Houston TK , Allison JJ , Sussman M , Horn W , Holt CL , Trobaugh J , Salas M , Pisu M , Cuffee YL , Larkin D , Person SD , Barton B , Kiefe CI , Hullett S .

the Center for Healthcare Quality, Outcomes, and Economic Research, eHealth Quality Enhancement Research Initiative, and Bedford Veterans Affairs Medical Center, Bedford, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; Cooper Green Mercy Hospital and University of Alabama at Birmingham, Birmingham, Alabama; University of Maryland, College Park, Maryland; University of Pennsylvania, Philadelphia, Pennsylvania; and AstraZeneca, Wilmington, Delaware.

Abstract

Background: Storytelling is emerging as a powerful tool for health promotion in vulnerable populations. However, these interventions remain largely untested in rigorous studies. Objective: To test an interactive storytelling intervention involving DVDs. Design: Randomized, controlled trial in which comparison patients received an attention control DVD. Separate random assignments were performed for patients with controlled or uncontrolled hypertension. (ClinicalTrials.gov registration number: NCT00875225) Setting: An inner-city safety-net clinic in the southern United States. Patients: 230 African Americans with hypertension. Intervention: 3 DVDs that contained patient stories. Storytellers were drawn from the patient population. Measurements: The outcomes were differential change in blood pressure for patients in the intervention versus the comparison group at baseline, 3 months, and 6 to 9 months. Results: 299 African American patients were randomly assigned between December 2007 and May 2008 and 76.9% were retained throughout the study. Most patients (71.4%) were women, and the mean age was 53.7 years. Baseline mean systolic and diastolic pressures were similar in both groups. Among patients with baseline uncontrolled hypertension, reduction favored the intervention group at 3 months for both systolic (11.21 mm Hg [95% CI, 2.51 to 19.9 mm Hg]; P = 0.012) and diastolic (6.43 mm Hg [CI, 1.49 to 11.45 mm Hg]; P = 0.012) blood pressures. Patients with baseline controlled hypertension did not significantly differ over time between study groups. Blood pressure subsequently increased for both groups, but between-group differences remained relatively constant. Limitation: This was a single-site study with 23% loss to follow-up and only 6 months of follow-up. Conclusion: The storytelling intervention produced substantial and significant improvements in blood pressure for patients with baseline uncontrolled hypertension. Primary Funding Source: Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation.

Raffaitin C , Féart C , Le Goff M , Amieva H , Helmer C , Akbaraly TN , Tzourio C , Gin H , Barberger-Gateau P .

From the Diabetology-Nutrition Unit (C.R., H.G.), University Hospital of Bordeaux, Pessac; INSERM, U897 (C.R., C.F., M.L.G., H.A., C.H., P.B.-G.), Bordeaux; Victor Segalen Bordeaux 2 University (C.R., C.F., M.L.G., H.A., C.H., H.G., P.B.-G.), Bordeaux; INSERM, U888 (T.N.A.), Montpellier; Montpellier 1 University (T.N.A.), Montpellier; University Hospital of Montpellier (T.N.A.), CMRR Languedoc Roussillon, France; and INSERM, U708 (C.T.), Paris, France.

Abstract

OBJECTIVE: To examine associations between metabolic syndrome (MetS) and its individual components with risk of cognitive decline on specific cognitive functions.

METHODS: Participants were 4,323 women and 2,764 men aged 65 and over enrolled in the longitudinal Three-City Study. Cognitive decline, defined as being in the worst quintile of the distribution of the difference between baseline score and either 2- or 4-year follow-up, was assessed by the Mini-Mental State Examination (MMSE, global cognitive function), the Isaacs Set Test (IST, verbal fluency), and the Benton Visual Retention Test (BVRT, visual working memory). MetS was defined by National Cholesterol Education Program-Adult Treatment Panel III criteria (at least 3 of 5 cardio-metabolic abnormalities: hypertension, high waist circumference, hypertriglyceridemia, low high-density lipoprotein [HDL] cholesterol, hyperglycemia). Proportional hazards models were adjusted for age, gender, educational level, center, baseline cognitive score, APOE4 genotype, and other potential confounders.

RESULTS: MetS at baseline was associated with an increased risk of cognitive decline on MMSE (hazard ratio [HR] = 1.22 [1.08-1.37]; p = 0.001) and BVRT (HR = 1.13 [1.01-1.26]; p = 0.03) but not on IST (HR = 1.11 [0.95-1.29]; p = 0.18). Among MetS components, hypertriglyceridemia and low HDL cholesterol were significantly associated with higher decline on MMSE; diabetes, but not elevated fasting glycemia, was significantly associated with higher decline on BVRT and IST.

CONCLUSIONS: MetS as a whole and several of its components had a negative impact on global cognitive decline and specific cognitive functions in older persons.
PMID: 21288982 [PubMed - as supplied by publisher]

JAMA. 2007 Jul 4;298(1):49-60.

Taubert D, Roesen R, Lehmann C, Jung N, Schömig E.

Department of Pharmacology, University Hospital of Cologne, Cologne, Germany. dirk.taubert@medizin.uni-koeln.de

Comment in:

• JAMA. 2007 Oct 24;298(16):1862-3; author reply 1863-4.
• South Med J. 2008 Jul;101(7):670.

Methods MEDLINE, EMBASE, SCOPUS, Science Citation Index, and the Cochrane Controlled Trials Register were searched from 1966 until October 2006 for studies in parallel group or crossover design involving 10 or more adults in whom blood pressure was assessed before and after receiving cocoa products or black or green tea for at least 7 days.

Results Five randomized controlled studies of cocoa administration involving a total of 173 subjects with a median duration of 2 weeks were included. After the cocoa diets, the pooled mean systolic and diastolic blood pressure were –4.7 mm Hg (95% confidence interval [CI], –7.6 to –1.8 mm Hg; P = .002) and –2.8 mm Hg (95% CI, –4.8 to –0.8 mm Hg; P = .006) lower, respectively, compared with the cocoa-free controls. Five studies of tea consumption involving a total of 343 subjects with a median duration of 4 weeks were selected. The tea intake had no significant effects on blood pressure. The estimated pooled changes were 0.4 mm Hg (95% CI, –1.3 to 2.2 mm Hg; P = .63) in systolic and –0.6 mm Hg (95% CI, –1.5 to 0.4 mm Hg; P = .38) in diastolic blood pressure compared with controls.

Conclusion Current randomized dietary studies indicate that consumption of foods rich in cocoa may reduce blood pressure, while tea intake appears to have no effect.

Dirk Taubert, MD, PhD; Renate Roesen, PhD; Edgar Schömig, MD
Department of Pharmacology, University Hospital of Cologne, Cologne, Germany.
Arch Intern Med. 2007;167:626-634.

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