Smoking cessation is associated with lower rates of mood/anxiety and alcohol use disorders.

BACKGROUND: The psychological outcomes that accompany smoking cessation are not yet conclusive but positive outcomes could help to persuade quitting. METHOD: We used data from the longitudinal National Epidemiological Study of Alcohol and Related Conditions. Logistic regression was used to examine associations between cigarette smoking reduction and Wave 2 status of addiction/mental health disorder among daily smokers at Wave 1, stratified by status of the diagnosis of interest at Wave 1. We adjusted for differences in baseline covariates between smokers with different levels of smoking reduction between Wave 1 and Wave 2 using propensity score regression adjustment. RESULTS: After adjusting for propensity scores and other mental health/addiction co-morbidities at Wave 2, among daily smokers who had current or lifetime history diagnosis of the outcome of interest at Wave 1, quitting by Wave 2 predicted a decreased risk of mood/anxiety disorder [adjusted odds ratio (aOR) 0.6, 95% confidence interval (CI) 0.4-0.9] and alcohol disorder (aOR 0.7, 95% CI 0.5-0.99) at Wave 2. Among daily smokers with no lifetime history diagnosis of the outcome of interest at Wave 1, quitting smoking by Wave 2 predicted a decreased risk of drug use disorder at Wave 2 (aOR 0.3, 95% CI 0.1-0.9). CONCLUSIONS: There is no support in our data for the concern that smoking cessation would result in smokers' increased risk of some mental disorders. To the contrary, our data suggest that smoking cessation is associated with risk reduction for mood/anxiety or alcohol use disorder, even among smokers who have had a pre-existing disorder.

Reengineering and improving the information-intensive work of patient tracking for inpatients and outpatients.

This article describes a CQI-driven effort to reengineer the tracking procedures for both inpatients and outpatients, refined to the extent that they have been identified as "best practices." The goal was to shift the work paradigm from a departmental focus to one that accepts work as a network of processes, but also to prepare for the new era of the electronic medical record, moving computer record keeping far closer to the point of care, requiring more precise recording of patient location.

Evaluation of a hospital admission HIV antibody voluntary screening program.

Voluntary screening for the presence of human immunodeficiency virus (HIV) is recommended by the healthcare profession. The optimal settings to accomplish screening have not been established. We evaluated an admission HIV screening program in a large private hospital to assess advantages and disadvantages in this setting. In a three-month study period, 4,535 of 8,868 patients (51%) admitted to the hospital agreed to HIV testing. Serum specimens from 500 patients who refused testing were blindly, anonymously tested. The seroprevalence of the patients agreeing to (0.26%) and refusing (0.60%) testing was not statistically different (p = .12). There were 12 HIV cases discovered; ten (83%) of these were known to be in a high-risk group at the time of admission. Eighty-five percent of patients interviewed were in favor of this screening program. Difficulties associated with confidentiality or consent were not evident. Calculated charges of testing for each HIV case discovery was $14,550. There was no evidence that this screening program provided for a more effective infection control policy to prevent nosocomial HIV transmission. A hospital admission HIV screening program can be implemented, can meet with favorable patient opinion and can detect previously unknown HIV-positive patients. Hospitals are an efficient and practical setting for HIV testing. The benefit of this program appears to be greater for the patient than hospital or healthcare worker. Cost-benefit analyses will identify optimal candidates to be screened in different hospital populations.

Distribution of Ehrlichia canis among military working dogs in the world and selected civilian dogs in the United States.

Antibodies to Ehrlichia canis were detected by indirect immunofluorescence in sera from 233 of 2,077 (11%) military working dogs in various locations throughout the world and from 535 of 938 (57%) civilian dogs in the United States during a 1-year period of study. Overall, E canis infection rates ranged from 13% in the tropical and temperate zones below 45 degrees N to 8% in the cold zone north of 45 degrees N latitude. The highest antibody prevalence rate (24%) was found among a select population of dogs stationed between 40 degrees and 45 degrees north latitude (Japan and Okinawa). The seropositive military dogs did not have clinical signs of ehrlichiosis, thus indicating that the predominant form of infection was subclinical. On the other hand, 216 (23%) of the seropositive civilian dogs had various signs of the disease. The difference was attributed to the fact that the sera from civilian dogs were submitted by practitioners who suspected the disease.