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How can I help prevent my child from getting and spreading diarrhoea?

December 20, 2011 by Leave a Comment

Answer:  Encourage everyone to wash their hands with soap after going to the toilet and before eating and preparing food.

Cochrane Database Syst Rev. 2008 Jan 23;(1):CD004265.

Hand washing for preventing diarrhoea.

Abstract

BACKGROUND:

Diarrhoea is a common cause of morbidity and a leading cause of death among children aged less than five years, particularly in low- and middle-income countries. It is transmitted by ingesting contaminated food or drink, by direct person-to-person contact, or from contaminated hands. Hand washing is one of a range of hygiene promotion interventions that can interrupt the transmission of diarrhoea-causing pathogens.

OBJECTIVES:

To evaluate the effects of interventions to promote hand washing on diarrhoeal episodes in children and adults.

SEARCH STRATEGY:

In May 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 2), MEDLINE, EMBASE, LILACS, PsycINFO, Science Citation Index and Social Science Citation Index, ERIC (1966 to May 2007), SPECTR, Bibliomap, RoRe, The Grey Literature, and reference lists of articles. We also contacted researchers and organizations in the field.

SELECTION CRITERIA:

Randomized controlled trials, where the unit of randomization is an institution (eg day-care centre), household, or community, that compared interventions to promote hand washing or a hygiene promotion that included hand washing with no intervention to promote hand washing.

DATA COLLECTION AND ANALYSIS:

Two authors independently assessed trial eligibility and methodological quality. Where appropriate, incidence rate ratios (IRR) were pooled using the generic inverse variance method and random-effects model with 95% confidence intervals (CI).

MAIN RESULTS:

Fourteen randomized controlled trials met the inclusion criteria. Eight trials were institution-based, five were community-based, and one was in a high-risk group (AIDS patients). Interventions promoting hand washing resulted in a 29% reduction in diarrhoea episodes in institutions in high-income countries (IRR 0.71, 95% CI 0.60 to 0.84; 7 trials) and a 31% reduction in such episodes in communities in low- or middle-income countries (IRR 0.69, 95% CI 0.55 to 0.87; 5 trials).

AUTHORS’ CONCLUSIONS:

Hand washing can reduce diarrhoea episodes by about 30%. This significant reduction is comparable to the effect of providing clean water in low-income areas. However, trials with longer follow up and that test different methods of promoting hand washing are needed.

Filed Under: infectious diarrhoea in children, physical, preventing specific diseases Tagged With: , , , ,

How can I slow down the progression of my age-related macular degeneration?

December 20, 2011 by Leave a Comment

Answer: Ask your doctor about trying supplements of zinc and antioxidant vitamins (beta-carotene, Vitamin C and vitamin E).

“The review of trials found that supplementation with antioxidants and zinc may be of modest benefit in people with AMD. Long-term harm from these supplements cannot be ruled out.”
Cochrane Database Syst Rev. 2006 Apr 19;(2):CD000254.
Evans JR.

Plain language summary


Antioxidant vitamins and mineral supplements to slow down the progression of age-related macular degeneration

Age-related macular degeneration (AMD) is a condition affecting the central area of the retina (back of the eye). The retina can deteriorate with age and some people get lesions that can lead to loss of central vision. It has been suggested that progression of the disease may be slowed down in people who eat a diet rich in antioxidant vitamins (carotenoids, vitamins C and E) or minerals (selenium and zinc). The author identified nine randomised controlled trials; four trials based in the USA, four in Australia, Austria, Switzerland and the UK and one in China. The review of trials found that supplementation with antioxidants and zinc may be of modest benefit in people with AMD. Long-term harm from these supplements cannot be ruled out. Large well-conducted trials in a range of populations and with different nutritional status are required.

Here is the scientific abstract:

Abstract

Background

It has been proposed that antioxidants may prevent cellular damage in the retina by reacting with free radicals that are produced in the process of light absorption.

Objectives

The objective of this review was to assess the effects of antioxidant vitamin or mineral supplementation on the progression of age-related macular degeneration (AMD).

Search strategy

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2007, Issue 3); MEDLINE (1966 to August 2007); EMBASE (1980 to August 2007); NRR (2007, Issue 3); AMED (1985 to January 2006); PubMed (24 January 2006 covering last 60 days) and SIGLE (1980 to March 2005), reference lists of identified reports and the Science Citation Index. We contacted investigators and experts in the field for details of unpublished studies.

Selection criteria

We included randomised trials comparing antioxidant vitamin or mineral supplementation (alone or in combination) to a control intervention in people with AMD.

Data collection and analysis

The author extracted data and assessed trial quality. Where appropriate, data were pooled using a random-effects model unless three or fewer trials were available in which case a fixed-effects model was used.

Main results

Nine trials were included in this review. The majority of people were randomised in one trial (AREDS in the USA) that found a beneficial effect of antioxidant (beta-carotene, vitamin C and vitamin E) and zinc supplementation on progression to advanced AMD (adjusted odds ratio 0.68, 99% confidence interval 0.49 to 0.93). People taking supplements were less likely to lose 15 or more letters of visual acuity (adjusted odds ratio 0.77, 99% confidence interval 0.58 to 1.03). Hospitalisation for genito-urinary problems was more common in people taking zinc and yellowing of skin was more common in people taking antioxidants. The other trials were, in general, small and the results were inconsistent.

Authors’ conclusions

The evidence as to the effectiveness of antioxidant vitamin and mineral supplementation in halting the progression of AMD comes mainly from one large trial in the USA. The generalisability of these findings to other populations with different nutritional status is not known. Further large, well-conducted randomised controlled trials in other populations are required. Long-term harm from supplementation cannot be ruled out. Beta-carotene has been found to increase the risk of lung cancer in smokers; vitamin E has been associated with an increased risk of heart failure in people with vascular disease or diabetes.

Filed Under: macular degeneration, managing older persons' health problems, physical Tagged With: , , , ,

Now I am post-menopausal, how can I increase my bone density?

December 20, 2011 by Leave a Comment

Answer:  Exercise!


Cochrane Database Syst Rev. 2011 Jul 6;(7):CD000333.

Exercise for preventing and treating osteoporosis in postmenopausal women.

Abstract

BACKGROUND:

Osteoporosis is a condition resulting in an increased risk of skeletal fractures due to a reduction in the density of bone tissue. Treatment of osteoporosis typically involves the use of pharmacological agents. In general it is thought that disuse (prolonged periods of inactivity) and unloading of the skeleton promotes reduced bone mass, whereas mechanical loading through exercise increases bone mass.

OBJECTIVES:

To examine the effectiveness of exercise interventions in preventing bone loss and fractures in postmenopausal women.

SEARCH STRATEGY:

During the update of this review we updated the original search strategy by searching up to December 2010 the following electronic databases: the Cochrane Musculoskeletal Group’s Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2010 Issue 12); MEDLINE; EMBASE; HealthSTAR; Sports Discus; CINAHL; PEDro; Web of Science; Controlled Clinical Trials; and AMED. We attempted to identify other studies by contacting experts, searching reference lists and searching trial registers.

SELECTION CRITERIA:

All randomised controlled trials (RCTs) that met our predetermined inclusion criteria.

DATA COLLECTION AND ANALYSIS:

Pairs of members of the review team extracted the data and assessed trial quality using predetermined forms. For dichotomous outcomes (fractures), we calculated risk ratios (RRs) using a fixed-effect model. For continuous data, we calculated mean differences (MDs) of the percentage change from baseline. Where heterogeneity existed (determined by the I(2) statistic), we used a random-effects model.

MAIN RESULTS:

Forty-three RCTs (27 new in this update) with 4320 participants met the inclusion criteria. The most effective type of exercise intervention on bone mineral density (BMD) for the neck of femur appears to be non-weight bearing high force exercise such as progressive resistance strength training for the lower limbs (MD 1.03; 95% confidence interval (CI) 0.24 to 1.82). The most effective intervention for BMD at the spine was combination exercise programmes (MD 3.22; 95% CI 1.80 to 4.64) compared with control groups. Fractures and falls were reported as adverse events in some studies. There was no effect on numbers of fractures (odds ratio (OR) 0.61; 95% CI 0.23 to 1.64). Overall, the quality of the reporting of studies in the meta-analyses was low, in particular in the areas of sequence generation, allocation concealment, blinding and loss to follow-up.

AUTHORS’ CONCLUSIONS:

Our results suggest a relatively small statistically significant, but possibly important, effect of exercise on bone density compared with control groups. Exercise has the potential to be a safe and effective way to avert bone loss in postmenopausal women.

Filed Under: managing older persons' health problems, osteoporosis - low bone density, physical Tagged With: , ,