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Affecting the World Through Health
A Global Health Initiative

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According to the data obtained from a study in 2018, about 128 people in the United States lose their lives daily after overdosing on pain killers, with numbers reaching an alarming average of 43,000 to 50,000 deaths per year- almost comparable to flus and other highly infectious diseases. Pain killers such as opioids are originally prescribed to treat chronic pain but with prolonged use, the pain relieving effects may lessen with the pain worsening and the body can develop dependence. Worse still, in addition to prescription-dependence cycle, some of the illegal/street drugs that are available to the public are made with unknown amounts of fentanyl. Fentanyl is a very potent opioid that cannot be seen, smelled or tasted and is lethal in a dose as small as a pinch).This dependence towards opioids causes withdrawal symptoms making it difficult to stop taking them. A major fact is that some patients can be condemned to a life of addiction within a week of exposure to the drugs as proven by several studies. Currently, there is no other known drug or medication that kills people such as opioid overdose. Drugs classified as opioids include oxycontin, fentanyl, buprenorphine, oxymorphone, codeine and morphine. These are usually prescribed by healthcare providers to manage severe and chronic pain in addition to heroin and are illegal drugs of abuse. These drugs are regrettably almost indispensable in the practice of medicine and even till this day some of the drugs remain essential in managing some covid-19 patients on ventilators.

Negative effects of opioid use vary broadly and may differ from person to person. These include:

  • Powerful and compulsive urge to use these drugs even when they are no longer required medically
  • Withdrawal symptoms such as muscle cramping, diarrhea and anxiety
  • Shortness of breath, unconsciousness and deaths
  • Neonatal opioid withdrawal syndrome
  • Spread of infectious diseases such as HIV and viral hepatitis B and C due to injection drug use
  • Social, economic and health crisis such as lost productivity , addiction treatment and criminal justice burdens

Opioid crisis dates as far back as late 1990’s when pharmaceutical companies started. The Sackler brothers reassured the medical community that patients cannot become addicted to the prescription opioid pain relievers and then the health care providers began to prescribe them at very high rates as they were very effective. This led to the widespread lie and abuse of the medications before it was proven that these medications were highly addictive.

With current statistics and data, including the percentage of patients that are prescribed opioids who misuse them and those that develop an opioid use disorder, it is obvious that opioids crisis is on the rise.

The US Department of Health and Human Services spreads it efforts across five major aims which are:

  • Improving access to treatment facilities and recovery services
  • Promoting use of overdose-reversing drugs and medications such as naloxone and Suboxone
  • Strengthening the understanding of the epidemic through improved public health surveillance
  • Supporting up to date research on pain and addiction
  • Advancing better practices for pain management

The above measures help in tackling the opioid crisis but a lot more can be done to end the epidemic. Pharmaceutical companies are currently allowed to sell these drugs without regulation which is unsafe. Unfortunately, corruption, lobbying and a profit motive have led individuals and lawmakers to take actions like stripping the DEA of its ability to suspend suspicious narcotic sales thus hindering their ability to regulate and enforce laws that prevent the over use and over distribution of opioids. This does not serve the interest of the people affected by this crisis but favors the big pharmaceuticals that clearly want to make profits at risk of human lives. Additionally, more organizations like HEAL (helping to end addiction long term) and NIH should be endorsed. The Saskatchewan Health Authority since its launch in 2015, has also aided in fighting of the opioid crisis by the use of its naloxone kit program and the training of personnel for people at risk of an opioid overdose. Finally, people should be more informed and educated on these, more studies on medications and technologies to handle opioid abuse should also be conducted.

CORONAVIRUS: IMPORTANT FACTS AND UPDATES

Although, the early symptoms of COVID-19 and influenza (flu) infections are similar in that they both cause fever and similar respiratory symptoms, the speed of transmission is an important difference between the two viruses. Influenza typically has a shorter incubation period (the time from infection to appearance of symptoms) than COVID-19, which means that influenza spreads faster than COVID-19. On the other hand, the proportion with severe disease appears to be higher for COVID-19 given that approximately 15% of infected people have severe symptoms and 5% require intensive care in a hospital. Generally, the proportions of severe and critical COVID-19 infections are higher compared to influenza infections.

Currently, the World Health Organization suggests that the risk for contracting coronavirus from someone who isn’t showing any symptoms is quite low. However, experts believe that people infected with coronavirus can possibly transmit it to others even before showing any serious symptoms. According to the CDC, people who have contracted the virus are most contagious when they’re showing symptoms- and that’s when they’re most likely to transmit the virus. CDC maintains that COVID-19 is not limited by race as infection can make anyone sick regardless of their ethnicity. However, the immediate risk of becoming seriously ill from the virus is thought to increase by age- higher in older adults compared to younger adults. Older adults and people of any age with underlying health conditions, such as diabetes, lung disease, or heart disease, have weaker immunity, are more vulnerable and are at greater risk of severe illness from COVID-19.

The overall period of COVID-19 infection varies from person to person and depends on the immune system of the host. Mild symptoms in an otherwise healthy individual may resolve in about a few days. However, recovery in older or unhealthy individuals with underlying health problems, such as respiratory conditions, may take weeks and in severe cases lead to mortality. People who have completed quarantine or have been released from isolation pose no risk of infection to others and should not be stigmatized. Experts emphasize there isn’t a specific course of treatment for corona virus infection, considering that a new strain of virus causes it. Therefore, one must heed the general advice and take the standard precautionary measures as these can help to strengthen the immune system.

It is uncertain how long COVID-19 specifically survives on surfaces but it seems to behave like other coronaviruses- persisting on varying surfaces from some hours up to several days, depending on the material. This duration may be influenced by different conditions and factors such as the type of surface, as well as the temperature and humidity of the environment.  Maintaining proper hygiene and cleanliness remain the best ways to protect one-self. Surfaces thought to be exposed should be wiped thoroughly with household disinfectant to kill the virus and keep the surface clean. Hands must be regularly and constantly cleaned with alcohol-based sanitizers or washed for at least 20 seconds with soap and water. Additionally, it is important to avoid touching the face, eyes, mouth, or nose with unclean hands.

Today, most of the world is on lockdown with borders, airports, companies, schools, churches mosques and stores shut down in order to contain the spread of the virus. Countries such as China, Italy, the United States- representing three continents, have had the highest cases so far. It is advised that people, especially those experiencing symptoms, should wear masks and hand gloves, call their hospital or public health hotlines, stay at home and not go out to public areas, not use public transport, taxis, or ride-sharing services and not attend public events such as religious gatherings, social events, music festivals or sporting matches.

As Always, Stay Safe!

CORONAVIRUS:  SYMPTOMS AND PREVENTION- HOW TO PROTECT MYSELF AND OTHERS

Following exposure to coronavirus, it takes about 14 days for symptoms to develop. This is called the incubation period of the virus, which is the number of days between coming in contact with the infectious agent (exposure to droplets of infected people) and the establishment of an infection. An infection is established when the virus replicates in sufficient amount to overwhelm the host’s immunity and cause symptoms. Symptoms associated with corona virus are somewhat similar to that of other viruses that cause upper respiratory tract infections. They include:

  • Runny nose
  • Sneezing and Wheezing
  • Coughing and Sore throat
  • Headache and Fever
  • Lethargy
  • Shortness of breath and breathing difficulties

Most of the above listed symptoms are identical to some other viral infections making it challenging to reach a diagnosis. Corona virus usually affects the upper respiratory tract and can be mild. However, the infection may become severe and result in more serious conditions such as pneumonia, bronchitis, severe acute respiratory syndrome, kidney failure or death if it affects lower respiratory tract, including lungs and windpipe. The severity of the symptoms is much more in older adults and vulnerable populations with compromised immunity. It is important to seek medical advice if one comes in close contact with anyone diagnosed with COVID-19. More so, people who live in or have recently traveled from areas with ongoing spread of COVID-19 should be isolated for 14days. Since the major reliable and medically protective measure- vaccination, is not yet available for corona virus, it is important to follow a few simple guidelines and measures to prevent infection:

  • Proper and frequent hand washing with soap or any other alcohol-based hand sanitizer- for at least 20 seconds, especially after blowing the nose, coughing,  sneezing, going to the bathroom and before eating or preparing food
  • Covering nose and mouth with tissues when sneezing or coughing, tissues should be immediately disposed properly in a trash can
  • Social distancing and avoiding any form of close contact with infected individuals, typically anybody feeling feverish or exhibiting associated symptoms
  • Cooking foods thoroughly, particularly meat and eggs, before consumption
  • Avoid touching face- eyes, nose, and mouth with unwashed hands
  • Staying and remaining home when sick
  • Keeping oneself protected when in contact with wild or domestic animals, dead or alive
  • Drinking sufficient amounts of fluids daily
  • Getting adequate rest and taking prescribed over-the-counter medicines in case of sore throat or fever

CORONA VIRUS: WHAT IT IS AND HOW IT IS TRANSMITTED

In general, viruses are inactive, microscopic and parasitic infectious agents that cannot reproduce by themselves outside a host cell. However, once they infect a susceptible cell, viruses have the capacity to direct the machinery of the infected cell to reproduce and multiply itself, thereby causing diseases. The whole infectious virus particle is called a virion and it consists of the nucleic acid and an outer shell of protein. Viruses contain either RNA or DNA as their genetic material and their nucleic acid may be single or double-stranded. The simplest virus particles contain only enough RNA or DNA to encode four proteins while the most complex viruses encode about 200 proteins.

Now that we understand what viruses are in general, let us then focus on and discuss the virus of significance at the moment- corona virus. The most recent outbreak is reported to have begun in Wuhan (China) in late 2019, infecting more than 90,000 people and claiming over 4,000 lives. Corona viruses are crown-like shaped infectious agents or a group of agents which can cause diseases in birds and mammals. The virus, which was first identified in the 1960’s, is a common virus that predominantly infects the nose, upper throat and sinuses. While most strains aren’t dangerous, some strains and less common forms such as SARS, MERS, and COVID-19 cause severe symptoms and can be lethal. In humans more specifically, corona viruses cause respiratory tract infections that are characteristically mild, as in some cases of the common cold. Symptoms vary in other species, for example; in chickens, they cause an upper respiratory tract disease, while in cows and pigs they cause diarrhea. Treatment measures for viruses such as vaccines and antiviral drugs to prevent or treat human corona virus infections are yet to be developed.

Coronavirus infection, like all viral infections, begins when the virus gains access into the body of the host organism and attaches itself to the complementary host cell receptor using its spike protein. Following the viral attachment, a protease of the host cell cleaves and activates the attached spike protein. Depending on which protease is available in the host cell, cleavage and activation permits the entry of the virus into the cell through endocytosis or direct fusion of the viral envelop with the host membrane. Once in the host cell, the virus particle is uncoated, and its genome enters the host cell cytoplasm. Then, the viral RNA attaches to the host cell’s ribosome for translation and transcription while the host ribosome begins to replicate and reproduce the viral genome. Establishing an infection, determining tissue tropism, infectivity and species range of the virus all depend on the interaction of the corona virus spike protein with its complementary host cell receptor.

Similar to most flu-like viruses, human to human transmission of corona virus occurs predominantly through respiratory droplets generated by sneezing and coughing. Infection occurs when the virus gains access into the host cell following direct or close contact with these droplets released by already infected people. Infection can also occur through touching everyday objects such as doorknobs that may be harboring these droplets, and then using the infected hands to touch ones face.

The past few months have got everyone talking about the corona virus disease, COVID-19, caused by SARS-COV2 a novel type of corona virus similar to the ones that caused the SARS and MERS outbreaks in 2002 and 2012 respectively. With over 88,900 recorded cases and 2,900 deaths worldwide as of today, it has been placed as an international public health alert and emergency by the WHO. Although most of the cases started in China, the incidence rate in China has been dropping recently while spread to other countries like Iran, Italy, France and more recently , the US have been on the increase. Despite the relatively lower case mortality ratio when compared to other viral diseases like Ebola and Rabies, COVID-19 is a serious problem to the world because of the lack of vaccine or antiviral agent and more importantly, the ease of spread (which is common to many respiratory illnesses). Certainly, nothing is easier than spread via respiratory droplets whether it’s by coughing, wheezing and sneezing. There may also be other means of spread; however, these routes have not been confirmed. In general, not much is known about this nouvelle virus but more information will be unveiled with time. When infected by the virus, the person may be asymptomatic or present with the following unspecific symptoms:

  • Fever
  • Tiredness
  • Dry cough

Others may develop aches, pain, nasal congestion, runny nose, sore throat and diarrhoea which are mild and begin gradually. Most cases resolve without any intervention but some people run the risk of developing very severe respiratory disease like pneumonia and consequently die. The population most vulnerable and with the highest risk of falling sick include:

  • Elderly (those above 65 years)
  • Those with co-morbid medical problems like hypertension and diabetes
  • People with compromised immunity

It is paramount to follow the following tips to stay safe:

  • Regular hand washing with soap and water or alcohol based hand sanitizers
  • Avoid touching eyes, nose and mouth with hands
  • Maintain at least 6-meter distance from anybody especially people who are sick- coughing and sneezing
  • Avoid going to overcrowded areas
  • Keep yourself up to date with recent COVID-19 news
  • Follow new health tips and avoid unnecessary travel especially international travel if possible

Report to health authority if you notice the above symptoms

The increase in Substandard and falsified medical products is a growing public health concern that is not always in the public’s mind. It is always assumed that all health products affect health positively but that is not always true. Just as there are fake gold necklaces and adulterated fruits, there are also substandard and fake medical products. Drugs are by far the most common medical products implicate as well as vaccines and in-vitro diagnostics. Drugs come in either brand or generic forms; the brand forms are made and sold exclusively by the producer while the generic forms can be produced and sold by any manufacturer. Unlike other products that their generic forms are poor, generic drugs actually do very well when compared with their brand counterparts as they contain the same active substances and ingredients. However, brand drugs are far more expensive due to their strict monopoly and exclusivity. It is due to this price difference that insurance companies continue to advocate for the use of generic drugs to help improve drug coverage not only in low and middle income countries but also in developed countries. Furthermore, this price difference also accounts for the safety of brand drugs and is why the vision of improved drug coverage have been sabotaged by substandard and fake drugs.

Substandard drugs are drugs that fail to meet quality standard or specifications due to poor production practices or storage procedures. There are common thoughts that brand drugs are never substandard and that generic drugs are all substandard but that is actually not true. Some brand drugs, no matter how expensive they are sold, can be substandard. The problem with generic drugs is that the manufacturers (particularly those in China and India) tend to send their higher quality generics to developed nations like Canada and the United States while they sell poor quality drugs to developing nations like Nigeria. The ideal is that generics should be as effective as brand drugs. Sometimes, substandard dugs are released by mistake and then subsequently taken out or recalled voluntarily by the pharmaceutical company unlike fake drugs. Fake drugs are not even drugs in the true sense and its production is a pharmaceutical crime. They are drugs and pharmaceutical products that are deliberately and fraudulently falsified products which do not represent their identity, composition or source and are produced for monetary gains. Whether substandard or fake, these drugs pose significant limitations to the realisation of the SDG 3 which aims to achieve universal health coverage, including access to essential medicines and vaccines. This problem is not only faced by developing, low and middle income countries because of their poor drug regulation and poor access to care, but every country and every one is a potential target due to online marketing.

The impacts of accidentally using substandard or fake drugs are glaring. Some of the resulting problems include treatment difficulties, non-responsiveness to health care, adverse reactions, dissatisfaction with drugs and death. In countries where these drugs are very common, many patients have died of treatable infections due to poor activity of these drugs since antibiotics are mostly involved. This can be really frustrating for doctors who sometimes question their diagnosis or drug recommendation and may even increase doses to over 10 times what is considered normal with no perceived effect. In addition, the poor activity of these drugs ends up worsening the problem of antimicrobial resistance since not all organisms are wiped out. More so, some of these products can contain substances that can harm an individual; there have many cases of drugs contamination with toxic substances.

The availability and sale of substandard and fake drugs is a life-threatening problem and must be tackled as a priority. This must be taken seriously by all governments and followed with proper legislative actions including clear and hefty punishments on offenders. There should increase in drug surveillance and these bad drugs should not just be seized but traced back to the source and disciplinary action carried out by responsible regulatory agencies. Currently, there are already very efficient means of detecting these drugs such as scanning of codes or product labels but they are mostly in developed countries. Improved and effective communication between clinics, local and national regulatory agencies and pharmaceutical companies would also help increase surveillance. Finally, we must learn to be careful ourselves and know that these medicines are capable of causing severe harm… always remember to:

  • Check if the production and expiry dates of the inside and outside packaging match
  • Examine the packaging for spelling mistakes and errors
  • Make sure the medicine is not disclosed and doesn’t smell unusual
  • Report adverse reaction to your doctor
  • Report suspicious products to regulatory agency

If you asked a random person the tips to healthy living, you’re probably going to hear things like being physically active, not smoking, having a balanced diet, going for regular health checks and so on… of course, these are what we are constantly fed by the media. Healthy living as it turns out is more complicated than only these lifestyle modifications. It is easy to understand why we often talk about lifestyle modifications- it’s proactive, cost-friendly and the human mind naturally thinks of prevention. Using a sports case example: Why is a certain sports player so good? Probably because he practices a lot- however, there are other circumstances surrounding the individual such as having a good coach. So, just as having a good coach and other important advantages surround such an individual, there are other factors that surround and consequently influence healthy living- some of these are even more important than lifestyle modifications. Health is not just affected by what we do or don’t do; it is also influenced into our environment. For instance, no matter how many times you wash your hands, you are still more likely to suffer from COVID19 infection if you’re living in China because of the prevalence of the infection in that location. This is not to undermine the benefits of proper hand washing, staying physically active or practicing safer sex, but it’s high time we brought the other factors that influence health into limelight and address them:

  • Aboriginal status
  • Disability
  • Early life
  • Education
  • Employment and working conditions
  • Food insecurity
  • Health services
  • Gender and gender identity
  • Housing
  • Income and income distribution
  • Race
  • Sexual orientation
  • Social exclusion
  • Social safety net
  • Unemployment and job security

These factors are worthy to be addressed because of the health inequalities associated with them. Health is a universal human right and should not be treated like luxury or a mere commodity. Research has documented that people with disabilities are likely to be refused  care, blacks have shorter lifespan in countries like America and even Canada despite universal health coverage. These differences in health outcome are clearly due to differences in realities of daily life such as poor employment which leads to low income and poor housing.

Considering the preceding paragraphs, tackling poverty should definitely be a health priority! This is however very difficult because health inequality is rooted in the fundamental problem of different forms of inequality in human life. It is then left for world leaders and governments to determine what should be a right or privilege and what should be bought as a commodity. Given the importance of health, most developed nations are pushing for universal health care. Income is a better predictor of good health than any lifestyle modification; therefore, it makes sense that income redistribution policies would be a bold step in the right direction for any country that has the health of her citizens at heart. Additionally, education should be made accessible and available to all as it correlates with better income and also contributes to knowledge about ways of staying healthy.

PATIENT SAFETY

2.02.2020

Blog

Hospitals and health care facilities are generally seen as one stop solutions to most health problems. However, these places have the potential to increase or add to our health problems when we visit them while seeking treatment. There is always a small risk of something going wrong during health visits or interventions and this; unfortunately, happens quite a number of times as patients often suffer one complication or the other when they go to the hospital or healthcare facility.  Examples of such complications include:

  • Developing a VVF from an obstetric surgery
  • Developing a nosocomial infection
  • Losing a child due to injection of a wrong drug
  • Overdosing

Patient safety is a serious and common situation- The World health Organization reports that 4 in 10 patients (40%) are harmed in primary and ambulatory care settings. This is of course worse in low and middle income countries which have substandard health care facilities with 134 million adverse events (over 2/3 of the world burden) occurring annually. A patient in the United States has a 1 in 4 chance of experiencing injury, harm or death when admitted to the hospital, and this situation is quite similar in Canada as well as many developed countries. This bothersome statistics begs the question: Are health facilities doing more harm than good? I mean, should we decline doctors’ appointments and develop cold feet towards hospitals visits- the very place we need to go to get help? Well, the answer remains YES. However, we need to recognize the importance of patient safety and endeavour to make it a top priority. WHO defines Patient safety as the absence of preventable harm to a patient during the process of health care, and reduction of unnecessary harm associated with health care to an acceptable minimum. This harm can come in form of infections, injuries, errors and poor care.

Hospital infections, also known as nosocomial infections are caused mostly by antibiotic resistant bacteria which can affect any part of the body like the skin, lungs and can lead to sepsis and can quickly progress to organ damage and ultimately, death. Invasive procedures like surgeries have increased risk of complications and contaminations due to additional problems with anaesthesia while higher risk procedures like pancreatic surgeries are even worse. This risk is further increased by poor training and expertise. Errors in drug prescriptions also account for many hospital problems which errors cost about 42 billion dollars annually and can easily result in death especially in children. Poor patient management cause problems like bed sores and thromboembolism due to prolonged hospital stay. Patient safety is a serious issue, a matter of life and death actually. Health providers must endeavour to do no harm consciously and unconsciously because it violates the ethics of healthcare. Furthermore, lawsuits to health workers for making a mistake may be cultivating unsafe blame culture which focuses on the ‘WHO’ (who made the mistake), instead of the ‘WHY’ (why the mistake was made in the first place). Focussing on the person that made the error also prevents identification of errors within the system itself.

Errors arise as a result of poor system organisation and usually result from workers being extremely tired, probably experiencing fatigue or burnout. Since human errors are inevitable, a good system- which develops only when there is good safety culture of transparency and no blame games should sufficiently reduce errors. For example, if a nurse gives propranolol to a patient with heart failure that is coincidentally asthmatic (this would sadly cause an asthmatic attack), a good safety culture should seek to find out how the error moved past the entire system, and not just focus on the nurse. Additionally, effective communication, which involves active listening, showing empathy and patient involvement in care, is important and necessary to reduce errors. It would help for patients to be more involved in their care and clarified if need be as this emphasizes the importance of individual care as well as the gradual shift from patient to client. Patients who have questions about their care or feel uncomfortable about a procedure should be able to:

  • Talk to someone immediately- preferably someone involved in their care
  • Discuss the issue in a polite way and let the person know they want feedback if the issue warrants investigation  OR
  • Report to the hospital through the customer service, suggestion box, hotline, patient advocacy or patient and family relations department.

Finally, it is important to have a national hospital rating system like the leapfrog hospital grade system in the US for the public to make choices about which hospital to visit depending on the safety and quality of care; this should also help foster better safety culture for health facilities.

Everyone continues to talk about under-nutrition, starvation, malnutrition and lack of food supplies in developing nations and regions in conflict. However, there is little or no conversation around the exponential increase in the number of obese children. This is not much of a surprise as overweight is the other face of the nutrition problem common in developing nations like Canada and the US particularly in minority groups. Just to give you an insight into the depth of this problem; the number of overweight and obese children has quadrupled since the 90s in Canada and little has been done about it as the situation is even worse in the US with 1 in 4 children currently overweight. As if this is not enough, many of these children continue into adulthood remaining overweight and obese worsening the obesity epidemic. As we know, obesity whether in childhood or adulthood is not a disease in itself however, it predisposes a child to a whole lot of problems including NCDs like:

  • Hypertension and cardiovascular diseases
  • Diabetes mellitus and it’s complications
  • COPD, obstructive sleep panda and other respiratory issues
  • Arthritis and other musculoskeletal problems

In addition to the above health risks, there are social implications of childhood obesity. Most times, these children tend to be mocked, bullied and teased a lot leading to psychosocial problems such as depression, poor self-esteem and anxiety disorders. And of course, those with poor coping mechanisms and weak support systems can engage in violence, drug addiction and even more overfeeding detrimental to themselves and the society. The natural question that follows is: What can be done to address this problem? Well, there’s a lot but we have to first understand the factors that are responsible. It is not difficult to see why diet is an important factor; the more you eat, the more likely you are to grow fatter though this is rather too simplistic as some diets like high energy, carbohydrate and trans fat diet are more likely to make one fat than fruits and vegetables. The increase in snacks, sweet and sugary products partly account for the increasing rate of obesity in children. However, that is not full piece of the puzzle; the increasing sedentary lifestyle due to technological advancements is another important factor. Children spend most of their time on TV, video games or with their mobile phones or laptops surfing the internet, they don’t burn off their extra calories which leads to weight gain. These two factors, diet and physical inactivity remain the major focus of most interventions in childhood overweight and obesity.

There are three groups of interventions:  government, population and community based interventions. Government interventions can include dedicated investment in health promotion by using food policies like import tariffs and taxes on unhealthy foods and subsidies on healthy foods. Additionally, policies to incorporate teaching the importance of good diet and physical activity on health are effective. Population wide policies include traffic light labelling of products, restriction in television advertising of snacks, drinks rich in sugar and trans-fat as exemplified by Denmark, increased provision of fruits and vegetables to school canteens, provision of school playgrounds and incorporating exercise in daily school schedule. These interventions should involve key stakeholders in the community and tailored to fit into the culture and organisation of the community to ensure high level of participation and success.

Finally, there’s actually so much parents can do for their overweight or obese children, although it still revolves around better diet and physical activity. Parents may have to restrict their child’s intake of sugary or high carb foods. It is also important to start at an early age to always make fruits and vegetables available as well as keep snacks away from the house since feeding habits are formed at an early age. Also you may want to go for a walk on evenings or on weekends if you’re busy which not only increases physical activity but also gives you enough bonding time. Children should be encouraged to engage in other forms of leisure aside from watching TV and playing video games. Outdoor sports like football, running and some time out with friends are great ways to pass time and would help in better social development for your child.

When you say the word addiction, people tend to think alcohol, marijuana, crack, opioids and the like; of course, they’ve caused a lot of deaths; opioids alone account for over 40,000 deaths (50% of all overdose deaths).However, to think that drug addiction is the only form of addiction is nothing further from the truth. The fact is that there are a lot of things one can get addicted to… thinking of it scientifically, one actually gets addicted to the reward system in the brain not the substance or action itself. These substances cause addiction because they cause a potent rise in the dopamine level in the brain; hence, the likelihood of a substance to cause addiction depends on the level of dopamine rise in the brain. This is why we don’t get addicted to other things like washing clothes or cooking. What this means in essence is that if something gives you as much or even greater dopamine rush as marijuana, it would probably lead to an addiction. Such is the case with internet addiction, the 21st century wave of behavioural addiction gradually eating into the lives of our youth particularly the adolescents and teenagers.

It is really difficult to comprehend the effects of internet addiction since it has not been recognised by the DSM or ICD as a distinct condition; however it is quite easy to see its impacts on the society. Why is internet addiction becoming an increasing problem? possibly the dramatic shift in social life of recent times in addition to the anonymity, affordability and accessibility of internet makes it very available and consequently, addicting. There are various forms of internet addiction including:

  • Online pornography: It is very easy to see why pornography can be very addictive knowing that sex is a primitive human drive. Individuals easily browse through videos of inappropriate sexual content eventually leading sexual problems like premature ejaculation and erectile dysfunction
  • Online video gaming: A long recognised problem particularly in Asian countries- here, individuals immerse themselves in virtual reality where they connect with multiple players anywhere in the world. With well-known recorded deaths of people playing games days without food, some countries like China are already placing restrictions to use and including it as a psychiatric condition
  • Social media: Here, individuals connect to friends via social media platforms like Facebook, Whatsapp, Twitter etc. However, due to the changing social system, individuals are relying more on social media even when there is room for tangible conversation; it is relatively common these days to see a group of individuals sit close to each other busy chatting online without exchanging a single word. There is compulsive and insatiable need to acquire more friends for their sense of ego and identity; mostly due to weak psychosocial support around the individual.

Whether its compulsive use of the internet for pornography or inappropriate sexual content, gaming, chatting etc, these behavioural addictions may actually develop as a form of escape from an uncomfortable reality, for example poor interpersonal relationships and psychosocial support system, the individual is confronted with. And of course, it makes to address this problem by building better support system in communities, in schools, religious gatherings and creating awareness of these problems to encourage parents to help their children build positive interpersonal relationships and avoid social exclusion. For individuals struggling with these addictions, there are also treatment options similar to other forms of addiction though they are not standardised as internet addiction is not yet recognised as a distinct disorder. There should be stronger advocacy to include this as a separate entity.