Paramedics are less likely to identify a stroke in women than men. Closing this gap could save lives – and money
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A stroke happens when the blood supply to part of the brain is cut off, either because of a blockage (called an ischaemic stroke) or bleeding (a haemorrhagic stroke). Around 83% of strokes are ischaemic.
The main emergency treatment for ischaemic strokes is a “clot-busting” process called intravenous thrombolysis. But this only works if administered quickly – ideally within an hour of arriving to hospital, and no later than 4.5 hours after symptoms begin. The faster treatment is given, the better the person’s chance of survival and recovery.
However, not everyone gets an equal chance of receiving this treatment quickly. Notably, research has shown ambulance staff are significantly less likely to correctly identify a stroke in women compared to men.
In a recent study, we modelled the potential health gains and cost savings of closing this gap. And they’re substantial.
The sex gap in stroke diagnosis
In Australia, about three-quarters of people who experience stroke arrive at hospital by ambulance. If paramedics suspect a stroke, they can take patients directly to a hospital which specialises in stroke care, and alert the hospital team so scans and treatment can start immediately.
Research has shown women aged under 70 are 11% less likely than men to have their stroke recognised by paramedics before they arrive at the hospital.
While younger men and women experience stroke at a similar rate, the symptoms they present with may be different, with “typical” symptoms more common in men and “atypical” symptoms more common in women.
Research has shown women and men are equally likely to present with movement and speech problems when having a stroke. However, women are more likely to show vague symptoms, such as general weakness, changes in alertness, or confusion.
These “atypical” symptoms can be overlooked, leaving women more vulnerable to misdiagnosis, delayed treatment, and preventable harm.
What we did
In our study, published recently in the Medical Journal of Australia (MJA), we used ambulance and hospital data from a 2022 MJA study in New South Wales. This is the study we mentioned above that showed paramedics correctly identified stroke more often in men than women under 70.
From this dataset, we identified more than 5,500 women under 70 who had an ischaemic stroke between 2005 and 2018. Using this group, we built a model to compare two scenarios:
- the status quo, where women’s strokes are identified at the current rate of accuracy; and
- an improved scenario, where women’s strokes are identified at the same rate as men’s.
We then projected patients’ health over time, including their level of impairment, risk of another stroke, and immediate and long-term survival.
Closing the diagnosis gap would save lives and money
When women’s stroke diagnosis rate was improved to match men’s, each woman gained an average of 0.14 extra years of life (roughly 51 days) and 0.08 extra quality-adjusted life years (QALYs), meaning an additional 29 days in full health.
Scenario two also meant A$2,984 in health-care costs would be saved per woman.
Scaled to the national level based on the number of women under 70 hospitalised with ischaemic stroke each year, closing this gap would mean 252 extra years of life, 144 extra QALYs, and $5.4 million in cost savings annually.
Some limitations
We didn’t have sex-specific data for every aspect of the model, which is in itself a telling sign of the lack of recognition of sex as an important factor in understanding disease. Because of this, we used combined data from both men and women in some parts of our model, which may have affected the results.
Further, the NSW data we used for rates of treatment with intravenous thrombolysis were higher than the national average, so our national figures may be slightly over-estimated.
Beyond stroke – why all this matters
The disparity we found is one example of a broader, systemic issue in women’s health: sex-based differences in diagnosis and treatment that favour men.
Too often, women’s symptoms are misinterpreted or dismissed because they don’t match a “typical” pattern. This can lead to delays, missed opportunities for early treatment, and worse outcomes for women.
In stroke, faster and more accurate diagnosis means people are less likely to die or require long-term care, and more likely to recover better and get back to their daily lives sooner.
So what can we do to close the diagnosis gap?
Investing in better training for paramedics and other emergency responders, so they can recognise a wider range of stroke presentations, could pay off many times over. Public awareness campaigns that highlight atypical stroke symptoms could also help.
Technologies such as mobile stroke units and telemedicine support may be part of the solution, but they must be implemented with attention to sex-specific needs.
Lei Si, Associate Professor in Health Services Management, Western Sydney University; Laura Emily Downey, Senior Lecturer, Health Economics and Policy, George Institute for Global Health, and Thomas Gadsden, Research Fellow, Health Systems Science, George Institute for Global Health
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Healthy Habits for Managing & Reversing Prediabetes – by Dr. Marie Feldman
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The book doesn’t assume prior knowledge, and does explain the science of diabetes, prediabetes, the terms and the symptoms, what’s going on inside, etc—before getting onto the main meat of the book, the tips.
The promised 100 tips are varied in their application; they range from diet and exercise, to matters of sleep, stress, and even love.
There are bonus tips too! For example, an appendix covers “tips for healthier eating out” (i.e. in restaurants etc) and a grocery list to ensure your pantry is good for defending you against prediabetes.
The writing style is very accessible pop-science; this isn’t like reading some dry academic paper—though it does cite its sources for claims, which we always love to see.
Bottom line: if you’d like to proof yourself against prediabetes, and are looking for “small things that add up” habits to get into to achieve that, this book is an excellent first choice.
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How To Avoid Slipping Into (Bad) Old Habits
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Treating Bad Habits Like Addictions
How often have you started a healthy new habit (including if it’s a “quit this previous thing” new habit), only to find that you slip back into your old ways?
We’ve written plenty on habit-forming before, so here’s a quick recap before we continue:
How To Really Pick Up (And Keep!) Those Habits
…and even how to give them a boost:
How To Keep On Keeping On… Long Term!
But how to avoid the relapses that are most likely to snowball?
Borrowing from the psychology of addiction recovery
It’s well known that someone recovering from substance addiction should not have even a small amount of the thing they were addicted to. Not one sip of champagne at a wedding, not one drag of a cigarette, and so forth.
This can go for other bad habits too; make one exception, and suddenly you have a whole string of “exceptions”, and before you know it, it’s not the exception anymore; it’s the new rule—again.
Three things that can help guard against this are:
- Absolutely refuse to romanticize the bad habit. Do not fall for its marketing! And yes, everything has marketing even if not advertising; for example, consider the Platonic ideal of a junk-food-eating couch-potato who is humble, unassuming, agreeable, the almost-holy idea of homely comfort, and why shouldn’t we be comfortable after all, haven’t we earned our chosen hedonism, and so on. It’s seductive, and we need to make the choice to not be seduced by it. In this case for example, yes pleasure is great, but being sick tired and destroying our bodies is not, in fact, pleasurable in the long run. Which brings us to…
- Absolutely refuse to forget why you dropped that behavior in the first place. Remember what it did to you, remember you at your worst. Remember what you feared might become of you if you continued like that. This is something where journaling helps, by the way; remembering our low points helps us to avoid finding ourselves in the same situation again.
- Absolutely refuse to let your guard down due to an overabundance of self-confidence in your future self. We all can easily feel that tomorrow is a mystical land in which all productivity is stored, and also where we are strong, energized, iron-willed, and totally able to avoid making the very mistakes that we are right now in the process of making. Instead, be that strong person now, for the benefit of tomorrow’s you. Because after all, if it’s going to be easy tomorrow, it’s easy now, right?
The above is a very simple, hopefully practical, set of rules to follow. If you like hard science more though, Yale’s Dr. Steven Melemis offers five rules (aimed more directly at addiction recovery, so this may be a big “heavy guns” for some milder habits):
- change your life
- be completely honest
- ask for help
- practice self-care
- don’t bend the rules
You can read his full paper and the studies it’s based on, here:
Relapse Prevention and the Five Rules of Recovery
“What if I already screwed up?”
Draw a line under it, now, and move forwards in the direction you actually want to go.
Here’s a good article, that saves us taking up more space here; it’s very well-written so we do recommend it:
The Abstinence Violation Effect and Overcoming It
this article gives specific, practical advices, including CBT tools to use
Take care!
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Cabbage vs Zucchini – Which is Healthier?
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Our Verdict
When comparing cabbage to zucchini, we picked the cabbage.
Why?
In terms of macros, cabbage has 2.5x the fiber, as well as slightly more protein and carbs, making it the more nutrient-dense option in the macronutrient category.
In the category of vitamins, cabbage has more of vitamins B1, B5, B7, B9, C, E, and K, while zucchini has more of vitamins A, B2, B3, and B6, yielding a 7:4 win to cabbage in this round.
Looking at minerals next, cabbage has more calcium and iron, while zucchini has more copper, magnesium, phosphorus, potassium, and zinc, winning a round finally.
In other considerations, cabbages also have notably more polyphenols, so that’s another round in their favor.
Adding up the sections makes for a clear overall win for cabbages, but by all means do enjoy either or both, as diversity is best!
Want to learn more?
You might like:
Super-Nutritious Shchi ← for what to do with that cabbage
Enjoy!
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This Kind Of Stretching Sucks, But It’ll Also Sky-Rocket Your Mobility
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Would you do it?
Proprioceptive Neuromuscular Facilitation (PNF)
This method combines muscle stretching with muscle contractions, to improve mobility more effectively than passive stretching alone.
This works, because muscles contain sensors that monitor tension and stretch, helping protect against injury by limiting movement when a position feels threatening—and PNF stretching helps by teaching the muscle that it’s safe to go a bit further, because contracting a muscle in a stretched position signals to your nervous system that you have control of the position, which can reduce protective resistance afterward.
How to do it: stretch a muscle, actively contract it while stretched, then relax and move deeper into the stretch ← yes, it’s that simple!
Or if you want more detail:
- To PNF your hamstrings: start in a half-kneeling position, hinge forwards until you feel a stretch without pain, then press your heel into the floor as if trying to bend your knee; use about 7 out of 10 effort rather than a maximal contraction.
- The release phase: after the contraction, fully relax and slowly move deeper into the stretch, often gaining additional range immediately.
Note: it will not feel relaxing while you are doing it; it will feel more like a workout.
For more on all of this plus a visual demonstration, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
What is PNF stretching, and will it improve my flexibility?
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How Often Do You Eat Fries?
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“Fries are not a health food” is not breaking news, but how often can you get away with them before it starts impacting health outcomes?
Researchers (Dr. Seyed Mousavi et al.) investigated the effects of fries, various kinds of non-fried potatoes, and white vs whole grains, on diabetes risk.
This was done over the course of three US cohort studies involving a total of a total of 205,107 participants, mostly women, whose diet and health outcomes were followed for 4 decades. Of these participants, 22,299 developed type 2 diabetes.
Here’s what they found:
❝After adjustment for updated body mass index and other diabetes related risk factors, higher intakes of total potatoes and French fries were associated with increased risk of T2D.
For every increment of three servings weekly of total potato, the rate for T2D increased by 5% (hazard ratio 1.05, 95% confidence interval (CI) 1.02 to 1.08) and for every increment of three servings weekly of French fries the rate increased by 20% (1.20, 1.12 to 1.28). Intake of combined baked, boiled, or mashed potatoes was not significantly associated with T2D risk (pooled hazard ratio 1.01, 95% CI 0.98 to 1.05).
In substitution analyses, replacing three servings weekly of potatoes with whole grains was estimated to lower T2D rates by 8% (95% CI 5% to 11%) for total potatoes, 4% (1% to 8%) for baked, boiled, or mashed potatoes, and 19% (14% to 25%) for French fries. In contrast, replacing total potatoes or baked, boiled, or mashed potatoes with white rice was associated with an increased risk of T2D.
In a meta-analysis of 13 cohorts (587 081 participants and 43 471 diagnoses of T2D), the pooled hazard ratio for risk of T2D with each increment of three servings weekly of total potato was 1.03 (95% CI 1.02 to 1.05) and of fried potatoes was 1.16 (1.09 to 1.23). In substitution meta-analyses, replacing three servings weekly of total, non-fried, and fried potatoes with whole grains was estimated to lower the risk of T2D by 7% (95% CI 5% to 9%), 5% (3% to 7%), and 17% (12% to 22%), respectively.❞
That’s a lot of numbers, so let’s break it down, translate it from sciencese, and look at some of the key points.
In order, we have, for the emprical data:
- Every extra three servings of total potatoes per week increased risk by 5%
- Every extra three servings of French fries per week increased risk by 20%
- Baked, boiled, or mashed potatoes gave no significant change in risk
- Replacing three weekly servings of total potatoes with whole grains lowered risk by 8%
- Replacing baked, boiled, or mashed potatoes with whole grains lowered risk by 4%
- Replacing French fries with whole grains lowered risk by 19%
- Replacing total potatoes or baked, boiled, or mashed potatoes with white rice increased risk by 15%*
And now for the meta-analysis** numbers:
- Every extra three servings of total potatoes per week increased risk by 3%
- Every extra three servings of fried potatoes per week increased risk by 16%
- Replacing total potatoes with whole grains lowered risk by 7%
- Replacing non-fried potatoes with whole grains lowered risk by 5%
- Replacing fried potatoes with whole grains lowered risk by 17%
*This figure wasn’t in the abstract we quoted above, but we found it in the full substitutions table lower down in the paper, where it’s expressed as a Hazard Ratio of 1.15, which equates to a 15% increase in risk.
**A meta-analysis can be thought of as an “imaginary experiment” performed by collated existing data from other studies, running it through statistical models, and seeing what comes out. As you can see, the resultant numbers are slightly different, but the associations remain the same (i.e. the same additions/substitutions still give approximately the same relative increase/decrease in risk), which means the meta-analysis also supports the conclusions drawn from the empirical data.
On which note, the full paper itself can be found here: Total and specific potato intake and risk of type 2 diabetes: results from three US cohort studies and a substitution meta-analysis of prospective cohorts
That’s a lot of information; what’s most important?
In few words:
- Whole grains are the best
- Non-fried potatoes are ok
- White grains are bad
- Fried potatoes are the worst
Thus, substituting between those four categories will yield changes in risk proportional to how far apart they are from each other on that list.
Furthermore, to answer the question posed in our introduction today (how often can one eat fries before it starts impacting health outcomes), the honest answer is: never, technically.
See for example: Is Fast Food Really All That Bad? ← we realize that fries do not necessarily have to be fast food, but they share the nutritional profile being examined there.
And while “one bad meal” will not impact long-term health, it will have an immediate negative impact on short-term health, due to its gut-disrupting activity. If it really was just a one-off meal, an otherwise healthy gut will bounce back just fine, but it’s another argument for the case of “the negative health effects do start immediately”.
However, the dose does make the poison, and in this case, increments of 3 portions per week increased risk by 20%. We can say, therefore, that each portion per week increases the risk by 6.6%, and this risk is cumulative.
On which note: what is a portion?
- A portion is not: “however much you eat at once”
- A portion is: “a 4–6 oz serving”
So, if you have twice that at a sitting, that’s two portions. Thrice that at a sitting, and that’s the weekly 3 portions that increase the risk by 20%, already, in one day, and if you have more in the rest of the week, it will continue to add to the risk cumulatively.
If you’d like to dial down the portion sizes while simultaneously enjoying what you eat more, there are two useful approaches you might want to consider (you can do both if you want; there’s no conflict between them, and in fact, they can go quite well together):
- Some Surprising Truths About Hunger And Satiety
- Mindful Eating: How To Get More Out Of What’s On Your Plate
Want to learn more?
Check out:
Take care!
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The Epigenetics Revolution – by Dr. Nessa Carey
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If you enjoyed the book “Inheritance” that we reviewed a couple of days ago, you might love this as a “next read” book. But you can also just dive straight in here, if you like!
This one, as the title suggests, focuses entirely on epigenetics—how our life events can shape our genetic expression, and that of our descendants. Or to look at it in the other direction, how our genetic expression can be shaped by the life experiences of, for example, our grandparents.
The style of this book is very much pop-science, but contains a lot of information from hard science throughout. We learn not just about longitudinal population studies as one might expect, but also about the intricacies of DNA methylation and histone modifications, for example.
Depending on your outlook, you may find some of this very bleak (“great, I am shackled by what my grandparents did”) or very optimism-inducing (“oh wow, I’m not nearly so constrained by genetics as I thought; this stuff is so malleable!”). This is also the same author who wrote “Hacking The Code of Life“, by the way, but we’ll review that another day.
Bottom line: this book is the best one-shot primer on epigenetics that this reviewer has read (you may be wondering how many that is, and the answer is… about seven or so? I’m not good at counting).
Click here to check out The Epigenetics Revolution, and learn how dynamic you really are!
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