher seropositivity (p=0.06, OR: 1.14, 95% CI: 1.0, 1.3). The estimated risk ratio for seropositivity for the participants compared to the general Zurich population after propensity score matching was 1.5 (95% CI: 0.53, 4.0). 94% of participants reported later receiving a COVID-19 vaccination. Discussion: Our study suggests that COVID-19 seropositivity was slightly elevated among people taking PrEP in Zurich during the first wave of the pandemic, but that socializing and sexual activity were less important than other factors in contributing to risk.

Changes in sexual behavior among MSM during the spread of COVID-19 in China: results of an online survey (preprint)

Background Sexual behavior drives the transmission of sexually transmitted infections, especially among men who have sex with men (MSM). This study aims to evaluate the sexual behavior changed among MSM during the COVID-19.Methods An online survey was conducted to collect socio-demographic, sexual behavioral, and HIV testing information before and during the COVID-19. Chi-square was used to determine the behavior differences before and during the COVID-19. We identified the factors associated with sexual behavior among MSM using logistic regression.Results Totally 506 MSM participated in the survey. Compared with participants who didn't reduce the number of sexual partners (193, 38.1%), participants who reduced sexual partners (313, 61.9%) had higher values of multiple sexual partners, causal sexual partners, used condoms with causal sexual partners, and sought sexual partners using apps. Participants who reduced the number of sexual partners than before COVID-19, reported having a higher proportion of causal sexual behavior (χ2 = 21.047, p < 0.001), which means engaged in casual sex in the last three months.Conclusions The lockdown measures significantly impacted the sexual behavior of MSM. After the epidemic is over, however, we need to increase health education for MSM to reduce their high-risk sexual behaviors and protect them from STDs.

Rates of Trauma Exposure, Posttraumatic Stress Disorder (PTSD), Depressive, and Anxiety Symptoms in Primary School Children: Findings Six Months before Covid-19 Pandemic (preprint)

Studies on mental health rates among primary school children are still limited particularly related to psychological trauma and its relationship to other mental health challenges. This is the first cross-sectional study examining the rates of trauma exposure, posttraumatic stress disorder (PTSD), depressive, and anxiety symptoms in primary school children before covid-19 pandemic in Malaysia. Two hundred and twenty-one students participated in this study. They were recruited from four primary schools that volunteered to participate in the study. PTSD) Checklist for DSM-5 (PCL-5), Child PTSD Symptoms Scale-5 (CPSS-5), The Center for Epidemiologic Studies Depression Scale version (CESD) and the Spence Children's Anxiety Scale (SCAS) were used to survey psychological symptoms. Most of the students, or 54.3% of them, have experienced at least one traumatic event. Of 221 students, 39.4% reported having PTSD symptoms, 38% reported having depressive symptoms and 19% reported having anxiety symptoms. Female students were more likely to report PTSD symptoms compared to male students. The first regression analysis model showed that only depressive symptoms were significant predictors for PTSD. In the second model, religion, family income, anxiety and PTSD symptoms were significant predictors of depressive symptoms. In the third model, only depressive symptoms were significant predictors of anxiety. Findings, limitations, research future directions and recommendations were discussed.

Youth-developed Recommendations on Public Health Planning for Future Pandemics or Public Health Emergencies: A National Delphi Study (preprint)

Background. In Canada, multiple studies reported an increase in youth-reported anxiety, depression, and substance use over the course of the COVID-19 pandemic. As the country has decreased restrictions, it is important to consider public health planning for future pandemics and emergencies, in light of the associated youth mental health and substance use burden. To prevent youth from falling further behind, we need to focus on public health planning recommendations to optimize Canada’s future response. The objective of the study was to generate concrete, youth-derived recommendations for government, policymakers, and service planners to support public health planning for the next pandemic or public health emergency. Methods. Using a virtual, modified Delphi, Youth Delphi Expert Panel Members rated recommendation items over three rounds, with the option to create their own recommendations items. “Consensus” was defined a priori if ≥ 70% of the entire group, or subgroups of youth (e.g., age, race/ethnicity, gender and sexual identities), rated items at a 6 or 7 (on a 7-point Likert scale). Items that did not achieve consensus were dropped in subsequent rounds. Content analysis was used for qualitative responses in Rounds 1 and 2. Youth were engaged as members of an expert advisory committee throughout the design, implementation, and interpretation of findings. Results. A total of n=40 youth participated in Round 1 with good retention (>95%) in subsequent rounds. Youth endorsed eleven recommendations to support public health planning for the next pandemic or public health emergency. Youth prioritized easily accessible, clear, and understandable information about pandemics; and equitably and efficiently distributed vaccines. They also prioritized increased awareness of timely and accessible mental health and substance use services in schools, workplaces and communities; greater investment in free or inexpensive MHSU services; and health professionals and scientists leading pandemic-related policy decisions. Conclusions. For Canada to move forward in a relevant, efficient, and ethically sound manner, decisions must be guided by the population that these decisions affect. These recommendations can be used to guide Canada’s strategies and policies to prepare for future public health emergencies and pandemics, prioritizing the needs of youth, families/caregivers, and communities.

Regional Health Divides: Understanding Inequities in Late Diagnosis of HIV in Tajikistan (preprint)

HIV early detection (CD4 counts ≥350 cells/μL) is correlated with higher life expectancy among people living with HIV (PLHIV). Several factors including physical, cultural, structural, and financial barriers have contributed to HIV late detection. This is the first-of-its-kind study on the regional differences in early detection of HIV within Tajikistan and any country in the Central Asia region. Utilizing Tajikistan Ministry of Health's national HIV data (N=10,700) spanning 2010 to 2023, we developed median regression models with median CD4 cell count as the outcome and as predictors: time (years), region, age, gender, and area (urban/rural status). Individuals younger than 19 years old are more likely to be detected early for HIV, whereas those older than 39 years are more prone to late detection. Given their active engagement in age-related and sexual activities, those older than 39 years face a higher risk of HIV transmission to others if diagnosed late. Therefore, they require further attention and targeted interventions. Females are detected earlier compared to their male counterparts, regardless of region of residence. Rural populations are detected earlier in most years compared to their urban counterparts. The COVID-19 pandemic accelerated HIV early detection in 2021 but most regions have returned to near pre-pandemic levels of detection in 2022 and 2023. These fluctuations in early detection may signify a shift in attention and resource allocation, potentially affecting efforts to address access gaps during the initial year of the COVID-19 pandemic. There are significant health inequities among different demographic and geographic groups which warrant further attention.

Exploring the Efficacy of Shirodhara as an Add-on Therapy for Alleviating Post-COVID Anxiety and Depression: A Case Study (preprint)

Background This study explores post-COVID-19 psychological challenges in a 31-year-old female patient—manifesting as Anxiety, fatigue, weakness, irritability, anger, and concentration issues. The treatment approach combines SSRI and Clonazepam medications with Shirodhara therapy using Balashwagandhadi taila, presenting a novel and comprehensive intervention strategy.Methods The patient was evaluated using recognized scales, such as HAM-A, HDRS, PHQ-9, and QOL. Additionally, monitoring serum cortisol levels served as a potential physiological marker. The integrative treatment approach addresses psychological symptoms and potential underlying physiological mechanisms.Results Significant improvement is observed across various domains, evidenced by reduced HAM-A, HDRS, and PHQ-9 scores and enhanced QOL. Post-Shirodhara therapy, a notable increase in serum cortisol levels from 3.09 ug/dL to 11.76 ug/dL, suggesting a correlation with clinical improvements.Conclusion This case underscores Shirodhara's promising role as an adjunctive therapy for post-COVID-19 Anxiety and depression. Findings advocate further exploring integrative approaches in post-viral psychological care, emphasizing addressing psychological and potential physiological aspects for holistic recovery.

Modeling the relative influence of socio-demographic variables on post-acute COVID-19 quality of life: an application to settings in Europe, Asia, Africa, and South America (preprint)

Long-term COVID-19 complications are a globally pervasive threat, but their plausible social drivers are often not prioritized. Here, we use data from a multinational consortium to quantify the relative contributions of social and clinical factors to differences in quality of life among participants experiencing long COVID and measure the extent to which social variables impacts can be attributed to clinical intermediates, across diverse contexts. In addition to age, neuropsychological and rheumatological comorbidities, educational attainment, employment status, and female sex were identified as important predictors of long COVID-associated quality of life days (long COVID QALDs). Furthermore, a great majority of their impacts on long COVID QALDs could not be tied to key long COVID-predicting comorbidities, such as asthma, diabetes, hypertension, psychological disorder, and obesity. In Norway, 90% (95% CI: 77%, 100%) of the effect of belonging to the highest versus lowest educational attainment quintile was not attributed to intermediate comorbidity impacts. The same was true for 86% (73%, 100%) of the protective effects of full-time employment versus all other employment status categories (excluding retirement) in the UK and 74% (46%,100%) of the protective effects of full-time employment versus all other employment status categories in a cohort of four middle-income countries (MIC). Of the effects of female sex on long COVID QALDs in Norway, UK, and the MIC cohort, 77% (46%,100%), 73% (52%, 94%), and 84% (62%, 100%) were unexplained by the clinical mediators, respectively. Our findings highlight that socio-economic proxies and sex may be as predictive of long COVID QALDs as commonly emphasized comorbidities and that broader structural determinants likely drive their impacts. Importantly, we outline a multi-method, adaptable causal machine learning approach for evaluating the isolated contributions of social disparities to long COVID quality of life experiences.

Health and wellbeing of staff working at higher education institutions globally during the post-COVID-19 pandemic period: Evidence from a cross-sectional study (preprint)

Background The ongoing global crisis of Higher Education (HE) institutions during the post-COVID-19 pandemic period has increased the likelihood of enduring psychological stressors for staff. This study aimed to identify factors associated with job insecurity, burnout, psychological distress and coping amongst staff working at HE institutions globally.Methods An anonymous cross-sectional study was conducted in 2023 with staff at HE institutions across 16 countries. Job insecurity was measured using the Job Insecurity Scale (JIS), burnout using the Perceived Burnout measure question, psychological distress using the Kessler Psychological Distress Scale (K10), and coping using the Brief Resilient Coping Scale. Multivariable logistic regression with a stepwise variable selection method was used to identify associations.Results A total of 2,353 staff participated; the mean age (± SD) was 43(± 10) years and 61% were females. Most staff (85%) did not feel job insecurity, one-third (29%) perceived burnout in their jobs, more than two-thirds (73%) experienced moderate to very high levels of psychological distress, and more than half (58%) exhibited medium to high resilient coping. Perceived job insecurity was associated with staff working in research [Adjusted Odds Ratio 1.37 (95% Confidence Intervals 1.04–1.81)] and part-time, having an academic appointment [2.45 (1.78–3.27)], perceived burnout and moderate to very high level of psychological distress. Perceived burnout was associated with being female [1.35 (1.12–1.63)], having a leadership appointment [1.30 (1.05–1.61)], perceived job insecurity, and moderate to very high levels of psychological distress. Staff with administrative roles [1.26 (1.04–1.52)], mental health issues [2.73 (1.79–4.15)], perceived job insecurity, and perceived burnout were associated with moderate to very high levels of psychological distress. Staff who perceived their mental health as good to excellent [3.36 (2.69–4.19)] were more likely to have medium to high resilient coping.Conclusions Factors identified in this study should be considered in reviewing and updating current support strategies for staff at HE institutions across all countries to reduce stress and burnout and improve wellbeing.

Factors Associated with Changes in Reproductive Outcomes during the first year of COVID- 19 pandemic in Burkina Faso: A multinomial analysis from a longitudinal study using PMA 2030 data (preprint)

Background:The advent of COVID-19 pandemic has dramatically affected women’s life and livelihoods. In the past decade, the promotion of family planning contributed to reduced poverty and averted poor maternal and child outcomes. There is evidence that these gains may be threatened by social restrictions following COVID-19 outbreak. Methods:We used data from a longitudinal survey collected by the Performance Monitoring Accountability in Burkina Faso. Data were collected over one-year period, from before (November 2019–February 2020) and during (November 2020–February 2021) COVID-19 pandemic. We evaluate changes in reproductive outcomes with respect to changes in health and economic circumstances as well as sociodemographic conditions among 1372 women aged 15-49 at risk of pregnancy and potential contraceptive users. Bivariate and multivariate multinomial logistic regression were performed to examine correlates of reproductive outcomes. Results:Half (52%) of women did not change their reproductive status. While, 29% had childbearing, 19% started using a contraceptive method. In the multivariate analysis, childbearing was relatively higher among women exposed to family planning promotion, healthcare utilization, but relatively lower among those employed without cash paid and those who experienced household income loss. As of contraception, women exposed to family planning promotion were also associated with a relatively higher contraceptive use while concerns about getting COVID-19 infection had the opposite effect. Conclusion:After a year period of COVID-19 outbreak, contraceptive adoption increased significantly, but at a slower pace which was not enough to reduce childbearing. The most vulnerable women may remain at greater risk of unintended pregnancies and poor maternal and child outcomes. Therefore, family planning programs should direct their efforts into combatting misinformation and reaching out women in communities in the context of COVID-19 restrictions.

Effectiveness of a Nasal Spray on Viral Respiratory Infections

Influence of COVID-19 Infection on Early Pregnancy Outcomes in Different Periods Around Frozen Embryo Transfer (preprint)

Purpose The study aimed to investigate the potential influence of COVID-19 infection on embryo implantation and early development in women undergoing frozen embryo transfer(FET), with a specific focus on infections occurring at different periods around FET.Methods A retrospective analysis was performed on women who had undergone FET during a period marked by a significant surge in COVID-19 infection in Shanghai. All enrolled women experienced their first documented COVID-19 infection around the time of FET, ensuring that infections did not occur prior to oocyte retrieval. Participants were categorized into six groups based on the timing of infection: uninfected, ≥ 60 days, < 60 days before FET, 0–14 days, 15–28 days, and 28–70 days after FET. Clinical outcomes were compared across these groups.Results The infection rate among the total of 709 cases was 78.28%. Infected individuals exhibited either asymptomatic or mild symptoms. The ongoing pregnancy rates for the first four groups were 40.7%, 44.4%, 40.5%, and 34.2% (P = 0.709) respectively, biochemical pregnancy rates (59.1% vs. 61.1% vs. 67.6% vs. 55.7%, P = 0.471) and clinical pregnancy rates (49.6% vs. 55.6% vs. 55.4% vs. 48.1%, P = 0.749), all showed no significant differences. Early spontaneous abortion rates across all six groups were 18.3%, 20.0%, 25.0%, 28.9%, 5.4%, and 19.0% respectively, with no significant differences (P = 0.113). Multivariable logistic analysis revealed no significant correlation between the infection and ongoing pregnancy.Conclusion Asymptomatic or mild COVID-19 infections occurring around FET do not appear to have a significant adverse impact on early pregnancy outcomes.

Increased reproductive tract infections among secondary school girls during the COVID-19 pandemic: associations with pandemic related stress, mental health, and domestic safety (preprint)

Background: Kenya, like many countries, shuttered schools during COVID–19, with subsequent increases in poor mental health, sexual activity, and pregnancy. We sought to understand how the COVID–19 pandemic may mediate risk of reproductive tract infections. We hypothesized that greater COVID–19 related stress would mediate risk via mental health, feeling safe inside the home, and sexual exposure, given the pandemic mitigation–related impacts of school closures on these factors. Methods: We analyzed data from a cohort of 436 girls enrolled in secondary school in rural western Kenya. Baseline, 6–, 12–, and 18– month study visits occurred April 2018 – December 2019 (pre–COVID), and 30–, 36–, and 48– month study visits occurred September 2020 – July 2022 (COVID period). At study visits, participants self–completed a survey for sociodemographics and sexual practices, and provided self–collected vaginal swabs for Bacterial vaginosis (BV) testing, with STI testing at annual visits. COVID–related stress was measured with a standardized scale and dichotomized at highest quartile. Mixed effects modeling quantified how BV and STI changed over time, and longitudinal mediation analysis quantified how the relationship between COVID–19 stress and increased BV was mediated. Findings: BV and STI prevalence increased from 12.1% and 10.7% pre–COVID to 24.5% and 18.1% during COVID, respectively. This equated to a 26% (95% CI 1.00 – 1.59) and 36% (95% CI 0.98 – 1.88) increased relative prevalence of BV and STIs, respectively, in the COVID–19 period compared to pre–COVID, adjusted for numerous sociodemographic and behavioral factors. Higher COVID–related stress was associated with elevated depressive symptoms and feeling less safe inside the home, which were each associated with increased likelihood of having a boyfriend. In longitudinal mediation analyses, the direct effect of COVID–related stress on BV was small and non–significant, indicating increased BV was due to the constellation of factors that were impacted during the COVID pandemic. Conclusions: In this cohort of adolescent girls, BV and STIs increased following COVID–related school closures. These results highlight modifiable factors to help maintain sexual and reproductive health resiliency, such as anticipating and mitigating mental health impacts, domestic safety concerns, and maintaining sexual health services to prevent and treat reproductive tract infections.

Non-Consensual Sex among Japanese Women in the COVID-19 Pandemic: A Large-Scale Nationwide Survey-Based Study (preprint)

Background: Non-consensual sex including rape and sexual assault has been a global concern and may have been influenced by the COVID-19 pandemic, however the information on this topic is limited. Therefore, our objective was to survey the incidence rate of non-consensual sex among Japanese women aged 15-79 years between April to September 2020, following the COVID-19 pandemic in Japan.   Materials and Methods: We utilized the data obtained from a nationwide, cross-sectional internet survey conducted in Japan between August and September 2020. Sampling weights were applied to calculate national estimates, and multivariable logistic regression was performed to identify factors associated with non-consensual sex. Data was extracted from a cross-sectional, web-based, self-administered survey of approximately 2.2 million individuals from the general public, including in men and women.   Results: Excluding men and responses with inconsistencies, the final analysis included 12,809 women participants, with 138 (1.1%) reporting experiencing non-consensual sex within a five-month period. Being aged 15–29 years and having a worsened mental or economic status were associated with experiencing non-consensual sex.   Conclusions: Early intervention to prevent individuals from becoming victims of sexual harm should be extended to economically vulnerable and young women, especially during times of societal upheaval such as the COVID-19 pandemic. Additionally, Japan should prioritize the implementation of comprehensive education on the concept of sexual consent.

Shared genetic architecture and causal relationship between the age at first sex and COVID-19: A large-scale cross-trait analysis (preprint)

COVID-19 is genetically associated with numerous immune disorders, and young age at first intercourse (AFS) may lead to early activation of innate immunity. However, the genetic overlap between COVID-19 and AFS remains undetermined. Here we perform a large-scale cross-trait analysis to investigate their shared genetic etiology and causal relationship. An overall negative genetic correlation between the AFS and three COVID-19 traits was observed. We further identified 186, 221, and 213 shared genetic loci for AFS-COVID-19 infection, hospitalization, and severity, respectively. Among these shared loci, those closest to the genes CADM2, and ARPC1B showed the strongest signals. Our post-GWAS functional analysis revealed that the shared mapped genes were mainly involved in neural genesis and development within several brain structures. Finally, bidirectional Mendelian randomization (MR) results showed that earlier sexual debut may increase the risk of SARS-CoV-2 infection, hospitalization, and severity.

UBA1-CDK16: A Sex-Specific Chimeric RNA and Its Role in Immune Sexual Dimorphism (preprint)

RNA processing mechanisms, such as alternative splicing and RNA editing, have been recognized as critical means to expand the transcriptome. Chimeric RNAs formed by intergenic splicing provide another potential layer of RNA diversification. By analyzing a large set of RNA-Seq data and validating results in over 1,200 blood samples, we identified UBA1-CDK16, a female-specific chimeric transcript. Intriguingly, both parental genes, are expressed in males and females. Mechanistically, UBA1-CDK16 is produced by cis-splicing between the two adjacent X-linked genes, originating from the inactive X chromosome. A female-specific chromatin loop, formed between the junction sites, facilitates the alternative splicing of its readthrough precursor. This unique chimeric transcript exhibits evolutionary conservation, evolving to be female-specific from non-human primates to humans. Furthermore, our investigation reveals that UBA1-CDK16 is enriched in the myeloid lineage and plays a regulatory role in myeloid differentiation. Notably, female COVID-19 patients who tested negative for this chimeric transcript displayed higher counts of neutrophils, highlighting its potential role in disease pathogenesis. These findings support the notion that chimeric RNAs represent a new repertoire of transcripts that can be regulated independently from the parental genes, and a new class of RNA variance with potential implications in sexual dimorphism and immune responses.

Comparing Risk of Post Infection Erectile Dysfunction Following SARS Coronavirus 2 Stratified by Acute and Long COVID, Hospitalization Status, and Vasopressor Administration (preprint)

No study has yet assessed the risk of developing erectile dysfunction (ED) after a diagnosis of long COVID-19, especially when compared to those diagnosed with only acute COVID or cases in which more severe treatment is required. To assess these risks, we queried the TriNetX COVID-19 Research Network from December 1st 2020 through June 2023. Men aged ≥ 18 diagnosed with long COVID-19 were compared to those diagnosed with acute COVID-19 and analyses were performed to compare men who were/were not hospitalized within 1 month of acute COVID diagnosis and men who did/did not need vasopressors. Cohorts were propensity score matched and compared for differences in new ED diagnosis and/or prescription of phosphodiesterase-5 inhibitors (PDE5i). After propensity score matching, the long and acute COVID cohorts included 2839 men with an average age of 54.5±16.7 years and 55.1±17.1 respectively. Men with long COVID-19 were more likely to develop ED or be prescribed PDE5i (3.63%) when compared to men with only acute COVID-19 infections (2.61%) [RR 1.39; 95% CI 1.04, 1.87]. There was no statistically significant risk of developing ED or being prescribed PDE5i for individuals who received vasopressors [RR 0.922; 95% CI 0.774,1.098] or were hospitalized [RR 0.933; 95% CI 0.824,1.056].

Community Led Health Promotion to Counter Stigma and Increase Trust Amongst Priority Populations: Lessons from the 2022-2023 UK MPox Outbreak (preprint)

Background Stigma, lack of trust in authorities and poor knowledge can prevent health-seeking behaviour, worsen physical and mental health, and undermine efforts to control transmission during disease outbreaks. These factors are particularly salient with diseases such as MPox, for which 96% of cases in the 2022-2023 UK outbreak were identified among gay, bisexual, queer and men who have sex with men (MSM). This study explored stigma and health-seeking behaviour in Liverpool through the lens of the recent MPox outbreak. Methods Primary sources of data were interviews with national and regional key informants involved in the MPox response, and participatory workshops with priority populations. Workshop recruitment targeted Grindr users and sex positive MSM; immigrant, black and ethnic minority MSM; and male sex workers in Liverpool. Data were analysed using a deductive framework approach, building on the Health Stigma and Discrimination Framework. Results Eleven key informant interviews and five workshops (involving 15 participants in total) were conducted. There were prevalent reports of anticipated and experienced stigma due to MPox public health messaging alongside high demand and uptake of the MPox vaccine and regular attendance at sexual health clinics. Respondents believed the limited impact of stigma on health-seeking behaviour was due to actions by the LGBTQ+ community, the third sector and local sexual health clinics. Key informants from the LGBTQ+ community and primary healthcare felt their collective action to tackle MPox was undermined by central public health authorities citing under-resourcing; a reliance on goodwill; poor communication; and tokenistic engagement. MPox communication was further challenged by a lack of evidence on disease transmission and risk. This challenge was exacerbated by the impact of the COVID-19 pandemic on the scientific community, public perceptions of infectious disease, and trust in public health authorities. Conclusions The LGBTQ+ community and local sexual health clinics took crucial actions to counter stigma and support health seeking behaviour during the 2022-2023 UK MPox outbreak. Lessons from rights based and inclusive community-led approaches during outbreaks should be heeded in the UK, working towards more meaningful and timely collaboration between affected communities, primary healthcare, and regional and national public health authorities.

Impact of COVID-19 Lockdowns on Rates of Adolescent Pregnancies: A Systematic Review (preprint)

Background: Education is known to protect adolescent girls from unplanned pregnancy. School closures were component of COVID-19 “lockdown measures”. The impact of these measures on adolescent pregnancy worldwideis unknown.  Methods: We performed a systematic review to find evidence of the impact of “lockdowns” and school closures on adolescent pregnancy events during the COVID-19 pandemic. Databases including Pubmed, EMBASE, CINAHL, WHO Index Medicus, and Literatura Latinoamericana y Caribe en Ciencias de la Salud (LILACS) were searched. Studies that provided data on pregnancy rates in girls aged 10-19 before, during, and after the onset of the COVID-19 pandemic (defined as March 2020) were eligible for inclusion. Extracted data included study design, study location, age of participants, exposure period, and percentage or pregnancy rate data. Findings: On August 21st, 2023, 3049 studies were screened, with 79 eligible for full-text review. Ten studies were included in the final review: Seven performed in Africa (Uganda, Kenya, South Africa, and Ethiopia), and three in the Americas (USA and Brazil). Adolescent pregnancy increased in six out of the seven African studies while a decrease or no change was noted in USA and Brazil.All studies were at a high risk of bias. Interpretation:   Adolescent pregnancy rates during the COVID-19 pandemic may have substantially increased in sub-Saharan Africa. Data scarcity and low-quality evidence are significant limitations. The dynamic relationship between lockdown measures and adolescent pregnancies warrants ongoing multifaceted research and adaptive policies to safeguard adolescent sexual and reproductive health during health crisis. Systematic Review Registration: PROSPERO registration number CRD42022308354.