Standing graceful at the
pinnacle of the Malaysian
entertainment scene is
Maya Karin – acclaimed
actress, musician, TV host,
brand ambassador and
environmentalist.

Known for her award-winning role as the restless, vengeful vampire in Pontianak Harum Sundal Malam, the German-born Maya Karin started her career as a TV host, releasing her debut album “Erti Cinta” (Definition of Love) in 2002 before transitioning into film. To date, Maya has starred in over 20 movies, as well theatre performances and musicals, while keeping busy on the music front with her 2014 release, “Teka-Teki”.

One of Maya’s achievements includes her MayaLovesNature campaign, an environmentally conscious programme that has raised awareness of 22,000 school children in Malaysia on the excessive use and waste of plastic bags. As an active supporter of the Malaysian Nature Society (MNS) and World Wildlife Fund (WWF), Maya practises what she preaches by composting her organic waste at home and planting it in her garden.

When it comes to health, Maya knows she’s 100 per cent in charge. She takes great care and effort to work hard to maintain her slender body and her health.

Her healthy habits include regular workouts in the gym, drinking plenty of water daily and going vegan on certain days. In addition to all that, she finds the time to practise yoga.

Warner Music Malaysia invited InfoMed to speak with Maya Karin on personal healthcare. She is a good Malaysian role model for all, especially the younger generation who needs greater awareness on healthcare and the importance of taking charge of one’s own health.

InfoMed:
When did you decide to play a more active role in your health and fitness, and what prompted that decision?

Maya Karin:

My parents actually decided for my siblings and I by making sure we had healthy eating habits and exercise! It’s great because I grew up out of the city with lots of cycling and climbing trees. I was always good at sports in school and naturally athletic, participating in hockey, swimming, tennis, basketball and all kinds exercise. It became a habit, and even after finishing school, I was always moving.

Maya Karin: You’ve got to take care of your body. It’s as simple as that, but not many people do it. That’s sad, and it’s got to change.

InfoMed: What’s healthcare to you?

InfoMed: The celebrity life doesn’t generally leave you with a lot of time, and it must be challenging to meet all your obligations. How do you manage it and still find time to stay healthy?

Maya Karin: Celebrity or not, everyone’s busy with something. You’re working two jobs with five kids, or you’re in a constant photo shoot, and it feels like you’re always occupied. But the truth is, to be healthy you don’t have to be at the gym six hours a day. All you need is a little exercise of 20 minutes every day, or even if it’s just once a week, it’s something. A little commitment, that’s it, and it can be done. You just have to make time.

Maya Karin: Personally, my family doesn’t. It’s hard when you don’t actually have a base; we used to move around a lot. That said, you should be managing your own healthcare history. You know yourself best.

InfoMed: Do you have a family doctor who knows your healthcare history and manages your healthcare?

InfoMed: Malaysia is now number one in this region for obesity. How can celebrities play an important role to create awareness on good healthcare and habits to circumvent this serious health issue?

Maya Karin: We definitely need to highlight this issue more. People need to know that this is a problem and it can kill you because of all the diseases obesity makes you vulnerable to. There are quite a few campaigns already but it’d be nice to see the ministry come up with a focused campaign by engaging local personalities.

Maya Karin: Number one is definitely regular exercise. Just find a regular time and make a habit of it, it’s not hard. I also drink lot of water and stay away

from sugary drinks. Soft drinks are a definite no-no, and I even limit my caffeine intake, keeping the coffee and teas to a minimum. Thirdly, is eating my greens! I actually love eating ulam (raw vegetable Malay salad) so it’s enjoyable for me.

InfoMed: What are your three most important healthy habits?

InfoMed: How often do you take vegetarian food and do you have specific preferences?

Maya Karin: It’s sporadic, because for me, the most important thing is variety and balance. I like to make sure I get all my food groups – variety is the spice of life!

Maya Karin: I actually dabbled in yoga about 10 years ago but I’ve only gotten more disciplined about it four years ago – though I have to admit, I’ve been slaking a little in the past year! My dad is always telling me how your body gets stiffer and less flexible when you get older, and yoga does a good job of keeping you limber, which means less accidents too. Oh, and definitely being able to find a peace of mind for at least two minutes!

InfoMed: Yoga is as much about the mind as it is about the body. How long have you been practising and what changes about yourself have you experienced?

InfoMed: What does your calendar as a social activist for the environment look like?

Maya Karin: The little things like advocating recycling and composting are things I make into habits, and posting about it helps raise awareness (Maya posts regularly on her Twitter account, @maya_karin to her 1.07 million followers). I’m also an ambassador or the Ministry of Energy, Green Technology & Water (KeTTHA) and am right now involved in a campaign for electric cars. We’re looking at bringing this alternative method of transport to the public as well as increasing the charging stations around Kuala Lumpur. The idea is to advocate renewable energy; if you keep the earth healthy, you keep you body healthy. I mean, it’s the circle of life! If you pollute the land and the waters, and you eat the produce from that, you’re only poisoning yourself.

Credits: InfoMed ( Malaysia )

Website: Infomed.com.my

– Abraham Mathew Saji on the importance of
breastfeeding a newborn.

As parents, we are willing to sacrifice all that we have to ensure the happiness, health and safety of our children. It is every mother’s wish that her newborn baby is happy and healthy forever. One of the biggest and most crucial decisions that a mother makes – very early in her child’s life – is that of breastfeeding her baby. This decision will go a long way to help both the baby and mother for the rest of their lives. Breast milk is a perfect blend of vitamins, minerals, proteins, antibodies and an array of other nutrients at the perfect temperature, ready for the baby to consume. It has been prepared personally by a mother, especially for her baby. Thus we see a happy, healthy and personal touch in the act of breastfeeding.

According to a World Health Organization (WHO) factsheet, nearly nine million children died in 2008 from preventable illnesses before even reaching their fifth birthday, with more than two thirds of them during the first year of life. Millions more survive only to face diminished lives, unable to develop to their full potential. Under-nutrition is a contributing cause of more than one third of these deaths. Poor nutrition during the mother’s pregnancy or the child’s first two years can slow a child’s mental and physical development for life.

WHY BREASTFEED?

According to the WHO and American Academy of Pediatrics (AAP), breastfeeding for at least six months can decrease worldwide infant morbidity and mortality rates (mainly due to diarrhoea, respiratory diseases and other infectious diseases) by at least 55 per cent.

Breast milk alone is the most ideal source of food and drink for an infant for the first six months of life. After six months, infants need other nutritious foods, in addition to breastfeeding up to two years and beyond, to meet their growth and development needs. Babies who are breastfed are generally healthier and achieve optimal growth and development.

If the vast majority of babies were exclusively fed breast milk in their first six months of life – meaning only breast milk and no other liquids or solids, not even water – it is estimated that the lives of at least 1.2 million children would be saved every year. If children continue to be breastfed up to two years and beyond, the health and development of millions of children would be greatly improved.

Infants who are not breastfed are at an increased risk of illness that can compromise their growth and raise the risk of death or disability. Breastfed babies receive protection from illness through their mothers’ milk. Breastfeeding is the natural and recommended way of feeding all infants, even when artificial feeding is affordable, clean water is available, and good hygienic conditions for preparing and feeding infant formula exist. Breastfeeding helps in the development of the baby’s jaw and helps in the overall oral structure, from the alignment of teeth and tongue to prevention of an over-crowded mouth.

A 2013 MRI study conducted at Brown University adds to growing body of evidence that breastfeeding improves brain and cognitive development in infants.

MECHANISM OF PROTECTION AND BENEFIT

As the immune system of a newborn is under-developed, mother’s milk provides protection against a wide variety of enteric and other diseases. Breast milk contains components that inhibit the attachment of microorganisms like streptococcus pneumoniae and Hemophilus influenzae to host cell surface receptors. Breast milk is also a rich source of colostrum.

Also referred to as “liquid gold” for its colour, it is the first perfect food prepared by a mother especially for the baby. It is easy for the newborn’s immature system to digest and it coasts the intestinal tract, thereby acting as a barrier to prevent the invasion of harmful microorganisms. It also provides important nutrients and antibodies.

Breast milk and colostrum are very potent and rich sources of immunogobulin A (lgA). These antibodies are produced by the mother when microbes, food or other antigenic material pass through her gut. lgA is secreted by the mammary and other exocrine glands during lactation. lgA helps prevent attachment of bacteria and viruses to the host epithelial cells, thereby preventing infection. lgA antibodies protect against vast array of microorganisms like vibrio cholerae, enterotoxic escherichia coli, campylobacter, shigella and giardia liamblia, to name a few common ones infecting infants.

In addition to lgA, breast milk is also rich in a variety of oligosaccharides. These complex sugars from human milk also help to prevent the attachment of microorganisms like streptococcus pneumoniae escherichia coli to the epithelial surface of host cell receptors.

Lactoferrin is another important constituent of breast milk. It is the main source of protein that not only acts as a source of nutrition, but also exhibits microbicidal activity against certain bacteria and viruses. It measures up to about 4 grams per liter of breast milk.

Other bioactive components of breast milk are B lymphocytes, T lymphocytes, immunoglobulin G (lgG), immunoglobulin M (lgM), neutrophils and eosinophils. These factors – transported in the baby’s body system via feeding – are absorbed and help to not just provide protection, but also share some of the immune responses from the mother to the child.

A gastrointestinal hormone, cholecystokinin (CCK) signals sedation and a feeling of satiation and well being. During breastfeeding, CCK release in both mother and baby produces a sense of satisfaction and sleepiness. The infant’s CCK level peaks after being breastfed, which enables the infant to be calm and rest comfortably.

The essential fatty acids in human milk optimise cognitive function and vision. Human milk has a significant impact on the growth of the central nervous system. Also, breastfed infants have higher visual acuity. These benefits of human milk can be attributed to the presence of long-chain polyunsaturated fatty acids, docosahexaenoic acid (DHA) and arachidonic acid (AA).

Mothers need to be aware of the numerous benefits of breastfeeding to her baby and herself. The role of healthcare professionals and other support medical staff in this educational approach is deemed highly beneficial and significant.

BENEFITS THE MOTHER AND THE ENTIRE FAMILY

Breastfeeding enhances the release of oxytocin and prolactin (also called as bonding hormones) that help to relax the mother, enable smooth flow of milk and strengthen the bonding between mother and child. It helps the baby feel more comforted, secure and warm.

Frequent breastfeeding can delay the return of fertility through lactational amenorrhea. By this indirect method of spacing birth, it provides enough time for the mother to recuperate before she conceives again.

Breasfeeding also helps in the process of weight loss, keeping modern risks like diabetes, hypertension, obesity and associated cardiac diseases at bay. Mother can burn calories during lactation. The weight gained during pregnancy serves as the source of energy for lactation.

Breastfeeding plays a great role in reducing the risks of certain cancers. According to data derived from 47 epidemiological studies in 30 different countries, both pre-menopausal and post-menopausal women can expect a significant reduction in any risk of developing breast cancer with breastfeeding. In fact, the data also suggested that the risk of breast cancer decreases with ans increased duration of lifetime lactation and feeding. Breastfeeding also exhibits a protective effect againt uterine, ovarian, endometrial and thyroid cancers.

Breastfeeding helps to replenish the lost bone mineral density, thereby preventing osteoporosis and rheumatoid arthritis. Breastfeeding also enables the mother to get much-needed rest while she sits or lies down to feed her baby. She gets an opportunity to nurse and understand the needs of her baby.

Breastfeeding enables easy baby care in the sense that there are not bottles or accessories to be cleaned and maintained. Breastfeeding helps to save money, make travelling easy and reduce waste.

Upon hospital discharge it is not unusual for mothers to discontinue breastfeeding. Although for some mothers, this change may be beyond their ability and resources; for others it appears to be based on a conscious choice. Mothers need to be aware of the numerous benefits of breastfeeding to her baby and herself. The role of healthcare professionals and other support medical staff in this educational approach is deemed highly beneficial and significant.

Credits: InfoMed ( Malaysia )

Website: Infomed.com.my

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Millions of women experience it, the involuntary loss of urine called urinary incontinence (UI). UI is a loss of bladder control resulting in urine leakage or an uncontrollable and immediate need to urinate. Women experience UI thrice as often as men and it can be slightly bothersome to totally debilitating. UI can cause emotional stress and for some, the risk of public embrassment will keep them away from enjoying many activities with family and friends. InfoMed sat down with Dr. Warren Lo Hwa Loon, consultant urologist from Hospital Kuala Lumpur, Ministry of Health Malaysia, to discuss this important and common medical condition.

“It is a taboo subject,” says Dr. Lo, who sub-specialises in neuro reconstructive and female urology. “No one wants to talk about how they’re leaking every time they cough.”

The problem affects 10 to 30 per cent of the general population with age and gender playing a factor. Older people are more susceptible to UI due to the lost of muscle strength while women are more susceptible to UI due to anatomical differences and childbirth that loosens the pelvic floor.

UI is an under-reported problem, partly due to the fact that it is not fatal, so people’s attitudes are more “grin and bear it” rather than “know and fix it”. There’s also the fact that many people accept it as a part of growing old, not realising treatment options are available. Young people affected with UI on the other hand, may simply not report it due to shame.

UI isn’t simply “not being able to hold your pee”, as there are several types and thus different associated causes and risk factors. The two most common type of incontinence are Stress Incontinence and  Urge Incontinence. It is not uncommon for people to be affected by a mix of the two, or other types of incontinence, like overflow incontinence.

There is no effective medication to strengthen the pelvic floor muscle, so if Kegel exercises (a type of pelvic strengthening exercise) do not work, surgery may be necessary. For men, a male sling procedure can be performed on those with mild to moderate stress urinary incontinence but artificial urinary sphincter (with a pump that allows for manual urine control) should be performed in severe cases. Both procedures have up to 90 per cent success rates.

Women suffering from stress urinary incontinence are usually fitted with a tension free vaginal tape, which sits around the mid urethra to tighten the urinary passage without obstructing it. For those who do not respond to the tension free vaginal tape, Burch colposuspension, which involves lifting the bladder neck by suturing the tissue around it to the strong ligaments of the pelvic floor muscle. There is also an outpatient alternative for elderly candidates or those unsuitable for surgery to undergo a process where a bulking agent is used to occlude the passage and stop the leaking.

Sharing horror stories, Dr. Lo said he’s come across male patients who have used penile clamps to stop the leaking. It is not a method endorsed, as there is a high risk of infection and erosion to the skin.

Most importantly, Dr. Lo says, is the need for general practitioners to have frank discussions and diagnose the problem, as patients are not likely to bring it up on their own. As one of the few practitioners in the country who specialises in and performs these surgeries, Dr. Lo also mentioned that more public awareness is needed to highlight that UI is a treatable condition and does not have to be an inevitable part of ageing. With greater public education, more treatment options can be made available so people don’t need to suffer in silence.

Practise Your Kegels

• Practise Your Kegels

To identify your pelvic floor muscles, stop urination in mid-stream or tighten the muscles that keep you from passing gas. These are your pelvic floor muscles.

• Perfect your technique.

Empty your bladder in the toilet and then lie on your back comfortably with your knees bent and spread apart. Tighten your pelvic floor muscles, hold the contraction for three seconds, and then relax them for another three seconds. When your muscles get stronger, try doing Kegel exercises while sitting, standingvor walking.

• Maintain your focus.

For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.

• Repeat three times a day.

Aim for at least three sets of five to eight repetitions a day.

RISK FACTORS

STRESS INCONTINENCE

Up to 43 per cent of men develop stress incontinence after a prostatectomy, while more than 50 per cent of women develop stress incontinence as they age above 40 years old, with probabilities doubling if they had multiple vaginal childbirths or traumatic deliveries. Obese individuals are likely to develop stress incontinence due to the additional pressure caused by excess weight in the abdominal area.

URGE INCONTINENCE

Caffeinated products (tea, coffee, soda) and alcohol should be avoided or consumed in moderation. Neurological conditions like Parkinson’s disease, Alzheimer’s disease and spinal cord injury can result in poor control of the bladder muscles, leading to urge incontinence. Urinary tract infection can also result in overactive bladders with incontinence.

TREATMENTS

Stress Incontinence

The first hurdle is in recognising the need for medical care, Dr. Lo says, as patients are apt to ignore the problem and suffer in silence or modify their lifestyle. Modifying lifestyles, he says, are things when patients stop themselves from laughing or sneezing because of stress incontinence, or cutting off their favourite latte rather than admitting they have incontinence. In fact, it’s not until the problem is severe enough to require pads and diapers do they seek medical attention.

The first line of treatment is always pelvic floor exercises (Kegel exercises), involving a very specific set of movements. Dr Lo recommends his patients perform about three minutes of Kegel exercises, repeated five times throughout the day. Kegel exercises are effective for both urge and stress incontinence.

Mixed Incontinence

Various treatment options for both urge and stress incontinence should be offered.

Overflow Incontinence

Intermittent self-catheterisation or indwelling urinary catheters are treatment options. Unfortunately there is no medication at the moment that can be prescribed for this condition.

Dr. Warren Lo Hwa Loon, consultant urologist from Hospital Kuala Lumpur, Ministry of Health Malaysia

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Credits: InfoMed ( Malaysia )

Website: Infomed.com.my

PREVENTIVE CARE

Practical thoughts for responsible people and their governments. – By Dr. Mehdi Khaled

There are striking similarities between global warming and modern-age chronic medical conditions. Both come with enough scientific evidence predicting their paths, their effects on our planet, and on our wellbeing and economies respectively. While a lot has been undertaken globally in defining the framework of actions to be engaged at individual and government levels in tackling the global warming plague, initiatives anticipating the onset of preventable causes of premature deaths and poor life quality are fragmented and poorly coordinated.

While there is more than one underlying cause to life-threatening chronic diseases, I will focus on obesity which, because of its pandemic nature, remains the main underlying factor of human health mischief and high mortality rates today. The causality link between obesity, metabolic (diabetes, high cholesterol, etc) and cardiovascular illnesses is supported by a wide array of scientific evidence¹.

Globally, the prevalence of chronic, non-communicable diseases is increasing at an alarming rate. About 18 million people die every year from cardiovascular disease, for which diabetes and hypertension are major predisposing factors. Propelling the upsurge in cases of diabetes and hypertension is the growing prevalence of overweight and obesity – which have, during the past decade, joined underweight, malnutrition, and infectious diseases as major health problems threatening the developing world.

In 2014, there were around 600 million obese adults, with over twice that number overweight – that means around 1.9 billion adults are too fat. Over 200 million school-age children are overweight, making this generation the first predicted to have a shorter lifespan than their parents, according to the International Obesity Task Force².

Obesity is a medical condition described as excess body weight in the form of fat. When accumulated, this fat can lead to severe health impairments. The prevalence of obesity is continuing to increase at an alarming rate in both the developed world and the developing world. This is of major concern not only because of the well-established detrimental health consequences for the obese person but also because obese parents are likely to have obese children, thus perpetuating a cycle of obesity³.

Obesity is measured by the Body Mass Index (BMI) value. That is the body weight in kilograms divided by the square of the body height in meters. According to the WHO, a BMI equal or higher than 30 for adults defines obesity. In clinical settings though, the interpretation of the BMI value depends on the gender, age and race. Henceforth, an 8-year-old Caucasian boy whose BMI is 30 is considered a healthy individual, whereas a 42-year-old with the same characteristics and BMI value would be considered obese. Nevertheless, a clinical study published in 2011 suggests that an elevated BMI in adolescence – one that is well within the range currently considered to be normal – constitutes a substantial risk factor for obesity-related disorders in midlife.

Although the risk of diabetes is mainly associated with increased BMI close to the time of diagnosis, the risk of coronary heart disease is associated with an elevated BMI both in adolescence and in adulthood, supporting the hypothesis that the processes causing incident coronary heart disease, particularly atherosclerosis, are more gradual than those resulting in incident diabetes⁴.

In the past 20 years, the rates of obesity have tripled in developing countries that have been adopting a Western lifestyle involving decreased physical activity and overconsumption of cheap, energy-dense food. Such lifestyle changes are also affecting children in these countries; the prevalence of overweight among them ranges from 10 to 25 per cent, and the prevalence of obesity ranges from 2 to 10 per cent. The Middle East, Pacific Islands, Southeast Asia and China face the greatest threat. Interestingly enough though, none of the developing nations in these geographies is represented on the World Obesity Federation Steering Committee.

The relationship between obesity and poverty is complex: Being poor in one of the world’s poorest countries (i.e., in countries with a per capita gross national product [GNP] of less than USD$800 per year) is associated with underweight and malnutrition, whereas being poor in a middle-income country (with a per capita GNP of about USD$3,000 per year) is associated with an increased risk of obesity⁵.

Simply put, obesity is a behavioural disorder and diet studies are nothing else but behavioural studies. Obesity is frequently an acquired condition through the perpetual iteration of poor lifestyle choices, especially in adults. Children’s obesity is a more complex problem where their parents largely make these choices for them. There are two types of choices: Those made deliberately by the individual and those under the influence of their immediate social circles – choice by proxy.

Social network models in the Framingham Heart Study⁶ (No, not Facebook! This was a real social life network back in 2000) show a clear social connection between individuals of similar BMI. This strongly suggests that individuals with a certain body weight tend to flock with their peers in the same BMI range.

There are two types of actions underpinning poor choices: Emotionally active actions and emotionally passive ones.

Making a deliberate decision to not do something science has proven is good for your health is a passive action. While active actions trigger the classic feeling of ‘guilt’ and the related (mostly missed opportunities of) New Year’s resolutions (“I will quit smoking by Jan 1st!”), the passive actions are mostly sub-conscious and don’t surface as often as the active ones, e.g. every smoker I know thinks about quitting every day, but they remember they missed an opportunity to go for a 30-minute run only once a week – at the very best. The prevalence of choice types and their sub-categories in society is not clear as there’s a high level of individual and contextual variance. While the psychological mechanisms of making poor lifestyle choices is well understood, changing the course of actions to make better ones remains a true individual challenge.

Following the universal consensus that every individual is responsible for his own health, it really remains up to every one to seek ways to bring their high BMI back to normal and maintain it over time. Ultimately, the BMI is nothing else but the clinical representation of the delta between the calories ingested into a body and those burned by the same. Because we’re humans and we live in an increasingly complex world, mathematical variations in that formula always occur. In summary, most of us know the best way to keep a sane BMI is to maintain a balanced food and exercise ratio over time.

Today, the modern world offers a myriad of wearable sensors to monitor our energy outputs from the simple step-count to the number of sports activities with all the covered distances in kilometres over time. While the scientific correlation between using wearable health trackers and achieving significant and long-term health benefits have been very controversial, these devices carried the promise to change their users’ physical activity profiles by kicking them out of a sedentary lifestyle.

This can be achieved by triggering more awareness on the user’s perceived activity levels. However, while the awareness expectation was widely met, the initial high adoption rate of these sensors contrasts sharply with the high dropout rates. Indeed, in a 2015 study of the Pennsylvania State University, results show a 50 per cent drop rate at 15 days and a surprising 75 per cent drop rate at just 30 days from the beginning of using wearable activity trackers⁷. These results clearly show that like classic food diets, these “digital diets” are not changing their user’s behaviours in short and long terms. Like with food diets and if these ever helped them lose weight, users gain it back again as soon as they stop using their wearable health trackers.

The lifestyle choices we make remain very much framed by local government healthcare strategies, food and drug policies, as well as by the existence of infrastructure to practice physical activities.

The emergence of Pay-for-Performance models (P4P) in the UK Healthcare System in the early 90s, was more recently followed by a tuned-up version under the so-called Accountable Care Act in the USA are encouraging initiatives to tackle the obesity issue at the population level. Both are national programmes that reward caregivers who improve their patients’ BMI and/or help them quit smoking (among other health outcome KPIs). Still, these programmes fall short from implementing long-term lifestyle changes that would reverse the course of obesity in the related societies.

Classic health models suggest there are three population segments among the citizens: Healthy people, those at risk of developing certain diseases and those who are already sick. Predictive statistical models show alarming projected prevalence rates of obesity globally. A sound and logical healthcare strategy would therefore anchor its priorities in designing and driving programmes aiming at keeping the healthy people healthy and those at risk of running overweight at bay – as long as possible. With the exception of the US, the GDP percentage of public healthcare expenditure is a single digit number (five to eight per cent) in most affected economies.

Knowing that 80 per cent of those healthcare budgets flow into managing chronically ill patients (most of which are obese), it is innocuous to argue that spending some two per cent of that budget to proactively prevent obesity from eating up the society would not only flatten the growth rate of healthcare expenditure, but also directly contribute to more positive economic balance sheets. Yes, taking down fat from your population grants you a leaner economy as well. Scientific evidence is however needed to support these presumptions but we can safely consider disease prevention as an economic growth accelerator.

In the US, government healthy-eating initiatives are dwarfed by the USD$1.6 billion spent by the food industry influencing kids to consume unhealthy food. The Centers for Disease Control’s budget for nutrition, physical activity, and obesity is about USD$41 million for Americans of all ages. The U.S. Department of Agriculture’s Team Nutrition, whose goal is to improve children’s eating and physical-activity habits, has an annual budget of about USD$10 million⁸.

Today, many governments still make a deliberate choice to sustain the unhealthy spending drivers instead of drafting and enforcing successful practices on food policies. By not doing so, these governments directly contribute to incurring physical long-term prejudice to the wellbeing of the very citizens they have vowed to protect.

I remain a strong advocate of enforcing detailed food labeling and agriculture policies as well as imposing high-level taxes on junk food if not banning certain items from entering the food chain at all. Education and awareness remain however the biggest challenge, especially in scattered Asian geographies. Professional and sound recommendations to governments on strategies to tackle the obesity pandemic in their respective societies are very well documented. Approaches to action those are largely lagging behind in most countries mainly because of political short-sightedness and other mysterious economic drivers.

Realistically though, short-term positive outcomes and quick wins remain very much within reach: If active lifestyle programmes are already working at individual levels, scaling them up to run healthy population campaigns would very much benefit from the social accelerator effect and other incentives to achieve the desired outcomes within one year only. Other complementary initiatives will then have to kick in to maintain the social BMI at the newly achieved levels (long-term benefits). Cascading social models to design and drive these programmes to success are documented.

The other reality about healthcare today is the word itself infers a negative state of wellbeing and sickness. However true, the aptitude of modern healthcare systems to successfully promote wellbeing, foresee and prevent diseases should be added to the metrics measuring their ability in curing them. In most Asian countries, the ageing tsunami is right around the corner and if these governments keep ignoring the rampant obesity issue, the already shorter life-spanned “active” population won’t be lean enough to keep their economies going.

It would be very practical to think that Earth Day is every day, not once a year. The very same line of thoughts should apply for our lifestyle choices. Nobody’s perfect but every day we have an opportunity to make the right choices. Hence, whether you represent your government body or your own, carpe diem!

Dr. Mehdi Khaled is the Founder and Managing Director of Fit Populations LLC and can be reached at mehdi.khaled@me.com.

Reference

1. Franks P.W., Hanson R.L., Knowler W.C., et al. Childhood Obesity, Other Cardiovascular Risk Factors, and Premature Death. N Eng J Med 2010; 362:485-493
2. Haslam DW, James WP. Obesity. Lancet 2005;366:1197-1209
3. Susan E. Ozanne, Ph.D. Epigenetic Signatures of Obesity. N Eng J Med 2015; 372:973-974
4. Amir Tirosh & Al. Adolescent BMI Trajectory and Risk of Diabetes versus Coronary Disease. N Eng J Med 2011; 364:1315-1325
5. Parvez Hossain & Al. Obesity and Diabetes in the Developing World — A Growing Challenge. N Engl J Med 2007; 356:213-215
6. Christakis NA, Fowler JH. The Spread of Obesity in a Social Network. N Engl J Med 2007; 357:370-379
7. Shih, P.C., Han, K., Poole, E.S., Rosson, M.B., Carroll, J.M. Use and Adoption Challenges of Wearable Activity Trackers — iConference 2015 Proceedings.
8. US Federal Trade Commission report on food marketing to children (2006)

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Credits : InfoMed (Malaysia)
Website: www.infomed.com.my 

HEPATITIS

Hepatitis C is the leading cause of liver cancer deaths and liver transplants worldwide. Is alarming that most of those infected don’t know they have it!

Hepatitis is the inflammation of the liver that can be caused in a variety of ways. Most common cause of hepatitis is the viral infection of three different viruses, named A, B and C. Hepatitis can also be caused by heavy alcohol use and certain drugs. Hepatitis A is caused by the hepatitis A virus and hepatitis B is caused by the hepatitis B virus (HBV), while hepatitis C is caused by the hepatitis C virus (HCV). Worldwide, there are 1.45 million viral hepatitis deaths per year, mainly due to hepatitis B and hepatitis C (Hep C) as shown in the 2014 Lancet study with more deaths caused by viral hepatitis than HIV/AIDS. This is likely due to the fact that there are 400 million people living with hepatitis B or hepatitis C compared to HIV sufferers. InfoMed spoke to Professor Dr. Rosmawati Mohamed, the co-chairperson for WHO Strategic and Technical Advisory Committee for Viral Hepatitis (STAC-Hep) and founding member of the Coalition to Eradicate Viral Hepatitis in Asia Pacific.

THE BURDEN OF UNDER-DIAGNOSED HEPATITIS C

In her opening comments, she made the point of how under-diagnosed hepatitis C is, with three out of four people living with hepatitis C being unaware of their condition. Considering hepatitis C is the leading cause of liver cancer deaths and liver transplants worldwide, it is alarming loophole of medical awareness. The problem she says is because chronic hepatitis C is a slow and silent process. There are no obvious symptoms, and by the time jaundice and water retention is noticeable, the liver disease is already too advance for treatment. Early detection is absolutely vital, she stresses, because even though no vaccine is available, unlike HIV or hepatitis B, hepatitis C can be cured. The key is early detection.

WORLDWIDE MORTALITY FROM VIRAL HEPATITIS (2012)

Asia Pacific

1,012,873

deaths per year

Rest of the World

431,681

deaths per year

You are more likely, by three times to die from viral hepatitis than HIV/AIDS

EXCERPTS OF THE INTERVIEW WITH PROF. DR. ROSMAWATI

In terms of global impact of hepatitis, definitely we are seeing lot more deaths due to hepatitis, mainly hepatitis B and hepatitis C, the two diseases that causes serious complications such as liver cirrhosis and liver cancer. The main reason for transmission of hepatitis B is mother to child transmission.

Good news for hepatitis B is that with the advent of universal neonatal vaccination for newborn since 1989, we are seeing less and less cases of hepatitis B for those born after 1989.

But for hepatitis C, we are still seeing new cases, mainly due to sharing of needles and equipment like tattoos and razors. Testing for hepatitis C was only available worldwide since the early 1990’s, and since 1993, transmission of hepatitis C through transfusion of blood or blood products does not arise at the hospital settings and is not an issue in Malaysia.

Treatment is available for hepatitis B and C. The aim of treatment for hepatitis B is to suppress the viral replication but for hepatitis C, we can achieve complete clearance of the virus with specific therapy. New drugs for hepatitis C, the direct antiviral agents, can achieve cure rates close to 100% with just 12 weeks of treatment and some are already available in Malaysia (these were only approved recently).
The standard treatment for all types of hepatitis C since 2003 is the combination of Pegylated Interferon, given as an injection once a week, and oral ribavirin.

Hepatitis C shows significant genetic variation, referred to as genotypes. There are at least 6 genotypes and the commonest in Malaysia is genotype 3 in about 60% of cases, followed by Genotype 1 in about 36%. The duration of treatment and the cure rates depend on the genotype. The standard duration of treatment for Genotype 3 is 24 weeks whereas for Genotype 1 is 48 weeks. The cure rate with the combination of Pegylated Interferon and ribavirin for genotype 3 is 80% but for genotype 1 the best at 40% to 50%. So with the new drugs we should expect cure rates of more than 90% and some approaching 100%.

A priority action to address the hepatitis C disease burden is to enhance hepatitis C detection among those who are at risk. Possible risk factors and for hepatitis C would include those who had received blood transfusion before 1994, those who had shared needles or sharp instruments which may contain and those on haemodialysis. The prevalence of hepatitis C among the IV drug users can be as high as 60 to 70%. A lot more contagious then we thought. Strengthening harm reduction programs such as the needle exchange program has helped to reduce transmission of hepatitis C. The reduction program has to be optimised.

In Malaysia, the prevalence of hepatitis B is higher than hepatitis C and the former is the major cause of liver cancer. Although hepatitis B vaccination can reduce the prevalence of hepatitis B amongst the vaccinated group (those born after1989), the liver cancer prevalence among adults who are infected with hepatitis B is still high. Worldwide, hepatitis C is the leading cause of liver cancer deaths and liver transplant.

KEY FACTS HEPATITIS C

• Hepatitis c is a liver disease caused by the hepatitis C virus: the virus can cause both acute and chronic hepatitis infection, ranging in severity from a mild illness lasting few weeks to a serious, lifelong illness.
• The hepatitis C virus is a bloodborne virus and the most common modes of infection are through unsafe injection practices; inadequate sterilization of medical equipment; and the transfusion of unscreened blood and blood products.
• 130-150 million people globally have chronic hepatitis C infection.
• A significant number of those who are chronically infected will develop liver cirrhosis or liver cancer.
• Approximately 500,000 people die each year from hepatitis C-related liver disease.
• Antiviral medicines can cure approximately 90% of persons with hepatitis C infection, therby reducing the risk of death from liver cancer and cirrhosis, but access to diagnosis and treatment is low.
• There is currently no vaccine for hepatitis C; however research in this area is ongoing.

(Media Centre World Health Organisation)

WITH THAT IN
MIND, PROF. DR.
ROSMAWATI GAVE INFOMED A DEEPER
LOOK INTO HEPATITIS C
IN MALAYSIA.

InfoMed: What is the most up-to-date number of prevalence and incidence of hepatitis C in Malaysia?

Rosmawati: The estimated prevalence is 2.5% of the population aged 15 to 64 years (which is more than 500,000 individuals) based on a recent study, and 60% are related to IV drug use.

InfoMed: How does the Ministry track these numbers? Rosmawati: Data from the Ministry is based on notified cases, as it is compulsory to report all cases of hepatitis B and hepatitis C in Malaysia.

InfoMed: Are there any active campaigns being done that seek to reduce the problem?

Rosmawati: Most campaigns are in conjunction with WHO designated World Hepatitis Day on 28 July. There is a need for a coordinated national response to address issues relating to viral hepatitis. A National Strategic Plan for Viral Hepatitis is required to ensure specific policies and tools are incorporated to reduce the burden related to viral hepatitis.

InfoMed: What makes the disease/ infection a cause for serious concern?

Rosmawati: High prevalence and the rising disease burden for hepatitis C.

InfoMed: Who are the most vulnerable groups in Malaysia to hepatitis C?

Rosmawati: Hepatitis C is mainly transmitted through contaminated blood. Those who had received blood transfusion before 1994 are at risk of contracting hepatitis C. Other ways of hepatitis C transmission include sharing of infected needles, unsafe practices such as tattooing and sharing of sharp instruments such as razors and patients with kidney failure who are on haemodialysis. Mother to child and sexual transmission are uncommon modes of transmission.

InfoMed: What are some easy prevention methods that people can do (in Malaysia)?

Rosmawati: Knowing the risk factors for hepatitis C is an important step to prevent new infections.

InfoMed: How often do you get checked?

Rosmawati: Only one time test is required for those at risk.

InfoMed: Where can people do so?

Rosmawati: You can get checked at any general practitioners (GP) clinic or hospital.

InfoMed: If you are infected, what treatment options are available in Malaysia?

Rosmawati: Pegylated interferon and ribavirin. New treatment options are now available for Genotype 1.

InfoMed: Based on the current prevalence of hepatitis C, where would Malaysia be in five years in terms of new cases and management of the disease? Rosmawati: The prevalence of hepatitis C virus (HCV) infection in Malaysia has been estimated at

2.5% of the adult population. A recent research article by McDonald SA, Dahlui M, Mohamed R, Naning H, Shabaruddin FH, Kamarulzaman

A (2015) titled, “Projections of the current and future disease burden of hepatitis C virus infection in Malaysia” concluded, “The HCV-related disease burden is already high and is forecast to rise steeply over the coming decades under current levels of antiviral treatment. Increased governmental resources to improve HCV screening and treatment rates and to reduce transmission are essential to address the high projected HCV disease burden in Malaysia”

InfoMed: What can the general public do now to reduce the incidence?

Rosmawati: Avoid the risk factors.

InfoMed: What about general practitioners, what is their role in managing hepatitis C in Malaysia? Rosmawati: Counsel and take the test on their patients at risk for Hepatitis C.

HCV INFECTION IS DIAGNOSED IN 2 STEPS:

Screening for anti-HCV antibodies with a serological test identifies people who have been infected with the virus. If the test is positive for anti-HCV antibodies, a nucleic acid test for HCV RNA is needed to confirm chronic HCV infection because about 15–45% of people infected with HCV spontaneously clear the infection by a strong immune response without the need for treatment. Although no longer infected, they will still test positive for anti-HCV antibodies.

(Media Centre World Health Organisation)

Credits: InfoMed ( Malaysia )

Website: Infomed.com.my

Healthcare Today

-An Overview

Facing the challenges and getting to the core of the policy issue and implementation
By Mohan Manthiry

Currently the estimated annual global healthcare spending is more than USD$4.2 trillion and is increasing every year. There exists a wide variation in terms of spending for healthcare. Developed countries are spending more than 10% of their GDP, with the highest being USA at almost 18% and the majority of developing and poor countries spend less than 4% of their GDP for healthcare. Malaysia allocated 4.4% of the GDP for healthcare in 2013.

Within the countries, we are witnessing the increasing inequalities in income levels and access to social services, healthcare being a major component. The current trend globally in countries is the depleting middle class and the recent Oxfam report on wealth distribution gave us some startling statistics – “The combined wealth of the richest 1 percent will overtake that of the other 99 percent of people next year unless the current trend of rising inequality is checked, Oxfam warned in January 2015 ahead of the annual World Economic Forum meeting in Davos”. Excerpts from the 2015 Oxfam report:

“Oxfam made headlines at Davos last year with the revelation that the 85 richest people on the planet have the same wealth as the poorest 50 percent (3.5 billion people). That figure is now 80 – a dramatic fall from 388 people in 2010. The wealth of the richest 80 doubled in cash terms between 2009-14. Billionaires listed as having interests in the pharmaceutical and healthcare sectors saw their collective net worth increase by 47  percent. During 2013, they spent more than $500 million lobbying policy makers in Washington and Brussels”.

The recent Ebola outbreak laid bare the weakness in the healthcare systems in the poor countries. The current trend and experiences globally tells us that the health will not automatically evolve to become fair and equitable for all naturally. Governments need concerted and deliberate policy decisions to tackle this issue.

In the words of the Director General of World Health Organisation on 10 February 2015 in Singapore, “Universal health coverage is one of the most powerful social equalizers among all policy options. It is the ultimate expression of fairness. If public health has something that can help our troubled, out-of-balance world, it is this: growing evidence that well-functioning and inclusive health systems contribute to social cohesion, equity, and stability. They hold societies together and help reduce social tensions.”

“The rise of NCDs (non-communicable diseases) adds considerably to the costs of health care. The costs of cancer care, for example, are becoming unaffordable for even the wealthiest countries in the world. In 2012, the US Food and Drug Administration approved 12 drugs for various cancer indications. Of these 12, 11 were priced above $100,000 per patient per year. How many countries can afford this cost?

Prevention is by far the better option, but this, too, is more problematic than for infectious diseases, many of which can be prevented by vaccines or cured by medicines, all delivered by the health sector.”

The latest WHO report identified chronic disease as the leading cause of death and accounts for 70% of all mortality globally. These chronic or non-communicable diseases which include heart disease, obesity, diabetes and cancer which can be attributed directly to negligent health behaviours are preventable. The challenge to nations is on how to address this difficult task of getting their citizens to maintain healthy habits. And also how to effectively address the increasing healthcare needs of the population at an affordable cost level.

The most probable and perhaps the only way forward is to get every individual to take charge of their own personal health. Motivating people to take responsibility for their own health is now a global initiative and has become a strategy for patient engagement. By closely associating and taking an active role in your own health, would reduce negligent and risky health behaviours and encourage patients to keep their health in check.

Now, how do we build this strategy and bring about the required change management in the attitude and behaviour of the individuals towards their healthcare? The good news is we have now the technology to assist and support this difficult lifestyle modification. The numerous strategies are all hovering around the mobile technology that has permeated the society and our daily lives. Some of the interesting developments are:

• Healthcare apps to be connected real time with your healthcare providers, to receive healthcare news, services, advise, information and to monitor personal health risks;
• Receive notification and reminders on medication and health checks;
• Reach out to your doctors online for advise, second opinion and follow-ups;
• Manage your own personal health record on the mobile. This eventually develops your close understanding of your own health conditions, enabling you better management of your health outcomes. At the same time be able to reach out to your doctor with accurate and detail historical information on your personal health condition. This eventually reduces medical errors and better diagnosis and treatment plan;
• Wearable technologies. Innovations in healthcare, capitalising on the mobile technologies is one way-forward. However, long term strategies are needed and instilling good healthy behaviour should start from the young. Education plays an important part. Introducing healthcare as a subject in the curriculum of schools from the primary level will be an excellent way to ensure that the long term strategies on healthcare geared towards prevention and wellness materialises. This would be a cost-effective strategy and would ensure the next generation of Malaysians have better control and shall take charge of their healthcare.

Instilling good habits from young is a noble and cost-effective method than trying to bring behavioural changes to adults who are already prone to unhealthy lifestyle.

Health is very important for the development and well-being of a nation and its people. It requires political leadership and highly committed public-private partnership and investment.

SOME STARTLING STATISTICS ON NCD FROM
MINISTRY OF HEALTH MALAYSIA

Malaysia – NCD
(non-communicable disease)
accounts for 70% of total deaths

Total deaths

146,000

Cost of Managing
Diabetes in Malaysia

RM 19,000

PER PATIENT PER YEAR

NHMS (National Health and Morbidity Survey) 2011 estimated 1.1 million diabetes patients with MOH hospitals (1.1 m x RM 19k)

RM 20.9

billion

NHMS 2011 data estimates 63.3% (18 years and above) are high risk and at risk factors for NCD

Credits: InfoMed ( Malaysia )

Website: Infomed.com.my

Dr. Kulendran Sivapragasam, Consultant Urologist at Columbia Asia Hospital, Bukit Rimau, Kota Kemuning provides an overview on stones formed in our kidney and their potential journey in our urinary system.

UROLOGIST

A Urologist is a doctor with specialized knowledge and skills regarding problems of the male and female urinary tract which includes the kidney, ureters, bladder and urethra and the male reproductive organs – testes, prostate, penis, epidydimis, seminal vesicles and associated glands.

Calculi or stones are hard masses or crystals that form in the urinary system. They can be found anywhere in the urinary system such as in the kidneys, ureters, urinary bladder or even in the urethra. They are often the most common kind of urological problem that an urologist sees and treats.

WHAT CAUSES STONES?

Stones can form due to various reasons. They can form due to infective causes and non-infective causes. Non infective causes can be due to metabolic disease, hereditary causes, and abnormal anatomical structure of the urinary system or even due to certain types of medicines. They can also form when the urine lacks the normal inhibitors of stone formation. Inadequate fluid intake can also cause stone formation especially in those individuals who are already susceptible to stones due to other reasons.

WHAT SYMPTOMS CAN THEY CAUSE?

The symptoms vary according to the size and location of the stone or stones. These symptoms include pain in the flanks that can be very severe and blood in the urine. The pain can be dull and aching as in the case of kidney stones and it can be excruciating and colicky in the case of stones in the ureter. They can be accompanied with nausea and vomiting. Sometimes when the stone is in the ureter and very close to the bladder it can make a person feel like wanting to urinate all the time.

If fever and chills accompany these symptoms, it can indicate an infection. In such cases one has to contact a doctor immediately.

HOW ARE THEY
DIAGNOSED?

The doctors will usually do blood and urine tests. This will help diagnose the presence or absence of infection and also assess kidney function among other things. The next will be to get diagnostic imaging done. The best form of which is a non-contrast-enhanced computed tomography (NCCT). Ultrasound, intravenous urography and plain x-rays can also be used but they do not give as much information as NCCT does and NCCT can help diagnose smaller stones that may be missed by the other modalities.

HOW ARE THEY TREATED?

Pain which can be severe will be treated with adequate painkillers. Existing infection if any will be treated with antibiotics. Any obstruction in the urinary system will have to be relieved especially if there is infection. Treatment of the stones depends on the type, location, size and number of the stones. Factor such as urinary system obstruction, presence of infection, existing kidney function and other co-existing medical conditions such as diabetes also need to be taken into account in choosing the treatment of choice. Medication which can help to dissolve certain types of stone 

in the kidney or help the stone in being expulsed from the ureter can be tried. In kidney stones as well as stones in the ureter, extracorporeal shock wave lithotripsy (ESWL) is a treatment option. Another common treatment option the urologist may use is rigid or flexible endoscopes, such as the ureteroscope. These are introduced into the urinary tract and the stones removed or broken into smaller pieces that can be removed or flushed out with the urine. Surgical removal has now become less common with the advances in endourological procedures.

RISK FACTORS

• Dehydration (decreased urine flow) increases risk significantly
• Obesity
• Family history
• Past history of kidney stones
• Sex (the incidence in women is increasing)
• High-protein, salt, or glucose diet
• Inflammatory bowel diseases (can cause increase calcium absorption)
• Other medical conditions (hyperparathyroidism can cause increase calcium absorption)

TESTING FOR KIDNEY STONES:

• Complete health history assessment and physical examination
• Blood tests for calcium, phosphorus, uric acid and electrolytes
• Urinalysis to check for crystals, bacteria, blood and white cells
• Blood urea nitrogen (BUN) and creatinine to access kidney function
• Examination of passed stones to determine type
• Abdominal x-rays, ultrasound of the kidney, ureter and bladder or a non contrasted CT to look at the size, site and number of the calculi and to look for signs of obstruction.

KEY POINTS

• 85% of urinary calculi are calcium, mainly calcium oxalate; 10% are uric acid; 2% are cystine; and most of the remainder is magnesium ammonium phosphate (struvite).
• Larger calculi are more likely to obstruct; however, obstruction can occur even with small ureteral calculi (i.e. 2 to 5 mm).
• Symptoms include hematuria, symptoms of infection, and renal colic.
• Test usually with urinalysis, imaging, and if the calculus can later be retrieved, determination of calculus composition.
• Give analgesics and drugs to facilitate calculus passage (eg, α-receptor blockers) acutely and remove calculi that cause infection or persist endoscopically.
• Decrease the risk of subsequent calculus formation by treating with measures such as thiazide diuretics, K citrate, increases in fluid intake, and decreases in dietary animal protein, depending on calculus composition.

MSD Manual by Glenn M. Preminger, MD

HOW CAN THEY BE PREVENTED?

For most types of stones, fluid intake should be increased to maintain urine output at 2-3 litres per day. Salt intake and the amount of meat and animal protein eaten should be reduced. Dietary restrictions defer depending on the composition of stones. Calcium levels should be maintained. In certain types of stones medication will be prescribed to help prevent recurrence.

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Credits: InfoMed ( Malaysia )

Website: Infomed.com.my

Connected Seamless Care is where with technology comes the rise in patient expectations who are accustomed to digital services and connectivity. C2H connected seamless care capitalized on this technological advance, optimizing the pathway to connect all the care providers and professionals, patient as well the family right across the healthcare ecosystem for a continuum of care.