HEALTH MATTER

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Thailand and the obesity epidemic

Published September 30, 2016 by SoClaimon

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

http://www.nationmultimedia.com/life/Thailand-and-the-obesity-epidemic-30290296.html

HEALTH MATTER

Obesity has reached alarming levels in the Asean Economic Community and especially in Thailand, where 32 per cent of the population are overweight

Obesity has reached alarming levels in the Asean Economic Community and especially in Thailand, where 32 per cent of the population are overweight, pushing the country into second place in terms of prevalence of obesity after Malaysia at 44 per cent and ahead of Singapore at 30 per cent. At this current rate of progression and without any vigorous intervention by the public health authorities, it is likely that half the Thai population will be overweight in the coming years.

Obesity is defined as having an excess proportion of total body fat. To assess weight, health professionals commonly use the Body Mass Index (BMI). BMI is the weight in kilogrammes divided by the square of your height. In the western world, the BMI test is based on WHO criteria and ranges from normal (20-24.9), overweight (25-29.9) to obese (over 30). In Asian countries, the index follows the Regional Office for the Western Pacific (WPRO) standard. Due to the higher risk of developing obesity-related complications compared to the western population, its cut-off point for obesity status is a BMI of greater than or equal to 25?kg/m2. Consequently, Asians are overweight when the BMI is between 23 and 25 and obese when the BMI is equal to or above 25?kg/m2.

It is essential to understand that excess weight is a lifestyle issue essentially related to the quantity of food ingested – not “a diet” issue per se. What overweight people need to realise is that any weight loss endeavour must come from significant and sustained motivation for behavioural changes. The diets listed in the “quick and easy weight loss” fads give rise to the illusion that eating pleasures can be maintained through a few dietary tips. By keeping the focus on the food intake, the lifestyle issue is not effectively addressed, leading to repeated diet regimen failures.

There are many factors behind the fast-growing epidemic in Thailand. In simple terms, there is a huge imbalance between the promoters of healthy lifestyle, who include the Public Health Ministry, related medical associations and a few laudable stakeholders, and the pro-obesity advertising forces driven mainly by fast food companies and some influential media.

Future obesity trends are exacerbated by food companies’ ads, which intentionally target all age-groups including the most influential individuals, young children. In addition, the publicity materials often display speedy meals or snacks with a smiling person quickly swallowing huge portions of food without taking the time to masticate.

Such commercials are known to induce disturbed eating patterns that can potentially lead to excess weight. In fact, food intake needs to be progressive, at least over a 20 to 30-minute period to allow physiological control of food absorption. When the stomach stretches, specific nerves and hormones send negative feedback to the centre of satiety located in the brain, eliciting the sensation that you’ve had enough to eat. Speed eating does not trigger this feedback mechanism and leads to subdued and much higher intake of food. Skinny models are used to imply that this eating behaviour keeps you slim.

Moreover, for the last decade, the “fat and happy” body culture has enjoyed both recognition and support. While it is of course positive that overweight people are not ostracized and can project a “feel good” attitude, the pendulum has swung too far, with a growing number of severely obese individuals seemingly not realising the grim consequences they will soon face.

It is thus essential that the population at large becomes really aware of the long-term complications of obesity that include not only serious diseases such as diabetes, cardiovascular illnesses and an increased risk of many cancers but also lead – always and sooner than expected – to a deprived quality of life with impairment of lung and liver function as well as chronic joints and bones problems.

Obesity is preventable and the epidemic is not fatal. In some countries such as Singapore, prolonged awareness campaigns to promote a healthy lifestyle and control obesity have already showed commendable results.

In Thailand, it is really time to do something concrete.

DR GERARD LALANDE is managing director of CEO-Health, which provides medical referrals for expatriates and customised |executive medical check-ups in Thailand. He can be contacted at gerard.lalande@ceo-health.com.

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Effective birth control with notes

Published September 30, 2016 by SoClaimon

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

http://www.nationmultimedia.com/life/Effective-birth-control-with-notes-30288055.html

HEALTH MATTER

Tubal sterilisation through Natural Orifice Transluminal Endoscopic Surgery (NOTES) has been used abroad for more than 10 years, but is still a relatively new technique in Thailand.

TUBAL sterilisation through Natural Orifice Transluminal Endoscopic Surgery (NOTES) has been used abroad for more than 10 years, but is still a relatively new technique in Thailand.

The method involves inserting a tiny camera and surgical instrument through the vagina, which is the body’s natural opening, so as to view the area that cannot normally be seen. This means there is no need to make any abdominal incisions. This technique is not only used for sterilisation of women, but can also be applied to other treatments, such as removing the fallopian tubes due to an ectopic pregnancy, removing an ovarian cyst, as well as performing a hysterectomy, with no postoperative scarring.

However, there are very few surgeons who can perform the NOTES technique for sterilisation. Even though this technique is a preferred method for sterilisation, it is not often the first option chosen by most practitioners.

Suitability for each individual patient depends on the results of a medical assessment and of course whether the patient wishes to use this method.

There are other advantages and benefits of tubal sterilization through NOTES. When people think of sterilisation, they usually believe that surgery is required. They become uneasy at the thought of the pain and hazards involved. Traditional endoscopic surgery causes minimal pain, but due to the greater number of pain receptors in the abdominal region, it is still more painful than making an incision in the vaginal lining, which is painless and will leave no visible scar. This method is highly preferable for most women, in part, for aesthetic reasons. Moreover, there is less chance of infection using this method. Additionally, traditional endoscopic surgery has some limitations for patients who have had previous surgeries and are left with excessive abdominal scarring. This technique is the answer for some, but not all; for many it is a better option than traditional surgery.

Before the decision is made to undergo tubal sterilisation through NOTES, the husband and wife must be |positive that they are ready to terminate their ability |to have additional children, because this technique is |permanent. Although attempts could be made to reverse this procedure, it would be very difficult, so patients |need to be certain of the decision to undergo tubal |sterilisation.

Having tubal sterilisation through NOTES requires only standard preparation and the associated expenses are not as high as one would expect. If you can afford to undergo endoscopic surgery for sterilisation, then the cost of tubal sterilisation through NOTES will not be an issue.

If you think it is time for contraception by sterilisation that leaves no scarring, is painless and affordable, this method should be your first choice.

Dr Santi Pongphantarak is an expert in Gynaecologic Laparoscopic surgery attached to the Women’s Health Centre of Samitivej Sukhumvit Hospital. Call (02) 022 2222.

Zika infection: an update

Published August 18, 2016 by SoClaimon

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

http://www.nationmultimedia.com/life/Zika-infection-an-update-30287028.html

HEALTH MATTER

The World Health Organisation’s sudden declaration of the Zika infection as a public health emergency of international concern in early 2016 inevitably generated poorly documented and often sensational headlines.

The World Health Organisation’s sudden declaration of the Zika infection as a public health emergency of international concern in early 2016 inevitably generated poorly documented and often sensational headlines. While these press articles have been relatively accurate in reporting geographical extension, route of contamination and Zika’s effects on patients, they have also partly occluded the relevant scientific facts.

Back then, speculation relating to Zika’s potential severity was primarily based on limited epidemiological data. The numerous studies conducted over the past six months have shed new light on the transmission of the disease and its two major complications, and justify a revision of the article published here last February.

So what is known today about this so-called new epidemic threat?

Like the dengue virus, the Zika virus is transmitted by the ubiquitous Aedes mosquitoes, which are found in tropical areas and southern parts of the western hemisphere. Associated with the cross-border movements of people potentially carrying the pathogen, the Zika infection could indeed spread in all these territories. Likewise, international travellers visiting these affected countries could be exposed to the virus and bring it back home when returning. In consideration of the risk, some scientists are urging postponement of 2016 Olympic games in Brazil, the country which has recorded the highest number of Zika cases so far.

In fact, as of last Wednesday, the virus had been identified in 60 countries, 46 of which are experiencing the first Zika outbreaks since 2015. In the other 14 countries, virus transmission has already been active since 2007. Interestingly, four territories, which had evidenced Zika virus transmission prior to 2014, did not report any new cases for the last 18 months, a sign that the epidemics in these locations were already subsiding.

The Zika virus was first identified in 1947 in Uganda. Besides insignificant outbreaks in Africa, Micronesia and in 2013 in French Polynesia, the recent outbreak, in comparison to other widespread and more severe infectious diseases such as influenza and dengue has induced relatively contained public health challenges among these populations.

Two concerns however deserve continuous research and close attention, namely a foetal defect named microcephaly (a congenital brain condition where a baby’s head is much smaller than average size) and the Guillain-Barr? syndrome, a potentially (although rarely) fatal neurological disorder in adults.

Unproven in February 2016, the cause of microcephaly of children born from pregnant women infected by the virus during the first trimester has recently been established through the identification of the virus in the newborns’ brain and imaging studies. The risk of contracting the malformation is however poorly understood and currently varies from 1 to 29 per cent of pregnancies afflicted by Zika infection during the first trimester.

Similarly, the causality of Zika infection with regard to the occurrence of neurological disorders has also been confirmed and the risk of this complication is estimated at 2.4 cases for every 10,000 infections based on the specificities of the 2013 outbreak in French Polynesia.

Researchers have recently suggested that the severe forms of Zika infections may be linked to co-infection with the dengue virus, which is also quite prevalent in the tropical regions.

With regard to sexual transmission of the virus, sexual contamination has occasionally been reported among heterosexual couples and male homosexuals in the USA but is likely to remain negligible in comparison to mosquito bites.

In consideration of these new findings, the recommendations for pregnant women include travelling precautions in endemic areas, protection against mosquito bites, protected sexual relationships when the partner is infected and the monitoring of pregnancy for any women at risk.

Finally, the change of date or location of the next Olympic games remains a controversy. The anticipated number of foreigners attending the August 2016 Rio games is estimated at half a million. This figure represents less than one per cent of all international travellers visiting Latin American countries where the outbreak is already active. While recommendations for pregnant women remain important to follow, the cancellation of the games alone would not effectively impact on the probable progression of this viral illness.

DR GERARD LALANDE is managing director of CEO-Health, |which provides medical referrals for expatriates and customised |executive medical check-ups in Thailand. He can be contacted at |gerard.lalande@ceo-health.com.

A weighty problem

Published May 17, 2016 by SoClaimon

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

http://www.nationmultimedia.com/life/A-weighty-problem-30284649.html

HEALTH MATTER

Once rare in Thailand, childhood obesity is today on the rise, with figures released by Thailand’s Ministry of Public Health in 2013 showing obesity growth rates of 36 per cent in pre-school age kids and 15 per cent in school age children.

Once rare in Thailand, childhood obesity is today on the rise, with figures released by Thailand’s Ministry of Public Health in 2013 showing obesity growth rates of 36 per cent in pre-school age kids and 15 per cent in school age children.

Obesity increases the risk of high blood pressure, diabetes and high cholesterol, which in turn heightens the risk of kidney failure.

Some obese children may have a darkening skin around the neck, which does not wash off no matter how hard you scrub. Known as acanthosisnigricans, this skin change indicates the body is resistant to insulin action, which increases the prevalence of diabetes. Insulin is a hormone produced by cells in the pancreas, which controls blood sugar levels by enabling the movement of sugar to the cells that need it. In the case of any insulin disorder, the body has trouble regulating sugar and cannot use glucose for energy supply effectively, thereby resulting in high blood glucose levels that consequently damage the kidneys as well as the body as a whole.

Other hormones that regulate energy use are also affected. The acanthosisnigricans is caused by an abnormality in a related hormone that over-regulates skin pigmentation.

Insulin resistance is one of the key factors leading to kidney failure in obese children even if there are no other complications.

Leptin is a hormone made by fat cells in the body. Leptin levels tend to be higher in people who are obese because it is produced by fat cells. The body does not respond well to leptin in these cases and that spells disaster as leptin is an appetite-suppressing hormone that sends signals to the brain. Leptin makes people feel full when the body has accumulated adequate energy levels and burns body fat for use as energy. Leptin also helps insulin to function properly.

When the brain does not respond well to leptin, the energy expenditure is less than usual and the hormone fails to suppress appetite. As a result, people tend not to feel full after a meal, thereby encouraging abnormal accumulation of body fat, developing a vicious cycle of obesity, and further worsening their insulin resistance.

In cases of obesity, there are some abnormalities of the blood vessels of the kidneys as well as of both renin and aldosterone, which are hormones that regulate renal blood flow, renal blood pressure and body blood pressure.

The hormonal disorders cause high blood pressure and abnormal filtration, thereby damaging the kidneys and altering the kidney tissue. Aldosteronein combined with other hormones may damage small blood vessels in the body. Although the blood pressure may not be very high, the kidneys can be directly damaged by these hormones.

Both adiponectin and resistin are “fat hormones”, like leptin. The roles of resistin and leptin are similar; whereas adiponectin helps control these misbehaving fat hormones. In obesity, the resistin level is usually high while the adiponectin level is frequently low, thereby decreasing the body’s ability to prevent complications.

In conclusion, “fat hormones” from body fat and high insulin level will stimulate reactive oxygen species (ROS) or free radicals that cause many illnesses. The ROS causes inflammation of the kidney cells, abnormal proliferation of tissues, increase in filtration pressure, and renal hypertension.

One initial abnormality is albumin leakage to the urine identified from a specific urine test, urine microalbumin. In the kidney tissues, free radicals cause fibrous bands and abnormal cells, which increase the risk of kidney damage, cause a domino effect of conditions, and ultimately lead to kidney failure. The free radicals also cause high blood pressure, which also affects the kidneys.

A urine test can show up apparent abnormalities in obese child as early as three years of age. This test can indicate the presence of kidney damage at an early stage. While a large number of studies have been conducted to examine the relationship between obesity and kidney disease in adult population, few have been conducted to examine the link between childhood obesity and kidney disease.

However, a recent study in teenage males unveiled potentially correlation between obesity and kidney failure. Additionally, findings from the other studies that have been conducted in this area show that childhood obesity significantly increases the risk of kidney diseases and complications in later adulthood or even during childhood, and the condition may start to develop before high blood pressure or diabetes has been detected.

The long-term complications in the form of heart disease and kidney failure in most adults can be traced back to childhood obesity.

So think hard before you let your kid eat unhealthy fast food, drink sodas and snack on crisps and ice cream. His or her kidneys will be glad you did.

DR NANTHIYA PRAVITSITTHIKUL is a Paediatric Nephrologist at Samitivej Children’s Hospital – |Srinakarin Campus. Call (02) 378 9082-83.

Lyme disease: beware of tick bites

Published March 17, 2016 by SoClaimon

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

http://www.nationmultimedia.com/life/Lyme-disease-beware-of-tick-bites-30280976.html

HEALTH MATTER

Often unrecognised and thus left untreated, Lyme disease is one of the most common tick-transmitted illnesses and is currently on the rise, especially in the northern parts of the USA, Europe, north Asia and the Far East.

Often unrecognised and thus left untreated, Lyme disease is one of the most common tick-transmitted illnesses and is currently on the rise, especially in the northern parts of the USA, Europe, north Asia and the Far East. It is estimated that more than 300,000 cases occur in the US alone every year. Although rarely deadly, the illness may lead to long-term morbidity due to potentially severe neurological or cardiac complications.

Lyme disease is caused by various species of the Borrelia bacteria that infect mammals and birds. The pathogen is transmitted to humans during a painless bite of an infected tick of the Ixodes genus and usually occurs after a quite long period of attachment (more than 24 hours) of the insect to the skin. Following a tick bite, the risk of Borrelia infection is however quite low, between one and five per cent and most ticks are fortunately detected and removed before 24 hours of attachment.

Infestation happens in places where ticks are present such as grassy and wooded areas with high humidity levels. Those exposed to forestry activities or who engage in outdoor sports in such locations are at higher risk of contracting the disease. Ticks can also transmit other microbes that induce disease in humans.

Symptoms occur after a few days or weeks after the bite and then typically evolve in successive phases. An initial small reddish spot is visible at the site of the bite and, in about 50 per cent of the cases, a characteristic painless, non-itchy rash – named erythema migrans – slowly expands to 20 to 30 centimeters around it, often leaving the centre of the skin lesion to return to its original color.

In endemic areas of Lyme disease, this type of rash strongly suggests early Lyme infection. Flu-like manifestations also often occur in parallel with the rash and include fever, headache, muscle and joint pains, nausea and fatigue. Left untreated, complications could happen after several weeks, months or even years and include joint pains especially at the knee (arthritis), various neurological disorders such as meningitis (inflammation of the brain), abnormal muscle movements and/or paralysis due to nerves inflammation as well as heart rhythm problems.

The main challenge of Lyme disease is to recognise it when this is no rash or when complications start, usually several months or years after suffering from the tick bite. Undiagnosed, the patient may be treated inadequately for chronic arthritis or neurological illnesses over a long period. In such a case, the late diagnosis exposes the patient to serious morbidity with very poor quality of life.

The diagnosis is confirmed by serology tests that identify antibodies to the Borrelia bacterium.

Treatment should be started as soon as possible and is quite effective at the early stages of the infection. Antibiotics, especially doxycyclin and amoxicillin, are used in oral form for 2 weeks in early Lyme disease and in intravenous infusion for up to four weeks when complications have appeared.

There is currently no vaccine against Borrelia infection. Prevention first starts by avoiding areas infested by ticks known to carry the pathogen.

Those working in endemic areas or practicing adventure sports in such environments should always wear long trousers and long-sleeved shirts, use tick repellents and carefully check their whole body after returning from the wild. Ixodes ticks are smaller than common dog ticks and may be as small as the head of a pin. They often attach in difficult-to-see areas such as the armpits, scalp and groin. If you find a tick, use tweezers to slowly remove the insect from its head and disinfect the bite site.

If a rash or any suggestive symptoms occur, consult a medical professional for further tests and possibly treatment. In some high-risk individuals to whom the tick has remained attached for more than 24 hours, a single dose of doxycyclin might be given to prevent the occurrence of the infection but has to be taken less than 72 hours after the tick bite.

DR GERARD LALANDE is managing director of CEO-Health, |which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at gerard.lalande@ceo-health.com.

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