Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial.

BACKGROUND: Hypertension is a major global public health problem. Elevated blood pressure can cause cardiovascular and kidney diseases. We assessed the effectiveness of health education sessions and home support programs in reducing blood pressure among patients with uncontrolled hypertension in a suburban community of Nepal. METHODS: We conducted a community-based, open-level, parallel-group, cluster randomized controlled trial in Birendranagar municipality of Surkhet, Nepal. We randomly assigned four clusters (wards) into intervention and control arms. We provided four health education sessions, frequent home and usual care for intervention groups over six months. The participants of the control arm received only usual care from health facilities. The primary outcome of this study was the proportion of controlled systolic blood pressure (SBP). The analysis included all participants who completed follow-up at six months. RESULTS: 125 participants were assigned to either the intervention (n = 63) or the control (n = 62) group. Of them, 60 participants in each group completed six months follow-up. The proportion of controlled SBP was significantly higher among the intervention participants compared to the control (58.3% vs. 40%). Odds ratio of this was 2.1 with 95% CI: 1.01-4.35 (p = 0.046) and that of controlled diastolic blood pressure (DBP) was 1.31 (0.63-2.72) (p = 0.600). The mean change (follow-up minus baseline) in SBP was significantly higher in the intervention than in the usual care (-18.7 mmHg vs. -11.2 mmHg, p = 0.041). Such mean change of DBP was also higher in the intervention (-10.95 mmHg vs. -5.53 mmHg, p = 0.065). The knowledge score on hypertension improved by 2.38 (SD 2.4) in the intervention arm, which was significantly different from that of the control group, 0.13 (1.8) (p<0.001). CONCLUSIONS: Multiple health education sessions complemented by frequent household visits by health volunteers can effectively improve knowledge on hypertension and reduce blood pressure among uncontrolled hypertensive patients at the community level in Nepal. TRIAL REGISTRATION: ClinicalTrial.gov: NCT02981251.

Semantic Predictability Facilitates Comprehension of Degraded Speech in a Graded Manner.

Previous studies have shown that at moderate levels of spectral degradation, semantic predictability facilitates language comprehension. It is argued that when speech is degraded, listeners have narrowed expectations about the sentence endings; i.e., semantic prediction may be limited to only most highly predictable sentence completions. The main objectives of this study were to (i) examine whether listeners form narrowed expectations or whether they form predictions across a wide range of probable sentence endings, (ii) assess whether the facilitatory effect of semantic predictability is modulated by perceptual adaptation to degraded speech, and (iii) use and establish a sensitive metric for the measurement of language comprehension. For this, we created 360 German Subject-Verb-Object sentences that varied in semantic predictability of a sentence-final target word in a graded manner (high, medium, and low) and levels of spectral degradation (1, 4, 6, and 8 channels noise-vocoding). These sentences were presented auditorily to two groups: One group (n =48) performed a listening task in an unpredictable channel context in which the degraded speech levels were randomized, while the other group (n =50) performed the task in a predictable channel context in which the degraded speech levels were blocked. The results showed that at 4 channels noise-vocoding, response accuracy was higher in high-predictability sentences than in the medium-predictability sentences, which in turn was higher than in the low-predictability sentences. This suggests that, in contrast to the narrowed expectations view, comprehension of moderately degraded speech, ranging from low- to high- including medium-predictability sentences, is facilitated in a graded manner; listeners probabilistically preactivate upcoming words from a wide range of semantic space, not limiting only to highly probable sentence endings. Additionally, in both channel contexts, we did not observe learning effects; i.e., response accuracy did not increase over the course of experiment, and response accuracy was higher in the predictable than in the unpredictable channel context. We speculate from these observations that when there is no trial-by-trial variation of the levels of speech degradation, listeners adapt to speech quality at a long timescale; however, when there is a trial-by-trial variation of the high-level semantic feature (e.g., sentence predictability), listeners do not adapt to low-level perceptual property (e.g., speech quality) at a short timescale.

Language proficiency does not modulate executive control in older bilinguals.

We examined if language proficiency modulates performance in tasks that measure executive control in older Telugu-English bilinguals (n = 50, mean age = 57.15 years). We administered numerical Stroop task, Attention Network Task, Dimensional Change Card Sorting task, and stop-signal task that are known to tap into different aspects of executive functioning on healthy aging Telugu-English bilinguals. Second language (English) proficiency was calculated as a cumulative score that considered both subjective and objective measures of L2 fluency and use. Bilinguals were divided into two groups based on the cumulative score and compared on each task. We did not find any effect of language proficiency on any of the executive control measures. The additional Bayesian analysis also supported these findings. Therefore, the results do not support the claim that bilingual language proficiency modulates executive control, at least in the elderly population. We discuss the results with regard to the issue of bilingual advantage in executive control and the role of age and language use.