Racial/ethnic disparities in health-related outcomes may have been exacerbated during the COVID-19 pandemic. Individuals from racial/ethnic minority groups or with a history of alcohol use disorder (AUD) may have greater medical mistrust. We examined racial/ethnic and AUD-related differences in group-based medical mistrust during the pandemic and tested whether medical mistrust dimensions were associated with mental health symptoms.

Two hundred and fifty participants from the National Institute on Alcohol Abuse and Alcoholism COVID-19 Pandemic Impact on Alcohol Study completed an online survey between April and July of 2022. Exploratory factor analysis and path analysis were conducted.

Group-based medical mistrust scores were elevated among participants who identified as Non-Hispanic Black and those with a history of AUD. Two medical mistrust dimensions were found: (1) Suspicion and Lack of Provider Support, and (2) Group Disparities in Health Care. Compared to Non-Hispanic White participants, Non-Hispanic Black participants reported higher scores on the Suspicion and Lack of Provider Support dimension of medical mistrust, which was associated with higher mental health symptoms. This medical mistrust dimension was also a significant mediator of the observed group differences in mental health symptoms.

Cross-sectional data, aggregation of racial/ethnic groups with small sample sizes, and nonrepresentative sample.

Non-Hispanic Black individuals and individuals with AUD may be more vulnerable to mental health symptoms due to higher suspicion toward medical professionals and healthcare systems and perceived lack of support from healthcare providers. Increased awareness among healthcare providers may help address medical mistrust, encourage help-seeking behaviors, and alleviate mental health symptoms.

IntroductionThe COVID-19 pandemic exacerbated existing challenges in treating substance use disorders. This study explores the impact of telehealth on addiction consult services (ACS) medication initiation in hospitalized patients with alcohol and opioid use disorders (AUD and OUD).MethodsWe retrospectively analyzed data from adult patients who received their first ACS consultation in-person (pre-pandemic) and telehealth ACS consultation (during the pandemic). We compared medication initiation rates for AUD and OUD before and after ACS consultation.ResultsThe ACS completed 398 in-person consults and 473 telehealth consults. In-person ACS consultation increased the medication initiation rates from 3.41% for AUD in hospitalized patients without an ACS consult, to 45.45% for AUD after an ACS consult. For OUD pharmacotherapy initiation, an ACS consultation increased medication rates from 6.94% to 41.67% for OUD. Telehealth ACS consultation increased medication initiation rates from 5.16% to 66.20% for AUD and from 7.53% to 67.74% for OUD. Buprenorphine and naltrexone were the most commonly initiated medications for OUD and AUD, respectively.DiscussionThe adoption of telehealth by the hospital ACS during the pandemic effectively increased medication initiation rates for AUD and OUD, consistent with pre-pandemic, demonstrating its potential to expand access to addiction services. This approach could address the current shortage of addiction providers and serve underserved populations.

Women were more prone to consuming alcohol as a coping mechanism for COVID-19 pandemic stressors than men. Worldwide evidence shows increased consumption during the social restriction phases, adversely impacting women's health. The study aimed to describe women's alcohol use throughout the restriction phases of the COVID-19 pandemic in São Paulo, Brazil.

A cross-sectional self-report survey was conducted by telephone with women who sought primary health care services. The sample comprised 3252 women, and 1308 (40%) reported consuming alcohol. The independent variable was the timing of the COVID-19 pandemic's restriction phases. The AUDIT-C was used as a measurement instrument. The covariates included sociodemographic factors, lifestyle characteristics, and outcomes related to COVID-19 infection. Univariate and bivariate models were used for analysis. A negative binomial distribution with zero inflation was used for the AUDIT-C score as the outcome variable in the entire sample.

Women's alcohol consumption during the COVID-19 restriction phase was compatible with moderate-risk use 3.5 (SD = 2.9). Binge drinking was observed in 41.8% of the participants. Alcohol consumption was 28.9% higher in the transition phase of social restriction than in the restriction and flexibilization phases. Hospitalization for COVID-19 and losing a loved one due to COVID-19 were associated with alcohol consumption.

Women presented a moderate-risk pattern of alcohol use. This consumption was higher during the restriction phase of the pandemic in South America's largest city. Therefore, this study provides critical reflections on women's patterns of alcohol consumption. It reveals this population's social and clinical vulnerability, which might be considered in future health policies and programs.

As a highly complex organ with digestive, endocrine, and immune-regulatory functions, the liver is pivotal in maintaining physiological homeostasis through its roles in metabolism, detoxification, and immune response. Various factors including viruses, alcohol, metabolites, toxins, and other pathogenic agents can compromise liver function, leading to acute or chronic injury that may progress to end-stage liver diseases. While sharing common features, liver diseases exhibit distinct pathophysiological, clinical, and therapeutic profiles. Currently, liver diseases contribute to approximately 2 million deaths globally each year, imposing significant economic and social burdens worldwide. However, there is no cure for many kinds of liver diseases, partly due to a lack of thorough understanding of the development of these liver diseases. Therefore, this review provides a comprehensive examination of the epidemiology and characteristics of liver diseases, covering a spectrum from acute and chronic conditions to end-stage manifestations. We also highlight the multifaceted mechanisms underlying the initiation and progression of liver diseases, spanning molecular and cellular levels to organ networks. Additionally, this review offers updates on innovative diagnostic techniques, current treatments, and potential therapeutic targets presently under clinical evaluation. Recent advances in understanding the pathogenesis of liver diseases hold critical implications and translational value for the development of novel therapeutic strategies.

Hepatocellular carcinoma (HCC) is a major global burden, ranking as the third leading cause of cancer-related mortality. HCC due to chronic hepatitis B virus (HBV) or C virus (HCV) infection has decreased due to universal vaccination for HBV and effective antiviral therapy for both HBV and HCV, but HCC related to metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease is increasing. Biannual liver ultrasonography and serum α-fetoprotein are the primary surveillance tools for early HCC detection among high-risk patients (e.g., cirrhosis, chronic HBV). Alternative surveillance tools such as blood-based biomarker panels and abbreviated magnetic resonance imaging (MRI) are being investigated. Multiphasic computed tomography or MRI is the standard for HCC diagnosis, but histological confirmation should be considered, especially when inconclusive findings are seen on cross-sectional imaging. Staging and treatment decisions are complex and should be made in multidisciplinary settings, incorporating multiple factors including tumor burden, degree of liver dysfunction, patient performance status, available expertise, and patient preferences. Early-stage HCC is best treated with curative options such as resection, ablation, or transplantation. For intermediate-stage disease, locoregional therapies are primarily recommended although systemic therapies may be preferred for patients with large intrahepatic tumor burden. In advanced-stage disease, immune checkpoint inhibitor-based therapy is the preferred treatment regimen. In this review article, we discuss the recent global epidemiology, risk factors, and HCC care continuum encompassing surveillance, diagnosis, staging, and treatments.

During the COVID-19 pandemic, the social distancing has significantly affected the healthy lifestyle behaviors of residents. China ended social distancing on January 8, 2023, and the healthy lifestyle behaviors of residents after this time are unclear. The goal of this study was to evaluate the differences in healthy lifestyle behaviors between Chinese urban and rural residency after the termination of social distancing.

From February 1, 2023, to February 8, 2023, a cross-sectional survey which include participants (≥ 18 years old) was carried out in four regions of mainland China (Changzhou in the eastern region, Zhengzhou in the central region, Xining in the western region, and Mudanjiang in the northeastern region). A healthy lifestyle behaviors scale containing 11 items was designed to calculate the healthy lifestyle behaviors scores among urban and rural residents. The healthy lifestyle behaviors scores ranged from 11 to 51. Multivariate linear regression was used to analyze the influencing factors of healthy lifestyle behaviors scores among urban and rural residents. Propensity Score Matching was used to assess the net differences in healthy lifestyle behaviors scores between urban and rural residents.

A total of 5780 residents (53.04% females) were included in the study, including 3302(57.13%) urban residents. The average healthy lifestyle behavior score was 38.33(95%CI: 38.18 to 38.49). Healthy lifestyle behaviors score among males was lower than that among females in both urban (β = -1.98, 95%CI: -3.05 to -2.10) and rural residents (β = -2.57, 95%CI: -2.37 to -1.60). Higher education was associated with higher healthy lifestyle behaviors scores in both urban and rural residents. PSM analysis indicated that urban residents still had higher healthy lifestyle behaviors scores (38.72, 95% CI: 38.46 to 38.99) than rural residents (37.85, 95%CI: 37.57 to 38.13), with a net difference of 0.87 points.

After the termination of social distancing, the overall healthy lifestyle behaviors of Chinese residents were found to be at a medium level. Urban residents have a better healthy lifestyle behavior compared to their rural counterparts. It is essential to prioritize efforts towards enhancing the healthy lifestyle behaviors of rural residents.

The COVID-19 pandemic may have interfered with individuals' access to alcohol use disorder (AUD) treatment, but limited research has documented the impact of treatment interference on drinking behavior. This study's purpose was to examine the associations of AUD treatment interference with problematic alcohol use, and the moderating roles of perceived stress and resilience.

A cross-sectional survey design was employed. Data were drawn from the baseline assessment of the National Institute on Alcohol Abuse and Alcoholism COVID-19 Pandemic Impact on Alcohol Study. Between June 2020 and March 2021, 288 participants (48.6% female, 51.4% male) responded to key measures of interest by phone and/or through an online survey. Study hypotheses were tested using multiple linear regression models adjusted for demographic characteristics (age, sex, race, ethnicity, years of education, household income, marital status), study enrollment phase, and history of AUD.

Self-reported AUD treatment interference was positively associated with problematic alcohol use as measured by the Alcohol Use Disorders Identification Test (b = 2.05, p < 0.001). Significant moderation effects indicated the association between AUD treatment interference and problematic alcohol use was stronger at a high level of perceived stress (b = 3.08, p < 0.001) and was attenuated at a high level of resilience (b = -0.13, p = 0.874).

Self-reported AUD treatment interference may indicate interruption to individuals' support systems and highlight the need for continued access to treatment. Fostering positive coping strategies and resilience may help individuals mitigate risks of problematic drinking amidst a public health crisis.

Objective: Alcohol consumption patterns during the COVID-19 pandemic have varied notably. Participants: We examined the acute impact of the pandemic on alcohol use disorder (AUD) in a generalizable sample of college students who were surveyed pre-pandemic and re-surveyed in May 2020. Method: Items assessed pre-pandemic included DSM-5 AUD and mental health symptoms. A COVID-19 impacts questionnaire was administered, and alcohol and mental health items re-assessed. Results: AUD symptoms decreased from pre-pandemic to during the pandemic, demonstrating a change in trajectory compared to prior cohorts. Students with persistent AUD reported greater concurrent symptoms of PTSD, depression, and alcohol consumption than those with remitted AUD (ps ≤ .02), but not increased COVID-19 impact. Persistent AUD status was predicted by higher sensation seeking and alcohol consumption. Conclusions: Students with concurrent mental health problems are at continued risk for persistent AUD. Findings highlight the impact of the college environment and social context for drinking on AUD.

People with schizophrenia-spectrum and bipolar disorders (severe mental illnesses; 'SMI') experience excess mortality. Our aim was to explore longer-term trends in mortality, including the COVID-19 pandemic period, with a focus on additional vulnerabilities (psychiatric comorbidities and race/ ethnicity) in SMI.

Retrospective cohort study using electronic health records from secondary mental healthcare, covering a UK region of 1.3 million people. Mortality trends spanning fourteen years, including the COVID-19 pandemic, were assessed in adults with clinician-ascribed ICD-10 diagnoses for schizophrenia-spectrum and bipolar disorders.

The sample comprised 22 361 people with SMI with median follow-up of 10.6 years. Standardized mortality ratios were more than double the population average pre-pandemic, increasing further during the pandemic, particularly in those with SMI and psychiatric comorbidities. Mortality risk increased steadily among people with SMI and comorbid depression, dementia, substance use disorders and anxiety over 13-years, increasing further during the pandemic. COVID-19 mortality was elevated in people with SMI and comorbid depression (sub-Hazard Ratio: 1.48 [95% CI 1.03-2.13]), dementia (sHR:1.96, 1.26-3.04) and learning disabilities (sHR:2.30, 1.30-4.06), compared to people with only SMI. COVID-19 mortality risk was similar for minority ethnic groups and White British people with SMI. Elevated all-cause mortality was evident in Black Caribbean (adjusted Rate Ratio: 1.40, 1.11-1.77) and Black African people with SMI (aRR: 1.59, 1.07-2.37) during the pandemic relative to earlier years.

Mortality has increased over time in people with SMI. The pandemic exacerbated pre-existing trends. Actionable solutions are needed which address wider social determinants and address disease silos.

Alcohol use disorders (AUD) are pressing social problems. News media play a key role in setting the agenda for the public discourse and framing these problems. They provide people affected and unaffected with health-related information on different facets of the disease and present the topic in various contexts. In doing so, they shape the public opinion and influence behaviors. On the basis of an explorative quantitative content analysis of N = 402 articles published in 2019 in nine German newspapers and magazines, this study provides information on the topic-specific framing with regard to AUD. The results show only scant contextualization of the topic in the German media. This deficiency has particular regard to causal relationships and treatment opportunities, leaving room for interpretation from the audience. The topic-specific framing analysis showed that articles on AUD mostly appear either in the context of celebrities, endorsing favorable presentations of recovered people, or in the context of crime and violence, which goes hand in hand with portraying acutely affected people as perpetrators. Increased news coverage that includes the portrayal of non-famous people who have successfully engaged in alcohol treatment and recovery is necessary.

The primary objective worldwide during the coronavirus disease 2019 (COVID-19) pandemic had been controlling disease transmission. However, lockdown measures used to mitigate transmission affected human behavior and altered lifestyles, with a likely impact on chronic non-communicable diseases. More than a year into the pandemic, substantial peer-reviewed literature emerged on altered lifestyles following the varying lockdown measures imposed globally to control the virus spread. We explored the impact of lockdown measures on six lifestyle factors, namely diet, physical activity, sleep, stress, social connectedness, and the use of tobacco, alcohol, or other harmful substances.

We comprehensively searched PubMed and the World Health Organization's global literature database on COVID-19 and retrieved 649 relevant articles for the narrative review. A critical interpretative synthesis of the articles was performed.

Most of the articles included in the review identified the negative effect of lockdown measures on each of the lifestyle factors in many parts of the world. Encouraging lifestyle trends were also highlighted in a few articles. Such trends can positively influence the outcome of lifestyle-related chronic diseases, such as obesity and diabetes.

The lockdown associated with COVID-19 has largely had a negative impact on the lifestyles of individuals and communities across many countries and cultures. However, some individuals and communities also initiated positive lifestyle-related behavioral changes. If the knowledge generated by studying the impact of COVID-19-related lockdowns on the six lifestyle factors is further consolidated, it could improve chronic disease outcomes. This will help better understand lifestyle behaviors amidst crises and assist in redesigning extreme public health measures such as lockdowns.. It is up to governments, communities, and healthcare/academic entities to derive benefit from lessons learned from the pandemic, with the ultimate objective of better educating and promoting healthy lifestyles among communities.

Professionals and academics have recently placed a greater emphasis on comprehending the elements that go into improving students' psychological wellbeing. Students frequently face major obstacles as a result of the rigorous nature of academic life, which can result in problems like tension, depression and other psychological health concerns. These complications have a long-lasting influence on their future aspirations in addition to affecting their academic achievement. This study determined the effects of music learning on students' academic performance and psychological well-being. The mediating role of self-efficacy and self-esteem are also examined in this study. The data is collected from 326 students in Chinese universities and applied structural equation modeling for empirical analysis. The findings show that music education improves the students' psychological well-being, which in turn improves their academic performance. Additionally, psychological health is a major factor in improving the academic performance. There is significant mediating impact of self-efficacy and self-esteem in relationship between mental well-being and music education. To improve students' psychological health, it is suggested that policy makers should consider the integration of music education into academic settings.

Alcohol-associated liver disease (ALD) represents one of the deadliest yet preventable consequences of excessive alcohol use. It represents 5.1 % of the global burden of disease, mainly involving the productive-age population (15-44 years) and leading to an increased mortality risk from traffic road injuries, suicide, violence, cardiovascular disease, neoplasms, and liver disease, among others, accounting for 5.3 % of global deaths. Daily alcohol consumption, binge drinking (BD), and heavy episodic drinking (HED) are the patterns associated with a higher risk of developing ALD. The escalating global burden of ALD, even exceeding what was predicted, is the result of a complex interaction between the lack of public policies that regulate alcohol consumption, low awareness of the scope of the disease, late referral to specialists, underuse of available medications, insufficient funds allocated to ALD research, and non-predictable events such as the COVID-19 pandemic, where increases of up to 477 % in online alcohol sales were registered in the United States. Early diagnosis, referral, and treatment are pivotal to achieving the therapeutic goal in patients with alcohol use disorder (AUD) and ALD, where complete alcohol abstinence and prevention of alcohol relapse are expected to enhance overall survival. This can be achieved through a combination of cognitive behavioral, motivational enhancement and pharmacological therapy. Furthermore, the appropriate use of available pharmacological therapy and implementation of public policies that comprehensively address this disease will make a real difference.

Research has documented that domestic violence increased worldwide during the COVID-19 pandemic. Studies have also suggested that alcohol use, which also increased during COVID-19, is a risk factor for domestic violence victimization. However, research has yet to examine whether alcohol consumption mediated the relationship between pandemic-related stressful events and domestic violence. Using structural equation modeling, the current study examines the impact of three types of pandemic-related strains (financial problems, familial problems, and work problems) on individual assessments about whether their drinking became problematic during the pandemic and then whether problematic alcohol use increases the risk of psychological and physical domestic violence. This model was analyzed across six countries: Ukraine, The Netherlands, Pakistan, Denmark, Guatemala, and the United States. Results indicate that the associations between pandemic-related strains and self-assessed problematic drinking varied by country. However, across all countries, problematic alcohol consumption was associated with increased physical and psychological domestic violence victimization. Overall, the findings of the current study support the use of programs that aim to reduce problematic consumption of alcohol with the hopes that they may, in turn, reduce psychological and physical domestic violence victimization.

The COVID-19 pandemic has sparked or amplified many mental health problems. The aim of this study was to compile evidence from existing systematic reviews to provide an overall assessment of the impact of social restrictions during the COVID-19 pandemic on people affected by eating disorders (EDs). PubMed and Scopus were searched up to August 16, 2023. Systematic reviews and meta-analyses were selected using the PRISMA 2020 statement. The quality assessment of the included studies was conducted using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Eleven studies were included in this umbrella review. Six main categories emerged from the studies described in the review: dietary changes and psychopathological effects showed an overall worsening of symptomatology; in studies concerning the impact of isolation and restrictive measures, it was found that social distancing was associated with feelings of loneliness, anxiety, and depression; limited access to direct care was found and therapeutic changes were made; the influence of mass media negatively impacted people with ED; several studies reported positive findings regarding symptomatology; finally, studies regarding 'impact on vulnerable populations showed that vulnerable people are more at risk of reporting body image distortion and eating disorders. The COVID-19 pandemic has negatively impacted most of the population with ED leading to a worsening of specific symptomatology. In addition, this worsening of the condition may be caused by limited access to care and treatment, changes in routine, or to the negative influence of the media.

Trauma case load is said to have declined during the Covid-19 pandemic, especially during the national lockdowns. Due to the altered frequency and changes in daily life, pre-hospital care (altered personal protective measurements) as well as mechanisms of trauma and initial trauma treatment may have changed. The purpose of this study was to assess differences in pre-hospital as well as initial treatment of trauma victims and trauma mechanisms during a national lockdown compared to the year before.

Pre-hospital as well as clinical data from all trauma patients admitted to our metropolitan level 1 trauma center resuscitation room during the hard lockdown in Switzerland (March 17 to April 26, 2020) and the same time period in 2019 were analyzed retrospectively.

In total, we assessed 91 patients (51 lockdown cohort, 40 control cohort) with a mean age of 50.7 years. Significantly more trauma was sustained in the household environment during the lockdown (p = 0.015). Pre-hospital treatment remained similar between the two assessed groups. No difference was found in length of stay or mortality. In severely injured patients (ISS > 15), we found significantly fewer motor vehicle accidents (p = 0.018) and fewer horizontal decelerations (p = 0.006), but insignificantly more falls (p = 0.092) in the lockdown cohort. None of the patients in the lockdown cohort had a positive PCR test for Covid-19 on admission.

Trauma systems seem not to have changed during hard lockdowns in terms of pre-hospital treatment. Fewer severely injured patients due to motor vehicle accidents and horizontal decelerations, but more household-related injuries were seen in the lockdown cohort than in the control cohort. A qualitative analysis of treatment during the hard lockdown is needed to gain further insights into the effect of the pandemic on trauma care.

Harmful alcohol use is a major public health issue. In-person treatment has been hindered by the restrictions necessary during the Covid-19 pandemic. This study examined the effects of an at-home smartphone-based cognitive bias modification training in heavy drinkers. Experiment 1 tested the effect of a short 20-30-min smartphone-based approach-avoidance training (AAT) on image-induced craving at a 1-day follow-up. Sixty-two participants consuming 14+ units of alcohol/week were allocated to either the training or waitlist group. Experiment 2 used an updated version of the same short AAT intervention with a sample of n = 107 participants who consumed 20+ units of alcohol/week. Training effects at 1-week follow-up were compared to an active control group. Experiment 1 showed a significant reduction in image-induced craving for the training group at 1-day follow-up. Experiment 2 found that AUDIT weekly scores were significantly reduced at 1-week follow-up for the training group, all the while craving for soft drinks remained unchanged. Experiment 1 served as a first proof of concept for the efficacy of the new smartphone-based AAT training, and experiment 2 suggested that training effects on problem alcohol use hold at 1-week follow-up.

Alcohol use disorder (AUD), the problematic consumption of alcohol, affects 107 million people worldwide. Individuals with AUD experience high morbidity and increased mortality. Nurses practicing in acute care are ideally positioned to deliver quality interventions to patients with AUD, including screening and brief intervention; formal training and assessment of baseline knowledge, attitudes, and perceptions are necessary.

The aim of this study was to explore the knowledge, attitudes, and perceptions of acute care nurses caring for patients with AUD.

This study used a cross-sectional survey design.

The Survey of Attitudes and Perceptions was completed by 93 nurses working in six acute care centers (seven medicine units) across Alberta. Data were analyzed using descriptive and inferential statistics.

Few participants reported receiving any prior structured training on AUD, with the majority reporting limited knowledge of alcohol and the effects of alcohol consumption. Although most participants said that caring for patients with AUD was a part of their professional role, few felt satisfied or motivated to work with this group of patients. Responses to individual questions or subdomains of the survey did not significantly differ by length of time in professional role, employment status, or sex.

Our results indicate that nurses need to learn more about caring for patients with AUD. Developing tailored educational interventions that are mindful of the importance of knowledge, support, satisfaction, and motivation is necessary to improve the quality of care for patients with AUD.

We previously investigated the impact of the COVID-19 pandemic on alcohol-related liver disease (ARLD), finding that admissions for alcoholic hepatitis (AH) increased by 50% in the summer of 2020 compared to the same period in 2016-2019. We have now expanded our analysis to consider full years' data and evaluate how rates changed in 2021. We also sought to identify factors associated with ICU admissions, need for dialysis, liver transplant evaluations, and death.

Using retrospective data, we identified patients admitted to our four Detroit, Michigan area hospitals for acute ARLD for three periods pre-COVID (2016-February 2020), early COVID (June-December 2020), and late COVID (2021). Clustered logistic regression was performed to study rates of AH admissions across the three eras, where the patient was defined as the cluster and the analysis accounted for multiple encounters per cluster. A similar regression approach, univariate followed by multivariable analysis, was also used to study associations between patient characteristics and outcomes during hospitalization for AH.

AH-related admissions declined significantly from the early COVID to late COVID eras (OR 0.68, 95% CL 0.52, 0.88), returning to levels similar to that of the pre- COVID period (OR 1.18, 95% CL 0.96, 1.47). In multivariable analysis, baseline MELD score was associated with ICU admission, initiation of dialysis, transplant evaluation, and death while hospitalized for AH. Female patients were at almost twice the risk of death during admission compared to male patients (aOR 1.81, 95% CL 1.1, 2.98). Increasing age was associated with slightly lower odds of transplant (aOR 0.97, 95% CL 0.94, 1) and higher odds of death (aOR 1.03, 95% CL 1.01. 1.06).

After a spike in AH-related admissions during the first summer of the COVID-19 pandemic, rates declined significantly in 2021, returning to pre-pandemic levels.

Alcohol-related liver disease (ALD) is a major cause of liver-related morbidity and mortality. Epidemiological trends indicate recent and predicted increases in the burden of disease. Disease progression is driven by continued alcohol exposure on a background of genetic predisposition together with environmental cofactors. Most individuals present with advanced disease despite a long history of excessive alcohol consumption and multiple missed opportunities to intervene. Increasing evidence supports the use of non-invasive tests to screen for and identify disease at earlier stages. There is a definite role for public health measures to reduce the overall burden of disease. At an individual level, however, the ability to influence subsequent disease course by modifying alcohol consumption or the underlying pathogenic mechanisms remains limited due to a comparative lack of effective, disease-modifying medical interventions. Abstinence from alcohol is the key determinant of outcome in established ALD and the cornerstone of clinical management. In those with decompensated ALD, liver transplant has a clear role. There is consensus that abstinence from alcohol for an arbitrary period should not be the sole determinant in a decision to transplant. An increasing understanding of the mechanisms by which alcohol causes liver disease in susceptible individuals offers the prospect of new therapeutic targets for disease-modifying drugs. Successful translation will require significant public and private investment in a disease area which has traditionally been underfunded when compared to its overall prevalence.

The explosion of information, misinformation and disinformation (the "infodemic") related to the coronavirus disease 2019 (COVID-19) pandemic on digital and social media is reported to affect mental health and quality of life. However, reports assessing the COVID-19 infodemic on health-related quality of life (HRQL) in patients with chronic diseases are scarce. In this study, we investigated the associations between the infodemic and HRQL in uninfected individuals with pre-existing chronic respiratory diseases (CRDs) such as asthma, chronic obstructive pulmonary disease (COPD) and other CRDs.

We conducted a multi-national, cross-sectional, observational study in Canada, India, New Zealand and the United Kingdom where we distributed a set of digitised questionnaires among 1018 participants with chronic respiratory diseases who were not infected with the SARS-CoV-2 virus at least three months prior to the study. We collected information about the infodemic such as news watching or social media use more than usual during the pandemic. HRQL was assessed using the short form of the chronic respiratory questionnaire (SF-CRQ). Demographic information, comorbidities, compliance, mental health, behavioural function, and social support were also recorded. We analysed the direct and indirect relationships between infodemic and HRQL using structural equation models (SEM).

Of all participants, 54% were females and had a mean (standard deviation (SD)) age of 53 (17) years. We found that higher infodemic was associated with worse emotional function (regression coefficient β = -0.08; 95% confidence interval (CI) = -0.14 to -0.01), which means a one SD change of the higher infodemic latent variable was associated with a 0.08 SD change of emotional function level. The association between higher infodemic and worse emotional function was mediated by worse mental health and behavioural functions but is marginally ameliorated by improved social support. In stratification analysis, we found significant disease and country-wise variations in the associations between infodemic and SF-CRQ domain scores.

These results provide new evidence that the COVID-19 infodemic significantly influences the HRQL in patients with CRDs through a complex interplay between mental health, behavioural function, and social support. This new dimension of research also opens avenues for further research on infodemic-related health effects in other chronic diseases.

COVID-19 led governments worldwide to enact a variety of containment and closure policies. Substantial attention has been directed toward the idea that these public health measures may have unanticipated negative side effects. One proposed effect relates to video games. There is a nascent evidence base suggesting that individuals played video games for longer and in a more disordered manner during lockdowns and school closures specifically. These increases are commonly framed as a potential health concern in relation to disordered gaming. However, the evidence base regarding changes in gaming during the COVID-19 pandemic is based on self-report and, thus, is susceptible to bias. Therefore, it is unclear what the true consequences of lockdowns were for gaming behavior worldwide.

The primary objective of this study was to estimate whether any specific lockdown policy led to meaningful increases in the amount of time individuals spent playing video games.

Rather than relying on self-report, we used >251 billion hours of raw gameplay telemetry data from 184 separate countries to assess the behavioral correlates of COVID-19-related policy decisions. A multilevel model estimated the impact of varying enforcement levels of 8 containment and closure policies on the amount of time that individual users spent in-game. Similar models estimated the impact of policy on overall playtime and the number of users within a country.

No lockdown policy can explain substantial variance in playtime per gamer. School closures were uniquely associated with meaningful increases in total playtime within a country (r2=0.048). However, this was associated with increases in the number of unique individuals playing games (r2=0.057) rather than increases in playtime per gamer (r2<0.001).

Previous work using self-report data has suggested that important increases in heavy gaming may occur during pandemics because of containment and closure ("lockdown") procedures. This study contrasts with the previous evidence base and finds no evidence of such a relationship. It suggests that significant further work is needed before increases in disordered or heavy gaming are considered when planning public health policies for pandemic preparedness.

There has been limited longitudinal study of the health of migrant farmworkers due to their migratory lifestyles and there are opportunities to test new remote data collection methods in this subpopulation. A small randomized controlled trial was conducted with 75 migrant farmworker families who were randomly assigned to one of three groups that participated by (1) telephone interview, (2) online survey, or (3) mobile app between June 2021-April 2022. Of 50 farmworker adults who completed the baseline survey, there was differential attrition with 21% of the telephone interview group, 18% of the online survey group, and 3.2% of the online app group completing the 2-month follow-up. Over this period, migrant farmworkers reported relatively few mental health problems but notable alcohol use problems. Online apps were less effective than traditional methods for remote data collection. Alcohol use problems among migrant farmworkers in the U.S. may be an issue that deserves further study.

Alcohol use disorder (AUD) is a leading cause of cirrhosis. Insufficient clinician knowledge and comfort managing AUD impacts access to treatment. Using Kern's Framework for Curriculum Development, we aimed to (i) develop and evaluate the effect of an "AUD in cirrhosis" educational intervention on clinicians' knowledge, attitudes, comfort, preparedness, and intention (practice habits) to integrate AUD management into their practice, and (ii) assess clinicians' motivation using Self Determination Theory.

Kern's approach was used for curriculum development. Pilot session feedback informed a three-part flipped-classroom series conducted by interdisciplinary clinicians in hepatology, psychiatry, primary care, and addiction psychology. Participants watched a video followed by a live session focused on (a) withdrawal, (b) screening and brief intervention, and (c) prescribing pharmacotherapy. Questionnaires assessing knowledge and practice habits were adapted from the literature. Attitudes were evaluated using the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). Self Determination Theory informed motivation questions.

Paired sample t-tests on pre-post questionnaires (n = 229 clinicians; 95 completed questionnaires) revealed significant improvements in preparedness and comfort screening, providing a brief intervention, prescribing pharmacotherapy, and SAAPPQ domains. No significant changes were observed in the intention to prescribe pharmacotherapy. Effect size analysis showed medium to large effects across most topic areas.

The developed sessions improved knowledge, attitudes, and practice habits of clinicians caring for this patient population. Given the rise in AUD and significant consequences in cirrhosis, this data offers promise that interactive education may improve practice habits of clinicians interfacing with this patient population.

The coronavirus disease 2019 (COVID-19) pandemic has caused significant shifts in alcohol consumption patterns in the United States, with potential long-term implications for liver transplantation (LT) programs. Alcohol consumption has increased, particularly in women, leading to a rise in alcohol-related liver disease (ALD) and alcohol use disorder. Psychological distress associated with the pandemic may further exacerbate alcohol addiction. ALD is now the most common indication for LT, with higher disease severity and complex clinical presentations, demanding a fundamental transformation in LT programs. Multidisciplinary cooperation among medical specialists, telemedicine, and remote healthcare are essential strategies to address these challenges. However, barriers to telemedicine and costs must be overcome. Curbing alcohol consumption at the societal level and bolstering mental health programs to mitigate healthcare workforce moral injury are recommended to optimize patient care in the post-COVID-19 era. Adequate planning and compassionate management of finite resources will be crucial for the successful continuation of LT programs amidst the concerning trends in alcohol consumption and addiction.

Suicide is a leading cause of morbidity worldwide. Among the known risk factors, alcohol use disorders (AUDs) are particularly relevant, but data on the epidemiology and characteristics of suicide attempts (SA) in this group are lacking. We used electronic health records of national health services to identify individuals who received a diagnosis of AUD in the Metropolitan area of Bologna from 2009 to 2019. In this cohort we identified accesses to Emergency Departments for SA from 2009 to 2020. The Crude Suicide Rate (CSR) for 1,000 Person Years was 2.93, higher than the general population. The CSR was higher in females, within one year from receiving the diagnosis of AUD, in patients with psychiatric comorbidities, concomitant abuse of cannabis or benzodiazepines. As for Covid-19 pandemic, the risk ratio of SA was significantly higher in 2020 compared to 2019 in females. Our results are relevant to identify clinical risk factors for SA in patients with AUDs, which are strongly associated with suicide risk but with scarce data in the previous literature and paucity of evidence-based therapeutic interventions.

The COVID-19 outbreak has had severe consequences for global public health, medical communities, and the socioeconomic status of a considerable number of countries. The emergence of COVID-19 has also significantly impacted the world of liver transplantation (LT). Studies from transplantation centers around the world have shown that LTs during the COVID-19 pandemic have been restricted because of the high risk of serious COVID-19 infection in this population. According to the Centers for Disease Control and Prevention, patients with liver disease are considered at higher risk for severe COVID-19 infection. In March 2020, the American Association for the Study of Liver Diseases recommended that LT should be limited to emergency cases. The COVID-19 treatment guidelines published by the National Institutes of Health are being constantly updated according to new epidemiology trends and treatment regimens. Immunocompromised patients have a higher risk of developing severe disease or death from COVID-19 compared with the general population. In this review, we summarize the available evidence regarding treatment guidelines and considerations for the evaluation and management of LT candidates and recipients in the era of COVID-19. In addition, we present data regarding COVID-19 among LT patients in our local transplantation center.

The effect of initial COVID-19 pandemic-associated lockdowns on alcohol-related hospitalizations remains uncertain. This study compares alcohol-related hospitalizations at a US Department of Veterans Affairs (VA) system in Massachusetts before, during, and after the initial COVID-19 lockdown.

This study is an interrupted time-series analysis at the VA Boston Healthcare System. Participants included all patients hospitalized on the medical, psychiatry, and neurology services at VA Boston Healthcare System from January 1, 2017, to December 31, 2020, excluding those under observation status. The period January 1, 2017, to March 9, 2020, was defined as prelockdown (the reference group); March 10, 2020, to May 18, 2020, was lockdown; and May 19, 2020, to December 31, 2020, was postlockdown. Alcohol-related hospitalizations were determined using International Statistical Classification of Diseases, Tenth Revision primary diagnosis codes.

We identified 27,508 hospitalizations during the study periods. There were 72 alcohol-related hospitalizations per 100,000 patient-months during the prelockdown period, 10 per 100,000 patient-months during the lockdown, and 46 per 100,000 patient-months in the postlockdown period. Compared with the prelockdown period, the adjusted rate ratio for daily alcohol-related hospitalizations during lockdown was 0.20 (95% CI, 0.10-0.39) vs 0.72 (95% CI, 0.57-0.92) after the lockdown. A similar pattern was observed for all-cause hospitalizations.

Our results suggest that COVID-19 pandemic lockdown measures were associated with fewer alcohol-related hospitalizations. Proactive outreach for vulnerable populations during lockdowns is needed.

Since March 2020, the COVID-19 pandemic has had a disproportionately high toll on vulnerable populations, coinciding with increased prevalence of alcohol-and drug-related deaths and pre-existing societal issues such as rising income inequality and homelessness. This poly-crisis has posed unique challenges to service delivery for people with substance use disorders, and innovative approaches have emerged. In this Perspectives paper we reflect on the poly-crisis and the changes to research and practice for those experiencing substance use disorders, following work undertaken as part of the InterGLAM project (part of the 2022. Lisbon Addictions conference). The authors, who were part of an InterGLAM working group, identified a range of creative and novel responses by gathering information from conference attendees about COVID-19-related changes to substance use disorder treatment in their countries. In this paper we describe these responses across a range of countries, focusing on changes to telehealth, provision of medications for opioid use disorder and alcohol harm reduction, as well as changes to how research was conducted. Implications include better equity in access to technology and secure data systems; increased prescribed safer supply in countries where this currently does not exist; flexible provision of medication for opioid use disorder; scale up of alcohol harm reduction for people with alcohol use disorders; greater involvement of people with lived/living experience in research; and additional support for research in low- and middle-income countries. The COVID-19 pandemic has changed the addictions field and there are lessons for ongoing and emerging crises.

To analyse: (1) Changes in clinical parameters and in the use of social healthcare resources by patients with alcohol abuse disorder between the six months prior to the start of the pandemic and the first year of the pandemic. (2) The factors related to a worsening of clinical parameters among patients with alcohol abuse disorder.

A retrospective and observational study of a population who have been diagnosed with alcohol abuse disorders according to their primary health care (PHC) electronic medical records was performed. The total sample was made up of 11,384 patients. The variables (sociodemographic variables, chronic comorbidities, analytical parameters related to alcohol abuse disorder, COVID-19 infection, and use of healthcare resources) were collected in three different time periods: (i) six months before the onset of the strict lockdown, (ii) six months following the end of lockdown and (iii) from six to twelve months after the end of lockdown. Paired Student's T-test and a multivariate logistic regression were performed.

Along the first year after the onset of the pandemic, between 44% and 54% of the patients suffered a decline in every clinical parameter. The number of PHC nursing, GP visits and social worker visits reduced significantly. As regards the associated factors related to deterioration of alcohol abuse disorder, being younger than 40 years old, having an income of over 18,000 euros/year and not having visited the social worker were associated with a worsening of the disorder.

These results suggest that the impact of COVID-19 on this group has been high, and the social care offered to these patients plays a significant role in minimising the repercussions of the pandemic.

The COVID-19 pandemic spurred public health measures to reduce viral spread. Concurrently, increases in alcohol consumption and conflict in romantic partnerships were observed. Pre-pandemic research demonstrated a bidirectional association between couples' conflict and drinking. Recent research shows one's drinking motives (proximal predictors of drinking behavior) can influence another person's drinking in close relationships. It is possible that individuals are drinking to cope with distress following romantic conflict. The current study examined 348 cohabitating couples during the first lockdown in the spring of 2020. Our analyses examined coping motives as a mediator between dyadic conflict and drinking behavior using actor-partner interdependence models. Results showed that conflict was associated with greater reports of own drinking in gendered (distinguishable) and nongendered (indistinguishable) analyses through coping motives. Further, in mixed-gender couples, men partners' coping motives predicted less drinking in women, while women partners' coping motives predicted marginally more drinking in men. Partner effects may have been observed due to the increased romantic partner influence during the COVID-19 lockdown. While these results suggest that men's coping motives may be protective against women's drinking, more concerning possibilities are discussed. The importance of considering dyadic influences on drinking is highlighted; clinical and policy implications are identified.

Widespread disruption of healthcare services and excess mortality not directly attributed to COVID-19 occurred between March and May 2020. We undertook the first UK multicentre study of coroners' autopsies before and during this period using postmortem reports.

We reviewed reports of non-forensic coroners' autopsies performed during the first COVID-19 lockdown (23 March to 8 May 2020), and the same period in 2018. Deaths were categorised as natural non-COVID-19, COVID-19-related, non-natural (suicide, drug and alcohol-related, traumatic, other). We provided opinion regarding whether delayed access to medical care or changes in behaviour due to lockdown were a potential factor in deaths.

Seven centres covering nine coronial jurisdictions submitted a total of 1100 coroners' autopsies (498 in 2018, 602 in 2020). In only 54 autopsies was death attributed to COVID-19 (9%). We identified a significant increase in cases where delays in accessing medical care potentially contributed to death (10 in 2018, 44 in 2020). Lockdown was a contributing factor in a proportion of suicides (24%) and drug and alcohol-related deaths (12%).

Postmortem reports have considerable utility in evaluating excess mortality due to healthcare and wider societal disruption during a pandemic. They provide information at an individual case level that is not available from assessment of death certification data. Detailed evaluation of coroners' autopsy reports, supported by appropriate regulatory oversight, is recommended to mitigate disruption and indirect causes of mortality in future pandemics. Maintaining access to healthcare, including substance misuse and mental health services, is an important consideration.

The COVID-19 pandemic has significantly impacted global economies and individual health. This study uses data from the China Family Panel Data (CFPS) in 2018 (before the pandemic) and 2020 (during the pandemic) to a) estimate the relationships between the perceived risk of unemployment and individuals' mental health, physical health, and health behaviors; and b) explore the variations of these relationships between rural and urban adults in China.

Ordinary linear regression models or Logit models are employed, depending on the nature (continuous vs. discrete) of the dependent variables.

We find that the perceived risk of unemployment was statistically and positively associated with the risk of depression, and the association was greater for rural adults than for urban adults. Rural-urban variations were observed in various dimensions. For rural adults, the perceived risk of unemployment was statistically and negatively associated with life satisfaction, the probability of gaining weight and becoming obese, the probability of having adequate sleep, and computer-based screen time. These associations were statistically insignificant for urban adults. On the other hand, the perceived risk of unemployment was statistically and negatively associated with self-rated very-good-to-excellent health condition and health-compromising behaviors (e.g., smoking and drinking) for urban adults; but such associations were statistically insignificant for rural adults.

These findings suggest that rural and urban adults exhibited different psychological and behavioral responses to the unemployment risk during the COVID-19 pandemic. Public policies aiming to improve health and employment should be strategically designed to address the unique needs of urban and rural populations.

COVID-19-infected individuals and those who recovered from the infection have been demonstrated to have elevated liver enzymes or abnormal liver biochemistries, particularly with preexisting liver diseases, liver metabolic disorders, viral hepatitis, and other hepatic comorbidities. However, possible crosstalk and intricate interplay between COVID-19 and liver disease severity are still elusive, and the available data are murky and confined. Similarly, the syndemic of other blood-borne infectious diseases, chemical-induced liver injuries, and chronic hepatic diseases continued to take lives while showing signs of worsening due to the COVID-19 crisis. Moreover, the pandemic is not over yet and is transitioning to becoming an epidemic in recent years; hence, monitoring liver function tests (LFTs) and assessing hepatic consequences of COVID-19 in patients with or without liver illnesses would be of paramount interest. This pragmatic review explores the correlations between COVID-19 and liver disease severity based on abnormal liver biochemistries and other possible mechanisms in individuals of all ages from the emergence of the COVID-19 pandemic to the post-pandemic period. The review also alludes to clinical perspectives of such interactions to curb overlapping hepatic diseases in people who recovered from the infection or living with long COVID-19.

This study examined the relationships between stress, excessive drinking, including binge and heavy drinking, and health insurance status among a regionally representative sample of adults living in Northern Larimer County, Colorado, during the COVID-19 pandemic.

Data from 551 adults aged 18 to 64 years (62.98% aged 45 to 65 years; 73.22% female; 92.98% non-Hispanic White) were used. The sample was weighted by age and binary sex. A series of logistic regressions were applied to examine bivariate associations among stress, drinking, and health insurance status, with and without accounting for the effects of sociodemographic and health-related covariates. Stratified analyses were applied to explore differential associations of stress and drinking among individuals with different health insurance coverage.

A total of 23.23% of the adult sample reported binge drinking, and 16.15% reported heavy drinking; 10.53% of the sample reported both binge and heavy drinking. Individuals with higher levels of stress were more likely to report binge drinking (OR: 1.65; 95% CI: 1.65, 1.68) and heavy drinking (OR: 2.61; 95% CI: 2.54, 2.67), after adjusting for sociodemographic and health-related covariates. Relative to individuals with private health insurance coverage, adults enrolled in Medicaid and those without health insurance coverage were more susceptible to the effect of stress on binge and heavy drinking.

Our results highlighted a need for continuing statewide and/or national efforts in closing the insurance coverage gap and providing affordable marketplace health insurance in the hope of preventing excessive drinking due to high levels of stress during a challenging time.

The COVID-19 pandemic has been associated with poorer mental health and, in some cases, increased alcohol consumption; however, little is known about the pandemic's effects on people in recovery from alcohol use disorder (AUD), especially how they have coped with novel stressors. Our mixed-methods study investigated strategies used to maintain recovery during the pandemic, with attention to variation by gender. We analyzed data obtained in fall 2020 from an online US national survey of adults with resolved AUD (n = 1,492) recruited from KnowledgePanel, a probability-based cohort of non-institutionalized adults maintained by Ipsos for internet-based research. Participants endorsed possible coping strategies on a 19-item choose-all-that-apply list, which were analyzed using chi-square tests. In addition, 1,008 participants provided text responses to an open-ended question about their strategies to maintain recovery during the pandemic, which were coded and analyzed using an inductive, thematic approach. The majority of our sample met criteria for severe lifetime AUD (72.9%), reported being in recovery more than five years (75.5%), and had never used specialty AUD services or mutual-help groups (59.7%). The ordering of the coping strategies was quite similar for women and men; however, the top strategy (talking with family and friends by phone, text, or video) was endorsed more frequently by women than men (49.7% vs. 36.1%; p < .001). Among qualitative themes, "staying connected" was the most common. It was dominated by statements about family, with women mentioning children more often than men. Among other themes, "cognitive strategies" mirrored established therapeutic modalities, and "active pursuits" aligned with many recent recommendations for service providers working with substance-using populations during the pandemic. A minority of participants invoked "willpower" for recovery or stated that pandemic restrictions helped by reducing exposure to relapse risks. These findings shed light on recovery mechanisms during the COVID-19 pandemic and suggest potential intervention targets to support recovery during other catastrophic events, such as natural disasters.

To compare changes in outpatient and acute care visits due to alcohol during the COVID-19 pandemic between individuals with and those without a history of alcohol-related health service use (AHSU).

We conducted a cross-sectional analysis of health administrative data in Ontario, Canada. The Ontario population was stratified into those with and those without 1+ health service encounter(s) due to alcohol in the past 2 years. We compared age- and sex-standardized rates of alcohol-related outpatient visits, emergency department (ED) visits, and hospitalizations during the first 15 months of the pandemic (March 2020-May 2021) to those during the same 15-month period prior to the pandemic (March 2018-May 2019).

Of 13,450,750 eligible Ontarians on March 11, 2022, 129,434 (1.0%) had AHSU in the previous 2 years. Overall, rates of alcohol-related outpatient visits and hospitalizations increased, while rates of alcohol-related ED visits decreased during the pandemic. There was a similar relative increase in rates of alcohol-related outpatient visits and hospitalizations between those with and those without prior AHSU. However, the absolute increase in rates of alcohol-related outpatient visits and hospitalizations was higher among those with prior AHSU (outpatient rate difference (RD) per 10,000 population: 852.3, 95% confidence interval (CI): 792.7, 911.9; inpatient RD: 26.0, 95% CI: -2.3, 54.2) than among those without (outpatient RD: 6.5, 95% CI: 6.0, 6.9; inpatient RD: 0.4, 95% CI: 0.2, 0.7).

Rates of alcohol-related outpatient and inpatient care increased during the COVID-19 pandemic, and high rate of recurrent harm among individuals with pre-pandemic AHSU was an important contributor to this trend.

People with substance use disorders (SUD) are suggested to have higher risk of hospitalization, intubation, or death from coronavirus disease 2019 (COVID-19), although data are mixed. Little is known about other COVID-19-related complications in this group. We compared morbidity and mortality among individuals with and without SUD who were admitted to an urban safety net hospital with COVID-19 early in the pandemic, contemporaneous to other published studies on this subject.

We performed a retrospective study of patients ⩾18 years old admitted with COVID-19 from March 16th to April 8th, 2020. SUD included alcohol, opioid, cocaine, amphetamine, and benzodiazepine use disorders and was identified using diagnostic codes, free text clinical documentation, and urine drug screens. The primary outcome was inpatient mortality. Secondary outcomes included clinical complications (eg, secondary infections, venous thromboembolism) and resource utilization (eg, mechanical ventilation, length of stay). We used multivariable regression to assess the relationship between SUD and mortality.

Of 409 patients, the mean age was 56 years and 13.7% had SUD. Those with SUD were more likely to be male, have experienced homelessness, have pulmonary disease or hepatitis C, or use tobacco or cannabis. After multivariable analysis, SUD was not associated with mortality (aOR 1.03; 95% CI, 0.31-3.10). Secondary outcomes were also similar between groups.

Our findings suggest that persons with and without SUD have similar COVID-19-related outcomes. Previously reported increased COVID-19 complications may be from medical comorbidities.

Psychosocial stressors related to the coronavirus-19 (COVID-19) pandemic increased alcohol consumption. The effect on patients with alcohol-related liver diseases remains unclear.

Hospitalizations at a tertiary care center due to alcohol-related liver disease from March 1 through August 31 in 2019 (pre-pandemic cohort) and 2020 (pandemic cohort) were reviewed retrospectively. Differences in patient demographics, disease features, and outcomes were estimated in patients with alcoholic hepatitis utilizing T-tests, Mann-Whitney tests, Chi-square and Fisher Exact Tests and Anova models and logistic regression models in patients with alcoholic cirrhosis.

146 patients with alcoholic hepatitis and 305 patients with alcoholic cirrhosis were admitted during the pandemic compared to 75 and 396 in the pre-pandemic cohort. Despite similar median Maddrey Scores (41.20 vs. 37.45, p=0.57), patients were 25% less likely to receive steroids during the pandemic. Patients with alcoholic hepatitis admitted during the pandemic were more likely to have hepatic encephalopathy (0.13; 95% CI:0.01, 0.25), variceal hemorrhage (0.14; 95% CI:0.04, 0.25), require oxygen (0.11; 95% CI:0.01, 0.21), vasopressors (OR:3.49; 95% CI:1.27, 12.01) and hemodialysis (OR:3.70; 95% CI:1.22, 15.13). On average, patients with alcoholic cirrhosis had MELD-Na scores 3.77 points higher (95% CI:1.05, 13.46) as compared to the pre-pandemic and had higher odds of experiencing hepatic encephalopathy (OR:1.34; 95% CI:1.04, 1.73), spontaneous bacterial peritonitis (OR:1.88; 95% CI:1.03, 3.43), ascites (OR:1.40, 95% CI:1.10, 1.79), vasopressors (OR:1.68, 95% CI:1.14, 2.46) or inpatient mortality (OR:2.00, 95% CI:1.33, 2.99) than the pre-pandemic.

Patients with alcohol-related liver disease experienced worse outcomes during the pandemic.

COVID-19 forced social interactions to move online. Yet researchers have little understanding of the mental health consequences of this shift. Given pandemic-related surges in emotional disorders and problematic drinking, it becomes imperative to understand the cognitive and affective processes involved in virtual interactions and the impact of alcohol in virtual social spaces. Participants (N=246) engaged in an online video call while their gaze behavior was tracked. Prior to the interaction, participants were randomly assigned to receive an alcoholic or control beverage. Participants' affect was repeatedly assessed. Results indicated that a proportionally larger amount of time spent gazing at oneself (vs. one's interaction partner) predicted significantly higher negative affect after the exchange. Further, alcohol independently increased self-directed attention, failing to demonstrate its typically potent social-affective enhancement in this virtual context. Results carry potential implications for understanding factors that increase risk for hazardous drinking and negative affect in our increasingly virtual world.