2010年7月27日 星期二

Finding a Way to Save Money and Blood

Vital Signs

Regimens: Finding a Way to Save Money and Blood


Hospitals that capture the blood patients lose during emergency internal surgery and infuse it back into patients instead of using banked blood can cut the number of blood products used by half, and reduce costs, a study reports.

Use of a patient’s own blood, called an autologous blood transfusion, also reduces the risk of infections and other complications associated with donor blood, the authors said in their paper, published in this month’s Archives of Surgery.

The overall cost of blood transfusions was $1,616 on average for patients who received autologous transfusions, compared with $2,584 for patients who only received blood bank products, because patients reinfused with their own blood required only half as many units of banked blood as the other patients, the study reports.

Cost estimates included the added cost of collecting a patient’s blood during surgery, which involves suctioning up blood from internal bleeding, collecting it in a sterile container and putting it through a process that separates and concentrates the red blood cells, which are then suspended in saline and reinfused into the patient.

“This is safe and cost-effective, and we should be using it more often,” said Dr. Carlos V.R. Brown, chief of trauma and University Medical Center Brackenridge in Austin, Tex. and the paper’s lead author.

2010年7月21日 星期三

Aging Gracefully, the French Way

Aging Gracefully, the French Way

From left: A. Devlin/Press Association; R. Duvignau/Reuters; Kamel Lahamadi.

Catherine Deneuve, left, Ségolène Royal, center; represent the French approach to aging gracefully, as does the woman on the street.


Paris

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Jean-Paul Pelissier/Reuters

The actress Isabelle Huppert, 57.

Matt Sayles/Associated Press

Ellen Barkin, 56, was smooth-cheeked at Cannes.

Francois Guillot/Agence France-Presse — Getty Images

Juliette Binoche.

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I OFTEN see an elderly woman in my Paris neighborhood waltzing down the street to her own imagined music, flashing a slightly demented smile at everyone she passes. Anywhere else, I would cross the street to avoid her. But she always wears a matching, if slightly kooky, outfit — like the red print skirt, loose cardigan and scarlet cloche hat she wore one day this spring — has great posture and is beautifully made up.

She clearly loves being herself. And she makes me think that in France, women might forget everything else as they age — but never their sense of style.

If there is a secret to aging well, Frenchwomen must know it. At least that’s what Americans think. We look at actresses like Juliette Binoche, 46, or politicians like Ségolène Royal, 56, or superstars like Catherine Deneuve, 66, and figure that they must have special insights into the “maturation” process.

And even the average Frenchwoman — say, shopping along the Rue du Faubourg St.-Honoré or enjoying a leisurely lunch on the Left Bank, or strolling through the Luxembourg Gardens — seems to defy the notion that, as one grows older, you either have to disguise that process with Botox, eye-lifts, lip plumpers and all sorts of procedures that convey a desperate “youthful” look, or else just give up altogether and let the ravages of time take their toll.

But do these women really have the answers when it comes to the aging process?

Women on both sides of the Atlantic realize that the keys to aging well are obvious, but challenging if you have bad genes, spend too much time in the sun or smoke a lot. But while American women, like me at least, approach personal care with practical efficiency, the Frenchwomen I know regard the pampering of the skin, hair and body as an enjoyable, gratifying ritual.

Looking attractive, at any age, is just what Frenchwomen do, especially the urban ones. For Parisiennes, maintaining their image is as natural as tying a perfect scarf or wearing stilettos on cobblestone streets. Beauty is a tradition handed down from generation to generation. “My grandmother always told me, ‘Never neglect yourself, not even in the tiniest details,’ ” my friend Françoise Augier said, with a sweeping head-to-toe gesture. The French actress Leslie Caron, still Gigi-like at 79, told me her mother’s favorite saying: “Women’s skin is too fair to go bare.”

Not that French adolescents are any more likely than their American counterparts to heed their mothers’ advice. My neighborhood esthetician, Martine, is concerned that so many of her young clients (age 12 and up) go outdoors without sunscreen. Maybe she shouldn’t worry. A survey by the market research company Mintel found that 33 percent of French girls between 15 and 19 are already using anti-aging or anti-wrinkle creams.

Though Frenchmen are clearly interested — they shamelessly ogle women on the street — beauty is a female topic. When, over dinner, I asked a grandmother of three how she managed to stay beautiful, she deflected my question, saying, “I never discuss these things in front of my husband.”

The No. 1 response to my informal survey of Frenchwomen about the years of magical aging is not gaining weight. Ever. If a Frenchwoman happens to see an additional kilogram or two on her bathroom scale, she will do whatever is necessary to force the needle back where it belongs. “I keep my weight steady, no ups and downs,” Ms. Caron said. “I avoid all excess.” She claims to eat all kinds of food in small — her friends say minuscule — portions, and she doesn’t drink alcohol. It’s not so much that “French Women Don’t Get Fat,” as the title of Mireille Guiliano’s best seller had it. Rather, Frenchwomen won’t get fat.

Not that they exercise. When my husband and I arrived in Paris and asked our personal banker — everyone has one — for a gym recommendation, her response was: “Why? Gyms are a form of torture.” It seems the only acceptable way to burn calories is to walk.

If Frenchwomen don’t walk enough to stay en forme, there is always a pill, a lotion, a machine or a treatment to do the trick. Pharmacies have counters full of diet and figure-improving remedies. One cream promises “accelerated reduction in the areas resistant to diet” (hips, thighs and buttocks). Capsules assure a flatter stomach in four weeks. A poster recently plastered all over Paris Métro stations advertises a tiny Slendertone “Electronic Muscle Stimulation” belt that claims to provide, in a single session, the equivalent of 120 abdominal crunches. (It’s available in the United States, too.)

Frenchwomen also recommend facials, massages and spa “cures” in their campaign against wrinkles, cellulite and saggy bottoms, bellies and breasts. One spa favorite is thalassotherapy, the seawater-based treatment that originated in France. It involves water jets, seaweed wraps, mud baths and sea-fog inhalation, meant to improve circulation, promote sleep, tone muscles and reduce cellulite. Some women are resourceful enough — or have legitimate medical reasons, like arthritis — to get doctors’ prescriptions for weeks at their favorite spa. That means government health insurance covers much of the bill.

As for makeup, Frenchwomen of almost every age (except those teenagers) regard less as best. Heavy foundation has a tendency to emphasize wrinkles and pores, and most women avoid it in favor of a bit of blush. Those who do use foundation make sure that it blends with the skin, often by applying it just after moisturizing. The idea is to look as natural as possible: a little color on the eyelids, mascara, maybe a bit of eyeliner and lip gloss.

Of course, it’s easy to look natural if your skin is great. And that may be where the French secrets really are. According to a 2008 Mintel report, Frenchwomen spend about $2.2 billion a year on facial skin care — as much as Spanish, German and British women put together. If you happen to use the bathroom in a French home — something that is not considered polite, by the way — you might see a line of skin care products rivaling a shelf at Duane Reade.

There will be day creams (with sunscreen), night creams (without it), re-pulping creams, serums, moisturizers, cleansers, toners and salves for anything from orange-peel skin to varicose veins. But you might not find much soap. Ms. Caron says she doesn’t use it on her face or her body (except for “certain places”). Madame Figaro magazine recently quoted the French actress and TV presenter Léa Drucker as saying, “The day I stopped using soap, my life changed.” Post-transformation, she uses a hydrating cream.

As in America, some women in France turn to dermatologists for their skin care, and their visits are likely to be covered by health insurance. Even the generous French system does not pay for Botox, collagen or hyaluronan injections, nor for “lifting” and most other cosmetic surgery.

That doesn’t stop Frenchwomen from having “something done.”

The objective of plastic surgery in France, according to Dr. Michel Soussaline, a Paris surgeon with more than 30 years of experience, is “to keep the natural beauty and charm of each individual woman, not to fit some current ideal of beauty.” After all, trends change. In the United States, he says, women who spend a lot of money on face-lifts want to show off their investments. (Maybe that explains the pumped-up lips and smooth cheeks that the American actress Ellen Barkin, 56, recently displayed on the Cannes red carpet.)

By contrast, Frenchwomen prefer results that look as natural as possible. (Cannes photos of Isabelle Huppert, 57, show elegant, un-enhanced aging.) In France, I have only one friend who has confessed to having had surgery, a discreet operation to firm up a sagging chin and flabby neck. She is thrilled with the result: no one notices.

Hair rituals come in two kinds: getting rid of the unwanted stuff on legs and underarms (older women tend to prefer depilatories), and making the most of what’s on top of the head. That means a good cut every three to four weeks, and a reasonably natural color. A plethora of beauty salons (50 of them in my arrondissement) and mostly low prices (as little as 18 euros, or about $22, for a cut, shampoo and blow-dry) make frequent hair maintenance easy. Frenchwomen use conditioners and other post-shampoo treatments, followed by a cold-water rinse. “It helps the circulation,” said a friend.

Of course, the whole idea that Frenchwomen age better than Americans is debatable. Obesity rates are rising in France, though they are still far lower than in the United States. And not every movie star or politician remains ageless. The midcentury sex symbol Brigitte Bardot, now 75, is gray, wrinkly and overweight. Martine Aubry, the chubby head of the French Socialist Party and almost 60, is not known for her sense of style. And when I asked Katie Breen, a Frenchwoman who is a former editor at Marie Claire magazine, to name a woman who had aged particularly well, her answer was decidedly un-French: Meryl Streep.

For Frenchwomen, aging seems to be a matter of mind over makeup. If women feel good about themselves, right down to their La Perla 100-euro panties, they look good, too. Françoise Sagan once wrote, “There is a certain age when a woman must be beautiful to be loved, and then there comes a time when she must be loved to be beautiful.” And many Frenchwomen seem to be well loved as they get older — by their tight-knit families, their friends and, perhaps most importantly, themselves. Case in point: my loony neighbor — completely coordinated, perfectly made up, thoroughly French.