Outcomes for a Public Hospital Tobacco Cessation Program: The Cook County Health and Hospitals System Experience.

The objective of this study is to determine the rate and predictors of sustained smoking cessation for a cohort of smokers exposed to a guideline-based health education program delivered during routine clinical care at an urban public hospital. This is a retrospective analysis of 755 public hospital system patients who had at least two health educator contacts embedded in routine clinical care, with the latter contact 12-18 months after the baseline. The education occurred during visits to primary care, specialty clinics, urgent/episodic care, or during hospitalization. The assessment of smoking status is determined by the health educators as part of their routine assessment and recorded in the program's database. The primary outcomes are self-reported 12-month sustained smoking cessation at the 12-18 month contact and predictors of cessation. The cohort is predominantly minority smokers (African American 69 % and Latino 15 %) and uninsured (70 %) or on Medicaid (13 %). The sustained cessation rate was 9.3 %. Latino ethnicity, smoking 1-9 cigarettes/day at baseline, reporting smoke-free home, and additional educator contact in the year after the baseline were independent predictors of sustained cessation in the multivariate analysis. Smokers with multiple risks for poor cessation outcomes exposed to a guideline-based program of health education during routine healthcare encounters had sustained smoking cessation rates that compare favorably with published National Health Interview Study population cessation rates. An additional educator contact after the baseline was a predictor of cessation. The findings support development of cessation programs in which health educators are integrated into clinical care settings.

Medical diagnoses associated with substance dependence among inpatients at a large urban hospital.

BACKGROUND: There are limited data on reasons for hospital admission among patients dependent on substances other than alcohol. We compared primary discharge diagnoses for heroin- or cocaine-dependent patients to non-dependent patients. MATERIAL AND METHODS: We evaluated a cohort of patients admitted to a general medicine service at a public teaching hospital during July 2005-June 2008. Through bedside interviews, we identified patients who had substance-use disorders. We categorized patients by substance used, route of administration, and dependent or non-dependent use. We grouped diagnostic codes (i.e., ICD-9) using Healthcare Utilization Project categories. We excluded HIV-infected patients. RESULTS: Of 11,397 patients, 341 (3.0%) were dependent on inhalational heroin, 260 (2.3%) on non-injection cocaine, and 106 (0.9%) on injection heroin. Compared to non-dependent patients, inhalational heroin-dependent patients were over three-fold more likely to have been admitted for respiratory diseases (28% vs. 8%, p<0.01); this association was strongest for asthma exacerbation (OR=7.0; 95% CI, 4.7 to 70.4, p<0.01). Of the 225 admissions for an asthma exacerbation, 44 (19.6%) had co-occurrent heroin-dependence. The most frequent diagnostic category among cocaine-dependent patients was circulatory, which was similar to non-dependent patients (22% vs. 21%, p=0.92). DISCUSSION: There is a strong association between heroin dependence and hospital admission for an asthma exacerbation. Provision of specialized substance-use treatment for inhalational heroin users will be necessary to reduce the frequency of exacerbations and repeat hospital admissions.

Residential mercury spills from gas regulators.

Many older homes are equipped with mercury-containing gas regulators that reduce the pressure of natural gas in the mains to the low pressure used in home gas piping. Removal of these regulators can result in elemental mercury spills inside the home. In the summer of 2000, mercury spills were discovered in the basements of several Chicago-area homes after removal of gas regulators by gas company contractors. Subsequent inspections of approximately 361,000 homes by two northern Illinois gas companies showed that 1,363 homes had residential mercury contamination. Urine mercury screening was offered to concerned residents, and results of urine bioassays and indoor mercury air measurements were available for 171 homes. Six of these 171 homes (3.5%) had a cumulative total of nine residents with a urine mercury > or = 10 microg/L. The highest urine mercury concentration observed in a resident was 26 microg/L. Positive bioassays were most strongly associated with mercury air concentrations > 10 microg/m3 on the first floor [odds ratio (OR) = 21.4 ; 95% confidence interval (CI) , 3.6-125.9] rather than in the basement (OR = 3.0 ; 95% CI, 0.3-26) , and first-floor air samples were more predictive of positive bioassays than were basement samples. Overall, the risk of residential mercury contamination after gas regulator removal ranged from 0.9/1,000 to 4.3/1,000 homes, depending on the gas company, although the risk was considerably higher (20 of 120 homes, 16.7%) for one of the contractors performing removal work for one of the gas companies. Gas companies, their contractors, and residents should be aware of these risks and should take appropriate actions to prevent these spills from occurring and remediate them if they occur.

Use of a national reporting system for occupational injuries in Costa Rica.

Occupational injury surveillance in developing countries may be hindered by the lack of health data infrastructure as well the large numbers of informal-sector workers. The goal of this study was to elucidate the scope of occupational injury in the Monteverde district of Costa Rica using data collected through the national workers social security system. A list of occupational injuries occurring in the district reported to the National Insurance Institute (INS) central office between 1998 and 2002 was taken to the regional INS office, and the original injury reports for the cases were pulled. Specific data on the injuries were collected. There were 184 injuries reported during the five year period. Occupations with the highest number of injuries included production, building and grounds maintenance, and agricultural/forestry/fishing. Descriptive data showed that prevention efforts in this rural region should target food manufacturing, hotels, and construction.

Heroin insufflation as a trigger for patients with life-threatening asthma.

STUDY OBJECTIVES: To determine the prevalence of self-reported, heroin-associated asthma symptoms among inner-city patients treated for life-threatening asthma, and to compare the rates of drug use between ICU patients with asthma and ICU control patients with diabetic ketoacidosis (DKA). DESIGNS: Study 1 was a sequential case series of patients requiring ICU admission for asthma (January to June 1999). Study 2 was a retrospective, case-control study of drug use among asthma patients and control subjects with DKA requiring ICU care (1997 to 1998). SETTING: Inner-city, public hospital ICU. PATIENTS: Twenty-three patients (26 ICU admissions) with asthma (age range, 16 to 50 years) admitted to the ICU from January to June 1999, and 84 patients (104 ICU admissions) with asthma and 42 patients with DKA (age range, 15 to 50 years) admitted to the ICU during 1997 to 1998. Outcomes studied: Self-reported, heroin-associated exacerbations, history of heroin or cocaine use, and urine drug screen (UDS) results. MEASUREMENTS AND RESULTS: In the sequential ICU admissions, 13 of 23 patients (56%) described asthma exacerbations associated with heroin insufflation. In the case-control study, asthmatics were significantly more likely to report heroin use (41.3% vs 12.5%; p = 0.006) and had a significantly higher prevalence of UDS results positive for opiates (60% vs 7%; p = 0.001) compared to subjects with DKA. The rates of cocaine use by history and UDS results did not differ significantly between the two groups. CONCLUSIONS: At least since 1997, heroin insufflation is a common asthma trigger in this inner-city ICU and should be considered in the care of patients with life-threatening asthma.