Evaluation of smoking cessation practice by physicians for hospitalized patients in a tertiary hospital.

OBJECTIVE: To investigate physicians' smoking cessation practice, consultation for smoking intervention for hospitalised patients and its determinants. METHODS: The cross-sectional study was conducted at Duzce University Hospital, Duzce, Turkey, from January to April 2013, and comprised hospitalised patients. The survey, including smoking habits and 5As (Ask, Advise, Assess, Assist and Arrange) steps of smoking intervention practiced by physicians was applied to those patients discharged from the hospital. SPSS 20 was used for statistical analysis.. RESULTS: Of the 502(31.6%) participants, 264(52.6%) were women and 238(47.4%) were men. The overall mean age was 52.8±18.2 years. Besides, 269(53.6%) respondents were at the level of elementary school education; 289(57.6%) had chronic disease; 119(23.7%) were current and 106(21.1%) were former smokers. The frequency of current smokers among men with chronic disease was significantly lower compared to those who did not have chronic disease (p=0.017). In women, the factor was insignificant (p=0.642). The physicians practiced the steps of "Ask, Advise, Assess, Assist and Arrange" on 354(70.5%), 240(47.9%), 194(38.7%), 88(17.6%) and 29(5.8%) patients for active smoking. Consultation during hospitalization significantly increased patient's effort to quit smoking after discharge (p=0.012). CONCLUSIONS: Smoking intervention by physicians for hospitalised patients was associated with the status of patient's gender, education level and chronic disease.

Investigation of relationship of visceral body fat and inflammatory markers with metabolic syndrome and its components among apparently healthy individuals.

Metabolic syndrome is a cluster of disorders and great risk for cardiovascular diseases. We aimed to investigate association between severity of metabolic syndrome (MetS) and anthropometric measurements, and to evaluate correlation of MetS and its components with metabolic deterioration and inflammatory indexes. The cross-sectional study enrolled 1474 patients with obesity and overweight. The patients were grouped as MetS and Non-MetS, and were sub-grouped as group 1 (three criteria), 2 (four criteria) and 3 (≥ five criteria) according to NCEP ATP III. Mean age was 38.7 ± 11.9 years and BMI was 35.1 ± 6.3 kg/m(2). Lipid profile, anthropometric and blood pressure measurements, liver function tests, bioelectric impedance body fat compositions, insulin resistance and HbA1c, and spot urinary albumin-creatinine ratio were significantly different between groups of MetS and Non-MetS. Age, lipid profile, bioelectric impedance fat analyses, BMI, blood pressure values, glucose, insulin resistance, uric acid and hs-CRP levels were significantly different between groups of MetS component groups. ROC analysis revealed that hs-CRP was found to be more predictive for severity of metabolic syndrome components 3 and 4 (P=0.030); uric acid and visceral fat were more actual to predict severity of metabolic syndrome between 3 and 5 MetS components, (P=0.006) and uric acid was detected as more actual to predict severity of MetS between 4 and 5 components (P=0.023). In conclusion, uric acid, hs-CRP and visceral body fat composition were useful to predict to severity of MetS in primary care.

Comparison of smoking habits, knowledge, attitudes and tobacco control interventions between primary care physicians and nurses.

BACKGROUND: Primary care providers are uniquely positioned to initiate smoking cessation. We aimed to evaluate knowledge levels about the health effects of smoking and attitudes toward smoking and tobacco control activities among primary care providers. METHODS: In the cross-sectional and primary care-based study, self-administered surveys modified from the WHO Global Health Professional Survey 5A steps of smoking cessation practice (Ask, Advise, Assess, Assist and Arrange) were provided to primary care physicians (PCPhs) and nurses (PCNs). RESULTS: Respondents included 1182 PCPhs and 1063 PCNs. The proportions of current and former smokers were significantly higher among PCPhs than among PCNs (34.4 vs. 30.7 % and 14.0 vs. 10.1 %, respectively; both P < 0.001). We observed that 77.2 % of PCPhs and 58.4 % of PCNs always or rarely practiced an "Ask" step about their patients' smoking status (P < 0.001). One-third of PCPhs (33.8 %) stated that they always practiced an "Ask" step, whereas only 27.6 % of PCNs always did so in their practice (P < 0.001). A small minority of primary care providers had advised patients to quit smoking, although there was a significant difference in this between PCNs and PCPhs (8.4 vs. 15.6 %; P < 0.001). Most PCPhs considered themselves competent in advising about smoking interventions, but only a minority of PCNs did so (75.1 vs. 17.3 %; P < 0.001). Among barriers to tobacco intervention measures, lack of time was the item most commonly cited by PCPhs, whereas low patient priority was most commonly cited by PCNs (35.9 and 35.7 %; P < 0.001). CONCLUSIONS: Smoking intervention practice by primary care nurses was quite low. Lack of time and low patient priority were identified as barriers by primary care providers. Strategies by which primary care providers could improve tobacco control should be established.

Is the neutrophil-to-lymphocyte ratio indicative of inflammatory state in patients with obesity and metabolic syndrome?

OBJECTIVE: Obesity causes subclinical inflammation. Leukocyte count and high-sensitivity C-reactive protein (hs-CRP) are used to indicate inflammation in clinical practice. Also, inflammatory markers are evaluated as important indicators of cardiovascular risk in patients with obesity and metabolic syndrome (MetS). We aimed to investigate the usage of the neutrophil-lymphocyte ratio (NLR) as an inflammatory marker in obese patients with and without MetS. METHODS: The study included a total of 1267 patients. The patients were assigned groups according to degree of obesity and status of MetS. Metabolic and inflammatory markers were compared between groups, and correlation analysis was performed. RESULTS: Leukocyte count and hs-CRP were significantly different (p<0.001), but NLR was not different between body mass index (BMI) groups (p=0.168). Both lymphocyte and neutrophil counts were significantly increased with increased degree of obesity (p<0.001, p=0.028, respectively). Leukocyte, neutrophil, and lymphocyte counts and hs-CRP level showed a significant correlation with BMI (r=0.198, p<0.001; r=0.163, p<0.001; r=0.167, p<0.001; r=0.445, p<0.001, respectively), whereas NLR was not correlated with BMI (r=0.017, p=0.737). Only a significant association between a MetS severity of 5 and 4 with hs-CRP level was observed (p=0.028), whereas there was no statistically significant association for leukocyte count and NLR (p=0.246; p=0.643, respectively). CONCLUSION: NLR was not a good indicator of inflammation, while leukocyte and hs-CRP were more useful biomarkers to indicate inflammation in non-diabetic patients with obesity and MetS.

Effects of the degree of obesity on achieving target blood pressure and metabolic deterioration in obese individuals: a population-based study.

BACKGROUND/AIMS: This study aimed to evaluate the severity of obesity and its impact on achieving target blood pressure and metabolic derangement in obese individuals. METHODS: This cross-sectional and population-based study was conducted between January and December 2012. A total of 1837 consecutive obese patients admitted to our outpatient clinic were enrolled. The anthropometric and blood pressure measurements, bioelectrical impedance fat analysis, blood sample analysis, impaired glucose status, metabolic syndrome, and insulin resistance of 1265 obese patients were compared between groups of patients separated by severity of obesity. RESULTS: Only approximately one-third of patients with previous hypertension achieved normal blood pressure. In addition, the majority of patients without previous hypertension had higher blood pressure at the end of the study compared with baseline. The percent of patients with an impaired fasting blood glucose ≥100 mg/dL was 38.5%. The frequency of impaired glucose tolerance was 39.1% in the patients who underwent OGTT Body mass index (BMI) was associated with impaired blood glucose, hypertension, insulin resistance, and the development of metabolic syndrome. The incidences of metabolic syndrome, insulin resistance, impaired glucose tolerance, and uncontrolled blood pressure were significantly different between groups of differing obesity severity (p<0.001, p<0.001, p=0.041, and p<0.001, respectively). CONCLUSION: The severity of obesity was associated with the failure to achieve target blood pressure and metabolic syndrome. Based on our data, blood pressure and metabolic parameters in obese patients should be monitored frequently and treated with caution.