Impediment profiling for smoking cessation: application in the worksite.

PURPOSE: To replicate results of a pilot smoking cessation study and demonstrate applicability to a worksite setting. METHODS: Smokers employed by a community hospital participated in an onsite smoking cessation program. Participants used an "impediment profiling" instrument to rate personal barriers to cessation and were assigned to between one and seven interventions. Cessation was defined as carbon monoxide concentration in expired air of < or = 10 ppm. RESULTS: Fifty-one employees participated. Subjects lost to follow-up were assumed to be smoking, resulting in a 39.2% 1-year quit rate; 47.5% of program completers (n = 40) were smoke-free at 1 year. Self-reported quit rate at 2.5 years was 25.5% (17 lost to attrition assumed to be smoking) with 38.2% of program completers smoke-free. DISCUSSION: This study suggests that impediment profiling holds promise far smoking cessation and demonstrates feasibility in a worksite setting. Further evaluation of this intervention in the context of randomized controlled trials is warranted.

Repeated serum lipid measurements during the peri-hospitalization period.

The early treatment of hyperlipidemia in hospitalized patients confers potential benefit, yet total cholesterol is known to vary with acute illness, often delaying treatment decisions. A prospective study was conducted of 61 patients (mean age 57 years; 49% women) admitted to an acute care community hospital with various diagnoses with random nonfasting lipid profile measurements at admission, followed by second fasting lipid profile measurements on day 3 of hospitalization or upon discharge (whichever occurred first), and final fasting lipid profile measurements 4 weeks after discharge. All individual values of the lipid profile decreases at discharge, whereas the ratios of total cholesterol to high-density lipoprotein (HDL) and of low-density lipoprotein (LDL) to HDL did not change significantly. The 95% confidence interval around the total cholesterol/HDL ratio for each patient was within the same National Cholesterol Education Program Adult Treatment Panel III treatment recommendation category 42.6% of the time, whereas corresponding intervals for total cholesterol and LDL were within a single treatment category only 6.6% of the time. The total cholesterol/HDL ratio was significantly more consistent with regard to treatment implications than LDL or total cholesterol (p <0.0001). In conclusion, serum lipid values vary significantly during and after a hospital stay, whereas the ratio of total cholesterol to HDL remains relatively stable. This ratio may therefore serve as a more reliable basis for early treatment decisions in dyslipidemia.

Egg consumption and endothelial function: a randomized controlled crossover trial.

BACKGROUND: Because of egg cholesterol content, reduction in egg consumption is generally recommended to reduce risk of cardiovascular disease. Recently, however, evidence has been accumulating to suggest that dietary cholesterol is less relevant to cardiovascular risk than dietary saturated fat. This randomized controlled crossover trial was conducted to determine the effects of egg ingestion on endothelial function, a reliable index of cardiovascular risk. METHODS: Forty-nine healthy adults (mean age 56 years, 40% females) underwent a baseline brachial artery reactivity study (BARS), and were assigned to two eggs or oats daily for 6 weeks in random sequence with a 4-week washout. A BARS was done at the end of each treatment phase, measuring flow-mediated vasodilation (FMD) in the brachial artery using a high-frequency ultrasound. RESULTS: FMD was stable in both egg and oat groups, and between-treatment differences were not significant (egg -0.96%, oatmeal -0.79%; p value >0.05). Six weeks of egg ingestion had no effect on total cholesterol (baseline: 203.8 mg/dl; post-treatment: 205.3) or LDL (baseline: 124.8 mg/dl; post-treatment: 129.1). In contrast, 6 weeks of oats lowered total cholesterol (to 194 mg/dl; p = 0.0017) and LDL (to 116.6 mg/dl; p = 0.012). There were no differences in body mass index (BMI), triglyceride, HDL or SBP levels between egg and oat treatment assignments. CONCLUSION: Short-term egg consumption does not adversely affect endothelial function in healthy adults, supporting the view that dietary cholesterol may be less detrimental to cardiovascular health than previously thought.

Oats, antioxidants and endothelial function in overweight, dyslipidemic adults.

OBJECTIVE: To determine effects of oat and antioxidant vitamin (C 500 mg, E 400 IU) ingestion on endothelial function in overweight, dyslipidemic adults. DESIGN: Randomized, blinded, placebo-controlled, crossover trial Intervention(s): Subjects (16 males > or = age 35; 14 postmenopausal females) were assigned, in random order, to oats (60 g oatmeal), vitamin E (400 IU) plus vitamin C (500 mg), the combination of oats and vitamins, or placebo, and underwent brachial artery reactivity scans (BARS) following a single dose of each treatment, and again following 6 weeks of daily ingestion, with 2-week washout periods. At each test, a provocation high-fat meal (50 g, predominantly saturated) was administered and subjects were scanned pre, and 3 hours post-ingestion. RESULTS: Mean flow-mediated vasodilation (FMD; measured as percent diameter change before and after treatments) at baseline was 6.35 +/- 3.37. Oats increased FMD non-significantly (p > 0.05) with both single acute dose (from 6.07 +/- 6.25 to 9.22 +/- 8.82) and six weeks of sustained treatment (from 6.01 +/- 10.07 to 8.69 +/- 8.42). The direction of effect was negative for vitamins and the oat/vitamin combination with both acute and sustained treatment. There were no significant differences in FMD change among the treatments in either phase of the study, however when acute and sustained effects were pooled, oat treatment significantly augmented FMD (p < 0.05). CONCLUSIONS: This trial suggests but does not confirm a beneficial influence of oat ingestion on endothelial function in overweight, dyslipidemic adults. Further study of this potential association is warranted.