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Beware of belly fat

Middle-aged women:

Strokes have tripled in recent years among middle-aged women in the U.S., an alarming trend doctors attribute to the obesity epidemic. Nearly 2 percent of women ages 35 to 54 reported suffering a stroke in the most recent federal health survey, from 1999 to 2004. Only about half a percent did in the previous survey, from 1988 to 1994.

The percentage is small because most strokes occur in older people. But the sudden spike in middle age and the reasons behind it are ominous, doctors said in research presented Wednesday at a medical conference.

It happened even though more women in the recent survey were on medicines to control their cholesterol and blood pressure - steps that lower the risk of stroke.

Women's waistlines are nearly two inches bigger than they were a decade ago, and that bulge corresponds with the increase in strokes, researchers said.

In addition, women's average body mass index, a commonly used measure of obesity, rose from 27 in the earlier survey to 29. They also had higher blood sugar levels.

No other traditional risk factors like smoking, heart disease or diabetes changed enough between the two surveys to account for the increase in strokes.

In a "pre-stroke population" of middle-age women, a tripling of cases is "an alarming increase," said Dr. Ralph Sacco, neurology chief at the University of Miami Miller School of Medicine.

The study was led by Dr. Amytis Towfighi, a neurology specialist at the University of Southern California in Los Angeles, and presented at the International Stroke Conference in New Orleans.

She used the National Health and Nutrition Surveys, a federally funded project that gives periodic health checkups and questionnaires to a wide sample of Americans. Participants are routinely asked whether a doctor had ever told them they had had a stroke, and about 5,000 middle-aged people answered that question in each survey.

Researchers saw that the stroke rate had spiked in middle-aged women but stayed about the same - around 1 percent - in middle-aged men. So they looked deeper at the responses to see if they could learn why. Belly fat stood out, Towfighi said.

The portion of women with abdominal obesity rose from 47 percent in the earlier survey to 59 percent in the recent one. The change in men was smaller, and previous studies have shown that "abdominal obesity is a stronger risk factor for women than men," she said.

Men traditionally have had a greater risk of stroke than women, and "women start catching up to men five or 10 years after menopause," said Dr. Philip Gorelick, neurology chief at the University of Illinois in Chicago and chairman of the stroke conference.

The new research means "we need to redefine our textbooks about stroke in women," because they may now be more at risk in middle age than men.

Obesity "sets the stage for all the other risk factors to come in" like diabetes and heart disease, Gorelick added.

In other news at the conference, two studies found that stroke patients were more likely to die if they went to hospitals on nights or weekends, echoing other recent studies that found similar risks for heart attack and surgery patients.

Michigan State University doctors analyzed 222,500 stroke cases at more than 850 hospitals participating in an American Heart Association quality improvement program from 2003 to 2007.

In-hospital deaths were about 6 percent for those who arrived during normal business hours and had strokes caused by a clot, compared with 5 percent of those who entered the hospital after-hours.

Deaths were 27 percent for off-hour strokes caused by bleeding in the brain versus 24 percent during normal hours.

A second study of 2.4 million stroke patients in California found death rates of 10 percent on weekends and nights versus 8 percent during weekdays.

Despite the poorer outcomes, doctors said no one should ever delay getting help, since any delay raises the risk of death. The best treatments can only be given in the first few hours after symptoms appear.

MayoClinic.com

Skin rash: A diagnostic challenge

GPs see so many skin rashes and people are understandably concerned about them because they're so visible and can be alarming. They're rarely serious, but often pose a diagnostic challenge for you and your doctor.

So if you develop a rash, how does your doctor decide what it is and what's causing it.

The story of your skin

Even with 21st century medical technology, the modern GP will make most skin diagnoses based on old-fashioned clinical skills listening to your story and examining you.

Although I have to rely heavily on what I see, there's more to dermatology than simple pattern recognition. With experience it's sometimes possible to make an on-the-spot diagnosis - the typical pearly lumps of molluscum contagiosum spring to mind - but your GP will often need more clues.

It's important to know how long you've had the rash, whether it's there all the time and if it's irritating or itchy. I would want to know about your past medical history, too, and whether any other members of your household are affected.

Several very itchy people in the same house might make me think of scabies. People often gasp with horror when I say the name - I think they imagine a ghastly medieval plague - but infestation with the scabies mite is common, it's no reflection on your standards of hygiene and it's easily treated.

It often takes a while to diagnose though, as it's easy to mistake it for other common itchy rashes such as eczema.

Patients often volunteer information about possible skin irritants they may have encountered, but it's often worth me asking about specific things such as washing powders, gardening (I remember one patient with a nasty itchy rash after clearing some poison ivy in the garden) or bubble baths.

I'll also want to know how you're feeling in general - skin rashes are often an outward sign of a general illness or infection. This is particularly true in children, where a fever and a rash are common bedfellows.

Skin rashes are often an outward sign of a general illness or infection.

Sometimes a typical rash points to a diagnosis of one of the common childhood viral infections, such as chickenpox or rubella.

The timing of the rash in relation to a fever can be helpful, too. In the viral infection Roseola infantum, for example, the temperature settles and the child starts to feel better after about three to four days, at which point the classic rosy pink rash starts to appear. Non-specific viral rashes are very common in children and adults.

They disappear on their own and usually don't need any specific treatment, but it can feel a bit feeble not to be able to give them a neat label and something to make them go away. It's the dermatological equivalent of 'there's a lot of it about'.

While parents often seem most alarmed by their child's rash, your GP will probably be more interested in how unwell the child is generally. We're all alert to the rash of meningococcal disease - the classic red or purple spots that don't disappear when you press a glass tumbler over them.

But in the early stages of the disease the rash is often rather non-specific, and many children don't develop a rash until very late on, if at all. So the rash, although an important clue, is just one part of the meningitis jigsaw.

I also try to remember to ask what you've already used to treat the rash. Topical steroid creams, for example, can alter the appearance of a bacterial or fungal skin infection so it looks nothing like how it should.

Finally, doctors are a common cause of rashes, too, or rather the medicines we prescribe are - name any medicine we prescribe (and many we don't) and I'd bet good money on 'rash' being in the list of its side-effects.

What does it look like?

As I scrutinise your rash, preferably in good light, this is probably what I'm thinking about. What do the lesions look like.

There are some jargon words that, in the right combination, can sometimes bring a particular diagnosis miraculously to mind.

They describe whether the lesion is raised (a papule or nodule), flat (a macule), filled with fluid (vesicles or blisters) or pus (pustule). Then there's scaling, crusting, excoriation (scratch marks), lichenification (thickening) or atrophy (skin thinning). A plaque is a raised uniform thickening of the skin with a well-defined edge: this is typical in psoriasis for instance.

Erythema is a useful word. It simply means redness, and so applies to most rashes, but it's also an impressive sounding label when you're stuck for ideas. I once saw a doctor tell a frustrated patient with a non-specific viral rash that he had 'idiopathic erythema'. The patient was delighted to have a name for his rash, even though it actually means 'redness of unknown cause'.

All these terms, and others, allow me to describe the rash accurately. Then I must make a note of where the rash is: its distribution.

Where is it?

Certain common skin conditions have a preference for particular sites on the body. Psoriasis, for instance, tends to affect the outer surface of the elbows or front of the knees, whereas eczema tends to affect the inside surfaces of the limbs.

Our old friend the scabies mite typically goes for the wrists, between the fingers and the genitalia. Pityriasis rosea, a dramatic rash thought to be caused by a virus and which goes away on its own, classically makes a Christmas tree pattern on the back or chest.

Looking at the configuration of the rash can also help. Ring-shaped lesions are often due to fungal infections (hence the term 'ringworm', although no worms are involved), but there are other causes, such as granuloma annulare (sometimes associated with diabetes), urticaria (itchy allergic type rash) or resolving psoriasis.

With your story, the distribution pattern of the rash and my jargon words, I can now put them all together and, hopefully, come up with a diagnosis.

So silvery, scaly plaques on the elbows make me think of psoriasis, red nodules on the shins make me think of erythema nodosum and an erythematous maculopapular rash starting at the head and spreading to the trunk and limbs might make me wonder about measles (although thanks to MMR vaccine, I've never seen a case - except myself as a child).

It sounds easy but it's rarely straightforward. If the rash isn't behaving as I'd expected, or it's taking a while to respond to treatment, then it's usually time to think about further tests - a skin sample for analysis (a biopsy), skin-prick tests for potential allergies, or referral to a dermatologist.

BBC.Com

Top 10 ways to live forever

* 1. Grill a steak.

You may think it's bad for your heart, but you'd be wrong. Beef contains immunity-boosting selenium as well as homocysteine-lowering B vitamins. And up to 50 percent of the fat is the heart-healthy monounsaturated variety.

* 2. Tell your wife to butt out.

People who are exposed to cigarette smoke for just 30 minutes, three times a week, have a 26 percent greater risk of developing heart disease than people who rarely encounter secondhand smoke.

* 3. Take aspirin.

Regular aspirin consumption cuts the risk of coronary heart disease by 28 percent in people who have never had a heart attack or stroke.

* 4. Drink more tea.

Men who drink 2 cups of tea a day are 25 percent less likely to die of heart disease than guys who rarely touch the stuff. The reason: flavonoids in the tea, which not only improve blood vessels' ability to relax, but also thin the blood, reducing clotting.

* 5. Touch her.

Ten minutes of skin-to-skin contact (hand-holding, hugs) with your mate can help keep your blood pressure and pulse from spiking during stressful times, according to University of North Carolina researchers.

* 6. Go fishing for tuna.

Omega-3 fats in tuna help strengthen heart muscle, lower blood pressure, and prevent clotting as well as reduce levels of potentially deadly inflammation in the body.

* 7. Pair up.

Married men are less likely to die of heart disease than bachelors. Scientists looked at men with mildly high blood pressure and found that after 3 years of marriage, the happily married men had healthier hearts than their unmarried brothers.

* 8. Adopt a dog.

All that love ("You're a good boy, yes you are!") and aggravation ("Bad dog! Don't eat Daddy's crab dip!") makes your heart more adaptable and better able to deal with the stress that can lead to heart disease.

* 9. Rinse, brush.

Rinse your mouth with mouthwash and toothpaste that has antibacterial properties. They'll reduce oral bacteria, which can decrease your risk of a heart attack by 200 to 300 percent.

* 10. Make friends at work.

Men with the most work friends also have the lowest heart rates and healthiest blood-pressure levels, even during times of stress.

Men's Health

Tattoo inks a toxic brew

As if the possibility of contracting AIDS or hepatitis from a dirty needle wasn't bad enough, two chemists have just completed a study that found carcinogenic chemicals are being used as tattoo pigments.

Researchers Ronald Petruso and Jani Ingram presented their findings at an American Chemical Society meeting in Atlanta, urging for more regulation in the tattoo industry, particularly in light of the increasing popularity of body art.

"It's not federally regulated. But it should be because since these pigments are going under the skin, they're being used as drugs," Petruso said. "The number of people with tattoos is growing and still we don't see much aired in the media about possible dangers outside of AIDS and hepatitis."

Visiting several parlors, the researchers found lead in some tattoo pigments, but more worryingly was the discovery of carcinogenic substances in a common tattoo pigment. Tracing the pigment back, the researchers identified the chemical plant where it was manufactured.

"When we told [the manufacturer] about our findings they were very concerned because this is not what they design their products for. The pigments they make are used by auto manufactures for making paint," Petruso said.

He also said that if they found out the source of who's misusing their products, they would go after them and sue them." The real danger, according to the researchers, is that since tattoos are not federally regulated, no one even considers the possibility that these pigments might be dangerous.

"There are so many tattoo parlors out there that you don't have any idea where they're buying their supplies. People come in knowing about hepatitis and AIDS, and tattoo artists are careful about ensuring that the needles are sterile. But they don't expect to see [dangerous] chemicals present in those pigments, and that's the situation that needs to be addressed," Petruso concluded.

Source: American Chemical Society