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Posted: 06 Apr 2013 06:19 PM PDT

Live great moments with Great Eastern Life.

THERE is a simple but wise saying which goes, "Health is wealth".

Simply put, healthy living is essentially about making healthy choices every day, healthy choices that keep us fit physically, mentally and spiritually, because life is not just about being alive, but living great.

Living great, in itself, can mean different things to different people. For most of us, it is a combination of having loving personal relationships with the ones we love, doing what we dream of, achieving personal goals and development, and having a deep sense of wellbeing that comes from knowing that we can handle whatever life throws us – all of which cannot be bought with any amount of money we may have.

The certainty of great living comes first from us being healthy, both physical and mentally.

One of the ways to live healthily is to observe a balanced diet that includes more grains, fruits and vegetables. This may help reduce the risk for heart diseases, and for those who are conscious of their weight, prevent obesity.

Exercising regularly by incorporating physical activities into our daily routine helps combat diseases such as cardiovascular diseases, and more importantly, can improve our emotional well-being.

Having sufficient amounts of sleep can reduce stress and promote mental well-being.

These are but a few tips to a healthy lifestyle, and more can be found in the Live Great Portal, which is part of Great Eastern Life's Live Great Programme.

The programme aims to help you turn your good healthy intentions into actions. The Live Great Portal was launched to provide effective methods to improve your health with its extensive library of health and wellness articles as well as a variety of online wellness tools such as Wellness Profiling Daily Calorie Needs Calculator, Body Mass Index Calculator, and many more.

At Great Eastern Life, we believe that experiencing total wellness of your mind and soul is as important as physical wellness. With this in mind, various topics are covered in the Live Great Portal, ranging from pregnancy and healthy ageing to positive mind management and stress relief (emotional health).

Having said that, health is, often times, neglected in the pursuit of material and career success.

Khairul Izwan, a manager in a local bank, comments, "As we all know, the demand for increased productivity and profitability has brought about more stressful working environments. This, in turn, has increased stress levels and forced lifestyle changes upon us that impact our health, family and general well being."

For Khairul, exercising and eating healthily was not on the top of his list of priorities when he first joined the workforce. He would even skip lunch just so he could deliver his work on time.

Khairul's choice of lifestyle eventually caught up with him when he developed gastric ulcer. "They always say health is not valued until sickness arrives. In my case, this is definitely true, and it was a painful lesson to learn. I now make sure that I eat well and exercise by running regularly. Running helps with managing my stress from work," he says.

Khairul adds: "I also make sure I have time for my loved ones. Every weekend, I'll bring my wife and son out for a little 'family getaway' as I believe having a good relationship with those you love and sharing meaningful time with them is also important to achieving a well-balanced lifestyle."

At first glance, work-life balance seems to be a daunting task that is almost impossible to achieve, but with discipline and good time management, it is possible. G. Saravanan, a director and chief technology officer of an MSC company, is another example of how work is not an obstacle to leading a healthy lifestyle as he would always find the time to exercise and constantly motivates his family and colleagues to do the same.

Saravanan, whose personal health regime includes running and attending physical boot camps, believes that although maintaining a healthy diet is an important factor to a healthy lifestyle, it is still not enough without exercise. "We live in a wonderful country where food is abundant and delicious. That can prove to be a challenge to resist," he says jokingly.

He continues: "I make sure that I eat moderately, and have a good workout. By saying moderate, I do not practise any particular dieting – I'd try any type of food, but I make sure that I do not go overboard."

Living healthier is a personal choice, but everyone has a role to play. Individuals, communities, government and corporate organisations can work together to create environments and conditions that support healthy living.

Great Eastern Life, in playing its part to contribute to a healthier nation, is committed to help its customers live healthier and better by delivering unique customer experiences.

For yoga teacher and practitioner, Youvarajan Vadiveloo, the "Yoga For Life" event organised under Great Eastern Life's Live Great Programme proved to be a new and exciting experience as it was his first time performing yoga postures for 45 minutes with 2,200 participants.

"Yoga is proven to be beneficial for our health," says Youvarajan, who practises yoga twice a day as a way to keep healthy. "I am happy to have been a part of this experience and also be able to contribute to a worthy cause," he comments on Great Eastern Life's effort which saw a total of RM44,400 collected from registration fees donated to the Breast Cancer Welfare Association.

Another major event which was organised by Great Eastern Life as part of the Live Great Programme was the inaugural Live Great Run which attracted close to 5,000 runners in 2012.

Saravanan, who was also a participant in the run, remarked that he enjoyed the event tremendously, and that "the environment was vibrant with lively people and energising music".

Saravanan adds: "I have participated in five other runs, but none of them were comparable to the Live Great Run. The most important motivator during the Live Great Run was the constant reminder of how many more kilometers we had to go, and this really motivated me, so much so that the tiredness after running 11.6km just faded away and I could sprint in the final 400m, which made a huge difference on my personal best timing for the 12km run."

Khairul, who participated in the run with his wife, sums it by saying: "It is the silent aim of everyone to be healthy and Great Eastern Life's efforts in reaching out to us by organising such events is a constant reminder of how being healthy is a duty we owe ourselves.

"Our lifestyle choices are important to achieve holistic well-being, and I am glad I chose to participate in the Live Great Run with my wife." Due to the overwhelming success and public support, the Live Great Run is set to return on Sept 15, 2013, promising to be bigger and better. So do keep a look out for the registration dates!

Great Eastern Life is the event partner for the Star Health Fair 2013. This year's theme 'Let's Live Great!' is to inspire Malaysians to lead a healthy lifestyle by being physically and mentally fit. Join in the journey to health and wellness with your loved ones by visiting Great Eastern Life's booth and take part in the 'Live Great Day Experience' and 'Live Great Challenge'. The Star Health Fair will be held in Halls 1 to 3 of the Mid Valley Exhibition Centre from April 12 to 14. It is open from 10am to 7pm and admission is free. For enquiries or to participate, call 03-79671388 (ext 1243/1529) or visit www.facebook.com/thestarhealthfair.

Emergency contraception

Posted: 06 Apr 2013 06:16 PM PDT

Emergency contraception is not a substitute for other contraceptive methods. It is to be used only when there is an episode of unprotected sex, or there is potential contraceptive failure.

EMERGENCY contraception (EC) provides women with a safe method of preventing pregnancy if there has been sexual intercourse without any contraceptive use or if there is potential contraceptive failure, eg burst, split, or dislodged condom, missed contraceptive pills, or expulsion of an intra-uterine contraceptive device (IUCD).

As other commonly used terms such as "morning-after pill" or "post-coital contraception" are often confusing, the term "emergency contraception" is preferred.

There are two types of EC available – hormones and IUCD. EC acts by stopping ovulation or fertilisation of an egg, or preventing a fertilised egg from implanting in the uterus.

Medical and legal opinions are clear that emergency contraception prevents pregnancy and is not a method of abortion. Abortion only takes place after a fertilised egg has implanted in the uterus.

However, those who believe that life begins when the egg and sperm are released or when the egg is fertilised may not wish to use EC.

The IUCD cannot be used in women who have a current pelvic infection. Care is needed in its use in women who are at risk of sexually transmitted infection (STI), ie those who have more than one sexual partner or the partner has more than one partner.

Women who are already pregnant cannot use EC. Hormones are not advisable for those who have a history of jaundice during pregnancy or oral contraceptive use, genital tract cancers, venous thromboembolism, and those who are on medicines like rifampicin, anti-epileptics, and possibly St John's wort.

The hormone regimes available are levonorgestrel, ulipristal acetate and oestrogen-progestogen EC. The overall effectiveness of emergency hormonal contraception varies depending on the regime used and when it is initiated.

This effectiveness rate cannot be compared with the effectiveness rates for other contraceptives because it is for a single use.

Levonorgestrel

Levonorgestrel (LNG), a progestogen, is thought to act by inhibiting ovulation. It should be taken within 72 hours (three days) of unprotected sexual intercourse (UPSI). It is more effective the sooner it is taken.

LNG taken on day five after UPSI has six times the pregnancy rate when compared to when it is taken on day one. It is not as effective as other contraceptive methods like the Pill or condoms, and it does not provide protection against STIs.

LNG is more likely to fail if the first dose is taken more than 72 hours after UPSI, the second dose is not taken or taken late, there is vomiting within three hours of taking the pills, or there is UPSI at another occasion, either since taking LNG or since the last menstrual period.

The first dose, which contains 0.75mg LNG, should be taken as soon as possible, and the second dose should ideally be taken 12 hours later, but not more than 16 hours later.

Sometimes, there may be concerns about poor compliance by the user. In such situations, a single dose of 1.5mg may be prescribed.

Most women can take LNG. However, if there is a medical condition or illness or concurrent consumption of prescribed or traditional medicine, it would be prudent to inform the doctor.

There are no serious side effects. About 20% of women will experience nausea and 5% vomiting. If there is vomiting within three hours of taking LNG, the doctor should be informed. They may prescribe extra pills, medicine to stop the vomiting, or suggest fitting an IUCD.

Other side effects include headache, breast tenderness, or abdominal pain.

Menstrual disturbances may occur after taking LNG. The next menstrual period will come earlier than expected or it may be up to a week late. On most occasions, it comes within a few days of the expected date. There may be some irregular bleeding between taking LNG and the next period.

There is still a small risk of pregnancy even if LNG is taken correctly. The possibility that the hormones in the pills may harm a developing baby cannot be completely ruled out, but this is thought to be very unlikely.

Ulipristal acetate

Ulipristal acetate (UA), a selective progestogen receptor modulator, acts by preventing or delaying ovulation. It should be taken as soon as possible and certainly no later than 120 hours (five days) after UPSI. It can be taken at any time of the menstrual cycle, but you must not be already pregnant before taking it.

Medical advice has to be sought if there is vomiting within three hours of taking UA as another tablet will have to be taken because of possible non-absorption.

As UA does not provide protection against pregnancy for the rest of the menstrual cycle, condoms have to be used until the next menstrual period because UA may reduce the effectiveness of the contraceptive Pill. The next period should be on time or a few days early or late.

Medical advice should be sought if the periods are more than seven days late, there is abnormal bleeding, or if you think you may be pregnant.

UA is unsuitable for regular use and cannot be used more than once during a menstrual cycle. It does not protect against STIs.

Oestrogen-progestogen emergency contraception

This is called the Yuzpe regime, named after the Canadian gynaecologist who first described it. It was the only method of EC until LNG and UA came along.

It involves taking pills containing 100mcg ethinyl oestradiol, and 0.5mg levonorgestrel or 0.5mg norgestrel, within 72 hours of UPSI, and then repeating the same dose 12 hours later. Its effectiveness is greatest when taken within the first 24 hours of UPSI, after which effectiveness decreases during each subsequent 24-hour period.

About 50% of women will experience nausea and 20% will vomit after taking the first or second dose. Another side effect is breast tenderness. It does not protect against STIs.

Intra-uterine contraceptive device (IUCD)

An IUCD containing copper can be inserted up to 120 hours (five days) after the first episode of UPSI at any time in the menstrual cycle, or up to 120 hours after the expected date of ovulation in a regular cycle.

Ideally, an IUCD should be inserted at the time a woman is first seen, but some women may need time to think about it. In this case, and if within 72 or 120 hours of UPSI, LNG or UA respectively will be prescribed.

The IUCD works by stopping an egg from being fertilised or implanting in the uterus. It prevents 99 % of expected pregnancies and can also provide continuing contraception if wanted.

Most women can use an IUCD. However, if a person is at risk of STI, there is risk of a pelvic infection. In such circumstances, screening tests will be done at the time the IUCD is fitted and antibiotics may be prescribed to those in high-risk groups to prevent a pelvic infection.

There is a six-fold increase in the risk of pelvic infection in the 21 days following insertion of an IUCD. The doctor will provide information about recognising symptoms and when to seek medical attention.

An IUCD is suitable if the user is too late to take LNG, does not want to take hormones, or wants to use the most effective method of EC.

Evaluation and follow-up

A medical history is taken from all those who request EC so that the risks of STI and the need for discussion on other sexual issues can be assessed. Screening for STI will be offered, especially to those who are at risk.

Information and counseling regarding the different methods of EC, as well as its side effects and effectiveness, will be provided to enable an informed choice to be made. Information and reassurance about confidentiality should readily be available as this is a concern for many young people.

The user of EC is advised to consult her doctor as instructed. After hormonal EC, about 87-90% of women will menstruate within seven days of their expected date. If the periods are delayed by more than seven days or are lighter than usual, a pregnancy test will be carried out.

If hormonal EC is used because of missed contraceptive pills, advice will be provided about the missed pills. Condoms should be used until these consecutive pills are taken.

Some fertility monitoring devices like the personal hormone monitoring system will not be reliable for up to three months after hormonal EC use.

It is important to see a doctor three to four weeks after an emergency IUCD has been fitted, whether or not there has been menses. The objective is to check if there is any pregnancy, the IUCD is in the correct place, and to discuss any problems.

If there is no desire to keep the IUCD as a regular contraceptive method, it can be removed any time after the next period if no UPSI has occurred after the menses or if hormonal contraception has been started within five days of the next cycle.

Another contraceptive method, eg condoms, has to be used for at least seven days prior to removal of the IUCD because sperm can live in the body for up to seven days and can fertilise an egg once the IUCD is removed.

It there is any concern about EC, it is advisable to consult the doctor as soon as possible. Medical attention should be sought immediately if there is any sudden or unusual lower abdominal pain as this may be due to ectopic pregnancy, a condition in which the pregnancy develops outside the uterus, which is potentially life threatening, although it is rare.

Hormonal EC does not protect against pregnancy for the remainder of the menstrual cycle. The doctor will counsel the user about other reliable and more regular contraceptive methods like the combined oral contraceptive pill, progestogen only pill, condoms, diaphragms, caps, fertility awareness methods, implants, injections and intra-uterine contraceptive device.

Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with. For further information, e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Incentives to a healthier life

Posted: 06 Apr 2013 06:15 PM PDT

To commemorate World Health Day today, we take a look at what employers can do to help their workers shed those extra kilos.

WHAT would it take for you to adopt a healthier diet and exercise regularly if you are obese or overweight?

Many Malaysians should be familiar with the following statistics by now: almost half of our adult population is overweight, including about 2.5 million who are obese, and nearly half a million of those aged 18 and below are also overweight.

The 2011 National Health and Morbidity Survey, which reported this, also found that only 7.5% of Malaysians follow the World Health Organization's recommendation of eating five servings of vegetables and fruits daily, and less than two-thirds actually exercise.

With all the various efforts at increasing awareness about the risks posed by carrying around all those extra kilogrammes, it is unlikely that anyone is unaware that being overweight is not really a good thing for your health.

However, for most of those who find themselves on the heavier end of the spectrum, there are plenty of deterrents to losing that excess weight; for example, the easy availability of food, the lack of time, not knowing where to start and lack of support, among others.

However, the most crucial factor in the battle against the bulge has always been willpower, or the lack of it.

So, what if you were given a helping hand or an external incentive to lose weight? Would that provide the adequate "push" factor to get you started on the path to a healthier lifestyle?

With the rise of corporate social responsibility and the increasing awareness that a healthy workforce is a productive workforce, many companies in the United States have implemented policies and programmes meant to help and encourage their employees to lose weight.

The obesity problem in the US is practically pandemic, with more than two-thirds of American adults overweight, including over a third considered obese, as well as almost 17% of those aged below 20.

With working adults spending about a third of their lives at the workplace, it makes sense that it is a good place to reinforce healthy eating and exercising habits.

Paying for lost weight

The vast majority of American employers that offer incentives as part of a workplace weight-loss programme tend to make it in the form of cash.

After all, we work for money, so the logic applies that we would lose weight for money too.

Usually based on either the number of actual pounds lost, percentage of decreased body weight or lowered body mass index (BMI, which is weight in kilogrammes divided by height in metres squared), these programmes reward employees according to how much they lose.

In addition, many companies also impose some kind of financial penalty for being an unhealthy weight, making it a carrot-and-stick approach.

A Mayo Clinic study presented at the American College of Cardiology's annual 2013 meeting last month suggested that this might indeed, be one of the best methods for this kind of programme.

The one-year study – the longest so far to examine the effects of financial incentives on workplace weight-loss programmes – looked at 100 obese employees, as judged by their BMI, aged 18 to 63, based at the Mayo Clinic's Rochester, Minnesota, main campus.

The participants were divided into four groups: one group was provided with weight-loss counselling, the other had the counselling and a three-month gym membership, the third had counselling and financial incentives, and the last had counselling, the gym membership and financial incentives.

This meant that half the participants were provided financial motivation for losing weight, while the other half were given the tools to lose weight, but no real external motivation.

All groups had to attend a monthly weigh-in to check their progress, with the aim of losing four pounds (1.8kg) a month up to an individual goal that was based on their starting weight.

The participants in the financial incentives group were given US$20 (RM61) if they reached the monthly goal, but had to pay the same amount as a penalty if they didn't.

They also earned US$10 (RM31) each month, as well as lottery tickets, for attending the monthly weigh-ins and sending their weights via SMS to the study leaders every week.

The penalties were put into a pool where about half was used to pay out the incentives, and the other half formed the lottery prize that anyone (in the two financial incentives groups) who completed the study, regardless of whether they achieved their weight-loss goal or not, could potentially win.

So, not only did participants have the chance of earning up to US$360 (RM1,107) for losing four pounds a month, attending the monthly weigh-ins and reporting their weight every week, they could have also potentially lost up to US$240 (RM737) of their own money for not losing the appropriate weight.

The lottery was instituted as a way of encouraging those who might get disheartened by their inadequate weight loss and bringing them back on track instead of dropping out altogether. As long as those in the financial incentives groups participated in the programme, they still had a shot at winning back their money.

According to one of the study's authors, Dr Steven Driver, the fear of losing money tends to motivate people about two and a half times more than the prospect of earning the same amount of money.

That is why the researchers included the penalty and lottery elements in the study.

At the end of the study, it was found that those receiving the financial incentives lost just over nine pounds (4.1kg) on average, compared to 2.3 pounds (1kg) for the other participants.

Around 62% of those in the financial incentives groups completed the study, versus 26% of those in the other two groups.

Moneywise, 27 of the 50 incentive participants earned more than they had to pay out, with 15 people receiving the maximum US$360 for reaching and maintaining their weight-loss goal, as well as attending all the monthly weigh-ins.

A total of US$2,200 (RM6,761) was paid in penalties, which was divided among the eight people who achieved the overall weight-loss goal of 10%, and two other people in the lottery. The researchers themselves spent about US$12,000 (RM36,876) for the monthly incentives.

Of course, despite the year-long study, there still arises the question of whether or not these lifestyle practices will continue once the financial incentives stop coming in.

And some health experts question the effectiveness of financial incentives at all, saying that motivation should come solely from within, in order to truly work in the long term.

Mayo's preventive medicine chairman Dr Donald Hensrud, who helped formulate the study, did comment that future studies should look at what financial incentives work best, and how long such programmes need to be in place in order to help maintain the weight loss.

Other than actual cash, companies have also offered other in-kind incentives to encourage their overweight employees to shed the pounds. These include more annual leave days, retail vouchers and competition prizes like holiday trips.

Slimming tools

Aside from financial or in-kind incentives, many US workplaces offer other types of support to encourage their employees to lose weight.

Workplace gyms that only require a minimal fee – the majority of the cost being subsidised by the company, or subsidised memberships at offsite gyms, are a popular option.

The ease of being able to go to a gym within the same building on your lunch break, or before or after work, helps remove – to a certain extent – the excuse of not having enough time to exercise, or easy access to gym equipment.

Meanwhile, saving some money on oftentimes expensive gym memberships might be that extra push needed to get someone to start working out.

Aside from gyms, there are also other ways to encourage exercise at the office workplace.

The American Heart Association recommends 150 minutes of moderate-intensity exercise a week, which can translate to 30 minutes five times a week, or 75 minutes of vigorous exercise, which can be divided to 25 minutes three times a week, to keep healthy and reduce the risk of chronic diseases like hypertension and heart disease.

Workout periods can also be broken down to 10-15 minutes segments throughout the day in order to achieve the necessary amount of exercise.

In Japan, companies usually have a 5-10 minute morning exercise or stretching routine before work starts. This is part of a wider Japanese practise called rajio taiso, or radio exercises.

At 6.30am every day, national broadcaster NHK plays a special tune, along with an announcer giving exercise instructions, nationwide.

Everyone with access to a radio can, and often does, join in.

Companies usually play this segment during their morning assemblies, where all employees are expected to join in the calisthenics.

Some companies even have an afternoon session around 3pm, when employees are expected to drop whatever they are doing, and join in the short workout.

Another method to promote exercise, especially for deskbound jobs, is the treadmill computer workstation.

Invented by University of California, Berkeley, psychology professor Dr Seth Roberts, in 1996, it was popularised by Mayo endocrinologist Dr James Levine, who rediscovered the idea while brainstorming ways to burn calories during a normal work day, following his 2005 study that showed lean people burned more calories than those who are overweight by doing things like fidgeting, pacing or walking on errands around the office.

The idea is that you are able to walk at a slow pace – a 1-2 miles per hour (1.6-3.2 kilometres per hour) pace has been found to be the most comfortable pace for most people – while working on the computer, or answering calls.

At less than two mph, this is enough to burn an extra 100 calories for every mile (1.6km) walked.

Some of the companies that utilise this piece of equipment – which include the Hyatt and Marriott hotel chains – have bought them for individuals, while many put them in a common area, where employees can book the workstation for certain periods of time.

Some have even replaced smaller conference tables with a few of these treadmill workstations in a circular formation, so that small meetings can be carried out while exercising.

Related to that concept is the walking meeting, where small groups take an actual walk around their premises while holding their meeting, instead of just sitting around a table.

Even seated around a table, upper body exercises can be encouraged during meetings through the provision of resistance bands or small hand weights.

Another sitting option that has also been explored is the use of an exercise or fitness ball, instead of a regular chair.

Using such balls helps increase balance, strengthens the core muscles of the back and stomach, and improves posture, as it actively engages the relevant muscles while sitting.

Certain workplaces also have pantries, which are stocked with edibles provided free by the company, or even weekly catered meals, supplied by local restaurants.

Web companies are, in particular, famous for this perk, including giants like Google, Microsoft and Facebook.

With most people more than willing to eat a free lunch or snack, companies can actively use this benefit to help promote healthy eating habits.

For those who don't know where to start, some companies bring in a health and fitness expert to provide free weigh-loss counselling or education for their employees.

Competition among colleagues

The jury is still out on whether these workplace-based programmes have significant effects in the battle against the bulge in the long run.

But it would seem that the support and/or competitiveness that comes in a group setting does help individuals get rid of the fat.

A study published in Monday's edition of the Annals of Internal Medicine reported that participants who were given incentives as a group lost 4.4kg on average, compared to 3.2kg for those who were given individual incentives.

The participants, who were obese employees at the Children's Hospital of Phladelphia, were divided into two groups.

Individuals in the first group were given US$100 (RM310) each month they met or exceeded their weight loss goals.

Meanwhile, the second group was divided into smaller groups of five where each small group was given US$500 (RM1,533) monthly to be split among those who met or exceeded their weight loss goals.

This meant that some of these participants could potentially earn more than US$100 if other members of their group didn't lost the appropriate amount of weight, thus, creating a more competitive atmosphere.

So, peer pressure combined with financial incentives might indeed prove to be that extra push factor to get the overweight motivated enough to start losing those extra kilos.

Editor's note: With reference to the article in Fit4life on March 24 titled 'A Snug Fit', it has been pointed out that the woman in the picture is not Kiran Kaur as captioned but an individual wearing Breathe apparel.

Kredit: www.thestar.com.my

Ahad, 7 April 2013

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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