Collagen creams. Collagen may be the ‘wonder’ ingredient in the cosmetic world’s coffers but it does not appear to do much for the skin.

Advertisements implying anything to the contrary are misleading. Collagen is a protein substance found in the connective tissue, cartilage, and bone of the body. While it is true that changes in collagen fibres contribute to wrinkles and the appearance of ageing skin, adding collagen to a cosmetic will not affect the collagen in the skin, nor in any way reverse the changes that have taken place.

Hormone creams. It has been claimed that hormone creams containing the female hormone oestrogen may cause thickening of the thinner skin of the elderly person. While such creams can be absorbed by the skin, there is however, no evidence of such thickening effects on facial skin. Nor is there any evidence that the addition of hormones will make skin creams more effective in relieving dryness. Indeed, there is no evidence to indicate that the thinner, less hydra ted dermis or subcutaneous fat layer of the elderly has any capacity to become thicker or more hydra ted with the addition of topical hormones. Furthermore, excessive use of such preparations may have harmful internal effects and therefore should be avoided.

Medicated creams. The practice of incorporating antibacterial agents into soap, cosmetics, and other toilet preparations has increased markedly in recent years. These medicated’ preparations in fact have the effect of limiting bacterial contamination of the product rather than of the user. Furthermore their potential harm often outweighs their benefits. People can become allergic to these anti-bacterials, and thereby allergic to many other commonly used products containing the same ingredients. As a result some of these people may develop a sensitivity to chemically related compounds, which is in itself a considerable disability.

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The chance of developing heart disease is increased if you smoke tobacco, have high blood pressure, have diabetes, have high blood cholesterol (which may be due to eating too much fat in your diet), are overweight or obese and/or do not take enough physical exercise.

• Smoking of tobacco is now clearly established as a cause of atherosclerosis. Few authorities now dispute the evidence. There are however some interesting dietary aspects: Did you know that smokers tend to eat less fruit and vegetables compared to non-smokers (and thus eat less of the protective anti-oxidant plant compounds)? Did you know that smokers tend to eat more fat and more salt than non-smokers? These characteristics of the smoker’s diet may be caused by a desire to seek stronger food flavours as a consequence of the taste-blunting effect of smoking. While these dietary differences may make the smoker at greater risk of heart disease there is only one piece of advice for anyone who smokes: please stop smoking!

• High blood pressure causes changes in the walls of arteries. The muscle layer (remember an artery is not a rigid pipe, it is a muscular tube, which when healthy can change its size to control the flow of blood) becomes thickened and atherosclerosis is more likely to develop. Treatments for blood pressure have become more effective over the last thirty years, but it is only now becoming clear which types of treatment for blood pressure are also effective at reducing heart disease risk.

• Diabetes is caused by a lack of insulin—either the body does not produce enough or the body ‘demands’ more than normal (because It has become insensitive to insulin). In diabetes some of the chemical (metabolic) processes which take place tend to accelerate atherosclerosis. Diabetes may also result in raised blood fats. The increased risk of heart disease is a major reason why so much effort is put into achieving normal control of blood sugar in diabetic patients, and also why all people with diabetes should be checked for the other risk factors of heart disease.

• High blood cholesterol increases the risk of heart disease. Your blood cholesterol is determined by genetic (inherited) factors— which you cannot change—and lifestyle factors—which you can change. There are some relatively rare conditions in which particularly high blood cholesterol levels occur. People who have inherited these conditions need a thorough ‘work-up’ by a specialist doctor followed by life-long drug treatment. In most people high blood cholesterol is partly determined by their genes, which have ’set’ the cholesterol slightly high and lifestyle factors which push it up more. The most important dietary factor is fat. The Sets prescribed for blood cholesterol lowering are low fat (low saturated fat), high carbohydrate, high fibre diets. Body weight also affects blood cholesterol—in some people being overweight has a significant effect on the levels—attaining a reasonable weight can be helpful. The blood also contains triglycerides, another type of fat which is particularly high after meals. High triglycerides may be linked with increased risk of heart disease in some people.

• Overweight and obese people are more likely to have high blood pressure and to have diabetes. They are also at increased risk of getting heart disease. Some of that increased risk is due to the high blood pressure, and the tendency to diabetes, but there is a separate ‘independent’ effect of the obesity. When increased fatness develops it can be distributed evenly all over the body or it may occur centrally—in and around the abdomen (tummy). This central obesity is particularly strongly associated with the risk of heart disease.

Thus every effort should be made to get body weights nearer to normal – especially if the extra weight is ‘middle-age spread’.

• Exercise has several benefits for the heart. Cardiovascular fitness is improved by regular strenuous exercise and the blood supply to the heart may be ‘improved’. Exercise is also important in maintaining body weight and has effects on metabolism and some factors related to blood dotting. Getting regular exercise is clearly important.

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Fat distribution is now regarded as of equal or greater importance to total fat as a health risk and new techniques of measuring fat distribution have recently been developed. Abdominal fat has been regarded as one of the key indicators and measures of this include waist-to-hip ratio (WHR) and the Gonidty or C-Index. Visceral fat, which in the future is likely to prove to be the most powerful predictor of disease, can only be measured in vivo, or in live organisms, through the imaging machines discussed below. How-ever, estimates can be made from techniques that measure abdominal fat including WHR, and the C-index, and more recently using techniques to measure sagittal diameter (SAD), or a measure of abdominal thickness known as the abdominal diameter index (ADI).

Conicity Index (C-Index). The C-Index was developed by Dr Radolfo Valdez and colleagues from Pennsylvania State University in an attempt to combine the best aspects of BMI with WHR or body fat distribution. The C-Index quantifies fat shapes as lying between two extremes; the first a cyclinder, i.e. very lean, and the second, bi-conical.

So far the C-Index has had only limited validatory research carried out on it, some suggesting it may not add significandy to other anthropometric measures. However, variations to this in the future may offer promise for a more sensitive measure.

The C-Index requires measures of height, weight and waist circumference and the following formula:

C = abdominal girth (at umbilicus) in metres/0.109/weight (kg)/height(m)

The range of scores is from 1.00 to 1.73 but, as yet there are no normative figures for comparison. People scoring towards the low end i.e 1.00, are closer to the ideal than those scoring towards the high end i.e. 1.73. The validity of the measure is so far unknown, although reliability and sensitivity could be expected to be quite high.

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The body contains a system of special glands called the endocrines. These are scattered throughout the body, from the head to the pelvis. They produce important chemicals called hormones. All play a vital part in keeping the body healthy. If too little or too much hormone is produced, then symptoms develop.

Some of these conditions are fairly common, whilst others are rare and will never be seen by the average parent. Some are readily and successfully treated, whilst others are extremely difficult to diagnose and even more difficult to successfully treat.

Many children with symptoms may be referred by family doctors to special centres, usually located in large hospitals, where special investigations may be carried out to help decide the diagnosis; also, facilities are available there to treat the patients. As some of these conditions may continue for a long time, getting linked to a major centre is often the best idea. So, if your family doctor finds your child’s symptoms puzzling and suggests referral to a centre of this nature, go along with this suggestion. In the long run it will be to everyone’s advantage, child and parent, and for the doctor also, who wants the best for the patient.

The endocrine glands that will be discussed here include the pituitary gland, in the brain, which stimulates the activity of other endocrine glands. In the neck are the thyroid gland and the parathyroid glands, located near the back of the thyroids.

The pancreas is situated in the abdominal cavity and is responsible for diabetes, if diseased. The gonads are the sex organs (ovaries in females, testes in males), and these are responsible for some conditions which need care and attention. The adrenal glands are small organs sitting on top of the kidneys; disorders of these are rare but serious.

Phenylketonuria (P.K.U.) is not really related to the endocrines but is included in this section. It is an inherited disease which can now be detected at birth and readily and successfully treated. Early detection of P.K.U. in Australian babies in the past few years is one of the major forward steps in neo-natal care. The results are now strikingly successful—once, a missed diagnosis was responsible for serious forms of mental retardation which could be lifelong.

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Rubella is a common, simple infectious disease which is widespread amongst children. It is produced by a virus, and the symptoms are a fine skin rash and swelling and tenderness of the glands around the neck. It spreads from person to person by droplet infection (the germs cling to microscopic drops coughed, breathed or sneezed into the air by an infected person).

The time from infection until the onset of symptoms (the incubation period) is usually between two and three weeks. There is a lapse of a few days (the prodromal period) from the start of symptoms until the typical rash sets in. During this time there are minor symptoms: the child may feel slightly off-colour and notice that the glands in the neck are a bit tender. Frequently, especially in younger children, these may be completely overlooked.

Finally the rash appears. This is usually a faint, very fine stippling that starts on the face and rapidly spreads on to the trunk and limbs. Within two to three days, and often sooner, it vanishes. Occasionally the temperature is raised, but generally this is only mild. In some instances, especially in epidemics, there may not even be a noticeable rash, just the glandular swelling. In some epidemics, as many as 40 per cent of cases may be rash-free. In some cases, a fine rash may be present but last only a few hours.

The chief concern of rubella is the amazing capacity of the virus to cross the maternal-placental barriers in pregnant women. This is vitally important during the first trimester (first three months); during this time, vital organs are developing in the foetus. The virus can interfere with their normal development, and cause serious and severe congenital abnormalities in the baby. These will vary according to the time of infection. But the heart, eyes, ears and brain may be adversely affected. This can cause blindness, deafness (in varying degrees up to total deafness), mental retardation and major heart defects. The liver and spleen may be affected, interfering with the blood system of the infant. Rubella infection occurring during the first month of pregnancy may incur a 50 per cent chance of serious defects. This falls to a 10 per cent risk by the third month.

So great are the potential hazards that rubella during early pregnancy is now a well-established indication for a legal termination of the pregnancy should the mother desire this. In fact, the majority of obstetricians would now specifically recommend it.

Treatment

Generally little or no treatment is necessary. If symptoms are present which cause discomfort, they may be treated symptomatically, along the same lines as for ordinary measles. Rest, fluids, simple adequate foods, analgesics and antipyretics (mixtures for relieving pain and reducing temperatures) are occasionally required, but these are usually minimal.

If there is rubella in the home, it is important that warning be given to any women known to be pregnant who have recently visited the family. It is important that pregnant women keep away from the infected person. Being highly infectious, the risks of contracting the disease are high, especially if the woman has not previously had rubella or has not been immunized. If contact has been made, she should contact her own obstetrician without delay. Special tests are available that will indicate her own degree of protection against rubella, and appropriate steps may then be taken.

Rubella vaccination is readily available at present in this and most Western countries. This is usually given to schoolgirls in the 12-14 age group. Every girl should be vaccinated. One single injection is all that is required.

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