Longitudinal decrease in blood oxygenation level dependent response in cerebral amyloid angiopathy

Lower blood oxygenation level dependent (BOLD) signal changes in response to a visual stimulus in functional magnetic resonance imaging (fMRI) have been observed in cross-sectional studies of cerebral amyloid angiopathy (CAA), and are presumed to reflect impaired vascular reactivity. We used fMRI to detect a longitudinal change in BOLD responses to a visual stimulus in CAA, and to determine any correlations between these changes and other established biomarkers of CAA progression. Data were acquired from 22 patients diagnosed with probable CAA (using the Boston Criteria) and 16 healthy controls at baseline and one year. BOLD data were generated from the 200 most active voxels of the primary visual cortex during the fMRI visual stimulus (passively viewing an alternating checkerboard pattern). In general, BOLD amplitudes were lower at one year compared to baseline in patients with CAA (p = 0.01) but were unchanged in controls (p = 0.18). The longitudinal difference in BOLD amplitudes was significantly lower in CAA compared to controls (p < 0.001). White matter hyperintensity (WMH) volumes and number of cerebral microbleeds, both presumed to reflect CAA-mediated vascular injury, increased over time in CAA (p = 0.007 and p = 0.001, respectively). Longitudinal increases in WMH (r_s = 0.04, p = 0.86) or cerebral microbleeds (r_s = − 0.18, p = 0.45) were not associated with the longitudinal decrease in BOLD amplitudes.

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Visual fMRI was performed in CAA and controls at baseline and at one year.

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BOLD response amplitude was lower at one year compared to baseline in CAA.

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BOLD response amplitude decreases were not seen in similarly-aged controls.

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Progressive impairment in vascular reactivity may be a feature of CAA.

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Decreased BOLD response amplitude was unrelated to other CAA-related vascular changes.

Transmission dynamics of hepatitis E virus in pigs: estimation from field data and effect of vaccination

Hepatitis E is a viral disease that causes serious concerns for public health. Hepatitis E virus (HEV) genotype 3 is endemic in commercial pig farms worldwide that act as a reservoir. Pig-to-human transmission may occur when infectious animals enter the food chain at slaughter, through consumption of contaminated meat, direct exposure or use of by-products. To reduce the fraction of infectious animals at slaughter age and thus the risk for public health, it is important to understand the transmission dynamics of HEV in pig populations. In this study, we estimate the transmission rate parameter and mean infectious period of HEV in pigs from field data, using a Bayesian analysis. The data were collected in ten commercial pig herds that are each divided into three different age groups. Two transmission models were compared, assuming that animals are infected either locally by their group mates or globally by any infectious animal regardless of its group. For local and global transmission, the transmission rate parameters were 0.11 (posterior median with 95% credible interval: 0.092-0.14 day(-1)) and 0.16 (0.082-0.29 day(-1)), the mean infectious periods were 24 (18-33) days and 27 (20-39) days and the reproduction numbers were 2.7 (2.2-3.6) and 4.3 (2.8-6.9). Based on these results, global transmission is considered to be the more conservative model. Three effects of vaccination were explored separately. When vaccination is not sufficient to eliminate the virus, a shorter mean infectious period decreases the fraction of infectious animals at slaughter age, whereas a reduced transmission rate parameter adversely increases it. With a reduced susceptibility, vaccination of animals at a later age can be a better strategy than early vaccination. These effects should be taken into account in vaccine development.

Retrospective evaluation of the referral pattern to an oral medicine unit in Ireland

OBJECTIVES

The aims of this study were firstly to examine patient demographics, lesion types and referral sources to Cork University Dental School and Hospital (CUDSH) for oral medicine services and secondly, to indicate factors that could improve the efficiency of the service provided.

METHODS

A retrospective analysis of the clinical records for all new patients, both public and private, seen in the CUDSH oral medicine unit (n = 412) in the calendar year 2007 was undertaken. For each patient the following parameters were recorded: age, gender, residence, referral source and the reason for referral including site of lesion.

RESULTS

The majority of patients were females and the majority of referrals came from general dental practitioners. The most common reason for referral was due to concern about white lesions. Raised soft tissue lesions including epuli and mucocoeles were second and ulceration, including recurrent aphthous and traumatic ulceration, was the third most common reason for referral.

CONCLUSIONS

To our knowledge this is the first study to investigate factors influencing referrals to oral medicine clinics in Ireland. Based on the results presented there appears to be a considerable demand for an oral medicine service dealing with oral lesions and conditions which other practitioners consider to be outside the scope of their practice. Studies of this nature should prove to be valuable in maximising hospital resources at a time when economic factors are leading to increased financial pressure in health care funding.

Impact of chronic oral mucosal disease on daily life: preliminary observations from a qualitative study

OBJECTIVE

To explore the experience of daily life of persons with chronic oral mucosal conditions.

METHODS

  Purposive sampling was used to recruit patients from the Oral Medicine Unit of Cork University Dental School and Hospital. An experienced independent facilitator convened the focus groups and conducted individual interviews in a non clinical setting. Focus groups were mixed with regard to gender, age, chronic oral mucosal condition, time since diagnosis and severity. A total of 24 patients took part, including patients with oral lichen planus, mucous membrane pemphigoid, pemphigus vulgaris, recurrent aphthous stomatitis and orofacial granulomatosis.

RESULTS

  Analysis of the interviews revealed that patient views could be divided into the following themes - biopsychosocial issues, treatment limitations and side effects, unpredictability of the conditions and the potential for malignant transformation and issues for the healthcare professionals.

CONCLUSION

Chronic oral mucosal conditions impact upon the experience of daily life of patients in a variety of areas from physical health and functioning, to concerns about their future. The role of the oral medicine practitioner in treating patients with chronic oral mucosal diseases extends beyond active management and symptomatic relief to the management of all aspects of these conditions that impact upon their daily lives.

Excretion of hepatitis E virus by pigs of different ages and its presence in slurry stores in the United Kingdom

Five faecal samples were collected from four different stages of production at each of 10 pig farms in the Yorkshire Humberside area of the UK, and samples of slurry were collected from nine of the farms. All the samples were tested for hepatitis E virus (HEV) RNA by a nested reverse transcriptase PCR. At least one sample from the pigs on each of the farms tested positive for hev; its prevalence in the 10 herds varied from 5 per cent to 35 per cent and its mean prevalence was 21.5 per cent. The mean prevalence in pigs aged three to five weeks was 26.0 per cent, in pigs aged 10 to 12 weeks 44.0 per cent, in pigs aged 22 to 24 weeks 8.9 per cent, and in adult dry sows 6.0 per cent. Two of the nine slurry lagoons tested positive for HEV RNA. Phylogenetic analysis of the sequence data indicated that the strains of the virus were of genotype 3 and closely related to strains detected in other pigs and in human beings in the UK.

Attitudes of Irish dental, dental hygiene and dental nursing students and newly qualified practitioners to tobacco use cessation: a national survey

BACKGROUND

Ireland has some of the strictest smoking regulations in the world. Little is known of the attitudes of student Irish dental healthcare workers towards tobacco control and tobacco use cessation. This study aimed at determining the knowledge and attitudes of these students towards the deleterious effects of tobacco in the mouth and towards tobacco use cessation in dental practice.

METHOD

A questionnaire survey was distributed to 654 students (including newly qualified) on dentistry, dental hygiene and dental nursing programmes in Irish dental schools. Information sought included college, course, year of study, sex, age, nationality, smoking status, knowledge of effects of tobacco in the mouth and attitudes towards tobacco use cessation in dental practice and towards the Irish smoking bans.

MAIN FINDINGS

There was a 90% response rate. In all, 12% of dental students, 25% of dental hygiene students and 31% of dental nursing students were current smokers. Newly qualified dental hygienists were as knowledgeable about tobacco effects in the mouth as newly qualified dentists. Overall, the majority in each student category believed that all three groups could be effective tobacco counsellors and should provide tobacco use cessation counselling to patients, although less than half of evening course dental nursing students felt that dental nurses could be effective counsellors or should provide counselling. There was overwhelming support for the Irish smoking ban. Only a minority of dental students and dental nursing students had received instruction in tobacco use cessation counselling.

CONCLUSIONS

There are strong positive attitudes to tobacco use cessation counselling in dental practice among these young dental healthcare students. This is true even amongst those who have not received specific instruction in tobacco use cessation counselling.

Waking and sleeping temporalis EMG levels in tension-type headache patients

Temporalis muscle activity in tension-type headache subjects (n = 36) and in matched nonheadache controls (n = 36) was evaluated in this study. Subjects' cumulative temporalis muscle activity was recorded every 30 minutes for 3 days and night using an electromyographic recorder. Analysis of variance showed that neither the waking nor the sleeping overall muscle activity levels for these two groups were statistically different. When the waking EMG data were dichotomized into function and nonfunction activities, a significant difference was found between groups during jaw function (i.e., chewing and talking). These data suggest that headache subjects are using their temporalis muscles with less efficiency than nonheadache subjects during function. This elevated EMG is more likely a consequence of pain (via protective splinting or guarding) rather than a cause in tension-type headache sufferers.

Molecular and phenotypic analysis of Candida dubliniensis: a recently identified species linked with oral candidosis in HIV-infected and AIDS patients

The discovery and characterisation of a novel species of Candida, termed Candida dubliniensis, associated with oral candidosis in HIV-infected individuals is described. These organisms share several phenotypic characteristics in common with Candida albicans and Candida stellatoidea, including the ability to produce germ tubes and chlamydospores. However, in contrast to these latter two species, C. dubliniensis isolates produce abundant chlamydospores, which are often arranged in contiguous pairs, triplets and other multiples suspended from a single suspensor cell. They belong to C. albicans serotype A and exhibit atypical substrate assimilation profiles. Genomic DNA fingerprinting analysis with the C. albicans-specific probe 27A and five different oligonucleotide probes consisting of short repeat sequence-containing motifs, demonstrated that C. dubliniensis has a distinct genomic organisation relative to C. albicans and C. stellatoidea. This was confirmed by karyotype analysis and random amplified polymorphic DNA (RAPD) analysis. Comparison of 500 bp of the V3 variable region of the large ribosomal subunit genes from 14 separate C. dubliniensis isolates and the corresponding sequences from C. albicans, C. stellatoidea, C. tropicalis, C. glabrata, C. parapsilosis, C. kefyr and C. krusei demonstrated that the C. dubliniensis isolates formed a homogenous cluster (100% similarity), representing a discrete taxon within the genus Candida that was significantly different from the other species analysed.

Autopsy findings in the tongues of 20 patients with AIDS

An extensive examination of the tongue was performed at autopsy in 20 consecutive patients who had died with AIDS. Abnormalities in the tongue were detected in 18 (90%) of the cases; the commonest lesions were ulceration (11), candidosis (8) and small foci of hyperkeratosis (10). The most extensive lesions were caused by Aspergillus infection (1), non-Hodgkin's lymphoma juxtaposed with Kaposi's sarcoma (1), herpetic infection (1) and candidosis (5). The disease causing death was identified in the tongue in two cases. There was a surprisingly low prevalence of oral hairy leukoplakia, which may be related to anti-viral or retroviral therapy.

Cross-correlation between stress, pain, physical activity, and temporalis muscle EMG in tension-type headache

Thirty-six tension-type headache subjects and 36 non-headache matched controls recorded their temporalis muscle electromyographic (EMG) activity and their pain intensity, stress and physical activity levels in a daily diary. Measurements were performed every 30 min for 6 days (EMG 3 days only). A time-lagged cross-correlational analysis between pain, stress, physical activity, and EMG shows that the highest correlation coefficient values occurred between pain and stress at the same (r = 0.33) and at the two preceding 0.5 h time points (r = 0.21 and r = 0.26) in the headache group. Virtually no correlation was found between pain, stress, or physical activity with EMG for either group. These data show that temporalis muscle activity levels were not related to the rise and fall of the subjects' pain or stress levels. Conversely, elevated stress appeared to be highly related to pain; it occurs as both an antecedent and simultaneous event with elevated headache pain.

Treatment of Kaposi's sarcoma with liposomal doxorubicin

The efficacy of liposomal doxorubicin for treating Kaposi's sarcoma (KS) in patients infected with human immunodeficiency virus (HIV) was studied. Eight men with HIV infection and KS were to be given liposomal doxorubicin 20 mg/sq m i.v. monthly for six months and 10 mg/sq m i.v. monthly thereafter, depending on the response. They were assessed for the onset, extent, and duration of clinical response; relapse; adverse effects; development of new opportunistic infections; quality of life; and survival. Five patients had a clinical complete response (i.e., complete resolution of the manifestations of KS, as determined by physical examination but not confirmed by biopsy) and three patients had a partial response to the induction regimen of liposomal doxorubicin. Relapse occurred in all patients in whom therapy was stopped; reinstatement of therapy elicited a partial response. Neutropenia occurred in two patients; filgrastim therapy enabled the liposomal doxorubicin therapy to continue uninterrupted. Thromboembolic events developed or were suspected in three patients, although they may not have been caused by liposomal doxorubicin. Monthly i.v. administration of liposomal doxorubicin partially or completely eliminated the clinical manifestations of Kaposi's sarcoma in eight men infected with HIV.

Clinical parameters associated with recalcitrant oral candidosis in HIV infection: a preliminary study

Clinical resistance in oropharyngeal candidosis is an increasingly significant management problem in HIV-seropositive patients. This study was undertaken to identify predisposing risk factors including the isolation of particular species of Candida which may be associated with the development of clinical resistance. The effect of particular antifungal prescribing regimens was also assessed. Data were compiled by chart review of 2 groups, each of 10 HIV-seropositive CDC stage IV patients with recurrent oropharyngeal candidosis. All patients had swabs taken at intervals during treatment and all candida isolates were species typed. The patients in group 1 exhibited candida infections which did not respond clinically to standard therapeutic regimens. The second patient group did respond to standard oral antifungal therapies. An association was found between the frequent utilization of azoles, particularly fluconazole and the development of clinically resistant oral candidosis. The number of candida isolates grown from the initial swab was also significantly related to the development of resistance.

MMPI short forms as predictors of response to conservative treatment for low back pain

This study (N = 115) compared the abilities of the Faschingbauer Abbreviated Minnesota Multiphasic Personality Inventory (FAM), the Midi-Mult, and the standard MMPI to predict response to conservative medical treatment for low back pain, as assessed by patient ratings of pain intensity 6 to 12 months later. The results indicated that all three inventory formats yielded significant correlations between the Hypochondriasis, Depression, and Hysteria scales and follow-up pain ratings. Less consistent findings were obtained with other scales and indices. The results provide tentative support for the clinical and research utility of these abbreviated MMPIs in substituting for the standard MMPI in outcome studies with back pain patients.

Repressive coping style and anxiety in stressful dental surgery

Elevated state-anxiety prior to oral surgery is common and is associated with increased post-operative pain. This paper presents a psychological model of predicting elevated anxiety prior to dental surgery. Elevated anxiety and intraoperative stress can be predicted by measuring trait-anxiety. However, prediction may be improved by using a situationally specific measure of trait-anxiety, and by taking the patient's coping style into account. Thirty-nine patients undergoing wisdom-tooth extraction took part in the study. The Corah Dental Anxiety Scale was a better predictor of pre-operative anxiety than the STAI trait-anxiety scale. Coping style was measured by means of the Marlowe-Crowne Social Desirability Scale in conjunction with scores on trait-anxiety to define three coping style groups: sensitizers (high-anxious), truly low-anxious, and repressors who verbally deny anxiety. Two oral surgeons rated patient intra-operative state on 100 mm visual analogue scales. These ratings indicate that 'repressors' exhibit significantly more stress responses than the truly low-anxious group, in spite of similar (low) trait-anxiety scores. It is concluded that a situationally specific measure of trait-anxiety is the most appropriate predictor of differential state-anxiety elevations prior to oral surgery. Repressive coping style may be a confounding factor, in terms of predicting elevated anxiety, since some people verbally deny being anxious but express it behaviourally.

A comparison of clinically and empirically derived MMPI groupings in low back pain patients

Two methods of grouping MMPI scales were employed with 271 patients who were attending a Back Clinic at a university hospital. One method involved clinically derived decision rules, while the other utilized a multivariate clustering procedure. Five subgroups of patients were identified with each method. Both procedures showed subgroup differences in terms of pretreatment pain intensity, activity limitations, McGill affective scores, and physician ratings of degree of functional impairment; the elevated subgroups showed more dysfunction. Follow-up comparisons revealed that, regardless of the classification procedure used, the elevated subgroups showed poorer response to treatment. Only the clinically derived groupings had significant differences in chronicity of pain and total scores on the McGill Pain Questionnaire. On the other hand, only the statistically based system showed significant differences on age and marital status. Furthermore, only the statistical system identified subgroups of male patients that predicted followup pain intensity decreases in a manner that indicated clinical usefulness.

Cigarette smokers do more than just smoke cigarettes

In this study, we hypothesized that light and moderate-to-heavy cigarette smokers, when compared with nonsmokers, would exhibit significantly less healthy attitudes and behaviors on several dimensions relevant to the risk of coronary heart disease (CHD). A factor analysis of survey items measuring knowledge, attitudes, and behaviors in five CHD risk areas produced four major factors, which we labeled Attitudes (Factor 1), Health Consciousness (Factor 2), Knowledge (Factor 3), and Unhealthy Behaviors (Factor 4). Factor-based scales generated for each of these four factors were used in a one-way multivariate analysis of variance to examine differences between nonsmokers, light smokers, and moderate-to-heavy smokers. Cigarette smokers versus nonsmokers exhibited less positive attitudes toward CHD risk behaviors, whereas moderate-to-heavy cigarette smokers, as compared with the light smokers and the nonsmokers, exhibited lower levels of health consciousness and enacted unhealthy behaviors at a greater frequency. The moderate-to-heavy cigarette smokers also exhibited a lower commitment to enact healthy behavioral changes in the immediate future, even after corrections were introduced for their lower frequency of healthy behaviors during the past week. Overall, these results support our hypothesis that cigarette smokers, particularly as they become more involved with cigarette smoking, do more than just smoke cigarettes; they exhibit a less healthy lifestyle as shown by cognitive, behavioral, and motivational dimensions related to cardiovascular health.

Controlled comparison of a new sublingual lormetazepam formulation and i.v. diazepam in outpatient minor oral surgery

In a randomized, double-blind, parallel groups study, 40 patients undergoing surgical removal of impacted 3rd molar teeth received either sublingual lormetazepam 2.5 mg (n = 20) in a new cellulose wafer formulation followed at 35 min by i.v. saline; or sublingual placebo followed at 35 min by i.v. diazepam 10 mg (Diazemuls). Rapid onset of sedation was seen after sublingual lormetazepam, while the course and duration of postoperative sedation, measured using standard psychometric tests, was similar following both treatments. Surgeons' ratings indicated that sublingual lormetazepam was comparable to i.v. diazepam but patients' ratings indicated greater satisfaction with and preference for i.v. diazepam. Significant anterograde amnesia was found following both treatments. Both treatments were tolerated well, with no significant cardiovascular complications. These results indicate that sublingual lormetazepam may have a role in anaesthesia as a premedicant and for conscious sedation.

Comparison of midazolam by mouth and diazepam i.v. in outpatient oral surgery

In a randomized double-blind, parallel groups study, 40 patients undergoing surgical removal of impacted 3rd molar teeth received either midazolam 15 mg orally followed at 35 min by i.v. saline, or oral placebo followed at 35 min by i.v. diazepam 10 mg (Diazemuls). Rapid onset of sedation was seen after midazolam, while the pattern and duration of postoperative sedation, as measured by standard psychometric tests, indicated slower recovery after midazolam than after diazepam. Ratings by the surgeon indicated superior anxiolysis following midazolam and significantly more patients expressed a preference for oral midazolam sedation. Significant, comparable anterograde amnesia was seen with both treatments. No significant cardiovascular complications occurred with either treatment. The findings indicate that rapidly acting oral benzodiazepines such as midazolam provide safe, effect alternatives to i.v. diazepam for conscious sedation in outpatients undergoing minor surgical procedures.

Benzodiazepine--induced event amnesia following a stressful surgical procedure

In a randomised, double-blind, parallel groups study, 40 patients undergoing surgical removal of impacted third molar teeth received either midazolam 15 mg orally followed at 35 min by intravenous saline or oral placebo followed by intravenous diazepam 10 mg (Diazemuls). Episodic (event) memory was assessed by showing patients photographs of dental and neutral objects both before and after sedation and by testing subsequent recognition at 1 week. Recall of actual surgical events was assessed by questionnaire. Both treatments induced significant amnesia for visual stimuli and for surgical events. However, the degree of amnesia was more profound for artificial stimuli and no relationship was found between the extent of amnesia for the two types of event. Drilling of bone was found to provoke the greatest cardiovascular stress response and a significant relationship was found between the degree of cardiovascular activation and subsequent memory for drilling. It is concluded that the extent of benzodiazepine-induced event-amnesia may be modified by cognitive factors and especially by the extent to which the event is cognitively encoded and elaborated.

Locus of control, repression-sensitization, and psychological disorder in chronic pain patients

Examined the relationship between locus of control and psychological disorder in chronic pain patients controlling for the effects of response sets. Fifty-nine patients with chronic low back pain were given Rotter's Internal-External Locus of Control (I-E) scale and the MMPI. Multiple regression analysis showed that the MMPI K, F, and Pt scales produced the most efficient prediction of I-E scores. Response set tendencies to dramatize problems and traits that involve excessive rumination and self-doubt were related to external locus of control.

Medication usage, emotional disturbance, and pain behavior in chronic low back pain patients

Examined chronic low back pain outpatients (N = 126) at a university hospital outpatient back clinic. Prior to their orthopedic examination, patients were given the MMPI, the Pain Experience Questionnaire (a modified form of the McGill Pain Questionnaire), and a medical history form that indicated onset of injury, number of surgeries, functional limitations, and use of medications. Four patterns of drug usage emerged with sufficient number to permit statistical analysis: (1) none; (2) aspirin-type medications; (3) single narcotics alone; and (4) narcotics combined with other medications. Group 4 patients scored significantly higher on the Hypochondriasis and Hysteria scales than the others, whereas Group 3 patients scored higher on the PD (acting out) scale. Group 4 patients reported more intense pain and chose more affective terms (punishing/terrorizing/sickening) in describing their pain than the other three groups. Group 1 patients reported significantly less limitation in walking, running, and climbing.

The MMPI as a predictor of response to conservative treatment for low back pain

Studies that used the MMPI to predict the response of chronic low back pain patients to standard medical treatment have not produced definitive results. Patients seen in a university hospital orthopedic back pain clinic were given the MMPI before treatment, and 6 to 12 months later 76 patients completed follow-up forms that indicated their level of intensity during the previous week and their ratings of the success of treatment in relieving their pain as well as in enabling them to return to normal activities. Predictions of poor response were made in terms of either single MMPI scales or code types. Patients with poor outcome on two of the three criteria (level of pain intensity and ability to return to normal activities) had significantly higher scores on the Hs scale. The predicted high risk code types very accurately identified patients with poor response on the same two criteria; however, the code-type procedure overpredicted poor response in the good outcome group.

MMPI differences among black, Mexican-American, and white male offenders

MMPI scores of black, Mexican-American, and white male offenders were compared in order to investigate whether cultural and/or socioeconomomic factors affect this personality inventory. Comparisons were performed on unmatched and matched (education and occupation) groups that utilized all profiles or valid ones only and examined both trait (individual scales) and type (Goldberg indices) differences. Black-white differences on the MA, K, and HY scales appeared to reflect cultural factors, while differences on MF and alcoholism seemed to be accounted for by socieconomic differences among the groups. Cultural factors seemed to be related to differences between Mexican-Americans and white on the L,K,and overcontrolled hostility scales, while socioeconomic factors appeared to explain differences on the Hs scale. Type differences were not apparent except that Mexican-Americans were classified more often as psychiatric, while whites and blacks scored well into the sociopathic range.

Cigarette smokers do more than just smoke cigarettes

In this study, we hypothesized that light and moderate-to-heavy cigarette smokers, when compared with nonsmokers, would exhibit significantly less healthy attitudes and behaviors on several dimensions relevant to the risk of coronary heart disease (CHD). A factor analysis of survey items measuring knowledge, attitudes, and behaviors in five CHD risk areas produced four major factors, which we labeled Attitudes (Factor 1), Health Consciousness (Factor 2), Knowledge (Factor 3), and Unhealthy Behaviors (Factor 4). Factor-based scales generated for each of these four factors were used in a one-way multivariate analysis of variance to examine differences between nonsmokers, light smokers, and moderate-to-heavy smokers. Cigarette smokers versus nonsmokers exhibited less positive attitudes toward CHD risk behaviors, whereas moderate-to-heavy cigarette smokers, as compared with the light smokers and the nonsmokers, exhibited lower levels of health consciousness and enacted unhealthy behaviors at a greater frequency. The moderate-to-heavy cigarette smokers also exhibited a lower commitment to enact healthy behavioral changes in the immediate future, even after corrections were introduced for their lower frequency of healthy behaviors during the past week. Overall, these results support our hypothesis that cigarette smokers, particularly as they become more involved with cigarette smoking, do more than just smoke cigarettes; they exhibit a less healthy lifestyle as shown by cognitive, behavioral, and motivational dimensions related to cardiovascular health.