Binge drinking alcohol and circadian misalignment in night shift nurses is associated with decreased resiliency to COVID-19 infection

Background: Nurses and other first responders are at high risk of exposure to the SARS-CoV2 virus, and many have developed severe COVID-19 infection. A better understanding of the factors that increase the risk of infection after exposure to the virus could help to address this. Although several risk factors such as obesity, diabetes, and hypertension have been associated with an increased risk of infection, many first responders develop severe COVID-19 without established risk factors. As inflammation and cytokine storm are the primary mechanisms in severe COVID-19, other factors that promote an inflammatory state could increase the risk of COVID-19 in exposed individuals. Alcohol misuse and shift work with subsequent misaligned circadian rhythms are known to promote a pro-inflammatory state and thus could increase susceptibility to COVID-19. To test this hypothesis, we conducted a prospective, cross-sectional observational survey-based study in nurses using the American Nursing Association network. Method(s): We used validated structured questionnaires to assess alcohol consumption (the Alcohol Use Disorders Identification Test) and circadian typology or chronotype (the Munich Chronotype Questionnaire Shift -MCTQ-Shift). Result(s): By latent class analysis (LCA), high-risk features of alcohol misuse were associated with a later chronotype, and binge drinking was greater in night shift workers. The night shift was associated with more than double the odds of COVID-19 infection of the standard shift (OR 2.67, 95% CI: 1.18 to 6.07). Binge drinkers had twice the odds of COVID-19 infection of those with low-risk features by LCA (OR: 2.08, 95% CI: 0.75 to 5.79). Conclusion(s): Working night shifts or binge drinking may be risk factors for COVID-19 infection among nurses. Understanding the mechanisms underlying these risk factors could help to mitigate the impact of COVID-19 on our at-risk healthcare workforce.Copyright © 2023 The Authors. Alcohol: Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.

Study of Clinical Profile and Outcome among COVID-19 Patients during Hospitalization in a Tertiary Care Hospital in Central India

Background: The COVID-19 outbreak in 2019 has presented in the form of pneumonia of unknown etiology in Wuhan. The complete clinical profile including the prevalence of different clinical symptoms of COVID-19 infection among Indian patients who develop a severe disease is largely unknown. This study is aimed to provide a detailed clinical characterization of the cohort of patients who visited our institute with signs and symptoms of COVID-19. Material(s) and Method(s): This was for inpatient hospital (inpatient) based prospective cohort study involving 520 COVID-19 patients admitted to the hospital. The adverse outcome included death and mechanical ventilation. Result(s): Total 520 participants enrolled in the study, (6.9%) participants died, (8.3%) participants required ICU and (5.5%) participants required mechanical ventilation. only signs and symptoms suggestive of severe respiratory system involvement or widespread infection were associated with adverse outcomes, T presence of dyspnoea, cyanosis and hypoxia. The most common chronic disease among patients with adverse outcomes were diabetes, hypertension and pre-existing respiratory disease, personal habit both smoking, and alcoholism was also associated with adverse clinical outcome. Conclusion(s): The adverse clinical outcome among COVID-19 patients is determined by several factors including advanced age, multi-morbidities, and the presence of severe respiratory symptoms.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

Positive Correlation Between Heavy Alcoholic Drinking and SARS-Cov-2 Non-Infection Rate.

Introduction During the SARS-CoV-2 pandemic, rumors claimed that alcohol drinking could someway be useful in contrasting the contagion and even the disease. It appears opportune to bring some robust data to determine whether heavy alcohol drinkers and non-drinkers experienced different infection rates. Methods A cross-sectional study through a simple survey based on the social media software Weixin and the mini survey program Wenjuanxing was carried out in China after the zero-Covid policy ended, namely from 15:00 January 1, 2023, to 12:35 January 3, 2023. The evaluation was conducted among subjects belonging to the first author's Weixin community, mostly residents in the higher populated China area. Study participants received a questionary and were asked about their virus infection status, and were classified into two groups: (a) infected, meaning he/she has been infected at least once (whether recovered or not); (b) remain uninfected, meaning the virus has not infected him/her. A total of 211 subjects adhered to the survey. Alcoholic drinking behavior about liquors with no less than 40% alcohol content in volume was retrieved from the participants. In China, such beverages are almost uniquely referred to as the Chinese Spirits or BaiJiu. The frequency of drinking quantified the drinking behavior, and it is classified into three groups: never drink or drink occasionally (group A); drink one or two times per week (group B); drink three times per week or more often (group C). The hypothesis of an existing relationship between infection status and drinking behavior was advanced before data collection. The numbers of the uninfected people in each of the three drinking groups were counted, and the rates of not-infection were calculated. The rates are compared with each other to conclude whether significant differences exist, considering the size of the samples. The conclusion is drawn from standard hypothesis testing. Results The male/female ratio was 108/103 (51.2% and 48.8%), the mean age was 38.8 years (range 21-68), and the median age of 37.4 years. The total 211 participants fell into three groups with different drinking frequencies, with counts (percentages in total 211 participants) 139 (65.9%) in group A, 28 (13.3%) in group B, and 44 (20.8%) in group C. The number (percentage within the group) of uninfected members in groups A, B, and C are 29 (20.9%), 7 (25.0%), and 17 (38.6%), respectively. The statistical analysis through the Cochran-Armitage trend test gave a significative result: p=0.0209. Conclusions Within the methodology's limitations, this study shows the significant relationship between alcohol drinking habits and the chances of avoiding SARS-CoV-2 infection. A possible hypothesis explaining these findings is advanced. However, the authors warn about misleading conclusions and advocate research that could properly guide ethanol use in the present and other possible pandemics. Limitations This study is based on self-reported data from a specific community in China. There could be recall bias and social desirability bias, and the generalizability of the findings to other populations could be limited. Other factors that could influence infection rates, such as age, occupation, and health status, are not controlled in the present study. There could be other explanations for the observed relationship between alcohol drinking habits and infection rates.

Limbic platform capitalism: understanding the contemporary marketing of health-demoting products on social media

The purposive design, production and marketing of legal but health-demoting products that stimulate habitual consumption and pleasure for maximum profit has been called 'limbic capitalism'. In this article, drawing on alcohol and tobacco as key examples, we extend this framework into the digital realm. We argue that 'limbic platform capitalism' is a serious threat to the health and wellbeing of individuals, communities and populations. Accessed routinely through everyday digital devices, social media platforms aggressively intensify limbic capitalism because they also work through embodied limbic processes. These platforms are designed to generate, analyse and apply vast amounts of personalised data in an effort to tune flows of online content to capture users' time and attention, and influence their affects, moods, emotions and desires in order to increase profits. Social media are central to young people's socialising, identities, leisure practices and engagement in civic life. Young people actively appropriate social media for their own ends but are simultaneously recruited as consumers who are specifically targeted by producers of limbic products and services. Social media platforms have seen large increases in users and traffic through the COVID-19 pandemic and limbic capitalism has worked to intensify marketing that is context, time and place specific, driving online purchases and deliveries of limbic products. This has public health implications that require immediate attention as existing regulatory frameworks are woefully inadequate in this era of data-driven, algorithmic marketing.

Scientific debrief: cirrhosis

Globally, hepatitis C (26%), alcohol (24%), and hepatitis B (23%) contribute almost equally to the global burden of cirrhosis. The contribution from nonalcoholic fatty liver disease (8%) is small but increasing. Patients with acutely decompensated cirrhosis have a dismal prognosis and frequently progress to acuteon-chronic liver failure, which is characterised by hepatic and extrahepatic organ failure, Cardiovascular alterations including portal hypertension trigger the formation of portocaval shunts and varices. Systemic under filling and arterial hypotension is compensated by vasoconstriction but might decline into a state of aggravated portal hypertension and cirrhotic cardiomyopathy, leading to a hyperdynamic state, microvascular dysfunction and reduced organ perfusion culminating in decompensation. The immune system is dysfunctional showing a contrary co-existence of immune paralysis and immune overstimulation leading to secondary infections and inflammatory response syndrome aggravating cardiovascular alterations but also initiating tissue injury and metabolic alteration. This transition from compensated to decompensated cirrhosis is characterised by the occurrence of ascites, variceal bleeding and/or hepatic encephalopathy or organ failures (in the case of ACLF. Precipitating events for ACLF vary between Western countries (bacterial infection, alcohol intake) and Eastern countries (flare of HBV, superimposed HAV or HEV). In the majority of patients, systemic inflammation is a major driver of progression from compensated to decompensated cirrhosis. Once the first episode of AD develops, systemic inflammation follows a chronic course, with transient periods of aggravation due to proinflammatory precipitants or bursts of bacterial translocation resulting in repeated episodes of AD. The multistate model describing the clinical outcomes of decompensated cirrhosis has been well validated. State 3 is defined by the occurrence of variceal bleeding alone, state 4 by any single non-bleeding event, state 5 by any 2 or more events and the late decompensate state by any event with organ failures either with or without ACLF. 5-year mortality across states from 3 to 5 is in the order of, respectively: 20%, 30%, 88%. With late decompensation mortality ranges between 60 and 80% at 1 year. Cirrhosis is increasingly common and morbid. Optimal utilisation of therapeutic strategies to prevent and control the complications of cirrhosis are central to improving clinical and patient-reported outcomes. Aetiology-focused therapies that can prevent cirrhosis and its complications. These include anti-viral therapies, psychopharmacological therapy for alcohol-use disorder, management of hepatic encephalopathy (HE), ascites, hepatorenal syndrome, non-pain symptoms of cirrhosis including pruritis, muscle cramps, sexual dysfunction and fatigue, and reduce the risk of hepatocellular carcinoma. New disease-modifying agents are expected to be identified in the next few years by systematic drug repurposing and the development of novel molecules currently undergoing pre-clinical or early clinical testing. COVID-19 continues to pose a significant healthcare challenge throughout the world. Comorbidities including diabetes and hypertension are associated with a significantly higher mortality risk. Cirrhosis is associated with an increased risk of all-cause mortality in COVID-19 infection compared to non-cirrhotic patients. Patients with cirrhosis should be considered for targeted public health interventions to prevent COVID-19 infection, such as shielding and prioritisation of vaccination.

Covid-19 Infection Presenting as Acute Pancreatitis

Purpose of study Introduction COVID-19 emerged at the end of 2019 as an epidemic of respiratory disease in Wuhan, China that later spread globally and was declared as pandemic. The common clinical manifestations of COVID-19 infection include fever, cough, myalgias, headache, sore throat, anosmia, nasal congestion, fatigue and chest pain. The most serious complications include bilateral multifocal pneumonia and acute respiratory distress syndrome. Acute pancreatitis is rarely reported in association with COVID-19 infection. We report a case of acute pancreatitis secondary to COVID-19 infection. Case Report: A 69-year-old man with past medical history of hyperlipidemia and seizure disorder presented with two days of epigastric pain radiating to back. The patient reported fever, malaise and dry cough for the last 3 days. Home medication included atorvastatin and carbamazepine for 10 and 15 years respectively. The patient denied smoking and alcohol use. COVID- 19 PCR was positive. Labs showed WBC of 3800/muL, hgb 11.8 g/dL, calcium 8.4 mg/dL , lipase 426 U/L, D-Dimer 179 ng/ml DDU, High sensitivity C-reactive protein 27.5 mg/L (normal <5 mg/L) ALT 26 U/L, AST 31 U/L, alkaline phosphatase 103 U/L and total bilirubin 0.3 mg/dL. Ultrasound of the right upper quadrant and CT abdomen showed normal pancreas, common bile duct and gallbladder with no evidence of gallstones. Triglyceride level was 70 mg/dL (<149 mg/dL) on the lipid panel. The patient was diagnosed with acute pancreatitis and received treatment with IV fluids and pain medication. The symptoms improved gradually and the patient was discharged home with resumption of home medications. Methods used Case Report Summary of results The common differentials for acute pancreatitis include alcohol use, gallstones, hypertriglyceridemia, viral infections like mumps and measles, hypercalcemia and medication-related, etc. Normal AST, ALT, alkaline phosphatase and total bilirubin along with absence of gallstones and normal common bile duct ruled out alcoholic and biliary pancreatitis. Normal calcium level and triglyceride level rule out hypercalcemia and hypertriglyceridemia as the cause of pancreatitis. Carbamazepine has rarely been reported to cause acute pancreatitis typically soon after the initiating the therapy or with increase in the dose. The use of carbamazepine for more than 15 years without any recent dose change makes this unlikely as the cause of pancreatitis. The onset of acute pancreatitis during the timeline of COVID-19 constitutional symptoms and absence of other risk factors suggests that COVID-19 infection is responsible for acute pancreatitis in our patient. Conclusions We report a case of acute pancreatitis secondary to COVID-19 infection. Further studies are warranted to better understand the etiology and the pathophysiology of acute pancreatitis secondary to COVID-19 infection.

Resilience in alcohol use disorder: associations with negative and positive emotionality, quality of life, and disorder severity

In previous work looking at individuals exposed to childhood trauma, we have found that decreased neuroticism, impulsivity, and trait anxiety, and increased conscientiousness are associated with a decreased risk of alcohol use disorder (AUD), suggesting these characteristics contribute to a relative resilience to alcohol misuse. In the current study we confirm and expand on these findings using the Connor-Davidson Resilience Scale (CD-RISC), which assesses resilience based on individual characteristics and coping mechanisms as well as social relationships. We analyzed CD-RISC data from two NIAAA protocols: 1) the Natural History Protocol (NHP) (n = 245;156 with AUD, 89 without AUD);2) the COVID-19 Pandemic Impact on Alcohol Protocol (C19PIA) (n = 280;77 with AUD, 203 without AUD). Participants ranged from non-drinking healthy volunteers to heavy drinkers. In addition to the CD-RISC, assessments included the Structured Clinical Interview for DSM-5 disorders, and questionnaires related to problematic alcohol use, positive and negative affect, personality, perceived stress, and quality of life (i.e., physical health, psychological health, social relationships, and environment). Data analysis was conducted using general linear models, and analyses were run separately for the two independent samples due to differences in data collection methodology. For the C19PIA protocol sample, analyses were conducted on measures collected both pre-pandemic and during the pandemic. In both the NHP and C19PIA samples, CD-RISC score was negatively associated with neuroticism, negative affect, and perceived stress, and positively associated with extraversion, conscientiousness, positive affect, and all four quality of life measures. In the C19PIA sample, these results were consistent for analyses of both pre-pandemic and pandemic-associated measures. CD-RISC score was lower in individuals with AUD compared to those without AUD. In the NHP sample, which was enriched for individuals with AUD, greater resilience was associated with decreased AUD severity, and decreased anxiety and depression symptoms, among those diagnosed with AUD. A similar association between resilience and decreased AUD severity was observed in the C19PIA sample before the pandemic. Resilience was also associated with a reduction in impaired control over drinking in the C19PIA sample, both before and during the pandemic. The current findings highlight resilience as a key construct associated with multiple factors at the individual, social, and environmental levels. Of note, the same resilience-associated factors were observed both before and during the COVID 19 pandemic, with the latter representing a major stressor for many individuals. The finding that greater resilience is associated with decreased disorder severity and reduced depression and anxiety symptoms among those with AUD highlights the potential of resilience-oriented approaches to treatment. These approaches, often promoted for trauma-exposed individuals, could also prove beneficial for alcohol use disorder.Copyright © 2023

Prevalence of substance use in adults with cystic fibrosis

Background: Substance use is an understudied aspect of cystic fibrosis (CF) care. Even casual use of drugs or alcohol may reduce compliance with complicated treatment plans, worsen existing conditions associated with CF, or cause potential drug interactions. To understand the need for mitigation mechanisms for risky substance use in a CF population, we studied the prevalence of substance use in our adult CF clinic population to characterize relationships between substance use and health status. Method(s): In our large academic CF center, we performed a retrospective chart ion of 420 patients over a 6-year period (2015-2021). Clinical staff annually administer the Drug Abuse Screening Test (DAST-10), Alcohol Use Disorders Identification Test (AUDIT), Patient Health Questionnaire (PHQ-9), and General Anxiety Disorder (GAD-7) to assess drug use, alcohol use, depression, and anxiety symptoms, respectively. Demographic characteristics, lung function (percentage predicted forced expiratory volume in 1 second (FEV1pp)), and anxiety and depression symptom screening scores were recorded. Because substance use can change over time, we counted each assessment date as an independent observation (n = 1434). The chi-square test (Table 1) was conducted in R/RStudio [1] to assess for associations between self-reported substance use and symptoms of depression and anxiety. Because of insufficient data, aggregate datawere used to describe the presence (PHQ-9 or GAD-7 >= 10) or absence (PHQ-9 or GAD-7 < 10) of symptoms of depression and anxiety. Result(s): Positive scores for risky use were defined as a DAST score of 1 or higher and an AUDIT score of 8 or hither. Eighty-three of 326 patients (25%) met criteria for risky substance use on at least one observation. Therewas a slight male predominance (54.2%) and wide age distribution (mean age 30 +/- 7, range 20-55);Thirty (36.1%) had a higher AUDIT score, 34 (40.9%) had a high DAST score, and 19 (22.9%) had high scores on both.We selected 2019 to evaluate single-year prevalence of positive screenings to avoid the impact of COVID. In 2019, 29 patients had at least one positive screening result (DAST,15/203, 7.3%;AUDIT, 24/193,12%;both,10/193, 5.2%). In the 6- year dataset, we did not find a statistically significant association between symptoms of depression and anxiety and indication of drug or alcohol use in self-reported users (355 observations). Conclusion(s): According to a 2020 national survey of healthy Americans, 20.8% have used illicit drugs at least once in the past year, and 10.2% meet criteria for alcohol use disorder [2], compared with 7.3% of patients in our 2019 data who have used drugs (n = 15) and 12% (n = 24) who indicated risky alcohol use. In this review, positive screening scores on the DAST and AUDIT were not associated with degree of symptoms of depression and anxiety, suggesting that substance use and symptoms of depression and anxiety were not temporally associated with each other. Future work will include analysis of the relationship between substance use and mental health in the larger University of North Carolina clinic population and linear regression to evaluate possible explanatory variables for substance use in this populationCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

Impacts of Public Health Status and Life Disruptions on Alcohol Consumption in Young Adults Early in the COVID-19 Pandemic

Using data from a national online sample, the current study examined factors impacting changes in alcohol use immediately following the WHO pandemic declaration (March 2020), including pre-COVID risk for alcohol use disorder (AUD). Participants with pre-COVID AUD risk, who experienced at least one COVID-related problem (e.g. housing, finances), demonstrated the greatest increase in weekly drinking. However, college students at-risk for AUD pre-COVID, with academic disruptions, showed the greatest consumption increases. The findings provide insight into the complex relationships between COVID-19 related disruptions, preexisting AUD risk, and their impact on risky drinking during a critical period in the pandemic. Implications for future public health prevention and intervention responses are discussed.Copyright © 2023 Taylor & Francis.

Social worker to therapist: Adaptation of role while addressing inequities in mental health care

Background: 2020 was a year of transformation in cystic fibrosis (CF) care. Many adults with CF started elexacaftor/tezacaftor/ivacaftor while COVID- 19 was unfolding. Occurring almost simultaneously, these two events created a dramatic shift in the disease landscape. Hospital admissions plummeted, and physical health improved. Clinic appointments turned virtual, and people with CF sheltered at home for months. These changes created opportunities for CF team members to adapt roles to meet evolving needs. Social work hours devoted to inpatient care, end of life, and discharge planning could be reallocated to other areas. Although many patients improved from a physical standpoint, mental health problems increased. Between 2020 and 2022, demand for mental health services increased exponentially, creating a national mental health crisis, but inequities in insurance coverage existed between physical and mental health care. Finding a mental health provider became an almost impossible task. This author sought to address insurance inequity and increased demand for mental health services by offering cognitive behavioral therapy (CBT) sessions to adults with CF to optimize their health andwellbeing. CBT is considered an evidence-based approach for most mental health problems. Method(s): Eight adults at the Stanford Adult CF Center were referred for CBT with social work from August 2021 to April 2022. Referrals were based on mental health crisis, mental health screenings, insurance barriers, and availability of mental health providers. Therapy sessions were offered via telehealth as part of the multidisciplinary care at the CF center. Patients were not billed for the sessions. The number of sessions was variable, with a mean of 10.5 sessions per patient. The frequency and content of sessions were tailored to patients' unique needs. Referrals were accepted on a continuous basis, space available. Mental health problems included anxiety, depression, alcohol use disorder, trauma, and gender dysphoria Results: All eight patients receiving CBT demonstrated significant improvement in mental health symptoms, as evidenced by a mean reduction in Patient Health Questionnaire-9 score of 3 and General Anxiety Disorder-7 score of 3.3. (Six of 8 patients were screened before and after therapy.) Other measures of improvement were patient selfreport as documented in therapy notes, sessions being tapered or discontinued as goals were met, and reduction in or stoppage of psychotropic medications. Conclusion(s): Mental health is a vital component of health and should be properly addressed as part of CF care. Although mental health care in CF has come a long way, patients continue to lack proper access to trained providers, especially those with expertise in CBT and CF. Given the current mental health crisis and shortage of therapists to meet newdemands, there are serious implications for long-term health outcomes for people with CF. As more studies are published demonstrating the effectiveness of CBT and other forms of therapy in the CF population, CF providers can adapt roles to implement new interventions in addressing mental health problems as part of CF care rather than referring patients to community providers who often are poorly positioned to meet their needs. The Stanford CF program will continue to use social work role to provide mental health servicesCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

Accessibility and Financial Barriers in the Utilization of Alternative to Discipline Programs in the United States

Nurses are facing increased mental health issues, substance use, and even suicide since the novel coronavirus pandemicarrived in the United States. Nurses with substance use disorder (SUD) may enroll in alternative-to-discipline (ATD)programs to retain their license during initial treatment with the goal to return to practice, but this process is not withoutchallenges. For example, previous analyses have shown that the time surrounding disciplinary/regulatory process regardingsubstance use disorder (SUD) by either employers or licensure boards was a trigger for nurses who died by suicide. Internetsearches are a common approach to find information on health-related topics. This limited critical review sought toreplicate and evaluate a simple internet search that a nurse seeking information on their state ATD program may complete.Google searches for information on ATD programs were completed on the 50 continental states and Washington, DCbetween April and September 2022. States with ATD programs were evaluated for evidence-based components andbarriers to accessing program information. Publicly available ATD program information ranged from requirements forcontact information to obtain details to websites that outline the entire program, including associated costs. While ATDprograms offer a significant improvement over traditional disciplinary responses to nurse substance use, a significantbarrier is program cost, which can often exclude participation. In this article, we discuss the detailed results of our criticalreview and offer implications for practice that include opportunities for research and a national database to track ATDprogram components and target outcomes to support return to practice for nurses with SUDs © 2023, Online Journal of Issues in Nursing.All Rights Reserved.

The americans with disabilities act, addiction, and recovery

The Americans with Disabilities Act (ADA) is sweeping civil rights legislation that affords people with disabilities equality of opportunity, economic self-sufficiency, independent living, and full participation in daily life. The protections of the ADA extend to individuals with alcohol and substance abuse disorders who are in recovery.The objective of this article is to understand the ADA's definition of disability and how it applies to addiction and recovery. The reader will recognize how the ADA applies to people with addiction to alcohol and those in recovery from substance abuse. The article will describe the rights and responsibilities employers and employees have in the three stages of employment.The material in this presentation was developed based on the authors' research, training, education, knowledge, and skill of the ADA.Individuals in recovery are often unaware of their civil rights under the ADA. The ADA ensures that people with disabilities, including those with alcohol use disorder and substance use disorders, have the same rights and opportunities in the workplace.The COVID-19 pandemic has resulted in an increase in increased rates of alcoholism and substance abuse. Individuals living with addiction are unaware of the employment protections they may have under the ADA. Title I of the ADA guarantees employment protections to ensure equality in the workplace for people with disabilities. A clearer understanding of the law will ensure that job seekers and employees are treated in an ethical, valued, and courteous way when disclosing disability and the need for accommodation. [ FROM AUTHOR] Copyright of Journal of Vocational Rehabilitation is the property of IOS Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Context of SARS-COV- 2 contamination of health care workers in a Tunisian academic hospital

Background: Since the emergence of SARS-CoV- 2 in China, health care workers have been identified as being at risk of contracting Covid-19. Objective(s): To describe the exposure situations of healthcare workers affected by SARS-CoV- 2. Method(s): A questionnaire was established and filled in by healthcare workers practicing at the Sahloul University Hospital of Sousse-Tunisia, who were diagnosed with COVID-19 during the period from September 1, 2020 to December 31, 2020. Data were collected on activity, type of tasks performed, wearing of protective equipment, and existence of possible contacts with cases (professional or extra-professional), in the 2 weeks preceding the date of symptom onset. Result(s): A total of 188/287 infected healthcare workers responded to the questionnaire. The gender and age distribution of the respondents showed a sex ratio of 0.34 and an average age of 41 years. Paramedical staff represented 63% of the participants. Among the infected caregivers, 16 (8.5%) had not worked during the 15 days preceding the symptoms. There were 69 (36.7%) professionals who worked in the Covid sector. The rate of use of a FFP2 mask for the most risky tasks varied greatly according to the sector of practice. Concerning hydro-alcoholic solutions, 58.5% of the workers stated that they had them as often as necessary. Other exposure situations outside of direct patient care were reported by these infected workers: 20.4% reported at least one contact without a mask with one or more caregivers with a confirmed Covid-19 infection, and 32.4% reported contacts with suspected or confirmed cases of Covid-19 infection outside of their professional activity. Conclusion(s): The context of contamination of healthcare workers seems to be essentially professional. The nonuse of protective masks, particularly in non-COVID sectors, as well as the role of contamination between caregivers at their workplace seem to be important determinants of healthcare workers' contamination.

Hypofibrinogenemia in a Patient with Cardiogenic Shock, Left Ventricular (Lv) Thrombus, Covid-19, and Severe Liver Injury: A Case Report of Complex Decision Making in the Setting of Multiorgan Failure with Unclear Causality

Background We present a case of a young male with new severe cardiomyopathy requiring critical care within 24 hours. Case A Latino male with alcoholism was admitted for COVID and severe liver injury due to alcohol-induced hepatitis. Within hours, he developed hypoxia, worsening metabolic acidosis with undetectable bicarbonate level and partial respiratory compensation, coagulopathy, acute kidney injury, right lower lobe infiltrates without pulmonary embolism. Reduced ejection fraction heart failure at 15-20% with a large left ventricle apical thrombus was also found. Worsening signs of cariogenic shock despite sustaining normal blood pressure was identified on a physical exam. The patient was transferred to ICU with confirmation of cardiogenic shock with right ventricular failure with Swan-Ganz Catheter. With Concern for impending fulminant liver failure, transfer to a tertiary care center for emergent liver transplant was initiated. Decision-making The dichotomy of requirement for anti-coagulation for LV thrombus with cardiogenic shock and worsening coagulopathy due to liver failure was a challenge. Decision was made to transfuse blood products as needed with goal fibrinogen of 150 mg/dl, later changed to 100-120 mg/dl with heparin. Liver enzymes were down-trending, but it was difficult to determine if this was due to recovery or worsening of liver failure with stabilization of hemodynamics. While awaiting transfer, he developed acute cerebrovascular accident requiring emergent mechanical thrombectomy of a left MCA occlusion with suspension of heparin complicated by acute large intraventricular and intraparenchymal hemorrhage with rapid decline in neurological function. The family declined decompressive craniotomy with evacuation of parenchymal hemorrhage and the patient was transitioned to comfort care measures. Conclusion There are no clear guidelines for transfusion of plasma-based blood products in the setting of cardiogenic shock and liver disease. Expert opinion recommends maintaining fibrinogen levels above 100-200 mg/dl, however, this is in the setting of acute blood loss and is not studied in patients with liver disease. Further studies are needed.Copyright © 2023 American College of Cardiology Foundation

The medicine of mercy: Preaching on addiction in the field hospital Parish

In the height of the COVID-19 pandemic, statistics related to the ongoing crisis of addiction in the United States hit record levels. Those statistics include drug overdose deaths, rates of substance use and misuse, and alcohol-related fatalities. Some Christian denominations and individual congregations, including a handful of Roman Catholic parishes, have sought to respond to the suffering experienced by those in active addiction through intentional ministries of care, support, and community. Yet preaching on the topic of addiction-and the hope found in recovery-remains rare in churches on Sunday morning. This thesis explores the complex and confounding realities of addiction, its causes, and multiple pathways to recovery, while articulating an urgent and salient call for Roman Catholic priests and deacons to address the crisis of addiction in their midst. The primary ministerial intervention for the thesis consisted of a one-day workshop for Roman Catholic priests and permanent deacons in Minnesota. Pre-workshop interviews were conducted with two cohorts: ten priests and permanent deacons in active ministry (Cohort One), and ten practicing Catholics in recovery from addiction (Cohort Two). The interviews considered whether preaching on the topic of addiction and recovery was taking place in Roman Catholic parishes around the country and what might be most helpful or harmful for people in recovery or in active addiction to hear from preaching in their parishes. Chapter 1 introduces the thesis project overall.Chapter 2 considers addiction theologically, focusing on three areas of study: sacramentality;sin, grace, and the unconditional love of God;and trauma-informed or trauma-sensitive theology. Chapter 3 explores the importance of story, specifically in the salvific and life-giving tradition of twelve-step storytelling and in the inductive practice of narrative preaching in the style of the New Homiletic. Chapter 4 provides a detailed exploration of addiction, considering clinical diagnostic criteria, neurological and sociological research, and current trends regarding the prevalence of stigma and challenges to achieving recovery for many. The chapter also considers multiple pathways to recovery, including twelve-step programs focused on abstinence, harm reduction strategies, and natural recovery methods. Chapter 5 reports on the ministerial intervention and provides key findings from the research conducted. Chapter 6 considers next steps and offers final conclusions. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Successful ingredients of effective Collaborative Care programs in low- and middle-income countries: A rapid review

Integrating mental health care in primary healthcare settings is a compelling strategy to address the mental health treatment gap in low- and middle-income countries (LMICs). Collaborative Care is the integrated care model with the most evidence supporting its effectiveness, but most research has been conducted in high-income countries. Efforts to implement this complex multi-component model at scale in LMICs will be enhanced by understanding the model components that have been effective in LMIC settings. Following Cochrane Rapid Reviews Methods Group recommendations, we conducted a rapid review to identify studies of the effectiveness of Collaborative Care for priority adult mental disorders of mhGAP (mood and anxiety disorders, psychosis, substance use disorders and epilepsy) in outpatient medical settings in LMICs. Article screening and data extraction were performed using Covidence software. Data extraction by two authors utilized a checklist of key components of effective interventions. Information was aggregated to examine how frequently the components were applied. Our search yielded 25 articles describing 20 Collaborative Care models that treated depression, anxiety, schizophrenia, alcohol use disorder or epilepsy in nine different LMICs. Fourteen of these models demonstrated statistically significantly improved clinical outcomes compared to comparison groups. Successful models shared key structural and process-of-care elements: a multi-disciplinary care team with structured communication;standardized protocols for evidence-based treatments;systematic identification of mental disorders, and a stepped-care approach to treatment intensification. There was substantial heterogeneity across studies with respect to the specifics of model components, and clear evidence of the importance of tailoring the model to the local context. This review provides evidence that Collaborative Care is effective across a range of mental disorders in LMICs. More work is needed to demonstrate population-level and longer-term outcomes, and to identify strategies that will support successful and sustained implementation in routine clinical settings. Copyright © The Author(s), 2023. Published by Cambridge University Press.

Effect of Alcohol Intoxication in the Emergency Department on Suicide Mortality

Introduction: Suicide represents a significant worldwide disease burden disproportionately affecting younger patients in their prime working years. Mortality by suicide remains within the five leading causes of death up to the age of 60. Compounding this, alcohol use disorder (AUD) is known to be a risk factor for death by suicide and has been on the rise over the last 20 years, particularly during the COVID-19 pandemic. The emergency department (ED) is often the first point of health care contact for those patients that have suicidal thoughts or behaviours and understanding their acute risk of death by suicide when presenting intoxicated with alcohol remains a challenge for ED physicians. While the chronic disease of AUD elevates their lifetime risk for death by suicide, it has not been established how a presentation for suicidality accompanied by acute alcohol intoxication affects this risk. Method(s): This was a retrospective cohort study using population-based linked health administrative data for adult patients aged 18 or above who presented to Alberta (ED) between 2011 and 2021 for suicidal attempt or self-harm behavior. Patients who were acutely intoxicated with alcohol were identified and analyses compared patients with and without alcohol intoxication. The primary outcome was six-month death by suicide. Categorical variables were summarized using proportions, whereas continuous variables were summarized using means and standard deviations (SD) or medians and interquartile ranges (IQR), as appropriate. Competing risk analysis was performed to explore the cumulative incidence of death by suicide within 180 days after their index ED visit and examine the association between death by suicide and alcohol intoxication. Result(s): Patients presenting to the ED for suicide attempt or self-harm behaviour were intoxicated with alcohol in 30% of cases as determined by diagnostic coding and blood alcohol measurements. Intoxicated patients were more likely to be placed under involuntary mental health hold (26% vs 16%) and had on average a longer length of stay in the ED (411 min vs 277 min) but were less frequently admitted (10.8% vs 15.4%). As a departure from previous literature, those intoxicated with alcohol were more likely to be consulted to psychiatry (15.8% vs 12.6%). Mortality due to suicide in the 6 months following the patient' index ED visit were similar between the intoxicated and non-intoxicated groups (0.3% vs 0.3%) however there was a significant increase in all-cause mortality at 6 months in the nonintoxicated group (1.5% vs 2.1%). Discussion(s): This study examined the patient and ED treatment characteristics of patients presenting to the ED with suicide attempt or self-harm behaviour. It found that the 6-month risk of death by suicide was no different in those who presented with acute alcohol intoxication vs those without. While these results differ from other studies discussing how alcohol use disorder confers a chronically increased risk of death by suicide, they provide new evidence for the emergency department providers to consider when assessing the patient who presents with suicidal behaviours while intoxicated.

Screening Older Adults for Alcohol Use

The number of older adults engaging in unhealthy alcohol use is on the rise, and this trend is expected to continue as the population ages. However, the likelihood a provider will ask an older adult about their alcohol use decreases with age. Geriatric screening tools take into account the particular features of alcohol use in older adults, but minimal research and guidance are available regarding the best method for screening. Lack of knowledge and time are significant obstacles to adequate assessment. Simply asking about alcohol consumption may be the best approach to evaluate the drinking habits of older patients.

Prevalence of alcohol consumption in most at-risk groups in Iran: a systematic review and meta-analysis

Many studies have assessed the prevalence of alcohol consumption in Iran. In this study, we investigated the prevalence of alcohol consumption in different groups. We searched international and databases including PubMed, Web of Science, Scopus and we searched two main Farsi-language index databases including Scientific Information Database (SID) and the Irandoc. Grey literature search was also performed in Google Scholar, PsycINFO, ProQuest Dissertation and Theses without time limit until June 2020. All studies that reported the prevalence of alcohol consumption among Iranians were included in current study. From 9,038 screened studies, 109 studies with 925,480 participants were included. The pooled prevalence of alcohol consumption was estimated 24% (95% CI: 18.0–31.0), 12% (95%CI: 10.0–14.0), 14% (95%CI: 13.0–15.0), 19% (95%CI: 13.0–26.0), 15% (95%CI: 3.0–28.0) among prisoners, general population, students, drivers, and street children, respectively. This systematic review indicated higher prevalence of alcohol consumption in prisoners, drivers, and street children than the general population and other subgroups. The distribution of the alcohol prevalence studies in different groups and provinces were heterogeneous. The lack of studies among some groups and in regions warrants further, attention.