This is based on a meta-analysis published in JAMA (Journal of American Medical Association) 2007 which analyzed over 26 studies of pedometer use in adult outpatients that reported a change in the number of steps walked per day. The 2767 participants in these studies were 85% women, with a mean age of 49. At baseline, most participants were overweight, with normal blood pressure (mean 129/79 mm Hg) and relatively well-controlled cholesterol levels (mean total cholesterol 198 mg/dL, HDL 52 mg/dL, LDL 113 mg/dL). The mean baseline activity level was 7473 steps per day (range 2140–12,371). Duration of interventions ranged from 3 to 104 weeks, with a mean of 18 weeks.

Participants walked 2183 steps per day more than they had at baseline when they were using pedometer. To put things in perspective, 2000 steps is about 1 mile. Overall, pedometer users increased their number of steps by 27% over baseline.

This study is the first large meta-analysis to show that pedometer use is an effective intervention for promoting physical activity. Another recent meta-analysis shows that pedometer use is also effective for short-term weight loss, even in the absence of dietary changes.

The Centers for Disease Control and Prevention (CDC) recommends that adults engage in moderate physical activity for at least 30 minutes a day, at least 5 days per week. Yet 40% of adults do not engage in any leisure-time physical activity. This percentage is higher in women (43%), African-Americans (52%), and Hispanics (54%).

The health benefits of exercise are clear. Regular physical activity has been shown to decrease overweight and obesity. It has also been shown to improve control of type 2 diabetes5 and hypertension. Frequent exercise is associated with a decreased mortality rate. Walking has been shown to decrease the risk of cardiovascular events in women, regardless of BMI.

Walking has similarly been shown to decrease overall mortality among men. Cardiovascular fitness has also been shown to decrease mortality in adults over 60, even in the absence of weight loss.

Pedometers and goal-setting are simple, relatively inexpensive ways to help patients become physically active and lose weight.

Source:

1. The Journal of Family Medicine, Vol 57, No.2. February 2008.
2. Centers for Disease Control and Prevention/National Center for Health Statistics website. FASTATS: Exercise/physical activity. Available at www.cdc.gov/nchs/fastats/exercise.htm.

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Duct tape is at least as effective as traditional cryotherapy for removal of wart.

Review:

Focht et al [1] conducted a randomized controlled trial to compare effect of duct tape vs cryotherapy on warts. 61 patients were enrolled and divided into two groups. One received cryotherapy (liquid nitrogen) every 2-3 weeks for a maximum of 6 treatments or untils wart resolution. The other group had duct tape applied on the wart in 6-day intervals for 2 months. The study found that duct tape was more effective treatment: 85% of patients using duct tape had their warts completely resolved versus 60% of those treated with cryotherapy.

In a recent study done by De Haen group [2], researchers compared duct tape with placebo. There data showed that 16% of patient had disappearance of wart compared to 6% in placebo group. They however concluded that duct tape had modest resolution of wart resolution and diameter reduction compared to placebo.

Duct tape also offers cost-effective and less painful option to treat warts. One may get skin irritation. Do check with your doctor before using it for yourself.

Reference:

1. Focht Dr et al. “The efficacy of duct tape vs cryotherapy in the treatment of verruca vulgaris (the common wart)”. Arch Pediatr Adol Med. 2002. 156: p971-4
2. de Haem M, Spigt MG et al. “Efficacy of duct tape vs placebo in the treatment of verruca vulgaris (warts) in primary school children.” Arch Pediatr Adolesc Med. 2006 Nov; 160(11):1121-5.

There is unclear evidence stating that Ginger would treat symptoms of common cold, but there is little evidence to suggest that Ginger juice may have antihistaminergic and anticholinergic effects that may help during common cold.

Review:

Most of what is know about Ginger is its anti-emetic effects and also lipid lowering effects. However, it is widely used agent during common cold as recommended by many alternative medicine modalities. There is no direct evidence to suggest that Ginger treat symptoms of common cold but there is a study done in China [1] Ginger juice may exhibits anticholinergic and anti-hisminergic effects through substance P. It is this effect that potentially may help in common cold.

Also, drinking wamr ginger tea may offer help with common cold but it is also due to the fact the warm fluid in itself is helpful in common cold.

Reference:

1. Qian DS, Liu ZS. Pharmacologic studies of antimotion sickness actions of ginger. Zhongguo Zhong Xi Yi Jie He Za Zhi. 1992 Feb;12(2):95-8, 70. Chinese.

Prior BCG vaccination have variable effect on PPD results. It varies with age at vaccination, number of years since the BCG vaccination, number of times vaccinated, and number of PPD performed. When evaluating Positive PPD among immigrants, disregard the history of BCG vaccination.

Review:

BCG vaccination is given in the areas where tuberculosis is prevalent. The World Health Organization recommends BCG vaccination at birth, without booster doses, to prevent childhood complications of TB infection [1]; however, the vaccine’s efficacy is known to be inconsistent. Though BCG vaccine given at birth can decrease the risk of miliary TB and TB meningitis among children, estimates of its effectiveness in preventing adult pulmonary TB range widely from 0% to 80%[1].

BCG vaccine may confound PPD readings, but several studies indicate that PPD can still be a useful screening tool for tuberculosis infection after vaccination. In a Quebec cohort of 1198 foreign-born children and young adults, prior BCG vaccination could account for 50% of PPDs with induration of 5 to 9 mm, but only 4% of reactions 10 mm or greater. This study also showed that patients from countries with a high or moderate incidence of TB were more likely to have reactive PPDs than those from countries of low incidence, suggesting that exposure to TB accounts for some of the positive PPDs [2].

The USPSTF further notes that reactions >10 mm should not be attributed to prior BCG vaccine [3]. The Centers for Disease Control and Prevention (CDC) and American Thoracic Society joint statement recommends against altering guidelines for testing and interpretation among BCG recipients [4]. BCG vaccine does not always protect people from getting TB [5].

Reference:

1. Fine P, Carnelro IA, Milstien JB, Clements CJ. Issues relating to the use of BCG immunization programmes. WHO discussion document. V&B 99.23. Available at: http://who.int/vaccine_research/documents/en/bcg_vaccines.pdf. Accessed on September 3, 2006.
2. Rowland K, Guthmann R, Jamieson, B. How should we manage a patient with a positive PPD and prior BCG vaccination? Clinical Inquiries. The Journal of Family Practice. Vol 55, No. 8, August 2006.
3. US Preventative Services Task Force. Screening for tuberculosis infection, including Bacille Calmette-Guérin immunization. Guide to Clinical Preventative Services; 1996. Available at: www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat3.section.10931#13112.
4. American Thoracic Society and Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161:1376–1395.
5. Latent TB Infection. Division of Tuberculosis Elimination. http://www.cdc.gov/nchstp/tb/faqs/qa_latenttbinf.htm#Latent3.

Bottom Line:

High dietary calcium intake does not promote weight loss.

Review:

Although energy balance is the key element in weight regulation, several studies suggested that calcium metabolism and perhaps other components of dairy products may contribute to shifting the energy balance and thus play a role in weight regulation.  In 1988 Metz et al. [1] demonstrated a reduction in body fat mass in two strains of hypertensive rats’ higher calcium intakes (in conjunction with higher sodium intake). This review discusses the effect of high dietary calcium on weight loss. Shapses et al [2] studied the effect of calcium supplementation in postmenopausal and premenopausal women with BMI ranging from 28-42 kg/m2. They found no significant differences in body weight or fat mass change between the placebo and the calcium-supplemented groups. Reid et al [3] found similar results for older women. Bowel et al [4] found similar results in overweight adults (male and female) with age range 25-64 yrs. Gunther et al [5] found similar results in young women age 18-30. Berkey et al [6] found similar results in a cohort study with children age 9-14 years.

References:

1. Metz JA, Karanja N, Torok J. Modification of total body fat in spontaneously hypertensive rats and Wistar-Kyoto rats by dietary calcium and sodium. Am J Hypertension 1988. 1:58-60
2. Shapses SA, Heshka S, Heymsfield SB. Effect of Calcium Supplementation on Weight and Fat Loss in Women. Journal of Clinical Endocrinology and Metabolism. Vol 89, No 2; Feb 2004. (LOE 1)
3. Reid IR, Horne A, Mason B. Effects of Calcium Supplementation on Body Weight and Blood Pressure in Normal Older Women: A Randomized Controlled Trial. Journal of Clinical Endocrinology and Metabolism. Vol 90, No 7; July 2005. (LOE 1)
4. Bowen J, Noakes M and Clifton P M. Effect of calcium and dairy foods in high protein, energy-restricted diets on weight loss and metabolic parameters in overweight adults. International Journal of Obesity (2005) 29, 957−965. (LOE 1)
5. Gunther CW, Legowski PA, Lyle RM, McCabe GP, Eagan MS, Peacock M, Teegarden D. Dairy products do not lead to alterations in body weight or fat mass in young women in a 1-y intervention. Am J Clin Nutr. 2005 Apr;81(4):751-6 (LOE 1)
6. Berkey CS, Rockett HRH. Milk, Daily Fat, Dietary Calcium, and Weight Gain – A Longitudinal Study of Adolescents. Arch Pediatr Adolesc Med. 2005; 159: 543-550 (reviewed by Jennifer Procopio) (LOE 2)

Bottom Line:

Aspirin decreases the incidence of coronary heart disease in adults who are at increased risk for heart disease. There is also good evidence that aspirin increases the incidence of gastrointestinal bleeding and fair evidence that aspirin increases the incidence of hemorrhagic strokes. There is no evidence of MI prevention with low dose aspirin in general population with no risk factors. Low-dose aspirin prevents stoke events in women >45 years of age.

Review

Patients at increased risk for cardiovascular (CV) events benefit from low-dose aspirin, provided that the patient does not have major risk factors for gastrointestinal (GI) or cerebral bleed.1 The risk of aspirin-induced bleeding usually outweighs the benefit of reducing cardiovascular events in patient with minimal to no risk factors for CV events.2,3, The results of Women’s Health Study (WHS) demonstrated that in women >45 years of age even with low risk factors for CV events, benefited from low-dose aspirin in reducing stroke events. No difference in cardiac event were note compared to placebo.4

References

1. Pearson TA, Blair SN, Daniels SR et al. AHA Guidelines for primary prevention of cardiovascular disease and stroke: 2002 update: consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases. Circulation 2002; 106:388-91.
2. Nelson MR, Liew D et al. Epidemiologival modeling of routing use of low dose aspirin for the primary prevention of coronary heart disease and stoke in those aged >70. BMJ 2005 Jun 4;330(7503):1306
3. Taha AS, Angerson WJ, Knill-Jones RP et at. Upper gastrointestinal hemorrhage associated with low-dose aspirin and anti-thrombotic drugs – a 6-year analysis and comparison with non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther. 2005 Aug 15;22(4):285-9.
4. Ridker PM, Cook NR, Lee IM et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N.Eng J Med. 2005 Mar 31; 352:1293-304

Bottom Line:

The calcium and Vitamin D supplementation alone does not cause significant reduction in risk of fractures in at risk women. There is no data available for male population.

Review

Dawson [1] and group studied the calcium (about 500 mg) and Vitamin D (700 IU) supplementation in elderly men and women in ambulatory setting for a three year period. A clinically relevant reduction in nonvertebral fracture rates was noted in the in elderly white women not currently taking estrogen replacement. The similar can not be concluded for the elderly men. The meta-analysis by Biscoff [2] found heterogeneity among the clinical trials on this topic. When they separated the studies by different doses of Vitamin D, it was noted that Vitamin D doses of 700 IU to 800 IU per day resulted in a significant decrease in hip fractures. How ever, two large studies [3, 4] in patients at high risk or with a previous osteoporotic fracture for whom these doses did not decrease the rate of fracture. The latest results from the Women’s Health Initiative (WHI) published in NJEM [5] where the postmenopausal women who were given calcium (1000mg) and Vitamin D (400 IU) and followed for 7 year, revealed that among healthy postmenopausal women, calcium with vitamin D supplementation resulted in a small but significant improvement in hip bone density but there was no significant reduction in hip factures. One may think that if these women were given higher doses of Vitamin D may have given different results. But the Cochrane review [8] indicated that Vitamin D alone showed no statistically significant effect on hip fracture.

References

1. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997;337:670-6
2. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation. A meta-analysis of randomized controlled trials. JAMA 2005; 293:2257-64
3. Porthouse J, Cockayne S, King C, et at. Randomized Controlled trial of Calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care. BMJ 2005;330: 1003-06
4. Grant AM, Avenell A, Campbell MK, et al, for the RECORD Trial Group. Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomized Evaluation Of Calcium OR vitamin D, RECORD): a randomised placebo-controlled trial. Lancet 2005; 365:1621-28.
5. Jackson RD, et al. Calcium plus Vitamin D Supplementation and the Risk of Fractures. New England Journal of Medicine 354(7): 6690683 Feb 16, 2006.
6. Francis, Roger M. Calcium, vitamin D and involutional osteoporosis. Current Opinion in Clinical Nutritional and Metabolic Care, 2006, 9:13-17.
7. Feaskanich D, Willet WC, Coldotz GA. Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. The Am J of Clin Nutri Vol 77, No. 2, 504-511, Feb 2003.
8. Avenell A, Gillespie WJ, Gillespie LD, O’Connell DL. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis (Cochrane Review). In: The Cochrane Library, Issue 1, 2006. Chichester, UK: John Wiley and Sons, Ltd.