Human skin color

It’s time to remove skin color from the Apgar Score for newborns

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Health care workers checking a new born baby's heart rate. -- first opinion coverage from STAT

In medicine, inertia can be a strangely powerful force, but Virginia Apgar never succumbed to it. She brought incredible energy to her work in anesthesia, neonatology, and dysmorphology (the study of birth defects) and questioned the status quo when she thought it might save lives.

With gratitude for her tireless work, we have reevaluated the eponymous health assessment Apgar developed more than 70 years ago and concluded that one of its components — skin color — should be abandoned. It’s a step Apgar herself might have encouraged; she knew this part of her evaluation method was weaker than the others. We have a chance now to correct that bias.

Apgar developed her scoring system in the early 1950s to help identify newborns who might need immediate medical attention after birth. The Apgar Score, performed one minute and five minutes after a baby is born, called for a consistent, rapid evaluation of five categories associated with a newborn’s health: heart rate, respiration, muscle tone or activity, reflex response to stimulation, and skin color. Her method worked, reducing infant mortality (although the original articles do not say by how much), and is still used today.

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Apgar’s system also was flawed — and she knew it. In her original paper presenting the scoring method, she wrote that color “is by far the most unsatisfactory sign” of newborn health because it did not work on darker skin.

The Apgar Score offers four limited choices for the skin color score: completely pink, acrocyanotic (bluish discoloration from a lack of oxygen), pale, and blue. Put simply, children of color cannot turn “completely pink” and may not seem to turn bluish due to a lack of oxygen as others might.

The skin color component’s utility is also limited by perception. Apgar meant to introduce objective measures to assess newborns, but color perception is subjective. People from different cultures, of different genders, and who have different visual abilities perceive color differently.

Apgar’s perspective was rooted in her own education and experience. The first part of her medical work was in anesthesiology, where she learned to identify how well oxygenated a patient was based on the patient’s skin color. At the time, it was a standard way to evaluate patients.

We conducted a study that reviewed a comprehensive, reliable national database to see which newborns received perfect Apgar Scores. Not surprisingly, white newborns had a significantly higher chance of receiving a “perfect” or “optimal” score of 10. We found that the harm is that more healthy babies of color may end up in the neonatal intensive care unit with more unnecessary interventions.

We also found studies that report unreliability and high variability in how medical observers perceive color. Perhaps most important, many medical professionals say the color score contributes little to the Apgar Score’s value, and there are regions of the world where those evaluating newborns ignore this part of the assessment. Hopefully, that’s where we’re headed, too.

To be clear, the Apgar Score has saved countless newborns, and Apgar was not racist.

However, today we have an opportunity — and a responsibility — to uncover and eliminate racial bias wherever it exists. Using skin color to evaluate and score newborns does not advance health equity or promote better outcomes for patients. It advances racial bias, systemically, from a child’s first minute.

It is time to part ways with this component of Apgar’s method, and the score would be out of eight, not 10.

The comprehensive adoption of the Apgar Score has led it to be said that every newborn is seen through the “eyes” of Virginia Apgar. That vision was not racist, but it did introduce a racial element to the assessment of newborn health for babies of color, one that is both subjective and not clinically useful. If we keep using it out of a sense of medical tradition, we are giving in to inertia, something Apgar never did.

Throughout her career, Apgar pushed herself and pushed boundaries. She established a new department of anesthesia soon after she graduated from medical school, attended more than 17,000 births, drew attention to newborn health and birth defects, and carried around a resuscitation kit because she didn’t want anyone dying on her watch. She never retired.

In keeping with her boundless energy and passion for progress in medicine and education, we must see what Apgar herself had noted: Skin color is the least useful way to evaluate a newborn.

Easy, Natural Ways to Remove Facial Tanning.

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Homemade tips to get rid of sun tan.

 

 

self-tanning

Here are some of the most popular and effective home remedies and methods to remove that horrid sun tan.

You can apply these natural packs to get rid of the tan from your face, arms, hands, neck, back and feet the natural way. These age old home treatments need at least a week of regular use to obtain noticeable results against the tan and to get your natural colour back.

We tend to use fairness cream which contain bleach that are harmful to the skin in the long run and should be avoided.

– A mixture of lemon juice, rose water and cucumber juice should be applied on the face as a face pack. Lemon juice is citric acid that helps remove the tan and the cucumber and rose water are cooling agents.

– Mixing together some honey and lemon juice and applying it on the affected area can be one of the best anti tan pack mixtures.

– Preparing a paste of some raw milk, turmeric and some lemon juice. This mixture should then be applied on the skin and be allowed to remain till it dries up. Thereafter, it should be washed with some cool water.

– Prepare a mixture of oats and buttermilk. This mixture should be rubbed onto the tanned area as the oats will help in exfoliating the skin and on the other hand the butter milk is known to be extremely soothing for the skin.

– Mixing together some gram flour, lime juice and some curd on the affected area on a regular basis gives best results against tanning.

– Applying some fresh lemon juice and allowing it to remain for at least 15 minutes on the elbows, knees or patchy areas helps remove the tan and making it fair.

– A regular use of fresh coconut water on the hands and face is known to be very effective in getting rid of a tan as well as making the skin supple and soft.

– Aloe Vera gel is an excellent remedy for taking care of dark tans. It will lighten the skin in as little as a week, if applied everyday to the affected area. However, aloe has the property of making your skin photosynthetic and can darken it if you go out in the sun without sunscreen lotion. This makes it important to remember to use sunscreen every time you go out.

– A cream with equal parts of milk powder, lemon juice, honey and almond oil can be applied and left on for 20 minutes. This will help lighten your tan. You can store this for about a week and use it thrice daily for best results.

– Apply a paste made with turmeric powder and lime juice thrice a week. This will lighten the skin colour considerably and remove the tan.

– Soak almonds overnight and grind them into a fine paste the next morning. Add equal quantities of milk cream to the paste and apply on the affected area to make the skin fair.

– Apply a paste of oatmeal, yogurt, a few drops of lime and tomato juice. Wash this with cold water after half an hour and see the difference.

– Mash the papaya pulp and massage the sun tanned area. Papaya is excellent for the skin and also helps in anti-aging.

– Combining ash gourd juice with multan mitti and applying it all over the face helps reduce the tan considerably.

 

 

Sun tanning remains a perennial problem for us with a long summer season where the sun is harsh enough to wreck our facial skin, inducing dryness, rough patches and overall tanning. While over-the-counter creams and lotions can reduce the intensity of the tanning, they cannot remove it comprehensively. For those with sensitive skins where using such chemically-formulated products is not an option, tanning becomes an even bigger issue. Thus, it makes sense to get familiar with some easy and natural ways of removing sun tan.

Daily Anti-Tan Remedy

You can use various types of flours to make a daily anti-tanning face pack. Your choices include jao atta or flour of oats that exfoliates in the gentlest manner. A similar pack prepared Corn Flour helps to lighten the skin tone. Flour prepared from lentils or dals combines the anti-tanning actions explained above.

Weekly Anti-Tan Remedy

Prepare a natural anti-tanning face-pack cum scrub at home by mixing some sugar and essential oil like mustard oil. Add a few teaspoons of honey and mix the ingredients vigorously until they turn into a smooth-textured paste. Add a few drops of lemon juice and beat the ingredients with a spoon. This paste acts like a scrubber due to the presence of sugar crystals. Scrubbing helps to remove the outermost, i.e. dead and darker, layer of the skin. Presence of honey and lemon ensure that the scrubbing doesn’t cause any harm to the skin and vitamin C of lemon acts like an antiseptic, alleviating the dryness too. To counter the dryness, apply pure aloe vera gel to the face. Rub this lightly over your face and wash it off with lukewarm water. This is best done before retiring to bed at night.

Monthly Anti-Tan Remedy

To ensure that the skin-darkening effects of tanning are neutralized, you need to use a face pack aimed specifically at lightening your skin tone. The safest option in this niche is using a Turmeric & Sandal Wood pack. Both these ingredients are commonly found in many skin creams. Both are easily available in the powdered form. Just mix equal amounts of turmeric and sandal wood powder and mix them with some rose water. Keep this face pack on for at least 25 minutes.

Keep Away From Tanning Foods

This might be shocking for you but there are food items with established tanning properties. These food items are commonly used in skin-tanning aids used by the fair-skinned Europeans and Americans.

Egg Yolks—high in vitamin A and High-Density Lipoproteins, a higher yolk intake and application has been a skin tanning formula in the West for decades.

Carrots—they contain carotene that is formed of carotenoids. Most natural tanning aids retailed in the West mention carotenoids as the main ingredient underling its tanning potency.

Besides these natural anti-tanning remedies and precautions, the most basic and potent solution remains restricting your exposure to sunlight. Use everything at your disposal, including wearing anti-glares, covering yourself with an umbrella, chunni/dupatta or just walking in the shade to keep out the sun.

 

Is drinking extra water good for your skin?

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If you yearn for smooth skin that glows with youth, the chances are that at some point you will have heard the exhortation to drink lots of water in order to flush out those evil toxins and keep your skin healthy.

The exact amount people suggest varies. US-based advice tends to recommend eight glasses a day, while in hotter climates people are advised to drink more to compensate for higher rates of sweating. But regardless of the exact volume of water suggested, the principle behind the advice remains the same – taking extra water on board will keep your skin hydrated. In other words, water acts like a moisturiser, but from the inside out.

This is such a common idea you might be surprised at the lack of evidence to back this up. You might expect there to be countless studies where people are separated into two groups, one assigned to sip water all day, the other to drink a normal amount. Then the smoothness of the skin could be assessed a month or so later to establish whether sipping more led to smoother skin.

In fact such studies are rare, partly because water can’t be patented, so it is hard to find anyone to fund such research when there will be no new medication or cosmetic to sell that could repay the costs.  A review by the dermatologist Ronni Wolf at the Kaplan Medical Centre in Israel found just one study looking at the effect of long-term water intake on the skin. But the results were contradictory. After four weeks, the group who drank extra mineral water showed a decrease in skin density, which some believe suggests the skin is retaining more moisture, while those who drank tap water showed an increase in skin density. But regardless of the type of water they drank, it made no difference to their wrinkles or to the smoothness of their skin.

That’s not to say that dehydration has no effect on skin. We can measure some effect through the assessment of skin turgor. This is a measure of how fast it takes the skin to return to normal if you pinch some skin and lift it up. If you are dehydrated your skin will take longer to get its shape back.

But it doesn’t follow that because drinking too little water is bad for the skin, drinking above average quantities is good. It would be like saying that because a lack of food leads to malnutrition, overeating must be good for us. Or as Wolf puts it, it’s like saying a car needs petrol, therefore the more petrol the better.

Mystery advice

Another common belief is that if you drink extra water the body will somehow store it. But it depends on how fast you drink it. Drink several glasses within a fifteen-minute period and you will just pass extra urine. If you spend more than two hours sipping the same amount, more liquid is retained.

There is one study suggesting that drinking 500ml of water increases the blood flow through the capillaries in the skin. But the skin was only evaluated thirty minutes after drinking the water, and what we don’t know is whether this in turn improves skin tone.

One counterargument is that skin contains up to 30% water, and this helps it to look plump. This may be true, but the skin’s youthful appearance is affected more by factors such as genetics, exposure to the sun and damage from smoking.

So the mystery is where the eight-glasses-a-day recommendation for good skin comes from. Few of the official guidelines even refer to the skin. Water is undoubtedly the most important nutrient for the body. Without it we die in a matter of days, and there are of course other health benefits from staying hydrated. A review in 2010 found good evidence that it reduces the recurrence of kidney stones in those who have already had them, but evidence for other specific benefits is weaker.

 

Rural communities across Africa may soon benefit from improved water supplies thanks to mobile phone technology.

Arguments rage over the eight glasses a day rule, with disputes over how much is needed to clear the kidneys of toxins and whether or not water helps curb the appetite. It depends on how high the ambient temperature is and how much you are exerting yourself. It’s also a myth that other liquids don’t count. It doesn’t have to be water. Even food contains more liquid than you might expect.  Pizza is 40-49% water, for instance. The percentage of water we derive from food in the diet depends on where you live. In the US it’s 22%. In Greece, where people eat more fruit and vegetables it is much higher.

So the problem is a general lack of evidence that drinking more water makes any difference to your skin. We can’t say it definitely doesn’t work, but there’s no evidence that it does. Which leaves the question of how much water you should drink. Since it depends on the weather and what you are doing, then there is a very good internal guideline we all have that can help. And that’s thirst.

Source: BBC.