The Star Online: Lifestyle: Health
The Star Online: Lifestyle: Health |
| Posted: 03 Dec 2011 04:26 PM PST The Health Ministry has introduced new clinical guidelines for the monitoring of diabetic retinopathy. DOES it surprise you to know that the most common cause of visual loss, including blindness, among working adults in Malaysia is actually preventable? And as it is a condition that arises as a consequence of having another disease, it is actually preventable on two levels. The medical condition we are talking about is diabetic retinopathy, which is one of the leading complications from having diabetes mellitus, or more commonly known as just diabetes. As a non-communicable disease, caused by mainly lifestyle factors, diabetes is preventable by living a healthy lifestyle. However, as it stands at the moment, the Third National Health and Morbidity Survey in 2006 estimated that 14.9% of Malaysians aged 30 and above have diabetes. This means that in a group of around seven adults, one is likely to be diabetic. And this number is only expected to increase, with the International Diabetes Federation predicting that the number of diabetes patients in Southeast Asia will double by 2025. If that was not bad enough, the 2007 Diabetic Eye Registry Malaysia reported that over one third of diabetic patients (36.8%) have diabetic retinopathy. Of these, 15.6% had sight-threatening retinopathy, with 9% practically blind already. Catch it early Now, there are two important things to bear in mind concerning diabetic retinopathy. Firstly, it is an almost inevitable consequence of having diabetes. The longer you are diabetic, the more likely you are to develop diabetic retinopathy. According to the World Health Organisation (WHO), around half of diabetic patients will have some sort of diabetic retinopathy after 10 years, while almost all patients with type 1 diabetes mellitus and over 60% of patients with type 2 diabetes mellitus (the more common variety) will have some degree of retinopathy after 20 years of having diabetes. Secondly, diabetic retinopathy can be reversed in the early stages of the condition. However, there are no symptoms during that early stage, and by the time the patient starts having symptoms of the condition — like floaters (dark spots that float across your field of vision), blurred vision, missing areas of vision, and trouble seeing at night — it is already too late to reverse the damage. That is why it is essential that diabetic patients go for regular eye check-ups once they have been diagnosed, so that any problem with the eyes can be caught at the stage when it is still reversible. According to Health director-general Datuk Dr Hasan Abdul Rahman, "Late presentation with irreversible blindness continues to be a major challenge in the management of diabetic retinopathy in Malaysia." Looking at the numbers from the 2007 Diabetic Eye Registry, around 70.9% of diabetic patients have never gone for an eye examination before. And this is despite the recommendation that all type 2 diabetes patients (comprising 92% of the entries in the registry) should get their eyes examined as soon as they are diagnosed. Bigger and better Dr Hasan made the statement in conjunction with the launch of the Clinical Practice Guidelines (CPG) for the Screening of Diabetic Retinopathy at Hospital Selayang recently. As can be inferred from its name, the CPG is the latest and most updated set of guidelines for healthcare professionals on the best screening procedure for diabetic retinopathy. As diabetic patients are followed up by general practitioners and non-eye specialists, it is crucial that these healthcare professionals are aware of the proper method to monitor for diabetic retinopathy. According to Hospital Selayang consultant ophthalmologist, and head of the committee that put together the CPG, Dr Nor Fariza Ngah, this edition of the CPG contains far more information than its predecessor. "The 1996 CPG was a simple one. Now, we have a new classification, new scheduling for follow-ups, and it is very evidence-based, from both local and international resources," she said. The contents of this CPG include the risk factors for diabetic retinopathy; a standardised grading for the severity of the disease; recommendations on screening methods, including sample fundus images; the recommended examination and follow-up schedules, including when to refer to an ophthalmologist; and treatment options. Also included is a list of the 107 government clinics that have a fundus camera — the recommended screening tool for diabetic retinopathy. A slim booklet of 35 pages, the CPG is aimed at all frontline healthcare professionals, including nurses, assistant medical officers, optometrists, general practitioners and family medicine specialists. Dr Hasan said during his speech: "I ask two things: number one, to make sure these guidelines are internalised and institutionalised by all our personnel." He added that he expects the CPG to be treated as a "bible" in the monitoring of diabetic patients for retinopathy. "Number two, another thing towards institutionalisation is that we must incorporate this CPG into all our teaching hospitals; put it into the curriculum," he said, adding that he is taking the implementation of the guidelines very seriously. "There is no point having a guideline if it is not practised," he said. The CPG is also meant for private practitioners. Dr Hasan said that doctors in the private sector can get it for free from the ministry's Health Technology Assessment Section in Putrajaya, or download it from the ministry's website (http://www.moh.gov.my/v/op). Full content generated by Get Full RSS. |
| Posted: 03 Dec 2011 04:25 PM PST While HIV treatment has become more accessible to patients, the number of HIV-positive people continues to increase, signaling a dire need for education, especially for healthcare professionals, in order for us to have the right perspective and fully understand the social and healthcare implications for people living with HIV (PLHIV). HIV and AIDS awareness programme, It Begins With You, recently made further inroads by reaching out to the people of Kota Bharu in conjunction with World AIDS Day 2011. The Kota Bharu initiative, which was spearheaded by healthcare company MSD, and the Malaysian Society for HIV Medicine (MaSHM), was supported by the Kelantan Health Department, Prihatin, SAHABAT, Kolej Kejururawatan, and the medical, nursing and pharmacy students from Hospital Universiti Sains Malaysia. Commenting on this latest initiative, Ewe Kheng Huat, managing director of MSD, said, "It is timely that It Begins with You spreads its wings beyond the Klang Valley as we are acutely aware of the need for education and awareness of HIV and AIDS in other regions. "As much as we have witnessed positive responses in the Klang Valley over these last six years, we look forward to seeing how the Kota Bharu initiative will also contribute to lives being changed, perspectives challenged, and, more importantly, to sow the seeds of commitment among future doctors and healthcare professionals in Kota Bharu. "We are indeed pleased to be able to launch It Begins with You in Kota Bharu and reach out to the community there. It has been great to see the enthusiasm of our partners – their dedication and excitement are certainly infectious and encouraging. They have rallied together to set out a good HIV and AIDS outreach programme, and we applaud each of them," Ewe added. Dr Mahiran Mustafa, President of MaSHM and advisor to Prihatin, said: "From 1986 up to 2010, 91,362 HIV-positive cases have been reported, with 12,943 of these lives lost. While HIV treatment has become more accessible to patients, the number of HIV-positive people continues to increase, signaling a dire need for education, especially for healthcare professionals, in order for us to have the right perspective and fully understand the social and healthcare implications for people living with HIV (PLHIV). This is so that we can accord them the respect and care they need. "One of the key reasons why we are raising awareness on HIV and AIDS in Kelantan is because the state records one of the highest incidences of new infections for HIV. According to figures from the Health Ministry, in Kelantan alone, there were 9,891 HIV-positive patients at the end of December 20092. The increasing number of reported new HIV infections needs to be addressed," said Dr Mahiran. The Kota Bharu initiative comprised programmes such as educational visits to a shelter home and support centre by the medical, nursing and pharmacy students, spearheaded by Prihatin and SAHABAT, as well as a public event at Kota Bharu Mall to drive the awareness on HIV and AIDS. The event was launched by Dr Wan Mansor bin Hamzah, the deputy director of the Kelantan State Health Department. Highlights of the It Begins With You event in Kota Bharu Mall included HIV quizzes for the public to enhance their understanding on HIV and AIDS, a board for public pledges in support of the cause, and a resident clown to entertain the crowd. Other interesting activities included a colouring competition for children, as well as dikir barat and wayang kulit performances with HIV themes. It Begins With You was first initiated in 2005 to address the low ratio of doctor to HIV-patient, by raising awareness among medical students of the dire need for more HIV and AIDS treaters. It also seeks to address the stigma associated with the interaction and treatment of people living with HIV and AIDS (PLHIV). The programme continually invites resources and expertise of partner organisations to address these issues and positively impact the lives of PLHIVs. Previous advocacy initiatives included participation of medical students from various universities, namely International Medical University, Universiti Teknologi MARA, Universiti Malaya and Universiti Putra Malaysia. To continue support towards these universities, HIV initiatives such as a HIV talk and a HIV awareness run were held at the International Medical University in conjunction with their HIV Week in October and November this year. Note: About Malaysian Society of HIV Medicine MaSHM was founded in 1998 by group of doctors dealing with HIV and AIDS. The primary aim is to provide and participate in education of HIV and AIDS and raise awareness among the medical and allied professions, patients, schools and the public. It is currently actively involved in conducting training courses and workshops to equip current and future doctors and paramedics with knowledge and skills to diagnose, counsel and treat PLWHAs. Related Stories: |
| Posted: 03 Dec 2011 04:21 PM PST All stakeholders must collaborate in the prevention of obesity. THE World Health Organization (WHO) has highlighted that obesity has reached epidemic proportions globally, with at least 2.6 million people dying each year as a result of being overweight or obese. Once considered a problem only in high-income countries, the incidence of overweight and obesity are now dramatically on the rise in low- and middle-income countries. It is an ever increasing problem, and worldwide, obesity has more than doubled since 1980. In 2008, it was estimated that 1.5 billion adults were overweight. Of these, over 200 million men and nearly 300 million women were obese. Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases, and cancer. All efforts must therefore be made to reduce the extent of the problem and prevent the disease. The WHO has emphasised that governments, international partners, civil society, non-governmental organisations and the private sector all have vital roles to play in contributing to obesity prevention. In Malaysia, available data have clearly indicated that the obesity problem has reached alarming proportions. Almost half of all adult Malaysians are overweight or obese; almost a third of primary schoolchildren are overweight or obese; and almost 15% of preschool children are overweight. We do not have an option; we must urgently implement measures to control and arrest the increase in obesity in the country. All stakeholders must make greater efforts to collaborate in these intervention measures. I would like to share with readers two recent activities related to the problem of obesity that I participated in. Both events highlighted the importance, and urgency, of the prevention of obesity. Obesity forum to raise awareness In early November, Nestle Malaysia organised a forum to raise awareness on the increase in prevalence of obesity, as well as to discuss ways to tackle the issue. It was an effort to improve public knowledge about nutrition and to promote wellness among Malaysians. Several key stakeholders participated in the forum, including representatives from the Health Ministry, the Nutrition Society of Malaysia (NSM), the Malaysian Association for the Study of Obesity (MASO), the Malaysian Dietitians' Association (MDA), and the media. Two presentations were made in the forum, followed by a panel discussion on topics related to the tackling of obesity in the country. The first presentation summarised findings of a study of the nutritional status and dietary habits of primary schoolchildren. It was a large study, carried out by Universiti Kebangsaan Malaysia in 2007/2008, involving more than 11,000 children. The prevalence of overweight and obesity was found to be 26%. There was also a significant increase in the prevalence of overweight and obesity compared to a similar survey in conducted in 2001/2002. The second presentation summarised findings from a study by the Universiti Pertanian Malaysia of the risk of obesity and eating disorders among Malaysian adolescents. It was a much smaller study, and it revealed that the prevalence of overweight and obesity was also found to be close to 26%. The panel discussion touched on a number of topics related to obesity reduction. These included discussions on the need to further empower people on knowledge about healthy eating and active living; obstacles to achieving a healthier diet and ways to overcome the challenges; making healthier options of foods and meals available, including foods sold in school canteens; and the role of the private sector, non-governmental organisations and professional bodies. There were some discussions on the current intervention efforts of various stakeholders. NSM, in collaboration with Nestle, has initiated a dedicated programme targeted towards primary schoolchildren, named its Healthy Kids Programme (www.healthykids.org.my). At the conclusion of the three-year programme, it is envisaged that an educational module to impart simple and practical nutrition messages can be made available to the Education Ministry for implementation to all primary schools. The Nutrition Month Malaysia initiatives, which commenced in 2002, will again be launched in April 2012 to bring about greater awareness of healthy eating and active living to combat non-communicable diseases, including obesity (www.nutriweb.org.my). It is hoped that all stakeholders will lend support for this nationwide effort. There are available strategies and action plans such as those outlined in the National Plan of Action for Nutrition (NPAN). Activities specifically directed towards tackling overweight and obesity include the need to increase awareness on obesity among all sectors of the community. The need to establish a childhood obesity prevention programme has also been identified in the NPAN. A significant recent development is the organisation of a workshop for the prevention of overweight and obesity in Sarawak (November 14-16). It was organised by the Sarawak Health Foundation, with the technical assistance of NSM and MASO. The expected output from the workshop was a set of programmes and activities that are practical and can be implemented in Sarawak for the prevention of overweight and obesity. It is envisaged that the action plans will be implemented, first on a pilot scale in selected sites, and then refined for implementation in other regions of the state. The participants of the workshop were from organisations and individuals who are anticipated to participate in implementing the identified intervention programmes and activities. These included principals and senior teachers from various kindergartens and schools in Kuching; nutritionists, dietitians, health education officers, doctors, nurses, non-governmental organisations, and other relevant stakeholders that are involved in promoting healthy eating and active living. Workshop participants were divided into four groups according to different settings: kindergartens and primary schools; secondary schools; community; and workplace (government and private sector). Each group was given the task to brain storm and recommend appropriate action plans for the prevention of obesity in Sarawak. Programmes and activities that are appropriate for the identified settings, ie school, workplace, and community settings were recommended. It was emphasised to the participants that the key factors to obesity are eating habits and sedentary lifestyle. The proposed activities should be addressing how to increase awareness on these key factors, and to take this knowledge a step further to making behaviour changes so that the public actually practises healthy eating and active living. Recognising that behaviour changes are difficult, approaches to promotion strategies must be innovative so as to motivate the public to make the required changes. Participants were also reminded to bear in mind that changes must be sustainable. Participants must recognise what the challenges or obstacles are to making these changes, and how to overcome such obstacles. Workshop recommendations It was heartening to note that there were active discussions in all the four groups. Numerous recommendations were put forth. It was unanimously agreed that priority should be given towards recommendations targeted at children. The following paragraphs highlight some of the main recommendations made at the workshop. There was a clear call by workshop participants to assign nutritionists to preschools and schools. Participants were informed that there are currently 18 nutritionists in Sarawak. This was felt to be grossly inadequate. One nutritionist could be assigned to be in charge of a few schools. I fully support this recommendation. It is timely that appropriately qualified professionals, i.e. nutritionists, should be assigned to handle all the recommended food and nutrition-related activities in preschools and schools as outlined below. Workshop participants recommended the immediate implementation of growth monitoring of children in all schools. Standardised weighing scales should be provided to all preschools and schools and teachers trained in the measurement and recording of body-mass index. Nutritionists are expected to work discreetly with parents in arranging for counselling sessions for overweight and obese children. In the third recommendation, participants recommended the intensification of nutrition education activities in all preschools and schools. Age-appropriate modules on healthy eating are recommended to be developed for use in schools. Regular awareness sessions aimed at parents and teachers on healthy eating and active living should also be carried out. The nutritionist assigned to the schools should also provide appropriate guidance and periodic review of foods sold in school canteens. In parallel with nutrition promotion, participants also called for the intensification of physical activity in all schools. It was recommended that physical education teachers should be assigned to every school, to organise activities related to physical activities, e.g. fitness activities, and sports and games. He is expected to collaborate with nutritionists to conduct active lifestyle activities in the school, and together ensure that the effective conduct of Pendidikan Jasmani dan Kesihatan (PJK) classes. An interesting, and I thought rather apt recommendation, was the call for the implementation of a 1Sarawak Breakfast Club. In this proposal, preschools are to be provided nutritious breakfast to children. In conjunction with this, brief nutrition promotion activities as well as physical activity sessions could be carried out. Aside from schools, workshop participants also made recommendations appropriate for the community as a whole. Recommendations were made to conduct regular healthy lifestyle sessions in the community, especially for mothers- and fathers-to-be so that healthy eating can commence in a newly formed family. Activities were also identified to promote increased awareness of healthy eating when eating out. A systematic set of recommendations was also made to promote healthy eating and active living in the work place. I certainly hope that Sarawak will be able to implement some of these recommendations soon. An urgent call for action Overweight and obesity are likely to become even greater problems in the country. There is an urgent need to take immediate action to tackle the problem. We need comprehensive obesity prevention programmes, not piece-meal activities. We need to elaborate on the programmes identified in the NPAN; there must be serious efforts to implement these identified activities. We need to start young, work with kindergartens, reaching out to the kindy operators, teachers, and children. We also need to work on primary schoolchildren, their parents, and the teachers, another "captured" population that is amenable to interventions. The National Strategic Plan for non-communicable diseases has emphasised promoting partnerships with NGOs, professional bodies, food industry, and all stakeholders to realise the objectives. The food industry too has a role to play and can make their contributions. We need to have trust so that all stakeholders can work together in these efforts. We need to act now. Dr Tee E Siong pens his thoughts as a nutritionist with over 30 years of experience in the research and public health arena. For further information, e-mail starhealth@thestar.com.my. Full content generated by Get Full RSS. |
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