Make-up, like cosmetics generally, has a long and fascinating history. There is evidence from Palaeolithic cave paintings of the use of red and yellow ochre for colouring the skin. Queen Mentuhotep, in 3000 B.C., owned a small cosmetic chest containing preparations to beautify the eyes and maintain the condition of the hair, as well as deodorant perfumes for the armpits and groin. Ovid, the romantic Roman poet (43 B.C-17 A.D.), lectured the women of Roman on the need to use cosmetics as an essential practice to retain lovers. He also described how the wrinkles of old age may be concealed. In Queen Elizabeth’s day, milk baths were the fashion. Turkish ladies of that time were advised to have their skin flamed by a torch held by a eunuch of the harem. Clearly, women for many centuries have been prepared to go to the utmost lengths to improve the appearance of their skin and forestall the inevitable ogre of age. Today, many men also show an interest in skin care and the use of cosmetics.
The basic make-up used is the foundation cream. This both protects the skin to some extent from the drying effects of the elements and serves as a base for powder or blusher. As mentioned before, this foundation cream is basically a cold cream, which is tinted.
Pace powders are a combination of talc the predominant ingredient, 8 tea rates, kaolin, perfume and colouring substances. Talc is a complicated salt of magnesium, whose main characteristic is that it is very easy spreading, Stearates, which are also metallic salts, enable the powder to stick to the skin. Kaolin is a variety of aluminium salt which acts as an absorbent for perspiration. Compressed powders are the result of combining face powder with binding agents such as gum arable. Similarly, binding can be attained by the use of a moist sponge applicator to collect and spread the requisite amount of powder on the skin.
Mascara is a make-up used for darkening eyelashes. The use of eye-liner pencil, mascara and eyeshadow to highlight the eyes is a popular practice. These products contain various dyes, anti-bacterial agents, resin and bases. Allergies to these are not uncommon, particularly since the skin about the eyes is very thin and sensitive.
The colouring of lips for decoration is an age-old custom. Lipstick as we know it today is very different from earlier products. Most contain oil-wax mixtures, lanolin, staining dye, perfume and colour pigments. Each of these substances may cause an allergic reaction in some users.
Nail polish is essentially a lacquer containing cellulose, nitrate, solvents, resins and colouring agents. The resins which are responsible for the sheen and stickiness are the agents most usually responsible for allergic reactions. The thin skin of the eyelids is particularly prone to contact dermatitis, being highly sensitive to various cosmetics, especially hair preparations and nail polish.
Fragrances are incorporated in nearly every type of cosmetic and may also, of course, be used alone. Perfume is created from a chemical formulation of fragrant volatile oils, preservatives and alcohol. The oils are obtained from a variety of sources including spices, flowers and fruits. Toilet water (l’eau de toilette) is made by using large amounts of alcohol in the perfume formula. The scent is similar to that of perfume but does not last as long and is not as strong. Cologne is similar to toilet water and the terms are often used synonymously, although generally cologne is limited to citrus and floral bases. Both are applied more liberally than perfume, the fragrances are lighter, and the higher alcohol content means the lotions have a cooling, refreshing effect on the skin.
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Most heart disease in the Western world, and increasingly elsewhere, is caused by atherosclerosis of the arteries, sometimes referred to as ‘hardening of the arteries’. Most people develop atherosclerosis gradually during their lifetime. If it develops sufficiently slowly it may not cause any problems, even into great old age, but if its development is accelerated by one or more of many processes the condition may cause trouble much earlier in life.
Atherosclerosis results in reduced blood flow through the affected arteries. In the heart this can mean that the heart muscle gets insufficient oxygen to provide the power for pumping blood, and it changes in such a way that pain is experienced (central chest pain or angina pectoris). Elsewhere in the body, atherosclerosis has a similar blood flow reducing effect: in the legs it can cause muscle pains on exercise (intermittent claudication); in the brain it can cause a variety of problems from ‘funny turns’ to strokes.
An even more serious consequence of atherosclerosis occurs when a blood clot forms over the surface of a patch of atherosclerosis on an artery. This process of thombosis can result in a complete blockage of the artery with consequences ranging from sudden death to a small heart attack from which the patient recovers quickly. The process of thrombosis can occur elsewhere in the arterial system with a range of consequences determined by the extent of the thrombosis. The probability of developing thrombosis is determined by the ‘tendency’ of the blood to dot versus the natural ability of the blood to break down clots (fibrinolysis). These two counteracting “tendencies’ are influenced by a number of factors, including some dietary factors (most notably the effect of fatty fish or fish oils in the diet).
People who have gradually developed atherosclerosis of the arteries to the heart (the coronary arteries) may gradually develop reduced heart function. For a while the heart may be able to compensate for the problem, so there may be no symptoms, but eventually it may begin to fail. Shortness of breath may begin to occur, initially on exercise, and there may sometimes be some swelling of the ankles. Modern medicine has many effective drug treatments for heart failure so this consequence of atherosclerosis does not have quite the same serious implications as it did in the past.
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WHR is a ratio of abdominal subcutaneous and visceral fat to hip subcutaneous fat. The measure is ‘anchored’ to a measure around the hips because it had been thought that this was less variable to change. Recently though, Canadian researchers at Laval University in Quebec have suggested that waist measures alone may be sufficient. WHRs (or other ratio measures used, such as waist-to-thigh ratio) generally have a cut-off point determined by epidemiological studies with large populations. Figures of 0.9 for men and 0.8 for women are often used as the cut-off points for WHR beyond which increased disease risk is indicated, but in some studies the figures of 1.0 and 0.9 respectively are used.
Some research has shown that with fat loss in some people, there is a loss from the hips as well as the waist and therefore WHR can remain relatively constant. For this reason it is probably best used as an absolute measure of risk in the first instance of measurement, rather than a relative measure of change, and is best used in combination with other measures such as BMI.
Attempts are currently being made to incorporate WHR and BMI into a single formula, but so far these have not added to the individual predictive value of either single measure. Waist measurements suggested by the Laval group as indicative of disease risk are above 100cm for men and 90cm for women—irrespective of height. Researchers at Glasgow University8 have compared waist measurements with BMI and have come up with the following conclusions for health promotion:
• men with a waist size of > 102cm and women with a waist size of >92cm should be encouraged to lose weight
• men with a waist of between 94-102cm and women with a waist of 80-88cm should be encouraged not to put on any more weight
• men with a waist size of <92cm and women with a waist size of <80cm do not need weight management.
WHR has a relatively high validity in the measurement of abdominal fat distribution, particularly in men and post-meno-pausal women, however validity may be affected by changes in hip size that occur with changes in body fatness. Reliability and sensitivity of waist measures alone is quite high, particularly in the hands of an experienced measurer.
Correct sites for measurement of waist and hips can vary and although there are currently attempts to standardise these, there is still controversy about the correct locations. There is general agreement that hips should be measured at the widest part of the buttocks as determined from side-on. Protocols for waist measurement include measures at umbilicus (the navel), which has the particular advantage of being easy to find, but the disadvantage of being almost at hip level in some obese women. Another waist site is mid-way between the lowest rib and the top of the iliac crest (hip bone), which has the advantage of bony landmarks but does not always capture the large abdominal mass in very obese people. In lean people the waist is the narrowest part between the chest and the hips but in obese people it can be the widest, therefore this is not recommended as a definition. Each has its disadvantages, but provided the measure is used constantly, the actual site becomes less relevant.
WHR and waist circumference measures have the advantages of being quick, non-intrusive and useful for large scale population surveys. WHR has disadvantages in making comparisons between varying groups of people such as is often seen in different cultural groups. Asian women, for example, have small hips and WHR measures are much less valid as an indicator of health risk. Negroid women on the other hand have large hips and buttocks and their health risk may be misinterpreted from WHR measures. Overall WHR, or waist alone, may provide a quick and simple indication of health risk. Waist alone can then be used to examine the success of a fat loss program in those groups where abdominal fat is stored readily.
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Congenital heart disease occurs in six to eight babies for every 1000 born. Nobody is certain why it happens. In some cases, the mother may have suffered from a bout of rubella in the early days of pregnancy. But with widespread use of vaccination this is becoming much less common.
So-called chromosomal abnormalities may take place. This means there has been damage to the fine filaments in the cells, occurring soon after conception. Once more, the reason why this happens is usually elusive. If a parent or other member of the family has this disorder, there may be an increased risk for future babies. Certain drugs taken during pregnancy may cause some cases. X-rays of the mother during pregnancy may in some cases be responsible. But in most, there is no known obvious cause.
Severe cases may result in the baby perishing during the first year of life. However, in recent years enormous progress has been made in medical research, and many cases can be surgically corrected to allow the child to develop into normal adulthood.
There are many and varied symptoms, but as a general guide the following should alert a parent to seek medical advice promptly. It could indicate some kind of heart disorder.
The infant or child may show a poor weight gain, and there are commonly feeding problems. There may be attacks of fainting, or even blackouts. In young infants this may show up as sighing bouts, when the infant becomes pale.
The infant may have difficulty in swallowing and may have a tendency to regurgitate curdled milk. Or may have difficulty in breathing comfortably. Sometimes the mother finds that the little fellow is more comfortable if he bends backwards. Often the child may decline activity and normal exercises which are being enjoyed by his or her friends. The child may simply want to squat down and watch the others at play.
Some cases are accompanied by a bluish skin colour- called cyanosis. This may occur from a very early age. A check of the mother’s case history may indicate that during pregnancy she suffered from rubella or had various other abnormalities.
Treatment
Any suspicious symptom needs prompt medical attention. The paediatrician has the facilities and knowledge for investigating all kinds of heart abnormalities. In the first instance this medical specialist will be seen because the parents feel their baby is not well or not normal. It is then up to the paediatrician to initiate the investigations and tests that will give the correct diagnosis.
Many different kinds of heart abnormalities exist, and because they are intricate and detailed we cannot here go into a minute study of them. But they involve various, single or multiple defects. There may be narrowing of the entrance to the different vessels; valves may be deficient and defective. One side of the heart may be connected directly with the other side via holes which should not be present. Similarly, the large heart vessels may interconnect in the wrong places. These will all lead to symptoms, and an increasing strain on the heart and on the child’s health in general.
Left unchecked, many of these will cause a deterioration of health either rapidly or during a period of some years. The outlook, when untreated, is usually poor.
However, with correct therapy, which often involves surgery, the outlook has been revolutionized in the past few years and in many cases the future prospect is excellent.
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‘Are schoolgirls still given rubella vaccines?’ Jane asked.
‘They certainly are. It’s offered to any girl between the age of 12 and 14 years, usually soon after they enter secondary school. Again, a single injection is given, and this appears to give adequate immunity. Medical practitioners may also immunize girls and women in the childbearing years. However, it is advised that it shouldn’t be given to pregnant women or to any woman who may become pregnant within two months of immunization. But it’s available again to women in maternity hospitals immediately after they have been confined if they haven’t already been immunized.’
‘How about smallpox vaccine? Is that a dead topic, or still alive?’
‘It is now believed that smallpox, once a terrible killer, may have been virtually eliminated from the face of the globe. Many countries have relaxed their laws requiring vaccination. But a few are still holding on, and it is now only recommended for persons travelling to countries that specifically insist on vaccination.’
‘What about booster shots and all that? The story seems to be a never-ending one,’ Jane said.
‘It is certainly advisable to maintain immunity to those diseases which could continue to pose a threat,’ I answered. ‘For that reason, health commissions suggest that diphtheria and tetanus immunization be repeated at certain intervals—certainly tetanus should be reinforced every five to ten years, and definitely if a potentially infective wound is sustained. It’s better to be sure than sorry.’
‘Are there any others I should know about?’
‘Not really. Of course, if Sarah plans to visit various overseas lands when she grows up, protection against such diseases as malaria, typhoid, cholera and perhaps hepatitis are worth thinking about. We get reports of about 260 cases of malaria each year in Australia from overseas travellers—it is still a major killer disease in other lands.
‘However, let us now concentrate on the potential troublemakers that are knocking at Sarah’s front door,’ I said, pulling out my ball point pen and prescription pad. ‘Supplies for Sarah’s immunization still have to be obtained, for I prefer to use a fresh batch for every patient.’
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