Expert Advice from Bonitas Medical Fund
Bonitas – innovation, life stages and quality care

SYMPHYSIS PUBIS DYSFUNCTION (SPD) AND HOW TO DEAL WITH IT

Symphysis pubis dysfunction or SPD is pain in your pelvis, which is caused by the relaxing of ligaments in the pelvic bones too early before birth. Many aspects of pregnancy can cause discomfort, and SPD is one of them. Here are the signs of SPD and what you can do if you think you to alleviate your discomfort if you are suffering from it.  What is SPD and what causes it? Not all moms-to-be will experience SPD but it is thought to be fairly common in pregnancy. SPD is a pain in the symphysis pubis (which can range from moderate to serve) caused by the relaxing and stretching of the ligaments around the pelvic bone. Pain can be brought on by opening your legs, walking up stairs or even turning over in bed, and this may be accompanied by a clicking/grinding sensation in the pubic area.  The cause of SPD in pregnancy is the hormone relaxin, aptly named as it relaxes your joints and ligaments to make it easier for your baby to come out at birth. SPD happens when these hormones come into play too early. Not only that but you’re shifting centre of as your baby grows, which can cause main in your lower back and pelvis as your body shifts to accommodate your little one.  What can I do to relieve SPD  Living with SPD can be uncomfortable at best, so you may be wondering what you can do to help alleviate some pain. Being fit before pregnancy can help, as stronger glute and abdominal muscles can help support your pelvis. Physiotherapy can help manage SPD pain, as a physio will be able to work with you as your pregnancy and pain levels change. Speak to your doctor first, as they may have recommendations for you. Your pelvis should return to normal between 4 and 12 weeks after birth

Bonitas – innovation, life stages and quality care

DEALING WITH POSTPARTUM DEPRESSION – PLUS WAYS TO DEAL WITH MENTAL HEALTH AFTER PREGNANCY

As a new mom, the birth of your baby is a beautiful and exciting time, but there is a darker side to childbirth. Postpartum depression affects about 15% of moms after delivery, and while it is a serious disorder it can be overcome through treatment. What is Postpartum depression? Feelings of anxiety, sadness and fatigue are common after birth and are often referred to as the ‘baby blues’ and should subside within the first two weeks. However, if these feelings stick around for longer, you could be experiencing postpartum depression. Restlessness, mood swings, insomnia, irritability, disconnection from your baby and feeling of worthlessness are all red flags for postpartum depression. Some moms feel guilty or ashamed to be feeling this way, however PPD can affect any woman. Don’t be afraid to reach out for help, as PDD is treatable through both medicated and unmedicated options. What should I do if I have the symptoms of Postpartum Depression? The good news is that PPD is treatable. There are a variety of common types of treatment, which depend on the type and severity of symptoms. Treatment can include counselling, therapy groups, antidepressants and hormone therapy. Self-help groups can be helpful, as it allows you to connect with others who have experienced similar problems and stop feelings of isolation. Recovery time will also vary from mother to mother, but untreated the disorder will last much longer and can interrupt mother-child bonding. Getting help does not mean you are a bad mother, it is important to reach out if you are feeling depressed. Postpartum Psychosis In rare cases moms can develop postpartum psychosis. This should be treated as a medical emergency, and it is essential that you receive help right away.  Symptoms include paranoia, delusion and erratic/disorganised behaviour.        How to deal with mental health after pregnancy  Your mental health is critical to you and your child’s well-being. If you are worried about PPD it is important to get professional help. However, you can help your mood by slowly getting back into exercise, setting aside time for yourself and leaning on those around you for support. It is important to stay connected to family and friends so that you don’t feel alone.

Bonitas – innovation, life stages and quality care

Medical aid contribution increases: The deferred increase debate

Traditionally, medical aid schemes implement fee increases from 1 January every year. However, the last two years have seen new trends emerge because of the Covid-19 pandemic. These include deferral of increases, dipping into reserves to reduce increases and announcing delayed increases above CPI. What does this mean for consumers? Globally people are feeling the financial pinch and South Africa is no different. High inflation has increased the cost of food, fuel and utilities.   Salary increases, if any, are below CPI and many South Africans have lost their jobs.  More so than ever, everyone is looking for value for money and better benefits, especially when it comes to healthcare.   The balancing act Lee Callakoppen, Principal Officer of Bonitas Medical Fund says, ‘the delicate balancing act between maintaining the sustainability of the Scheme, while ensuring our members have access to affordable, quality healthcare is a core focus. Last year, we were the only Scheme to announce a 0% increase on one of our plans – the BonFit option.   This was followed by the industry’s first ever reduction in a premium of 7,9% on our BonStart Plan in 2022.’  What using reserves meant for members ‘We opted to utilise around 3.2% – or R600 million – of the Scheme’s reserves to help limit contribution increases to below CPI for around 82% of our members for 2022. Contribution increases would have been closer to pre-pandemic levels of CPI + 4% if we had opted not to use some of our reserves.  Deferred increases vs using reserves This move was in line with the Council of Medical Schemes (CMS) Circular 42 of 2021 which suggested the utilisation of reserves to cushion members against increasing costs. However, despite the guidelines, several schemes opted to defer increases from January to later in the year. These deferred increases range from 5.5 to 7.9%. In general, medical schemes need to keep their contribution increases as close to the rate at which the cost of providing healthcare escalates. The challenge is that most healthcare costs in South Africa are not regulated, which means providers are free to charge as they see fit. And the consumer bears the brunt. An example is the cost of Covid-19 PCR tests, which was finally standardised earlier this year.  Consumers in for a rough ride Statistics SA cited CPI at 5,9% in December 2021, 0,4% higher than the month before. This trend is expected to continue with National Treasury projecting headline inflation (the change in CPI) at 4.8% in 2022 and 4.4% in 2023. So, consumers are in for tougher times. Is there freedom to change schemes with deferment? Callakoppen explains that the deferment of increases creates an anomaly for companies, medical scheme members and consumers. ‘Traditionally, members are free to change their options once a year during an open period. However, when a deferred increase arises, this open period does not always come with it.  This complicates matters for companies which allow their staff to choose between various medical schemes. If an employee chooses to stay with a scheme offering a deferred increase, it is difficult and sometimes impossible, to switch to another plan. This is compounded by the fact that when these deferred increases take place – they are often above CPI and do not always include an increase in benefits – so members effectively pay more for less.  Know what you are getting ‘By announcing our contribution increases in January, our members know what they will be paying for their medical aid from the outset of the year. This means they can plan and, if necessary, adjust their options accordingly to suit both their healthcare needs and their budgets. With the scenario of deferred increases, our advice is for companies to consider a mid-year open period to allow employees to change schemes or options to benefit already cash-strapped employees,” he added.  The downside of deferred increases The past year has shown that the actual contribution increases experienced by members, after the deferment period, is typically higher than the industry average. An example is a Scheme that offered a contribution deferment for the first 6 months of 2021 but then applied a 5.9% contribution increase, when the industry average was 4.6%. Contribution increase percentages cannot be looked at in isolation without looking at the Rand value of the contribution.  “Based on our analysis, we feel that a deferment strategy is not ideal. It merely utilises scheme reserves to provide a short-term contribution relief to members who subsequently experience an above market related contribution increase. This results in members being worse off compared to the scheme that applied a lower, market related contribution increase from the beginning of the year. Schemes implementing a contribution deferment are already applying above market average contribution increases. Callakoppen says that no matter whether a scheme has chosen to increase contributions or defer them, South Africans need to make sure they get the healthcare cover they need. “No two people or families are alike, medical needs differ, as do finances which is why you need to get cover that suits your health needs and budget. It’s important to interrogate what is being offered, to understand what is covered and any added benefits being offered which won’t impact your savings, before finalising your decision.”

Bonitas – innovation, life stages and quality care

GESTATIONAL HYPERTENSION, WHAT IS IT AND HOW CAN I AVOID IT?

Gestational hypertension is high blood pressure (the pressure of your blood on the walls of your blood vessels) during the later part of pregnancy, as opposed to chronic hypertension which is high blood pressure outside of pregnancy. Hypertension affects about 6 – 8 % of pregnant women, and unfortunately can negatively affect you and your baby. How will I know if I have gestational hypertension? You are more at risk if you’re carrying twins, are overweight, had high blood pressure, kidney disease or diabetes before becoming pregnant or are older than 40 or younger than 20.Gestational hypertension is high blood pressure in the second half of pregnancy and some moms may not even realise that they have it – which is why regular check ups are important. Unfortunately, high blood pressure during pregnancy can develop into preeclampsia. If left untreated, preeclampsia can lead to serious complications and even death. The most effective treatment of this is delivery of your baby (if possible). Symptoms of preeclampsia include headaches, nausea and excessive protein in your urine, with the most common first sign being a rise in blood pressure. How can I avoid or treat hypertension? Although there isn’t anything you can do to prevent hypertension(some variables such as age and number of babies you’re carrying is uncontrollable), you can try to keep yourself (and your baby) as healthy as possible during your pregnancy to help you control your blood pressure. Knowing your blood pressure level before getting pregnant, reducing your salt intake and regular exercise are all things you can do to help stay healthy and aware of your body’s condition. Going for regular checkups during your pregnancy will also help let you catch any problems early.

Bonitas – innovation, life stages and quality care

Obesity considered a global epidemic by WHO

Obesity is one of the biggest health challenges facing the world today, affecting around 800 million people, with millions more at risk. The prevalence of obesity has tripled over the past four decades, imposing an enormous burden on people’s health as well as the healthcare system.  According to a World Health Organization (WHO) report, more than a quarter of South Africans live with obesity, making the country among the top 20% of the most obese nations in the world! Studies by the SA Medical Research Council indicate that nearly half of all South Africans are overweight.  Even more shocking, is the fact that 22% of children between 1 and 9 are overweight or obese. The pandemic, lockdown and increased sedentary lifestyle has made the situation worse Dr Morgan Mkhatshwa,Head of Operations at Bonitas Medical Fund says, for overweight or obese people it’s not just an issue of vanity or fitting into a pair of jeans. ‘Risks associated with obesity include: Significantly contributing to the development of cardiovascular disease, type 2 diabetes, hypertension (high blood pressure), cancer (particularly colon, prostate and breast), sleep apnoea, degenerative joint disease, digestive tract diseases (gallstones), mental health and dermatological disorders. What determines if you are obese or not? Your Body Mass Indicator (BMI) calculator checks if you’re at a healthy weight. Here’s how to calculate yours: Divide your weight in kilograms (kg) by your height in metres (m²) If your BMI is over 25 you are considered overweight, at 30+ you’re classified as obese. There are detractors of BMI on its own The BMI screening may not be the best option for bulky, body-builder or stocky men for example. This is because it does not distinguish between lean muscle mass and body fat. Best practice is to measure body fat percentage along with the BMI calculation. This provides a better indication of one’s body composition. ‘Obesity is a chronic and progressive disease,’ says Dr Mkhatshwa,‘Urbanisation and the lifestyle associated with it, is one of the main contributing factors.’ There are two reasons for this: Lack of exercise:  Cities are often over-populated, there are too few public spaces for physical activity and many residents use transport to commute Poor nutrition. Changes in diet include more processed and refined food, an increase in high-fat and high-sugar diets, less fruit and vegetables, less complex carbohydrates and fibre Although obesity is often associated with poor lifestyle choices, lack of motivation or unhealthy habits – it isn’t always the case.  In America, where 40% of adults are obese, obesity has been recognised as a disease by the American Medical Association for nearly a decade. Despite this, they are still seeing most treatment approaches for obesity focus solely on behavioural therapy.  The stigma and assumptions like this continue to create barriers that have limited better obesity care. The origin of obesity is complex and poorly understood, but includes nutritional, physiological,  psychological and genetic factors. Environmental factors such as a sedentary lifestyle and excess calorie consumption can cause obesity Genetic studies with adopted children have demonstrated that they have similar BMIs to their biologic parents but not their adoptive parents. Twin studies also demonstrate a genetic influence on BMI Secondary causes of obesity can result from medications (eg. antipsychotics, steroids and anti-viral drugs) and endocrine disorders like Cushing’s syndrome and hypothyroidism According to the International Journal of Obesity, adults with obesity (BMI ≥ 30) incur 42% higher medical costs per capita and are nearly two times more likely to die before age 70 than adults with a healthy weight. They also say that health care providers play a vital role in the prevention, treatment and control of obesity. They recommend that multicomponent behavioural interventions, pharmacotherapy and bariatric (stomach shrinking) surgery are all effective strategies that support clinically significant weight loss. Obesity as with other co-morbidities,  was also a poor prognostic factor for Covid-19 hospitalisations The general consensus regarding self-monitoring though is through: Calorie restriction:  Reducing your intake by 500-1000 kcal per day will reduce total body weight by an average of 8% over a year Exercise: 30 minutes a day will yield health benefits, but 60 – 80 minutes will assist in weight loss and additional benefits Behaviour modification: Goal setting, self-monitoring and modification of one’s environment to enhance behaviours that will support weight management ‘The reality’, says Dr Mkhatshwa, ‘is that obesity and concomitant lifestyle diseases have become a pandemic in South Africa. Diabetes 2 is amongst these and has significant health implications.  Managing this disease is imperative.  We offer a diabetes management programme to help people understand this long-term condition and empower them to make the right decisions to stay healthy.  This includes access to specialised diabetes doctors, dieticians, podiatrists and diabetic educators to effectively manage of diabetes.  However, if you are not on a medical aid, there are several diabetic support groups.’ ‘Everybody needs to act’. It’s time to increase awareness of the root causes of obesity and encourage advocacy for change.

Bonitas – innovation, life stages and quality care

NHI – more questions than answers

In July 2019, the Minister of Health published a draft ‘National Health Insurance Bill’, which attracted a great deal of attention and the scrutiny hasn’t stopped. Despite several engagements, the Department of Health (DoH) has failed to provide clarity or explanations on several key issues within the ‘Bill’, which are of major concern to all stakeholders.  ‘That fact that universal healthcare is desperately needed in South Africa is not being debated. Having only around 16% of the population on private medical aid, with the rest relying on public health, is unsustainable,’ says Lee Callakoppen, Principal Officer of Bonitas Medical Fund. ‘What is worrying is the lack of detail around the implementation of this national health blueprint.  Before discussing concerns about the implementation of NHI, we should discuss the ramifications of curtailing the role of medical aids. Medical aids and associated services make an enormous contribution to the annual fiscus. The industry also contributes significantly to employment and, in turn, to the economy of the country. Healthcare administration is a massive undertaking that requires, skills, experience and expertise. State of the art technology is needed to comply with international best practices. South Africa’s medical administrators are world class, it is simply not feasible to consider having one administrator in charge of the healthcare of millions of South Africans.  Private healthcare is also a source of excellence in terms of innovation and development, which benefits the public sector. This essential role of private healthcare will be strangled if it is not able to continue in a private setting.  A few additional concerning NHI issues include: Funding of the NHI There is a proposed health financing system – designed to pool funds – but nowhere has detail been provided on this funding model.  When first presented, the estimated cost of NHI was R256 billion, with it due to be rolled out in 2026. It is not known how this figure was reached. The Institute of Race Relations (IRR) recently stated that NHI is likely to cost around R700 billion a year when fully operational in 2026, as the government now envisages.  According to the IRR, ‘The increased tax burden will fall particularly heavily on the 700 000-odd individual taxpayers who currently pay about two thirds of all personal income tax and a hefty chunk of VAT’. What will NHI offer? The Bill defines ‘comprehensive health care services’ as: Healthcare services that are managed to ensure a continuum of health promotion, disease prevention, diagnosis, treatment and management, rehabilitation and palliative care services across the different levels and sites of care within the health system in accordance with the needs of users. However, no further indication of the details of these services / benefits is provided except to indicate that medical schemes will offer what is referred to as ‘complementary cover’. This is defined as third party payment for personal healthcare service benefits, not reimbursed by the Fund, including any top up cover offered by medical schemes or any other private health insurance fund.  Single purchaser, single payer? The Bill states that the NHI will serve as the single purchaser and single payer of healthcare services, ie., that there can be no other legal entity that can purchase and pay for healthcare services. This doesn’t distinguish between complementary and duplicative services. Which means it would be illegal for medical schemes (or health insurance firms) to exist, even in a complementary form which contradicts other sections of the Bill. Constitutional rights  Bonitas does not agree or support the proposed amendments to the Medical Schemes Act (MSA) as set out in the Bill, we believe allowing medical schemes to provide only complementary cover is unconstitutional. Bonitas does, however, support the healthcare reforms as recommended by the Health Market Inquiry. The Constitution requires the State to protect, respect, promote and fulfil the rights in the Bill of Rights. The State must protect the rights to access that people already have. The right of access to healthcare is much wider than the right to obtain healthcare through the public sector. It includes the right to purchase healthcare from the private sector, if one can afford it.  The purchasing power of the consumer is a legitimate means of access to healthcare. Consumers must have the right to apply their purchasing power as they deem fit.  The Bill, in its current form, makes it unlawful for people to purchase healthcare services not covered by NHI.  The proposed Bill is fraught with illegalities and is in direct conflict with the Medical Schemes Act 31 of 1998 (MSA) and prevailing regulations. The administration of the proposed central system of healthcare will need strict governance as existing medical aids are strictly regulated.  Sound corporate governance is of critical importance in preventing mismanagement of assets, corruption, inefficiency, illegality, unethical conduct, abuse of the Fund’s resources and the collapse of the Fund.  The way forward The notion of NHI is commendable, but it’s a case of the ‘devil is in the detail’.  Detail which is yet to be unpacked and specified. The only way for the healthcare system to evolve is through inter-dependent relationships. Medical schemes should be allowed to assist the NHI administratively and take over some of the risk and burden which would lie with the NHI in respect of members of medical schemes. This would ensure that the funds deployed in the procurement of healthcare services are not unnecessarily exploited through duplication of services and functions. Lee Callakoppen, Principal Officer, Bonitas Medical Fund

Advice from the experts
Bonitas – innovation, life stages and quality care

Travel tips during Covid-19

With the increasing number of local Covid-19 cases – over 10 000 in the past 24 hours – we need to be mindful that the pandemic is not on vacation. The statistics are worrying.  South Africans need to shake off their Covid-fatigue and get back to making informed choices about their wellbeing and adhering to the protocols: Wear a mask when you leave your home, sanitise and socially distance – if we want to flatten the second wave curve, especially over the holiday season. We have also been asked to remember the 3 Cs: Avoid crowds, confined spaces and close contact. Bonitas Medical Fund, says, ‘Internationally many countries are reinforcing lockdown rules as the cases spiral, with reports too of coronavirus symptoms changing. Some medical practitioners are also saying the second wave is even more dangerous than the first.   ‘Over the past month, within our membership community, we have seen an increase in the number of tests, the percentage of positive results, people requiring treatment and those being hospitalised. Through our free virtual consultations we have noted an increase in non-members consulting with doctors around the pandemic, with our call centre load having also increased.’ Here are some tips for travel during the festive season whether within our borders, to neighbouring states or abroad. Medical aid card Remember to carry your medical aid card and details with you.  In the case of an emergency, it will streamline the process of getting care quickly or being admitted to hospital. Bonitas also advises that you put the Covid-19 emergency hotline (0800 029 999) or call centre number (0860 002 108) into your mobile phone so it is at hand. Virtual consultations Bonitas continues to offer free virtual consultations to all South Africans – not just its members – until 31 December 2020.  If you are on holiday and concerned about your health, download the Bonitas Virtual Care App and make an appointment. The doctor will engage with you in a virtual video consultation wherever you are. The consultation includes any medical issue, Covid-19 or unrelated and advice on the most clinically appropriate steps for further care. These consults are available 24/7.  Sanitise, sanitise, sanitise Pack your own soap and sanitiser.  The hospitality industry has stringent health and safety protocols in place and most establishments have enhanced their deep cleaning regimes. However, it is still recommended that you keep your sanitiser with you always.   If you are taking a road trip, make sure you have waterless soap and sanitiser in the car and limit your pit stops without compromising on taking the necessary rest breaks. Perhaps pack a picnic, to avoid crowded fast food outlets and restaurants on the main routes. Travelling internationally Remember that if you are leaving the country and crossing a border you will need to produce proof of a negative Covid-19 test and will also complete a travel health questionnaire.  Minister of International Relations and Cooperation, Dr Naledi Pandor, has warned South Africans travelling abroad to make sure they know what the respective countries’ Covid-19 protocols are to avoid being stranded – various countries have different protocols and some have also introduced new stricter lockdown measures. She has urged travellers to familiarise themselves with the immigration and health entry requirements of the country they are visiting, as well as South Africa’s re-entry health requirement upon their return. If you are uncertain, contact the local embassy for clarification or the Department of Health. Alert your medical aid It is important that you notify your medical aid scheme ahead of any international travel. Firstly, to check what medical conditions will be covered and, secondly to activate the international medical travel cover.  Travel insurance policies Medical expenses that you might encounter when travelling in Africa or other international destinations can be prohibitively expensive.  To avoid having your holiday and finances totally ruined, look at what your current medical aid scheme offers in terms of medical travel cover and, if necessary, top this up with additional travel insurance.  Carry your policies Travel insurance policies give detailed information about what to do in an emergency situation and have international call centres to assist you. Make sure everyone in the family has these numbers handy.   The claiming process  Most medical insurance requires an invoice as well as the proof of payment or receipt in order for them to reimburse you.  Make sure you are familiar with the claim process. ‘One thing 2020 has taught us, is that life is unpredictable.  And although additional, tougher lockdown regulations were recently announced in an effort to curb the second wave of Covid-19 infections, the burden of responsibility remains with each and every one of us,’ says Bonitas.  ‘There are real concerns around the current rate of transmission, not only in South Africa but globally.  In order to minimise your risks and to stay healthy and safe these holidays we all need to do our bit and stick to the protocols.’

Parenting Hub

Summer safety tips for parents

Most accidents that put children in the emergency room during the summer and festive season are preventable, says leading paediatrician and Paed-IQ BabyLine CEO Dr Iqbal Karbanee.  “Unfortunately, many common and fun family activities during the summer months can quickly take a turn for the worst and end in injury. Others can have lasting and traumatic consequences for families,” says Karbanee.  Examples of such activities include a trip to the beach or the local swimming pool (drowning), a home-based braai where there is a wood fire or paraffin burner that can fall over and cause a fire (burn wounds), or even bicycle or scooter rides (traffic accidents).   The ChildSafe Initiative in South Africa suggests that 80% of child injuries occur in or around the home and while many children are hospitalised, hundreds more end up visiting the emergency room and thousands more go to clinics and doctors.   Karbanee says that it is difficult to count the cost of treating preventable accidents in children, whether as once-off hospital visits or the longer-term costs of prolonged treatment and rehabilitation. It can cost up to as R500,000 when skin grafting or plastic surgery is required, which can be as a result of a burn.  The Child Gauge Report 2019 suggests that more than 8,000 children die every year as a result of injuries. About 5,000 of these are accidental or unintentional, with leading causes being road traffic injuries, burns and drownings. Globally, it is estimated that one million families lose a child to a preventable injury every year.  “Reducing the number of preventable accidents is therefore a healthcare priority that should be observed by all parents and caregivers, especially during the summer months,” says Karbanee.  Below Karbanee discusses the top summer risks that are preventable and how parents can keep their children safe.   1. Trampolines are great ways for kids to use up excess energy, but they are simply too dangerous. Children’s bones are still developing and experiencing an injury whether through a broken or fractured bone can set them back developmentally. Serious injuries related to the brain or spine can occur. If you are gifting your child or children a trampoline over the festive season, or if you already have a trampoline at home, there are ways you can lessen the risks associated with the equipment.  Always make sure there is adult supervision and only one child at a time should be on the trampoline. No children under the age of six should be allowed to jump and it is the parent’s responsibility to ensure that strict rules are enforced.   2. Shopping centres, amusement parks or even the beach are fun outings for families to enjoy. However, it can be easy for a parent to be separated from a child especially if these places are busy. Make sure you and your child have a plan should they become separated from you and how they can look for help.  Older children should be able to memorise your cell number.   3. Drownings are known as silent killers because children are unable to shout for help and they are amongst the most common preventable accidents that can happen in seconds. A drowning can happen in a few centimetres of water. Life jackets are a must if you want to boat, canoe, jet ski, SUP with your kids or even just spend time near a body of water. Never leave a child unattended near water and consider hiring a lifeguard to keep watch over the kids in the pool if you are having a gathering or party with several children in attendance.    4. Dog bites are a major cause of preventable traumatic injury in children. Too often what starts as a peaceful or exciting family day out turns into a horror story involving a dog attack, with the victims mostly being children who can sustain severe injuries. Teach your children to not go near a dog who is off leash or without a muzzle, and to not put their face close to the dog’s, even if it is a trusted family pet. If the dog runs up to the child or a family on the beach or elsewhere, children should not reach out to pat the dog, even if it looks cute.   5. Wood fires are common in South Africa during summer. They are dangerous to children if unattended, as children are naturally curious and may want to see what happens when they throw things in the fire. The smoke also poses a danger to young respiratory systems as they are still developing, even more so if the children suffer from asthma or allergies. Put fireplace tools and accessories out of a young child’s reach and keep a fire extinguisher on hand. It may seem obvious, but never leave children unsupervised with candles, paraffin burners or outdoor wood fires. Always ensure children are in the company of trustworthy responsible caregivers and ensure paraffin stoves are out of reach and on safe work areas. If an accident does happen, never apply any butter or other food onto a burn.  6. Playgrounds and parks are good to get kids to play outdoors, but be careful of hot slides and poorly maintained equipment that may have rusty nails or sharp hooks. Hot equipment can burn bodies and sharp objects can tear skin, which may require tetanus shots. Also remember to put sunscreen on your child of no less than SPF 50 when spending time outdoors. The CANSA association of South Africa suggests that exposure to UV radiation received as a child increases the risk of melanoma later in life.  7. Bikes, scooters, skateboards and other wheelie toys are fun for children but should not used near moving traffic. Traffic-related accidents are amongst the highest preventable accidents for children. Protective gear like helmets or shin or knee pads can go a long way in preventing injuries, whether only scrapes and bruises or more severe. If you live in a neighbourhood that does not have a bike line where kids are less at risk, then make the effort to go

Parenting Hub

Start 2021 Smart with Smart Nutrition and a Great Education

Stand a chance to win a year’s worth of school fees FUTURELIFE®, in partnership with Pick n Pay Smart Shopper, are thrilled to launch their Start Smart Campaign, an opportunity for one lucky child to win a year worth of school fees for 2021. “FUTURELIFE® was built on the vision to improve the lives of South African families through Smart Nutrition, and this exciting initiative is merely an extension of that commitment so that we can help future leaders start smart,” says Mark Bunn, FUTURELIFE®’s Managing Director. He adds that education is key to unlocking future success, “Education empowers our youth with the knowledge, skills and values they need to build a better society, and it all starts with the foundation built during pre-, primary- and high-school. Much like Smart Nutrition, which also is fundamental for good health and development during the early years.” How Start Smart will work: 1. Buy any 2 FUTURELIFE® bread and/or FUTURELIFE® cereal bars at any Pick n Pay across South Africa between 16 November 2020 – 10 January 2021 and swipe your Smart Shopper card. 2. You will then automatically be entered into a draw to stand a chance to win school fees for your child in 2021. 3. Winner will be drawn within four weeks of the competition closure date and will be contacted directly. FUTURELIFE® has been using and leveraging the knowledge, expertise and experience, of a multi-disciplinary team of science and nutritional experts for over 13 years. This together with a proprietary manufacturing process, and a unique combination of essential nutrients and ingredients, in a specially formulated recipe, is of nutritionally superior smart food products. “Our vision all those years ago has made a real impact. We have witnessed how far a little can go and appreciate how even the smallest action can make a huge difference. So, purchase your two participating products today and help your child to start 2021 smart with Smart Nutrition and a great education!” Bunn concludes. Buy any two of the following participating products: Futurelife High Protein Low GI Brown Bread Futurelife High Protein Honey and Oats Bread Futurelife High Protein Ancient Grains Brown Bread Futurelife High Protein Bar 50 g Futurelife High Protein Lite Bar 40g Futurelife High Energy Bar 40g Futurelife High Protein Crunch Bar 40g Futurelife Granola Bar 40g Products are available from all leading Pick n Pay Retail Outlets. For more information on the Start Smart Campaign, please go to www.futurelife.co.za or https://www.pnp.co.za/campaign/win-with-futurelife

Bonitas – innovation, life stages and quality care

Birth injuries

You only want the best for your baby, but sometimes harm comes to them unintentionally. During the birthing process, your baby can experience harm or physical injury; this is known as a birth injury.  Birth injuries are not uncommon, sometimes they are temporary and other times they may affect your baby for a lifetime. But what exactly are birth injuries? And what causes them?  What are the chances of my baby getting injured during birth? Birth injuries range from harmless to serve, either quickly healing or causing disability throughout life. Although significant injury or death during the birth process isn’t as likely, birth injuries are not uncommon – according to the Birth Injury Guide, about 29 in 1000 babies suffer a birth injury of some kind. Why would my baby become injured during the birth process? There are several reasons why a baby can experience physical trauma during the birthing process.  When you near the end of your pregnancy your baby moves into position for delivery, sometimes babies will move into an abnormal position, such as a breech (feet first), and this can cause them injury when they are born. Other reasons why baby’s may become injured during birth is being abnormally large, the mother’s pelvis is too small, or a long and difficult labour, where the mother’s contractions aren’t strong enough to push her baby out.  What happens if my baby has a birth injury? Generally, birth injuries affect the babies head neck and shoulders, as babies are generally born head first. There are a variety of injures that your baby could stain from birth trauma, such as bruising of the scalp, broken bones or brain damage. Sometimes these injuries are temporary and other times they can last a lifetime. Your doctors and midwives will assess the damage to your baby and help you and your baby accordingly.  Sometimes babies will sustain trauma during birth, and the injury won’t be noticeable until they have started school or being missing developmental milestones, as they struggle to mentally keep up with their peers or grow at what is considered a normal rate.  Sadly most birth injuries aren’t preventable, but even so, moms whose babies experience birth injuries often feel guilty and angry, as if they are too blame. Although feeling this way is understandable,  this is not the case and if you are feeling this way after your baby has experienced a birth injury it is best to speak to a health professional and reply on your partner, friends and family for support. 

The Bridge Assisted Learning School

Neurodiversity: What you need to know

“Neurodiversity is having a brain that functions in ways that diverge significantly from the dominant societal standards of ‘normal’, but is far from flawed” ~ Anonymous  Today’s children are growing up in a world that strives for inclusivity. Thus, we must teach our children and society about neurodiversity for this to be successful. Understanding neurodiversity is just as important as teaching our children that people come in all different shapes, colours, and sizes, all worthy of love and opportunity in this world. That means your child might be one of the few that is wired differently, and that his/her life may not follow the path you envisioned as they have a neurodivergent diagnosis. Before we can help him/her thrive, we must have a clear understanding of what a neurodivergent (the buzz word in psychology circles) diagnosis entails. What is Neurodiversity?  Neurodiversity is in concept a viewpoint that certain people have learning and thinking differences rather than inferiorities. The concept has been around for many years, but in a nutshell, it means that brain differences are just that, differences.  Neurodiversity includes people with variations of learning differences. Some of these differences may include: ADHD, dyslexia, dysgraphia, autism, etc. but they are not flawed. People with neurological differences are not broken or incomplete versions of ‘normal’ people. They approach life just a little differently, are highly intelligent human-beings and can live rich and meaningful lives.  When it comes to Neurodiversity, look at the bigger picture.  Let’s face it, to experience life through a uniquely neurodiverse lens and therefore have what is contemporarily described as a barrier to learning is a complicated thing, but often, it’s defined more by society’s misconceptions, misunderstandings and expectations, rather than by the individual condition itself. To battle with the consequences of the negative side of neurodiversity is nothing to be ashamed about.  All children need love, encouragement, and support, and for children with neurodiversity, such positive reinforcement can help ensure that they emerge with a strong sense of self-worth, confidence, and the determination to keep going even when things are tough. The term neurodiversity can be viewed as another positive contribution to this overarching commitment to diversity, and should be integrated into both classroom lessons on diversity, and educational policies dedicated to promoting inclusivity in learning. Teaching with a Neurodiverse approach. Teaching with a neurodiverse approach begins with helping children understand their own strengths and needs. Once children understand themselves, they realise everyone else has their own assortment of abilities as well, and when they work together as a group, classroom or community, they can do great things. At the Bridge Assisted Learning School we follow a Neurodiverse approach. It includes more hands-on learning, experiential learning, project-based learning, expeditionary learning, arts-based learning, brain-based learning, universal design learning, and other programmes to support the children with their neurodiversities in order to succeed with what will benefit each student in school and life. Every child has his or her own unique learning style. Some children learn best by seeing or reading, others by listening, and others by doing. You can help your child with their neurodiversity by identifying their primary learning style. Is your child a visual learner, an auditory learner, or a kinaesthetic learner? Once you’ve figured out how they learn best, you can take steps to make sure that the type of learning approach is reinforced during home study. Always remember that the way you behave and respond to the challenges your child faces, has a big impact on them. A good attitude won’t solve the challenges associated with a neurodiversity, but it can give your child hope and confidence that things can improve and that they will eventually succeed. To learn more about neurodiversity please visit https://www.thebridgeschool.co.za/  By Dr. Greg Pienaar, Principal at The Bridge Assisted Learning School

Parenting Hub

How an app can help you monitor your child’s growth Growth hormone deficiency

The growth of a child is a significant indication of the child’s health and irregular growth can be an early warning sign of medical problems.1 These kinds of medical problems first show themselves in a child’s irregular growth pattern.1 Growth hormone deficiency has been identified in about 1 in every 3,800 children.2 Therefore, it is important for parents to understand the significance of regularly checking their child’s growth development. This can be done during visits to your healthcare practitioner. For additional support and tracking, an easy to download growth app was launched this September 2020, in order to help parents to easily track their child’s growth. “Growth is one of the fundamental differences between child and adult health care. Physical growth is an indicator and predictor of both present and future health. Among the numerous measures of growth, height and weight are perhaps the most important measures in childhood. While weight may change in adult life, height changes from conception to shortly after the end of puberty.” Says Dr Kuben Pillay, a Paediatric Endocrinologist from Durban.  Human growth hormone is a chemical messenger that is vital for normal growth and development.3 Growth hormone is responsible for making us grow and in our bodies, growth hormone is produced naturally.  When a child is diagnosed as growth hormone deficient, it means his or her pituitary gland is not producing enough growth hormone.4This could be due to hereditary or genetic conditions. Without enough growth hormone, a child does not grow the way he or she should, to reach his genetic potential or height and to attain well-being. According to Dr Pillay “Changes in patterns of growth may occur during any of 3 different growth phases through childhood and may be due to numerous different causes. These phases are the period between conception and the end of the first year of life (the infant phase), from approximately 1 year of age until the start of puberty (child phase) and between the start and end of puberty. There are different causes that may change growth in these phases and thus, the timing of the change in growth may offer important clues to the underlying cause. For example, nutrition both in the womb and after delivery may result in changes in patterns of growth during the infant phase. Congenital abnormalities (particularly bone abnormalities) and genetic disorders may also be causes. During the child phase many more possibilities may influence growth including genetic disorders (e.g. Turner syndrome), severe chronic disease (heart disease, severe asthma, kidney, etc.), severe malnutrition and hormonal disorders. Growth in puberty is due to effects of the hormones of puberty viz. testosterone in boys and oestrogen in girls.” How to measure growth and treat a possible growth hormone deficiency The typical growth of a child, which would be considered normal, is as follows:4 From birth, infants grow about 20 cm in the first year of life From 1 to 2 years of age, babies and toddlers grow about 10 to 13 cm From 2 to 3 years of age, toddlers grow at a rate of about 7.5 to 10 cm From age 3 years to puberty, growth is stable at around 5 to 6 cm per year until puberty Most of a child’s growth occurs before puberty, but the pubertal growth spurt accounts for more than 20% of adult height.4 When puberty occurs, there is a fast phase of growth. With this guide, parents can easily notice whether their child reaches the growth requirements.  If, however, your child does not meet the growth requirements, he or she might need to consult with a healthcare professional, undergo tests and possibly undergo growth hormone therapy.  Growth hormones are also vital for the healthy development of essentially all tissues in the body, including muscle and bone.3 It is important that children who are growth hormone deficient are diagnosed and treated as early as possible in order to aid their bones in growing and developing at a normal pace. Children with severe growth hormone deficiency show increased body fat, subnormal bone mineral density, and reduced lean body mass and could potentially develop lipid abnormalities.5 Once a child is tested for growth hormone deficiency related disorders such as short stature, a methodical approach is necessary.6 An evaluation of growth failure is needed and if there is no evidence suggesting growth hormone deficiency, then other tests are done. If there are abnormalities suggesting growth hormone deficiency, then growth hormone stimulation tests and an MRI of the brain could be suggested.6 If a child does not undergo treatment once diagnosed with growth deficiency, he or she might not attain a normal height etc., when becoming an adult.7 Once a child is on a treatment plan, strict adherence is important to achieve the maximal benefits of growth hormone therapy. Early initiation of growth hormone treatment in children with isolated growth hormone deficiency improves their chance of achieving their genetic height potential.8 Once a diagnosis of growth hormone deficiency has been made, it is recommended that treatment with GH is initiated as soon as possible.8 The first year is a crucial indicator.8 Children who are on hormone treatment typically grow more over the first year of treatment, and further over the next 2 years.9 “Growth hormone continues to play an important metabolic role in adulthood long after the completion of linear growth, so growth hormone may become a lifelong therapy for children with childhood growth hormone deficiency whose condition persists into adulthood,” says Professor Thandrayen, Paediatric Endocrinologist at Chris Hani Baragwanath Academic Hospital. If effective, therapy should be continued for as long as there is a clinical benefit (defined as ongoing catch-up growth or maintenance of a normal growth velocity).5 The Growth Journey App To aid parents in checking their children’s growth, Novo Nordisk has launched an app for growth monitoring in September 2020 called the Growth Journey App.   The Growth Journey App is a free growth tracking app that uses a phone’s camera to help you track a child’s growth regularly.10 Parents can easily track their child’s growth as the app automatically measures a child’s height

Parenting Hub

Are day hospitals the new trend?

Globally, day surgery hospitals have changed the experience of patients by offering an alternative to acute/conventional hospital surgery. Hospital costs the highest expense In South Africa, the concept of day hospitals is also gaining popularity – particularly as a result of high hospital costs. Lee Callakoppen, Principal Officer of Bonitas Medical Fund, says, ‘Using our hospital dashboard for the full 2019 year, direct hospital costs were 43% of the total scheme expenditure.  These excluded doctor and allied services while a patient was in-hospital.  The increase in the use of day hospitals Internationally there is a trend in increased day surgery for multiple reasons including: Improved anaesthesia (with quicker recovery period) Improved pain control (anaesthetic blocks and improved medication) Instrumentation and procedures (keyhole surgery).  Cost saving initiatives Private medical aids are struggling to keep up with rising healthcare costs, which usually outpace inflation by 3+%.  They are continually looking for ways of reducing costs and keeping premium increases as low as possible without prejudicing the quality of healthcare or financial stability of the fund.  ‘We negotiate special rates through our hospital networks and Designated Service Providers (DSPs) and encouraging members to use our Managed Care initiatives.  Encouraging members to use day hospitals is another way in which we can save on costs.  That said, the strategy amongst acute hospitals is to reduce the tariffs for day surgery to the level of day clinics to prevent a market shift away from their facilities. For the Scheme and members this is a win-win as it still translates to cost savings. Examples of price differences ‘There remains a difference in costs between day and acute hospitals,’ says Callakoppen. The table below represents savings across some of the most prevalent surgeries. Procedure Difference in Case-Mix Adjusted Hospital Cost per Event (Acute Hospital Base) Corneal, Scleral And Conjunctival rocedures -6.3% Eyelid Procedures -28.1% Circumcision -13.9% Tonsillectomy And/Or Adenoidectomy (Child) -13.0% Tonsillectomy And/Or Adenoidectomy (Adult) -11.7% Myringotomy (grommets) -15.5% Colonoscopy -15.4% Other advantages of day hospitals Patient satisfaction  No overnight stay – patients are admitted, operated on and discharged on the same day  Child-friendly wards and facilities – day hospitals are the ideal alternative for children requiring same day surgery as the trauma of overnight stays are eliminated Lower risk of infection – due to the fact that patients return home on the same day, the risks of cross infection are reduced, which results in a shorter recovery Mortality and major morbidity is extremely low (<1%)* Improved surgery scheduling – decrease in waiting lists  Why is take up not higher? Day hospitals clearly have marked advantages but the reason take-up is not that high, is there are some perceived disadvantages of using them. One which is the geographical access – specifically in areas like the Eastern Cape. There is concern around procedure complications and the need for a patient to have advanced care. But legislation is strict around day hospitals and they have to be located within five kilometres of an acute hospital for exactly this reason.’   The issue of doctor access is another factor inhibiting the rapid increase in use. Many doctors have their consulting rooms close to an acute hospital and are unwilling to travel further. Equipment may be limited in day hospitals but the increasing list of procedures which can be performed in day hospitals speaks to this challenge being overcome. This is probably why the percentage of day cases, split between acute hospitals and day hospitals, is still biased toward acute hospitals. Currently the split of day cases being done in acute hospitals is 74% and 26% in day hospitals. This implies that 74% of all procedures which could be performed in a day hospital are currently performed in acute facilities. Safety is foremost Not all patients can go to day hospitals. Callakoppen says, “It should be noted that this percentage will be lower as some patients would have anaesthetic and comorbidity risks and from a safety perspective may rather have the procedure performed in an acute hospital where overnight facilities are available. Additionally, not all day clinics are adequately equipped to do some procedures and, as such, the true percentage will be lower.’ Day hospital options for 2021 Bonitas currently has 68 day hospitals on the BonCap network and 30 day clinics on the Select options. According to Callakoppen, ‘This will be enhanced in 2021 when we implement a day surgery network across all options. A comprehensive list of procedures that should be done as day procedures has been collated for our members. If any of these procedures need to be done then members must use a facility on the day surgery network, or alternatively pay a co-payment. While the day surgery network will be comprised mainly of day clinics, it should be noted that certain acute (conventional) hospitals will need to be included on the network where there are areas of access constraint to them.” Will day hospital use be enforced? The Day Hospital Association of South Africa has proposed that medical aid enforce day hospital use in the future but also caution   that there are some cases which cannot be carried out in day hospitals.  He says, “The Scheme is in agreement with the concept. Although we do promote the use of day hospitals, we must bear in mind that there are some procedures for which this is not suitable. High risk patients who require more intensive post-surgery care would require acute/conventional hospitals. But the benefits of day hospitals should definitely be considered by all patients when undergoing a procedure.”

Parenting Hub

Could your child have Type 2 diabetes?

It’s a question no parent wants to ask. But as with so many things in life, knowledge really is power. We’ve outlined all you need to know about the risk factors for Type 2 diabetes so you know what to look for. The difference between Type 1 and Type 2 diabetes First of all, it’s important to understand the difference between Type 1 and Type 2 diabetes. Type 1 diabetes used to be called ‘juvenile diabetes’ because it was most often diagnosed in children. It’s an auto-immune condition, unrelated to lifestyle or diet. If your child has Type 1 diabetes, you’ll know very quickly because they will get very sick. They’ll lose weight, eat a lot, constantly be thirsty and need to pee a lot – often at night. They’ll also be exhausted. Type 2 diabetes, on the other hand, develops slowly. Until recently, it was mostly seen in older people – one of the risk factors is being over 45 years old. But it is being diagnosed in children more and more. This is largely because our kids aren’t as active as they used to be – one of the main risk factors is a lack of physical activity. Another is being overweight or obese, particularly around the tummy area, and having a family history of diabetes.  What to do if your family is at risk for developing Type 2 diabetes If this is ringing a bell, there are a few simple things you can do. The easiest way to remember them is to think EEL: Eat healthy Exercise Lose weight if necessary Eating healthy means cutting out junk food, sweets and treats, juice and fizzy drinks. Also cut out refined carbs, which means white bread, white rice, pasta – all the white foods. Eat lots of green vegetables (half a plate with each meal), good quality protein and some wholegrain carbs. It might feel like a big adjustment, but your whole family will feel better if you can start eating healthier. Exercise doesn’t have to mean joining a gym. It can be as simple as a 30-minute walk, most days of the week. Or some stretching or yoga at home, or a game of soccer with the neighbourhood kids. It’s so important for kids to be physically active. Losing weight is important if your child is overweight or obese, but that doesn’t mean putting them on a diet. If they’re getting active and eating healthy, drinking lots of water and staying away from junk food, weight loss will be a natural result. If you’re not sure whether or not you’re at risk of Type 2 diabetes, check out our fun 1-minute diabetes risk test on www.sweetlife.org.za. We also have all the information you need on how to reverse Type 2 diabetes, and advice and tips on how to manage diabetes if you’re living with it. The most important thing to remember is that you’re not alone in this! There is a whole community of Diabetic South Africans, all living our best lives. Symptoms of Type 1 diabetes Very hungry Very thirsty Needing to pee a lot, especially at night Sudden weight loss Exhaustion Risk factors for Type 2 diabetes 45 years old (or older) OR Overweight or obese AND Physically inactive (not much exercise) High blood pressure Family history of diabetes High cholesterol Heart disease history High-risk ethnic group (Asian Indian, Coloured) Diabetes during pregnancy or a baby over 4kg PCOS (Polycystic Ovarian Syndrome) If this sounds like you, it’s important to go for a diabetes screening. There are free screenings at Clicks Clinics and many independent pharmacies during November (National Diabetes Month).  Bridget McNulty is a Type 1 diabetic and the co-founder of Sweet Life Diabetes Community, SA’s largest online diabetes community. Find out more about how to live well with diabetes at www.sweetlife.org.za 

Philips Avent

Top tips to encourage babies and toddlers to eat their fruit and vegetables  

We all know fruit and vegetables are an important food group, but persuading babies and toddlers to eat them can be a battle. Even if your child absolutely refuses to eat vegetables it’s important to put some on their plate at every meal so they get used to seeing them. Psychologists have found that once children become familiar with a food, they are more open to trying it, but you may need to present the same food on as many as ten separate occasions before your child feels comfortable eating it. While it’s important to put some vegetables on your child’s plate, many children find a large serving of vegetables off-putting, so it’s better to give them an amount you know they will eat and gradually increase the portion size:   Try to incorporate finely chopped vegetables such carrots, peppers and mushrooms into dishes like spaghetti bolognaise   Rather than serving them as a side dish, incorporate vegetables into main dishes. For example, add a variety of vegetables to a meat and cheese lasagna   When your child says they are hungry, offer them a piece of fruit rather than biscuit  Serve raw strips of pepper or carrot with a dip such as hummus. If you serve them at the beginning of the meal when children are hungry they are more likely to eat them  Mix cooked pureed spinach, carrots or shredded cabbage into mashed potatoes  To encourage toddlers and older children to eat their vegetables, use a star chart where you award one star for each serving of fruit or vegetable eaten. Offer a treat such as a trip to the swimming pool or the park at the end of the week if they’ve made the target of five portions each day for a week  Persuading children to eat fruit is usually less of a problem, but if children aren’t keen it can be used to make puddings or smoothies. To make fruit smoothies blend soft fresh fruit (berries, banana and, mangoes) or canned fruits such as apricots, peaches with low fat yoghurt and milk or fruit juice    Stewed or fresh fruit make a great filling for pancakes. For savory pancakes try adding spinach and soft cheese, stir-fried vegetables or ratatouille  Spread a mashed banana on toast in the morning instead of jam or marmalade or add a few chopped apricots or some fresh berries to cereal  Toddlers learn by example, so make sure that they see you and older siblings eating and enjoying fruit and vegetables     You can also share your toddler eating tips, and read advice from other moms by visiting Philips AVENT on facebook:  www.facebook.com/philipsavent   By Fiona Hunter, Nutritionist 

Parenting Hub

Smartick launches free online assessment to detect the risk of dyscalculia amongst children

First online e-learning programme to design dyscalculia early detection online resource tool Smartick, an AI-based maths, coding and logic e-learning programme for kids aged 4 – 14, has launched a free standardised online assessment that allows for quick and easy identification of children at risk of dyscalculia. Dyscalculia (pronounced dis·cal·koo·lee·a) is a mathematics learning disorder characterised, among other things, by the difficulty in acquiring number sense and calculation. In other words, a relative of the more commonly known and researched learning disorder dyslexia, which involves difficulty reading due to problems identifying speech sounds and how they relate to letters and words.  Smartick global research suggests that approximately 5-7% of a country’s population may suffer in silence from dyscalculia and that in a class of 25 students, it is likely that at least one child has the learning disorder. For a population of 57+ million in South Africa, and if similar percentages are anything to go by, it could equate to around four million people potentially being misdiagnosed. Smartick co-founder, Javier Arroyo says that dyscalculia is a disorder with serious consequences and high prevalence, but unknown among many children, parents and educators. “Dyscalculia tends to be confused with other disorders such as attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), low IQ or even study laziness. While it can result in failure in the mathematics subject, although not always the case, it can translate into real life difficulties that cause frustration and low-self-esteem,” says Arroyo. On a day-to-day basis, it can translate into misreading the time on a watch or car license plate, as well as having difficulty memorising phone numbers, number sequences or calculating the return on a purchase. Available to South Africans from 1 September 2020 with the aim of helping to detect the ‘dyslexia’ of the numbers, Smartick’s designed* free standardised online assessment takes approximately 15 minutes to complete and includes tasks around three fundamental areas of mathematical learning: comparison and recognition of numbers, arabic numerals and numbering and arithmetic.  “The exercises for each evaluate the ability to recognise and manipulate numerical quantities without counting, and numerical processing that use verbal symbolic code, such as number recognition and comparison. Children with dyscalculia often have severe and persistent difficulties in learning arithmetic,” says Arroyo. At the end of the assessment, a report is immediately generated and sent with the child’s strengths and weaknesses in each of the evaluated areas. If, according to the results, a child is at risk of dyscalculia, it is recommended that parents and / or guardians go to a professional for a complete evaluation, which includes psychological tests for intelligence, attention and reading, in addition to specific tests for maths. Arroyo says the e-learning programme wanted to provide the educational community and parents with an instrument with which to identify early on one of the mathematical learning disorders as common as unknown. “Children with dyscalculia need adapted, daily training based on a deep understanding of concepts and procedures. Your child might be the next Bill Gates and can help change the world, but he’s misdiagnosed and misunderstood,” he says. *The standardised dyscalculia assessment needs to be completed on a tablet and is aimed at children from first to fourth grade. It was developed in collaboration with the Universities of Malaga and Valladolid in Spain, with more than 800 students in different areas of Spain participating in the initial assessment validation study.

Bonitas – innovation, life stages and quality care

Ten tips for choosing the right medical aid

The medical aid landscape can be tricky to navigate so it’s best to compare all the available options and schemes to find a medical aid that works for your budget and your family’s health. Bonitas Medical Fund helps guide you through choosing the best plan.  Analyse your healthcare needs No two people or families are alike, medical needs differ so do a quick personal healthcare needs’ analysis to determine what cover you need.  If you have dependants, factor in their healthcare needs too. Factors to consider include: How often you visit your family visit a doctor or specialist Over-the-counter medication or chronic medication required Chronic conditions like high blood pressure or diabetes Specific conditions like cancer, HIV or renal failure Dentristy Optometry This will help you decide on whether you need a comprehensive medical aid or a hospital plan. Read the small print  Benefits vary from plan to plan, so establish what is and isn’t covered and look at whether the option offers additional risk benefits which can save on day-to-date expenses. Such as free wellness screenings (blood pressure, cholesterol, blood sugar and BMI measurements) through to mammograms, pap smears and prostate screening. In some cases this extends to maternity programmes, dental check-ups, flu vaccinations and more.  Managed Care options Managed Care programmes help members manage severe chronic conditions such as cancer, diabetes and HIV/AIDS.  What about savings?  Medical savings are a fixed amount a medical scheme gives you at the beginning of the year.  There are ways to maximise your savings but first you need to know what you annual allocation is.  The day-to-day detail Look at what the scheme suggests as a way to make your benefits last, bearing in mind the following: Some plans require you to use a specific GP, hospital network and have a list of Designated Service Providers (DSPs). These keep costs down because the scheme will have negotiated special rates with these services providers. Check the network in your area before making a final decision. Must you be referred to a specialist by your GP? Does your medical aid offer additional GP consultations, which they will pay for, after you have exhausted your day-to-day benefits?  Virtual Care and technology Technology and virtual care is being embraced by medical schemes and members. Check what is offered on the plan you’re considering and whether it you want access to your benefits 24/7. Age impacts your decision As parents of young children, ensure the option you select provides sufficient child illness benefits If slightly older, select a plan that covers chronic conditions and provides sufficient in-hospital cover in the event of hospitalisation Ensure the affordability  Consider all the costs involved before you make your final decision, such as: Monthly contributions: The rule of thumb is that contributions should not exceed 10% of your monthly income. A medical aid co-payment is a fee that the member is liable for when making use of certain medical services.  These co-payments usually apply to specialist or elective medical procedures and will differ from one medical aid scheme to another.  Waiting period and exclusions The Medical Schemes Act and the specific scheme’s rules determine this.  Bonitas recommends that you enquire with the relevant scheme about their exclusion list and waiting periods.   Brokers Using a broker doesn’t cost you anything. An independent broker will help you work your way through the different options and help choose the medical aid plan best suited to your and your family’s needs. For more information on the product offerings from Bonitas go to www.bonitas.co.za

Bonitas – innovation, life stages and quality care

Sunburn in babies, how to prevent and treat it

Living in sunny South Africa, worrying about your baby being exposed to the sun’s rays is a valid concern. Too much unprotected time in the sun can be harmful to your baby, leading to painful sunburn and, even skin cancer later in life. Here’s how to prevent and treat sunburn if your little one has spent too long outside. How to treat sunburn  Babies and toddlers are more sensitive to the sun as they have less developed skin than adults. Prevention is better than cure when it comes to sunburn, however, if your baby has spent too much time in the sun, the reddy, painful burn will only show up a view hours later. Those who have darker complexions tend to be less sun sensitive, however, everyone has some risk of sunburn. Redness, swelling of  the skin (warmth) and pain are all symptoms of sunburn. If the sunburn has caused fever, chills, blisters and headaches its best to consult your local health practitioner. You can treat mild sunburn with a cooling bath, moisturiser or aloe gel – all of which will help cool irritated and inflamed skin. Giving your baby extra fluid in the days following the burn should prevent dehydration. It is recommended that you keep your baby out of the sun until the burn has healed.x Tips for preventing sunburn Sun is strongest between 10am and 4pm so limit your little one’s sun exposure during this time. When your baby is spending time outdoors in the sun, be sure that they are wearing a hat and sunblock with an SPF of higher than 30, if your baby is older than 6 months (if they are younger you will need to find alternative protection for them). Try to find sunblock that is formulated for kids (as this will work best for sensitive skin) and do a patch test on their skin before using it. If your child doesn’t like the feel of sunscreen (or is younger than 6 months), sun protective clothing is the better option.

Organix

Convenient and Nutritious Food Pouches for Your Little One When You’re on The Go

For busy parents, there are always those times when you’re on the go, or pressed for time, and you don’t have any homemade baby food on hand. It’s at times like these, when baby food pouches can be a quick and convenient snack for your little one! With no plates, spoons or glass jars needed, you can satisfy your tots appetite on the go whilst being rest assured your little one is getting all the good nutrients they need. Organix has been cooking up scrummy, nutritious baby and toddler meals and snacks since 1992. Making sure little ones eat a healthy varied diet, full of texture and taste from real fruit and veggies is at the core of the brand.  When Organix make their foods, they think about little ones growing up to be healthy, independent food explorers. They also set their own standards based in their experience in children’s nutrition, from what goes in the food, to the portion sizes they recommend, so everything is just right for little ones as they grow and develop.   Organix pouches, suitable for little ones between the ages of 6 months – 36 months, are a convenient way for babies to explore food on the go – just simple combinations of fruits and grains for a fun taste adventure! When little tums are filled with tasty food you can trust, that’s when the wonder starts. The pouches retail for R32, 49 and are available in six delicious flavours; Just Apple, Pineapple & Coconut, Just Apple, Sweet Potato & Pineapple, Just Mango, Pear & Granola, Just Oat, Apple, Banana, Raspberry & Blueberry, Just Apple, Strawberry & Quinoa, Just Oat, Apricot & Banana. Their No Junk Promise is their stamp of reassurance that you will always find in all of their foods –  Always Organic – We promise to only use organic ingredients. Nothing unnecessary – We promise to only use recognisable ingredients that serve a purpose. Setting Standards – We promise to set the best standard in what good food for children should be. Organix pouches are available at Clicks, www.takealot.com  and www.babiesafrica.com.  Facebook: Organix South Africa                                  Instagram: @organixfoodsa                   #organixsouthafrica 

The Bridge Assisted Learning School

Coping with Anxiety

What could happen if we gave each person the tools to diminish their anxiety, reduce their fears and build a toolbox to achieve true resilience? Anxiety is a normal part of life, but during the recent Covid-19 pandemic, many people are more worried, concerned and/or depressed than in normal circumstances. In order to find the ways to move forward and manage the stresses that recent circumstances have thrown at us, we need to better understand what anxiety is.   “I’ve always described it as a gnawing, tightness in your stomach and even in your whole body. It’s a weird feeling, because you can’t really pin it down. You know you feel worried, but you’re not sure about what. For me anxiety is: an underlying fear of not knowing what the future holds, or what the outcome of a situation will be”, says Dr Greg Pienaar, Principal of The Bridge School for Assisted Learning in Beverley, Sandton.  Anxiety is a normal reaction to danger, the body’s automatic fight-or-flight response that is triggered when you feel threatened, under pressure, or are facing a challenging situation  An overwhelming number of questions may resonate with us during these circumstances and the pandemic that causes an anxious feeling in the pit of our stomach. They include: What does the future hold? Will we ever get beyond the Coivid-19 virus? What will life be like after… Will we go back to “normal”? What if we get sick? What if a loved one gets sick? What if a lot of people get sick? Will we survive? Am I safe at school? “I want to give you some ideas about coping with anxiety”, Dr Pienaar continues. There are many models out there which refer to methods of coping with anxiety. One of the most famous models is the ‘Three Basic Coping Styles model’ (Endler 1997, and Folkman and Lazarus, 1986): Task-oriented (time-outs, eat well-balanced meals, count to ten slowly, limit alcohol and caffeine, take deep breaths, humour, enough sleep and other similar tasks). Emotion-oriented (meditation, distracting oneself, releasing pent-up emotions). Avoidance-oriented (staying away from triggers where possible, drug or alcohol abuse, severe procrastination). (psychologytoday.com) Many models contain similar ideas but might not be the most suitable for everyone. Thus, consult an expert that could work with you on the different methodologies to find the best practice for you. In the meantime, we look at the following steps that may assist you in this pressurised time One of the best ways of coping with anxiety relates to music. Listening to music, finding appropriate songs for a specific mood. It is really strange that sometimes when you’re feeling down, to listen to sad songs can actually make you feel better. Or hearing a particularly “up” song can make you feel worse? Although at other times listening to particular songs or a specific playlist can make you feel better? For example, here is a “Coping with Covid top 5” playlist. These are songs which currently resonate with me: “I’m Not Over” Carolina Liar (Actually about not being over a girl in a relationship, but for me it’s about not being over The World and all the beautiful things in it, just yet). “Carry the Weight” (acoustic version) Denison Witmer (About “carrying the weight of anybody who needs help, especially at the moment). “Times Like These” (acoustic version) Foo Fighters (Who knew there would be times like these). “What a Wonderful World” Israel Kamakawiwo’ole (Just love this version of how beautiful the world could be…) “Beautiful Day” U2 (Just a reminder about this fact is sometimes required). “Listening to music can definitely make us feel better about the world. The ugliness of the world can melt away, and the important things can rise up: friends, finding beauty in different places or things, sharing, closeness. Especially during Covid 19, having to look at what is really important in life”, says Dr Pienaar However, everybody will have their own songs, or music. Part of the journey will be finding the songs of your life, or the music which is soothing to your soul and assists with anxiety. Enjoy the music. Exercise: If you love running or riding or swimming, this is easy and really helps. However, what if you don’t like exercising? The last thing you want to do when you feel anxious or depressed is to exercise. It’s strange, but that’s when it is the most effective. To force yourself to exercise in those moments will be highly beneficial to you. Walking, jogging, riding, swimming, dancing, stretching, yoga, any exercise. They talk about the release of “endorphins” (feel good hormones) when you exercise, often these can help with easing anxiety. However, be mindful that it won’t help you, if exercising makes you feel bad, frustrated and/or unfit. Another way of coping is to develop a mantra A mantra is a positive saying, expression or motto to live by, that you can use to inspire or motivate yourself. Just by saying it often enough can help with coping with anxiety. “My personal mantra has become ‘I’m Not Over the World’, says ….  My mantra used to be “Never, ever, give up”. Develop your own mantra, or use somebody else’s if it fits your world: “It’s going to be ok”, “This is completely understandable”, “The sun will come out tomorrow, or even “I’m doing the best I can”, and  possibly in these times: “It is, what it is”.  It’s amazing but just the act of talking to someone else is extremely important to assist you to organise your thought processes and help alleviate anxiety. It was once said: “A problem shared is a problem halved…”. It’s almost as if by sharing an issue, someone else hears it, and even if they don’t have answers, they are at least hearing and understanding your anxiety. Drawing, writing, painting, colouring, being creative and innovative can help with calming the anxieties that you are feeling. No-one has to see what you paint or write. It’s more about being

Parenting Hub

New Study Shows That Playing With Dolls Allows Children To Develop Empathy And Social Processing Skills

Today, Barbie®, and a team of neuroscientists from Cardiff University, announces findings of a new study conducted using neuroscience for the first time to explore the positive impact doll play has on children, bringing to light new evidence that doll play activates brain regions that allow children to develop empathy and social information processing skills, even when playing by themselves. Over the past 18 months, senior lecturer Dr. Sarah Gerson and colleagues at Cardiff University’s Centre for Human Developmental Science have used neuroimaging technology to provide the first indications of the benefits of doll play at a brain level. Through monitoring the brain activity of 33 children* between the ages of 4 and 8, as they played with a range of Barbie dolls, the team found that the posterior superior temporal sulcus (pSTS), a region of the brain associated with social information processing such as empathy, was activated even when the child was playing on their own. These benefits of solo doll play were shown to be equal for both boys and girls. Dr. Gerson explains: “This is a completely new finding. We use this area of the brain when we think about other people, especially when we think about another person’s thoughts or feelings. Dolls encourage them to create their own little imaginary worlds, as opposed to say, problem-solving or building games. They encourage children to think about other people and how they might interact with each other. The fact that we saw the pSTS to be active in our study shows that playing with dolls is helping them rehearse some of the social skills they will need in later life. Because this brain region has been shown to play a similar role in supporting empathy and social processing across six continents, these findings are likely to be country agnostic”. To gather the data for the study, the children’s play was split into different sections so the Cardiff team could capture the brain activity relating to each other kind of play separately: playing with the dolls on their own; playing with the dolls together with another person (the research assistant); playing with the tablet game on their own and playing with the tablet game along with another person (the research assistant). The dolls used included a diverse range of Barbie dolls and play sets, with all Barbie dolls and sets returned to starting positions before each child began their test to ensure consistency of experience. Tablet play was carried out using games that allow children to engage with open and creative play (rather than a rule or goal-based games) to provide a similar play experience to doll play.  The findings of the study show that when children played alone with dolls, they showed the same levels of activation of the pSTS as they do when playing with others. Another finding of the study is that when children were left to play tablet games on their own, there was far less activation of the pSTS, even though the games involved a considerable creative element.  To understand the relevancy of these neuroscience findings, Barbie independently commissioned a global survey** that asked more than 15,000 parents of children in 22 countries. Results of this showed 91 percent of parents ranked empathy as a key social skill they would like their child to develop, but only 26 percent were aware that doll play could help their child develop these skills. During this time at home, parents are increasingly worried about ensuring their child is developing social development skills, with more than two-thirds (70 percent) saying they are concerned about how this isolation might affect their child and how their child interacts with others. Similarly, 74 percent of parents are more likely to encourage their child to play with a toy if they knew it was proven to help their child develop social and emotional skills, like empathy. “As leaders in the dolls category, we’ve always known that doll play has a positive impact on kids, but up until now, we have not had neuroscientific data that demonstrates these benefits,” says Lisa McKnight, SVP and Global Head of Barbie and Dolls, Mattel. “The findings of this research highlights that playing with dolls, such as Barbie, offers positive benefits in preparing children for the future through nurturing social skills like empathy.  As we continue to inspire the limitless potential in every child, we are proud to offer dolls that encourage skills we know are highly valued by parents and are determinants in children’s future emotional, academic, and social success.” Barbie will be supporting these findings with an online hub, Barbie.com/Benefits, featuring resources for parents, caregivers, and children, to assist them in enhancing and applying their social processing skills. These resources have been developed alongside leading empathy expert, writer, and educational psychologist, Dr. Michele Borba. Michele Borba says: “The latest scientific findings from Cardiff University and Barbie are extraordinary and so relevant to the times we are living, given the limited social interaction our children can have. It’s been shown that children who have developed empathy and social skills early in life can have better grades, stay in school longer and make healthier choices overall. Empathetic children might also be more likely to stand up for a child being bullied and try to engage and resolve the conflict. Understanding that kids can help develop these skills through playing with dolls like Barbie, is remarkable and a helpful tool for parents.”  The results of the study are published today in Frontiers in Human Neuroscience as ‘Exploring the Benefits of Doll Play through Neuroscience.’ Recognising that this study is a first step towards understanding the positive impact of doll play with further research required to build on these initial findings, Dr. Sarah Gerson and the Cardiff University team along with Mattel, have committed to further neuroscience studies in 2021.

Parenting Hub

Get total protection for everyday oral hygiene with Biorepair®

The health of your mouth is important at every stage of your life and there’s no better time to pay extra attention to your dental routine.  With two of the world’s most common health problems affecting the mouth – cavities and gum disease, it really is in your best interest to practice good oral hygiene. Not only does it ensure a beautiful smile, but it is good for your health. Just like adults, it is important for little ones to look after their teeth too.  Children’s tooth enamel is thinner and more vulnerable than an adult’s. It is important to remineralise it to defend it from the acid attacks caused by sugar. Another important step to maintaining good oral hygiene is daily flossing.  Both interdental brushes and floss penetrate the places your toothbrush cannot reach, protecting against the formation of the dental plaque that causes cavities and inflamed gums. Biorepair®, the first and only toothpaste in the world that repairs tooth enamel based on the patented microRepair® technology (zinc-substituted-carbonate-hydroxyapatite crystals) offers total protection for everyday oral hygiene. It repairs the enamel surface and protects it from cavities plaque and tartar build-up.  What are microRepair® particles? A MicroRepair® particle is very similar to the composition of tooth enamel. This similarity gives microRepair® a biomimetic property, allowing the micro-particles to integrate permanently with tooth enamel and dentine, no matter the condition of the mouth, thus repairing enamel and dentine evenly and naturally. The microRepair® particles form an even coating on the tooth surface, penetrating cracks in the enamel and chemically binding to it, thus repairing and remineralising them. From total protection, and sensitive teeth to gum protection and teeth whitening, the Biorepair® range of oral care products will take care of all your oral hygiene concerns. Biorepair® Gum Protection Mouthwash (R129.99) is the only high-density formula with microRepair® that provides greater adhesion to the teeth. It helps fight gum disease, preventing bleeding and inflammation of the gums, promotes tissue healing and strengthens gums thanks to its hydrating and protective properties. It also prevents plaque and tartar build-up, provides an antioxidant and protective function for the oral mucosa and offers relief for gums thanks to the astringent and soothing properties of the natural ingredients.  Biorepair® Fast Sensitive Repair Toothpaste (R79.99) reduces dentinal sensitivity immediately. It closes the tubules, preventing thermal stimuli from reaching the tooth, prevents enamel erosion and the loss of natural tooth whiteness. Biorepair® Total Protective Repair Toothpaste (R74.99) repairs the enamel surface, protecting against plaque, tartar build-up and cavities. Biorepair® Pro White Toothpaste (R74.99) returns the natural white of your smile. It protects the enamel from the daily erosion process, restores the natural whiteness of teeth and uses an innovative PVP whitening technology. Biorepair® Gum Protection Toothpaste (R74.99) protects and strengthens sensitive gums. It repairs and regenerates gingival tissues, allows for antibacterial and anti-plaque action and has astringent and soothing properties. Biorepair® KidsToothpaste (R49.95) contains MicroRepair®, which strengthens tooth enamel and promotes the proper development of healthy permanent teeth.  Biorepair® Junior 7-14 Toothpaste (R49.95) contains MicroRepair®, which strengthens and protects tooth enamel from cavities while they are developing and is ideal for remineralising the erosion caused by braces. With the addition of the antioxidant Vitamin E, it helps to maintain healthy gums. Biorepair® Interdental Brushes (R79.99) are made with the innovative SELFCLEANING POLYMER technology and microRepair®, particles made up of the same substance as enamel, which penetrate into places toothbrushes cannot reach. Biorepair® Floss (R69.99) reaches where brushing cannot. The floss features microRepair particles, which are made from the same substance as tooth enamel, helping maintain tooth integrity. Exclusive to selected Clicks stores.

Parenting Hub

Goat milk provides nutritional and immunity benefits for the whole family

Goat milk is a rich source of protein, fat, oligosaccharides, essential vitamins and minerals, and micronutrients linked to immunity. When budgets are stretched tight and food costs are on the increase, shopping choices often change– for the worse. However, it is important to follow the basics of healthy eating to look after your immune system. One simple way to get an advantage is by adding goat milk to your trolley. Goats are among the oldest domesticated animals, and their milk has been consumed by humans for thousands of years. Goat milk offers numerous benefits for the whole family and is abundant in nutrients, such as proteins, carbohydrates, fats, and essential vitamins and minerals.  Nutritional benefits of goat milk While fresh full-cream goat milk can be enjoyed by children and adults alike, it is also available in powdered form as a base for infant formula where breastfeeding is not possible. Goat milk provides a complete protein with all essential amino acids7, making it an approved option for infant formula. The unique protein composition of goats’ milk allows it to form a softer curd during digestion, which may support a baby’s digestive health and comfort. The fat content of goat milk is similar to that of cow milk; however, the fat globules are up to 75% smaller in size, which may make them easier to digest., Fat is important in the diets of young children especially, as it aids in the development of the brain and nervous system. The most abundant saturated fatty acid in human milk is palmitic acid, present in a structure named ß-palmitate. In infant formula, ß-palmitate may positively influence gut health, growth, sleep and comfort of infants.Goat milk-based formula contains high levels of ß-palmitate.  Research shows that South Africans have a low intake of calcium. Calcium is essential for the development and maintenance of bones and teeth, to help prevent osteoporosis, and to help the breakdown of body fat as part of a calorie-controlled diet.,, , Full-cream goat milk has 6% more calcium than full-cream cow milk. (See table 1.)  Next to calcium, phosphorus is the most abundant mineral in the body. It works with calcium to build strong bones and teeth, plays an important role in how the body uses carbohydrates and fats, and is also needed for the body to grow, maintain and repair cells and tissues. , Goat milk is also a good source of phosphorus. One serving of goat milk (200ml) provides 11% of the daily requirement of vitamin B5 (pantothenic acid),,, which is needed for the release of energy from food, and 23% of the DRI for biotin,,, a B-vitamin that is important for a healthy nervous system. TABLE 1: Nutritional Comparison between different types of milks , (adapted) Composition per 100g Human Cow Goat Soy Almond Rice Energy (kcal) 70 62 66 32 56 47 Total protein (g) 1.0 3.3 3.4 2.9 1.3 0.28 Total fat (g) 4.4 3.3 3.9 1.9 3.3 0.97 Lactose (g) 6.9 4.7 4.4 n/a n/a n/a Calcium (mg) 32 112 118 13 14 11 How goat milk in the diet supports immunity and boosts gut health  The microbiome in the human body consists of trillions of microorganisms (also called microbiota or microbes) of thousands of different species.Each person has an entirely unique network of microbiota, which they are exposed to for the first time as a baby, during delivery in the birth canal and through breast milk. In a healthy person, these ‘bugs’ coexist peacefully, with the largest numbers found in the small and large intestines (gut), but also throughout the body.Diet is considered as one of the main drivers in shaping the gut microbiota, and intestinal bacteria play a crucial role in maintaining our immune system. Prebiotics help to stimulate, grow and maintain beneficial gut bacteria. Human milk contains an abundant supply and diverse array of oligosaccharides, which possess prebiotic properties. For breastfed infants, these oligosaccharides help to establish and maintain a healthy gut, support the immune system, and protect against gastrointestinal infections.  Amongst all the domestic animals, goats have milk with the highest amount of oligosaccharides. Studies continue to show that oligosaccharides present in goats’ milk-based infant formula have strong prebiotic and anti-infection properties, helping to maintain the health of the digestive tracts of babies.  Why it’s important to understand food labels Reading food labels helps you to make healthier choices when shopping. Focus on what’s in the ingredient list and the nutrition information table. Ingredients are listed in order of weight, so what’s first on the list is present in the largest amount, and what’s last, the least. Keep an eye out for fat, oil, lard, shortening, partially hydrogenated vegetable oil/fats; salt or any mention of sodium; and sugar, glucose, sucrose, corn syrup and molasses. If any of these words are in the first few ingredients, this isn’t a food you should eat often. When it comes to sugar, rather than obsessing over grams, focus on reducing ‘added sugars’ by limiting products that contain them. Next, the nutritional table tells you the quantity of various nutrients a food contains per serving, as well as per 100g or 100ml. Use the 100g column when comparing foods with each other, because the size of one ‘serving’ may differ between manufacturers.  The nutritional table shows ‘glycaemic carbohydrates’, which are carbohydrates available to the body for energy. The total sugars mentioned includes all sugars, both those found naturally in the food (not listed separately in the ingredient list) as well as those sugars added to food (listed). The Nutrient Reference Value (NRV) column is a recommended daily intake for a nutrient. It gives us a percentage for a certain nutrient, mainly protein, vitamins and minerals, which may be found in a food.   Foods containing possible common allergens such as egg, cow’s milk, crustaceans and molluscs, fish, peanuts, soybeans, tree nuts and gluten, should also be indicated.  Start making a habit of carefully reading labels to help you decide on healthier options when you shop.    Delicious and nutritious goat

ChildSafe

Preventing falls in children

The Red Cross War Memorial Children’s Hospital (RCWMCH) annually treats approximately 7500 children for injuries which are preventable. For every child death as a result of injury, many more are hospitalized, hundreds of emergency department visits and thousands of clinic and doctors’ visits. Many children surviving their injuries sustain temporary or permanent, life changing disabilities. There is little focus on these injuries despite injury being the number one killer of young children in our communities in South Africa.  Children are naturally curious and while exploring the world around them, they will fall. Not all falls require treatment; however, many children sustain injuries so serious that it requires treatment or hospitalization. Falls are the number one cause of childhood injury seen at RCWMCH, accounting for nearly half of all injuries. Over 2 819 children were treated for serious falls, a 5% more than 2018.  Falls accounted for 60% of head injuries. Head injuries are far more common than expected. The RCWMCH treated 763 children for head injuries. Often it is ignored and children suffer the consequences later in school and later in their work lives.  Children aged 0 to 5 years were at greater risk of fall-related injuries. 64% of these falls took place at home, 17% at playgrounds and 16% at schools. Children 0 to 4 were at greater risk of falls at home and age group 5 to 12 years was at greater risk of falling at school and on playgrounds. “From the moment your baby starts to crawl, the world is a magical place filled with new adventures and discoveries, says Yolande Baker, Executive Director of ChildSafe. “From a child’s perspective, everything is a potential mountain to climb (that giant bookshelf), obstacle to overcome (those pesky stairs) or mysterious place to investigate (anywhere beyond the safety gate). Little bumps will happen, but ChildSafe is here to help so these brave expeditions don’t result in something more serious”. The most common causes of falls are: Tripping and falling at ground level,  Falling off furniture, stairs, beds, walls and trees at higher level;  Falling out windows and balcony doors Falling from baby walkers and mobiles,  Falling off scooters, roller blades, bikes and skateboards are mobile risks;  Falling in the playground off swings, jungle gyms, see saws, slides and trampolines; Falling from arms, especially from arms of siblings, or if mother should fall asleep when feeding or holding baby Children are vulnerable to falls and other injuries because their growing brains do are not fully yet able to recognize and assess their own risk to injury. Degrees of dependence, activities and risk behaviors all change substantially as they grow older  As children develop, their curiosity and wish to experiment are not always matched by the capacity to understand or to respond to danger. Due to this lack of experience, children need to be shown and helped at every stage of their development, whether it’s crawling, walking or running. Supervision is key to child injury prevention. A challenge for parents is how to make their homes, including yards and gardens safer to prevent falls. Stages of child development      From the first days of life, we need to protect children from serious injuries. The different developmental stages need to be understood and considered when thinking about the level of supervision and care needed. For the first few years, children need 100% supervision by parents and adults. From about six months of age early signs of motor development appear with sitting up, rolling over, and crawling, and pulling to stand. When baby is awake and moving about careful supervision is necessary at all times. Children under 11/12yrs should not be left in charge of baby because they lack experience and easily lose concentration. A cot, play pen or a safe enclosure is best for safety when mother is busy. Safe cots, car seats, play areas & traditional back-carrying Mother needs to be confident that baby is safe in bed, and for this a cot with sides is recommended. The cot can be used as a safe place at other times too, when mother visits the bathroom, hangs washing, or is busy in the kitchen. Falls at this early stage need to be prevented as head injuries are highly dangerous and can cause permanent developmental and physical injury. As baby grows, time needs to be set aside for playing together so that falls can be anticipated and prevented. High chairs for meal times are safe zones and prevent falls from heights when baby is strapped in. Using a high chair can remove a baby from other dangers at the table like hot food and drink.  On trips in the car, however short, baby should be strapped into a car seat which is correct for size and age. Falls from car seats occur on route to the car and inside the car if baby is not carefully strapped in at all times. Baby walkers can be dangerous and are not recommended. They place the baby in situations of risk, by increasing height and mobility. From the walking ring baby can reach knobs and switches and kettle cords, stairs and steps. Traditional back-carrying is a safe zone for babies both in the home and outside.  Development stage 1-2 years To prevent falls at 1-2 years when baby is starting to move about and explore, homes need to be cleared of obstacles such as loose carpets and slippery floors, stairs need gates and windows bars. A play pen at this stage is a safe zone for play to continue when mother is busy and to prevent falls. Prams and pushchairs may be used for outings and shopping, but to prevent falls baby needs to be strapped in at all times.  Development stage 2-3 years The risk of falls increases as a child becomes more mobile. Children are quick and unpredictable. Climbing onto furniture and beds should be anticipated and prevented. Children are not ready for bunk beds at this stage. Development stage 3-6years By now

Vital Baby

A beginners guide for optimal nutrition during breastfeeding

Breastfeeding is the most perfectly designed feeding system that only Mother Nature could have devised. It provides everything a new-born or infant needs to thrive up until 6 months old, and remains the main component of a baby’s diet until 12 months old, even after solids are introduced. In fact, breastmilk assists in the digestion of baby’s first solids and makes the transition easier on little tummies. And as babies start exploring their surroundings from around 6 months, when everything goes into their mouths, breastmilk also offers protection against bacteria and viruses, and stimulates their immune systems in ways that formula milk simply cannot. Another function of this perfect system can also not be replicated with formula feeding – the calorie content and composition of breastmilk actually changes during a feed and at other times. At the start of a feed, the milk is more watery to quench the baby’s thirst. Hindmilk, the milk that comes after that, is thicker, more nutritious and has up to three times the fat content. This is why it’s important your baby empties a breast fully before switching to the other breast during a feed so he’s getting all the good stuff. Your breastmilk composition will also change depending on the age of your child, and if your child is ill, when your breastmilk will contain more antibodies. It really is magical stuff! The World Health Organisation recommends that children are exclusively breastfed until 6 months old, but that breastfeeding should continue, where possible, until 2 years old and even beyond. Toddlers benefit from the same immune system enhancement and protection from illnesses such as pneumonia, diarrhoea, colds, ear infections, allergies and other nasties as newborns do, and they continue to benefit from the protein, calcium, fat, vitamin A, and other nutrients in breast milk.  The long-term benefits of breastfeeding are equally as compelling, with research showing that, as adults, babies who were breastfed have lower blood pressure and cholesterol, and are less likely to develop type 2 Diabetes or to be obese or overweight. While the benefits to their baby will be a mother’s top priority, breastfeeding mothers also receive health-protecting benefits. Apart from the pure bliss, stress relief and bonding breastfeeding creates, mothers who have breastfed see reduced risk of breast and ovarian cancer, high blood pressure, heart disease, diabetes and rheumatoid arthritis, and this risk reduction is cumulative – meaning the longer you breastfeed the more your risk profile reduces. YOUR DIET DURING BREASTFEEDING Many new mothers worry that they are not getting enough nutrients to sustain breastfeeding over the long term, or that their milk may be lacking in nutrients, but the truth is that, for the majority of new mothers, the most important factor in milk production is the act of breastfeeding itself – the more you feed, the more milk you produce.  And no matter what you eat, for the first 6 months your milk will contain almost all the nutrients your baby needs, except for Vitamin D (or Vitamin Free). Consider women living in 3rd world countries where their staple diet is maize or sorghum: in spite of the mothers lacking important nutrients themselves, their babies can be sustained through breastfeeding. Of course, the breastmilk produced by an undernourished mother may not be optimal but it is sufficient for the baby’s survival. Pregnancy, birth and the first few years of your child’s life are mentally, emotionally and physically exhausting. Your overall health and your nutrient intake postpartum can have a big impact on your ability to get through it all in less of a sleep-deprived and foggy haze, as well as on the quality of your milk.  During pregnancy, from around week 12 when the placenta is fully formed and begins transporting blood, oxygen and nutrients, the unborn child receives all its nutrients from the mother’s blood. If you are not getting an adequate intake of important nutrients, your body will divert these from your own stores to ensure your baby is getting what it needs for development. According to the results of a National Health and Nutrition Examination Survey, vitamin and mineral deficiency in pregnant women is common, specifically Magnesium, Iron, Vits D and E, and to a lesser degree Vits A, B, C, Calcium, Folate and Zinc.   It is important to top-up your own levels of these and other nutrients to ensure you stay in top form during pregnancy and postpartum.   Nutrients needed to keep mother and baby in peak health while breastfeeding are split into two groups – Group 1 are the nutrients that need to be present in Mom’s blood in sufficient quantities so they can be secreted into breastmilk, and Group 2 are nutrients that will be secreted into milk regardless of how much or little the mother is taking in. Although Group 2 nutrients are not necessarily needed in a mother’s blood, it’s still a good idea to make sure you are getting enough of them to stay as healthy as possible during this time. Some common food sources of Group 1 nutrients: Vitamin A: sweet potatoes, carrots, dark leafy greens, organ meats, eggs Vitamin B1 (Thiamin): fish, pork, seeds, nuts, beans Vitamin B2 (Riboflavin): cheese, almonds, nuts, red meat, oily fish, eggs Vitamin B6: chickpeas, nuts, fish, poultry, potatoes, bananas, dried fruit Vitamin B12: shellfish, liver, yogurt, oily fish, nutritional yeast, eggs, crab, shrimp Vitamin D: cod liver oil, oily fish, some mushrooms, fortified foods Choline: eggs, beef liver, chicken liver, fish, peanuts Iodine: dried seaweed, cod, milk, iodized salt Selenium: Brazil nuts, seafood, turkey, whole wheat, seeds Some common food sources for Group 2 nutrients: Calcium: milk, yogurt, cheese, leafy greens, legumes Zinc: oysters, red meat, poultry, beans, nuts, dairy  Folate: beans, lentils, leafy greens, asparagus, avocados Iron: red meat, pork, poultry, seafood, beans, green vegetables, dried fruit Copper: shellfish, whole grains, nuts, beans, organ meats, potatoes You will almost certainly need to up your calorie intake while breastfeeding – by between 300 and 500 calories depending on your weight and activity levels – to cope with the physical demands of

Parenting Hub

Childhood Cancer impacting South African families

Nothing can fully prepare you for the horrific news that your child has been diagnosed with cancer – a sad reality for many South African parents. Statistics show that there are currently 1000 children under the age of 15 diagnosed with cancer each year. According to Laurence Hillman, CEO at 1Life: “What’s also horrifying is that half of the children who contract cancer in South Africa, are never diagnosed.” The international Agency for research on cancer (IARC), reported that the worldwide incidence of childhood cancer is increasing, from the 165 000 cases reported annually to 215 000 cases for children who are 14 years and younger and 85 000 cases reported for 15 – 19 year olds. Globally, childhood and adolescent cancer is threatening to overtake infectious diseases, as one of the highest causes of disease-related mortality in children. While survival rates in high-income countries reach an average of 84% and are steadily improving even in less-resourced areas of the world, South Africa is still well below the rate of developed countries as well as below the World Health Organisation’s survival goal of at least 60%. South Africa’s survival rate has improved over the last 5 years and is around 55%. This is concerning and points out a dire need for parents to not only look out for early warning signs of possible cancers, to improve survival rates, but also to consider what would happen if their child were diagnosed with a childhood cancer. Early identification can save lives According to CHOC Childhood Cancer Foundation South Africa parents should use the  Siluan early warning signs of childhood cancer and  keep an eye out for the following, which could be early warning signs that need to be checked out by a professional. Keep in mind that even if your child is experiencing some of these symptoms, it doesn’t automatically mean they have cancer, which is why a doctor’s opinion is vital in diagnosis. Siluan Early Warning Sign of Childhood Cancer: S – Seek medical help early for persistent symptoms I – Eye: A white spot in the eye, a new squint, new blindness, or a bulging eyeball L- Lump: Any lumps should be investigated. Lumps in the abdomen and pelvis, head and neck, limbs, testes, and glands U- Unexplained: Prolonged fever over two weeks, loss of weight, pallor, fatigue, easy bruising, or bleeding A – Aching: Bones, joints, back and easy fractures N- Neurological signs: Change or deterioration in walk, balance or speech, regression of milestones, headaches for more than a week with or without vomiting, enlarging head. “Many people don’t know that children can get cancer. It is a topic most people avoid and feel uncomfortable talking about but it is an important one and the sooner we speak up and create stronger awareness, the more children can be saved” says, Adri Ludick, CHOC Interim National Team Leader and Programme Development Manager. The financial implications of childhood cancers “Just like cancer, prevention is better than cure, and as such, it is important that you consider ways in which to not only identify how to protect your child’s wellbeing by early detection and treatment but that you too consider your finances and the impact of potential healthcare costs should they contract the disease,” says Hillman. If your child has been diagnosed with cancer, your priority will always be to get them the best treatment possible. However, have you considered how you will pay for this treatment as well as the extra expenses that come with the illness such as transportation, specialist consultations, treatments that aren’t covered by medical aid and child are for other children in your family while you care for your ill child? Or what if you had to take unpaid time off work or quit your job because of treatment schedules – which can leave a serious dent in your family’s financial stability and can have long term impacts on the entire family.  “Parents can ensure they have the right financial management tools in place that ensure the provision of adequate financial resources to support them through this very difficult time – things such as a good medical aid, a financial plan and long term insurance covers like a dread disease policy specifically for children, are crucial in this financial mix, should the worst happen,” continues Hillman. For example, there are policies on the market that cover more than one child on one policy, for majority of childhood cancers and offer additional value adds to make the family more comfortable during this time – benefits such as cancer coaching consultations to aid cancer remission, 24-hour advice line on a legal matters, and counselling benefits for example.   “During Childhood Cancer Awareness Month, we need to take action and ensure we are protecting our family’s health and finances.  I encourage all South Africans to take the time to ensure that that they put the above provisions in place to protect their children as well as that you take the time to join the movement towards stronger awareness when it comes to childhood cancers,” says Hillman. “We need to stand up and be bold, we need to have conversations about childhood cancer, and we need to empower people with knowledge, so that no child will be left behind. During the month of September, we ask people to wear a golden ribbon and in doing so raise awareness about childhood cancer,” Concludes Ludick. 

Parenting Hub

Intense allergy season predicted amid raging COVID-19 pandemic

The latter part of August typically signals the arrival of the pollen season, which this year, could prove more troublesome during the pandemic as tree pollen counts start to surge throughout most of the country.  The highest counts to date have been seen in Johannesburg, Pretoria and Cape Town from cypress, casuarina, poplar, rhus, oak and olive trees. Plane trees, which are prolific in all cities, as well as buddleja, which tends to reach high numbers in Bloemfontein, are now also entering their flowering season, therefore it’s only a matter of time before symptoms are triggered in those regions. Prof Jonny Peter, who heads up the UCT Lung Institute’s Allergy and Immunology Unit says the Coronavirus could make allergy sufferers hyperaware of every sneeze and sniffle as some symptoms overlap.  “Hay fever is activated by airborne allergens, such as pollen, which leads to a runny and itchy nose, scratchy throat, as well as allergic conjunctivitis in the eyes. While COVID-19 and hay fever share certain symptoms, there are some key differences. In COVID-19, fevers, body aches and headache are common, but these are rarely associated with seasonal allergies. In contrast, an itchy nose or eyes and sneezing signal allergy symptoms and are not common in Coronavirus infections.  “Shared symptoms may include a runny nose or nasal congestion, an intermittent cough, sore throat and fatigue. In asthmatics, very high pollen counts may trigger exacerbations with shortness of breath or difficulty breathing in some individuals. Fortunately, Coronavirus does not commonly trigger worsening asthma. If your symptoms do worsen, it’s advisable to consult your doctor especially if you have a known sensitivity to pollen.  “It’s also likely to have symptoms of both COVID-19 and seasonal allergies at the same time, which will affect each person differently. Some may experience mild symptoms, while others could have more severe symptoms.” SA’s pollen seasons vary across the country’s biomes, which is why the UCT Lung Institute is trying to establish pollen monitoring stations in all the provinces. Pollen allergy sufferers who are allergic to both trees and grasses usually have the toughest time in September and October as it’s the time of year when grass and tree pollen overlaps. That means a double dose of misery for people who are allergic to both. The grass pollen season can last for up to nine months of the year in certain parts of the country like the highveld, which only comes to an end in May. Prof Peter says as pollen levels rise it’s important to continue managing allergies during the pandemic with antihistamines, corticosteroid nasal sprays and inhalers. Here he answers some of the burning questions allergy sufferers have that will help them to manage their condition better during the pandemic: Q: Does having hay fever/allergic rhinitis pose an increased risk of severe COVID-19 complications? A: No. Current research does not indicate that allergic rhinitis or even well-controlled asthma increases either the risk of being infected with Coronavirus or the chance of developing severe disease. In fact, there have been reports that allergic rhinitis and some treatments used for allergic diseases may be protective, although the data is still emerging.  Q: Will wearing a mask reduce hay fever symptoms? A: Perhaps. I think it is going to be an interesting aspect of the current pandemic and maybe a silver-lining. Masks may offer some protection against seasonal allergies since they can prevent larger particles from being inhaled. However, smaller pollen particles are still likely to get through the covering, therefore masks should not be your only form of protection. Keep in mind that pollen is a fine powder, microscopic in size and can travel deep into the nose and lungs. The higher the concentration of pollen in the air, the greater the chance of an allergic reaction. It’s also important to wash your mask after each use, because it could be carrying pollen. Q: Does COVID-19 exacerbate asthma symptoms? A: Emerging data suggests that this is unlikely. There are several viral infections that are a common cause for asthma exacerbations, including the common cold rhinoviruses and the respiratory syncytial virus (RSV).  Interestingly, the SARsCoV2 or COVID-19 virus does not seem to be a major driver of asthma exacerbations. However, always remember to wear a mask in public to prevent the transmission of the Coronavirus. Q: Is there a way to reduce hay fever symptoms during the pandemic? A: It is impossible to completely avoid exposure to pollen. However, the second best option is to regularly check the pollen counts for your area on www.pollencount.co.za and to limit time outdoors when counts are high. Using a portable air filter in one or more rooms in your home will also help to filter pollen and dust. Use a high efficiency particulate filter (HEPA) for best results. Keeping windows and doors closed in the morning to midday when pollen counts rise will also help. The lowest pollen counts are usually in the late afternoon to early evening. When outdoors, avoid activities such as moving the lawn or raking leaves that will stir up pollen. Equally important is to remove clothes you’ve worn outside and to wash your skin and hair to remove pollen. Rather use a tumble dryer to dry clothes and bedding as pollen can stick to sheets and towels when hung outside.    One of the main reasons to monitor pollen levels in SA is international data that suggests pollen seasons are becoming longer and more intense due to climate change (warmer temperatures cause plants to begin producing and releasing pollen earlier, making hay fever seasons longer). Air pollution is also increasing, which further aggravates allergy symptoms from pollen and fungal spores. “As COVID-19 is likely to be with us for a long time, it’s important to learn about the risks and how to keep allergies under control to prevent asthma episodes. There has never been a more important time to know what is in the air we are breathing.” If you are among the 17.5 million South Africans that suffer from

Bonitas – innovation, life stages and quality care

Bonitas takes the edge off contribution increases

Financially solid, younger new members, two new plans, virtual healthcare and a renewed focus on Managed Care for chronic diseases are just a few of the insights from the Bonitas 2021 product launch. But it is the annual contribution increases which are highly anticipated and the moment of truth for all medical schemes.   Lee Callakoppen, Principal Officer of Bonitas Medical Fund announced an unprecedented 0% increase on its BonFit Select plan and a weighted increase of 4.6% across all plans. The highest increase is 7.1%. ‘Members on our growth options, which contribute to 91% of business, will only experience an increase on 3.9%. I think, looking at the pricing and the benefit richness we offer in comparison to the market, the changes for 2021 will be well received.’ He says, ‘The guidelines received from the Council for Medical Schemes (CMS), clearly highlighted that medical schemes should limit contribution increases as far as possible. We crunched numbers and worked tirelessly to find the sweet-spot between sustainability and ensuring affordability. Not an easy task, especially in a weakened economy. We took a responsible stance, with a long-term view, to ensure that our members wouldn’t have to pay the price of a low increase for 2021 in the coming years. One of our core considerations was finding ways to ensure members could get access to full healthcare cover and avoid out-of-pocket expenses and co-payments.’  Pricing and technology Seven of our current options are priced between R1 500 and R3 000 which is where the medical scheme market is experiencing growth currently. Member behaviour has changed significantly and demand is for innovation, accessibility and technology. This has the benefit of attracting, a younger, target audience and driving sustainability. We can’t talk about 2020 without mentioning Covid-19. Key trends that emerged from a medical schemes perspective were: Changes to benefit structures and PMBs  Lower than anticipated investment income as markets slumped Changes in claiming patterns in terms of seasonality and volume, due to the lockdown measures that came into effect And a Consumer Price Index that was lower than previous years which is expected to be at around 3.9% in 2021  In an industry like ours, it’s challenging to be different – to innovate, disrupt…to be better. But not impossible. The Fund needed to make short-term decisions with the long-term view and sustainability in mind.  One of the highlights over the past few years, has been the introduction of four Efficiency Discounted Options (EDOs).  Plans whereby members use network healthcare providers and pay around 15% less for the same benefits. The EDOs cover over 74 000 lives and the principal members who join are around 10 years younger than the average Bonitas member. 2021 – changes, contribution increases and enhancements Over the past five years, we have proactively driven innovative product design, actuarial modelling and constant engagement with various stakeholders. We believe we offer the ultimate split risk solution, with a comprehensive product range and diversified membership base.  To stay at the forefront of innovation we have introduced:  Edge – a new category driven by technology, intelligence and innovation, with two plans called BonStart and BonStart Plus. These are designed for economically active singles or couples, living in the larger metros. The plans include access to: A private hospital network and full cover for emergencies; PMB chronic medicine; excellent day-to-day benefits including unlimited GP consultations; layers of virtual care, dental and optical benefits; preventative care; wellness screenings; contraceptives and more.  The cost: R1 452 and R1 731 respectively for the principal member. Managed Care One of the leading trends worldwide is the rise in non-communicable diseases, such as diabetes, high blood pressure and oncology. In fact, during this global pandemic, the impact lifestyle diseases and comorbidities had on Covid-19 patients was put in the spotlight. 20% of our members have multiple comorbidities which means, even without the pandemic, we need a stronger focus on preventing and managing lifestyle behaviours. Poor diet, smoking and lack of exercise are the three lifestyle factors that contribute to over 80% of chronic conditions.   Managed Care continues to be a focus to empower members to take charge of their health and support them along the way.   Home-based care During Covid-19, home-based care received renewed interest and focus. This dovetails with our strategy to move more care to the home and out of hospital. As an example, post-surgery or mild pneumonia, treatment can be effectively provided at home through the assistance of nurses. Not only is home-based care a cost effective delivery of care but it also promotes healing. Studies show that patients recover faster in their comfort of their own home. Day hospitals We believe the use of day hospitals and clinics should be encouraged, where possible. Some procedures such as cataract surgery, circumcisions and scopes are better suited to be performed in day hospitals or clinics versus larger hospitals.  There is minimum disruption to members, speedier recovery times, less risk of infection and day hospital are also a more cost effective alternative. Technology  One of the key learnings has been adapting to a new way of working – with virtual technology at the forefront.  The WhatsApp channel we introduced has the most room for potential. This platform is convenient for members and allows them to manage their medical aid through live chats.  Virtual Care There was a positive response to the launch of the new Bonitas Member Mobile App and free virtual care for all South Africans. This provided access to GP consultations for a range of conditions, including Covid-19, as well as free delivery for chronic medicine.  At the heart of the model is the GP. This aligns to our care coordination initiatives, ensuring members receive the right level of care and support in managing their conditions. It allows access to a virtual nurse, advice in an emergency, auxiliary and home- based care, ensuring members have comprehensive support for any condition, in any circumstance, through our virtual based model. We’re pleased to announce that this model is unique and

Lamelle Pharmaceuticals

PCOS: You’re Not Alone – A Plea for Ovarian Health Consciousness

Acne, weight problems, excess hair, irregular periods – what if it’s all connected? This new ovarian health research asks you to take a minute for yourself and reflect … Every day, millions of women of every age and culture look at themselves in the mirror and see something that no one else does. We see that little bit of weight no diet or lifestyle changes seem to be able to fix. The excess oil, unwanted hairs and pimples that just won’t go away. We look straight past the beauty that’s there and see the girl who needs medication to have a normal period. Or the woman who’s umpteenth pregnancy test has come back negative. And we ask: why me? Why can’t I be normal? Funny thing is, that’s almost all of us. We just don’t talk about it. And perhaps it’s time that changed. Turns out, you’re not alone Over the past few years, doctors and researchers have been looking into a poorly understood and underdiagnosed ovarian health condition, known as Polycystic Ovary Syndrome (PCOS). And we’ve made a few startling discoveries along the way. PCOS impacts your ovaries and can cause infertility, and it’s usually only discovered when a woman struggles to conceive. But new research says that PCOS can show up at any age and as some of the most common “everyday” symptoms women experience today: Irregular, missed (or absent) menstrual cycles Weight loss or weight gain (the kind that you feel you can’t control) Acne, pimples and oily skin Excess hair growth And, in later life, difficulty falling pregnant Recognise these? The message is: You’re not alone. Research has shown 1 in every 10 women might have PCOS. What is PCOS really? New studies show that PCOS actually starts with your metabolism. Researchers realised that the bodies of most women with PCOS have trouble processing insulin, the hormone it uses to extract and store the energy from carbohydrates.  And if your body struggles with insulin, it builds up in your blood and triggers your ovaries to overproduce androgen (male hormone). The technical term for that is hyperandrogenism, and you can probably already guess its symptoms: acne, excess hair growth, weight problems, irregular periods and infertility. Suddenly it all makes sense.  You’re not weird or different. It’s more common than you think. And you can get help right now. If you think you might have PCOS Now, of course, not every pimple or stray hair indicates a serious underlying cause. But if you’ve really been battling with one or more of these conditions, the good news is you can get yourself tested and know for sure. Your doctor or gynae will be able to advise. And it doesn’t matter what age you are. In your teens, you might just want some answers about your weight, acne, hair growth and those times you missed your period. Or, if you want to start a family, you might already have some trouble conceiving. Even later in life, if you’ve had some of these symptoms and just want to make sure the insulin part doesn’t become something more serious (yes, PCOS has been linked to diabetes). Just know, PCOS can be managed. In fact, we at Lamelle Pharmaceuticals have developed an exciting new product specifically to complement the treatment of PCOS and promote ovarian health. Have a look: INTRODUCING: ALL-NEW OVARIA Using an inspired blend of ingredients, including a naturally-occurring sugar that’s part of the vitamin B family, Ovaria is a brand-new ovarian-health nutritional supplement whose ingredients are proven to be just as effective as traditional treatments (metformin or glucophage) for PCOS, but without any of the side effects. The naturally-occurring ingredients in Ovaria bind to cell receptors, activating the signalling pathways that regulate thyroid hormones and, most importantly, insulin in the body. This means Ovaria helps normalise blood insulin levels, which normalises androgen and improves the symptoms of PCOS. THE INGREDIENTS IN OVARIA ARE PROVEN TO Increase ovulation rate in 16 weeks Increase menstruation cycles  Reduce hirsutism (excess hair growth) by 29% in 6 months THE BENEFITS OF OVARIA Improves ovulation to enhance fertility in women Normalises the menstrual cycle – in case of period problems Improves insulin resistance – useful for managing weight problems Improves blood glucose level (fasting glucose) Reduces hirsutism – used for hair growth problems Reduces the severity of acne – used for acne problems Improves insulin resistance, reducing type 2 diabetes risk and its complications Reduces blood androgens – used for acne, excess hair and sebum NEW OVARIA FOR A HEALTHY LIFESTYLE Ovaria is a nutritional supplement that comes in powder form. Choose from two flavours – orange or peach. You simply tear open the sachet, mix the content with water and drink, once per day. Ovaria contains 4000mg of Myo-Inositol, the required daily dose clinically proven to be effective in the treatment of PCOS symptoms.  Doctors will have more information on PCOS. And Ovaria is available from reputable pharmacies – or simply order it online via Lamelle’s health store: https://lamelle.co.za/health-store. RSP: R350.00

RediscoverDairy

Dairy, centrepiece of the Kid’s food table

From infancy through the teen years, children have particular nutritional needs to support their healthy growth.  The culture of food they grow up in, and their food choices in the home and at school, also influence whether or not they will be lifelong healthy eaters.  Unfortunately, there is probably no greater aspect of our daily lives that is more inundated by misinformation and fads than our food. In the midst of constantly changing, attention-grabbing ‘trends’ and the plethora of ‘latest miracle foods’, there’s a real danger that the sensible, balanced nutritional needs of children get put on the backburner. The wake-up call for South African families is in our cold hard statistics which reveal a double burden of disease with persistent stunting and wasting, as well as rising child obesity.  Under-nutrition, which results in stunting and wasting that have lifetime impacts, remains a significant problem in South Africa’s low-income communities. The problem is, unfortunately, expected to be exacerbated by the ongoing economic impacts of Covid19.  Obesity is a major health risk, predisposing us to diseases such as Type 2 diabetes and hypertension.  Dietary intake associated with under- or overweight impact on both the physical growth and cognitive development of children who are then unable to realise their full potential in life.  Through the celebration of milk’s inclusion in school nutrition programmes, the 21st World School Milk Day on 30 September 2020 is a reminder that other food and health concerns should never eclipse the need for meeting our children’s needs for daily eating regimes that promote their healthy growth. Maretha Vermaak, the registered dietitian at Rediscover Dairy says, “Over so many decades, scientific research has confirmed that dairy offers a unique food matrix of bio-available nutrients that supports healthy development in children.  Milk, maas, yogurt and cheese offer specific diversity and versatility, so that it is easy to find dairy options for children and ensure that your family meets the recommendation of 2 to 3 portions of dairy a day.” Scientifically sound nutritional information is essential for families and schools. This empowers them to make good food choices and prioritise the nutritional needs of children.  Understanding that calcium-rich dairy plays a vital role in bone development, not only for small children but during the teen years when bone density development is accelerated, helps parents to make sure that the family gets enough of the key nutrients provided by dairy.  Dairy is not only a calcium-provider for healthy bones and teeth. It is an important source of affordable, high quality protein and is packed with vitamins such as A, B2, and B12, as well as potassium and zinc. Dairy Ideas for Kids No matter their income, many South African families fall short of the recommendations for 2 to 3 servings of dairy a day.  However, given the versatility of dairy, it is really easy to include it in meals, snacks and drinks.   Add milk or maas to oats and other porridges  Add dairy to every lunchbox – cheese wedges and cheese as sandwich filling; small yoghurts; cottage cheese and yoghurt-based dips for vegetables and crackers A simple toasted cheese sandwich is a firm favourite among children Make delicious smoothies with milk and yoghurt with fresh fruits   Add milk or buttermilk and cheeses to scrambled eggs and omelettes Melted cheese topping is always a winner that goes with many savoury dishes, vegetables and bread Bake with milk, buttermilk and yoghurt.  Top cakes and muffins with cream cheese icing to add more nutrients to your treat Make easy frozen yoghurt popsicles or pots for healthy treats Replace sweetened cold drinks with milk or milkshakes made with fruits or flavoured milk “Parents need to remember that when it comes to eating behaviour, they are the most powerful role models,” says Vermaak, “One of the easiest ways to ensure your kids consume enough dairy is to make sure it is available at home and for them to see you enjoying dairy too.” Through its Consumer Education Project (CEP), Rediscover Dairy partners with National School Nutrition Programme (NSNP) of the Department of Basic Education (DBE) to highlight World School Milk Day. The NSNP includes dairy once a week in their school  feeding programme to support South African children most vulnerable to stunting and wasting.  The CEP makes fun information and teacher resources available for Grades R to 7 at http://www.dairykids.co.za/ Parents who are home-schooling due to COVID-19 can download curriculum-aligned interactive posters, worksheets, fact sheets and teaching guides.  Children learn all about the healthy eating, SA’s food-based dietary guidelines, the role of dairy in healthy eating and the farm-to-table processing of dairy. For more dairy ideas join the Rediscover Dairy Facebook page: www.facebook.com/RediscoverDAIRY

Bonitas – innovation, life stages and quality care

Elective surgeries – the disruption, the trends and back to business unusual

On 9 September, South Africa recorded 1990 new cases of the pandemic in 24 hours. The country has now slipped to the eighth worst affected nation in the world in terms of the number of Covid-19 infections. In spite of this elective surgery has been given the green light and its back to business – albeit with strict protocols in place to safeguard staff as well as patients.  Almost five months ago elective surgeries came to a standstill. This was reflected in claiming patterns in the private healthcare sector during lockdown – a disruption of the norm globally.  In South Africa, elective surgery in both the private and public healthcare space and specialists’ visits are just two of the areas which have been affected by Covid-19. The link between the two is clear: Fewer specialists’ visits mean fewer referrals for surgery.  So what exactly is elective surgery? The term can be ambiguous. It does not mean, as the name implies, that the surgery is optional but rather that it doesn’t need to be performed immediately. It can be scheduled at the patient’s and surgeon’s convenience. Some of these surgeries are necessary to prolong life, for example an angioplasty or, as in most cases, improve the quality of life. In brief, elective surgery is ‘A planned, non-emergency surgical procedure.’  Elective surgeries dropped by over half According to Lee Callakoppen, Principal Officer of Bonitas Medical Fund, ‘there has been a 60% reduction in hospital authorisation requests compared to 2019. A study release in March predicted that an estimated 28.4 million elective surgeries worldwide, would be cancelled during the 12 weeks of peak disruption due to the global pandemic. This has been a similar experience to other industry role players and is predominantly due to a combination of member fears related to Covid-19, lockdown and provider caution.’  Surgeries delayed not cancelled The postponement of surgeries was done to prevent patients taking up hospital beds and to avoid unnecessarily exposure to the virus – a strategy that worked well to flatten the curve.  Surgeries were delayed based on provider discretion and subsequent patient engagement. Callakoppen says, ‘Providers are best placed to make these clinical decisions in the interests of their patients. If the procedures were emergencies or urgently required to enable member quality of life, those would have proceeded.’  The public sector too experienced backlogs in terms of elective surgeries. Examples are procedures including but not limited to, cataracts, orthopaedic surgeries, scopes, caesarean sections, tonsillectomies and adenoidectomies. BHF cautioned funders In July, The Board of Healthcare Funders (BHF) and its members in the healthcare funding space requested members of medical schemes to proceed with caution in scheduling elective surgical procedures. Dr Rajesh Patel, Head of Benefit and Risk at the BHF, said, ‘While the relaxation of the lockdown restrictions is good news for people, the country and the economy at large, we are still in the eye of the storm.’ The way forward? ‘As we move toward Level one, elective surgeries are almost back to normal,’ says Callakoppen. ‘It’s time to address the backlog of surgeries not considered emergency during lockdown. These include slow-growing cancers, orthopaedic and spine surgeries, airway surgeries, surgeries for non-cancerous tumours as well heart surgeries. We caution against a rush of elective surgeries though. Any surgery has an impact on the immune system which means the patient has a greater risk of contracting Covid-19 and developing complications from it. ‘It must further be noted that in some instances surgery is often recommended by specialists as one of the key courses of action. But we have noted that managed care protocols, in many instances, improve clinical outcomes with lower risk to the patient. One such example of this is spinal surgery, which is often unsuccessful. From a Bonitas perspective, we have noted that in the back and neck programme which enforces functional rehabilitation has been far more effective for our members. In addition, the risk to the member is significantly lower.’ Bonitas recommends the following is taken into account:  That elective surgeries should only be resumed in instances where not having the procedure will severely impact the members’ health and quality of life  That the current state of a patient’s healthcare is assessed –  individuals with chronic conditions such as diabetes, asthma HIV/AIDS and hypertension, are at high-risk of developing Covid-19 complications The patient’s age is taken into consideration (older individuals are identified as one of the most vulnerable groups) The impact of waiting on the patient’s healthcare outcomes (for example, is it essential that the surgery takes place now or can it safely be deferred for a few months) Alternative care protocols – in some cases surgery, which should be a last resort, is prescribed without considering other treatment protocols such as rehabilitation. The most common examples of this include back and spine procedures, elective c-sections as well hip and knee replacements The use of day hospitals and clinics,  where possible, to limit the possible chance of infection We may have flattened the curve but we are by no means out of the woods. Current Covid-19 cases in South Africa prove that.  What is happening in hospitals? ‘Surgeries are being resumed responsibly with due collaboration and consideration exercised between the surgeon, the patient and hospital staff,’ says Callakoppen. Where there are capacity constraints, surgeries will be classified in terms of priority at the various hospitals. Pre-operative screening will continue. Facilities will continue to utilise separate zones for Covid-19 positive patients, Persons Under Investigation (PUI) and those for whom the status is unknown at the point of admission. Surgeries will be carefully planned and scheduled. Specialist visits on the up ‘Consultations are starting to increase once again but providers in general are likely to remain prudent. However we urge people who have not had their necessary annual check-ups, particularly our high risk members, to consult with their doctors. There may be members who have put these consultations on hold and are now more comfortable to visit a specialist. But care coordination

Bonitas – innovation, life stages and quality care

Physical touch & newborns – why is this so important

The birth of your baby is a beautiful and special moment in both of your lives. You may be wondering about your newborn’s senses, while they are born with all necessary senses, some are less precise than others and develop as your baby grows. Physical touch is an important aspect of your child’s growth, coming from your womb, where they are tightly cocooned in your womb. Skin to skin contact offers benefits to both you and your baby, and touch is one of the senses that can help comfort your baby, making them feel more secure and helping strengthen the bond between the two of you. Why is touch important? Touch enables your baby to learn more about the world, bond with their mother and learn communication skills, as touch and body language will be the first way that you can ‘speak’ to one another. Breastfeeding is an important part of this, as your baby then spends time in her mother’s arms. The benefits of touch goes beyond the physical. Contact between mom and baby has been shown to lower cortisol levels, which in turn benefits the functioning of the immune system.  Children that are deprived of touch can be more aggressive with other conduct disorder problems. What is swaddling? Coming from a tightly packed womb, you’ll find that your baby is comforted by touch and close cuddles. Swaddling your baby in a blanket is also another technique that you can use on young babies to help them feel more secure, as it stops them from upsetting themselves from their own startle reflex. It’s important that your newborn finds their new world a comfortable and soothing place. Swaddling is an old technique, and beyond helping your little one feel safe and secure, your baby is likely to sleep better and will be kept nice and cosy in their blanket. If you decide to swaddle your baby it’s best to do so from birth, as opposed to introducing it when they are older as this can increase the risk of Sudden Infant Death Syndrome. Using the proper techniques when swaddling is also important, as incorrect wrapping can lead to issues.

Parenting Hub

Does your pantry have a nutrition gap?

‘Flu epidemics have us thinking hard about what foods to buy to support our family’s immunity and supply the best nutritional value for money. When shopping for the pantry, remember that our bodies not only need proteins, carbohydrates and fats, but also vitamins and minerals. Refined carbs and saturated fats are generally affordable and typically part of Western style meals, but protein is often perceived to be more expensive. Correct levels of all vitamins and minerals, although needed in smaller amounts, are difficult to ensure even in a so-called balanced diet, so people tend to buy a variety of nutritional supplements.   Lifegain® ALL-IN-ONE Advanced Nutritional Supplement is therefore a good choice, particularly when seasonal changes might leave your body requiring extra nutritional support. Lifegain® (click through to www.lifegain.co.za) costs just over R12.42 a serving a day*. It is high in protein with 15 g per serving from the triple protein blend of soy protein, milk protein concentrate and whey protein isolate, and high in energy.  24 vitamins and minerals, omega-3 fatty acids, fibre and Glutamine further support immune and digestive health. There is no equivalent all-in-one supplement that provides the whole body with the high levels of nutrients that Lifegain® does.  We usually can’t do anything about stressful events, but we can control good nutrition to help us through it.   For nearly 20 years Lifegain has been supporting the healthy and those whose nutritional needs are higher due to age, injury, hospitalisation or illness. Just add two level scoops of powder to 200 ml of milk, water, juice or smoothies  Available from selected pharmacies and retail outlets nationwide and online from Takealot, Clicks and Dis-Chem.  * Lifegain® 33-serving tins in vanilla, strawberry or chocolate flavours, at around R409.95 = R12.42 a serving.  Lifegain® 10-serving tins in vanilla, cappuccino, strawberry and chocolate, and Lifegain® Junior, both around R169.95 = R17 a serving. 

Bonitas – innovation, life stages and quality care

How does my diet affect my pregnancy?

A healthy diet is always important, but during pregnancy you are eating for both you and your baby so it’s critical that you remain healthy. Eating poorly during pregnancy can have a long term impact on your baby’s health growing up. So that being said, what foods should you be eating during pregnancy? If you eat healthily already you won’t need to go onto a special diet during pregnancy, but it’s important to get the right nutrients for you and your baby through a balanced diet. Don’t be alarmed if you find yourself hungrier than usual, but even if you are expecting twins you won’t need to eat for two. It is also important to note that weight gain during pregnancy is normal, so don’t be alarmed by this. Eating schedules differ between moms, however, it is generally recommended that you eat smaller amounts more frequently when pregnant, especially if you are struggling with morning sickness. What to eat when you’re expecting Fruit and veggies are your friend during pregnancy. Providing much needed vitamins and minerals, as well as fibre which helps with digestion and keeps you feeling fuller for longer. Protein is another important nutrient, and you should try to include it in your diet everyday as it helps your baby grow strong. Sources of protein include nuts, beans, pulses, eggs, lean meat and fish. However, raw, cured and uncooked meat are all risky to consume during pregnancy as they can cause toxoplasmosis. Another important source of energy is carbohydrates, specifically whole grains. They contain vitamin B, fibre and iron, which are all important for the baby’s growth and staying healthy. These include oatmeal, wholewheat pasta and bread, potatoes and maize. If you are suffering from morning sickness, these blander foods fill you and can be eaten little and often.  Foods that are rich in calcium should also be eaten regularly. Dairy foods, such as milk, cheese and yogurt are all options containing calcium as well as protein and vitamin D. That being said, some cheeses (such as soft cheese like brie) should be avoided as they can contain harmful (although rare) listeria bacteria. What foods should be avoided during pregnancy There are certain foods that you should take care to avoid during pregnancy. As mentioned, rare meats and certain cheeses should be avoided. Liver and raw fish (i.e sushi) are also on the to-avoid list. Consuming too much caffeine can also affect the baby negatively. Coffee is the obvious drink to avoid, but be aware that soft drinks, green tea, certain energy drinks and chocolate all contain caffeine.

Parenting Hub

Sugar, comorbidities and my family

We all know how important it is to eat healthily. But have you ever given thought to how much sugar you and your family consumes daily? These are trying times we are in, the current global pandemic has raised more awareness of health issues than ever before. People are now, for the first time, learning about comorbidities and how it affects their health especially when there is a serious virus doing the rounds.  We asked Owen Dunderdale, registered South African Dietitian and online coach to define comorbidities as more people become aware of the term however lack the understanding of it. “Conditions which exist simultaneously that may be related to a common medical illness. An example of this would be someone with Metabolic Syndrome. The person may be obese, have high blood pressure, type 2 diabetes and have cardiovascular disease, concurrently. These are all preventable through maintaining a healthy weight, exercising regularly and eating according to healthy nutritional guidelines. If the person changed their lifestyle, their overall health will drastically improve.” explains Dunderdale. “People who have comorbidities will most likely suffer a more severe case of COVID-19 than someone who is healthy. The higher the severity of the illness, the higher the incidence of mortality.”, he says.  Changing one’s lifestyle and eating habits is no easy task, it takes determination, lots of understanding the reasons why you started the lifestyle change in the first place and then sticking to that new change.  Health should always be the forefront for many changes. Luckily, Delite Foods locally produces products that can counteract these lifestyle issues and make it easier for one to adapt without even realizing it. Dunderdale mentions, “In order to lead a healthy lifestyle, it’s important to use products that are calorie controlled and/or are sugar-free. The World Health Organization recommends that we don’t consume more than 5-10 teaspoons of sugar/day (25-50g sugar). Why would someone consume products that are high in sugar when there are healthy, sugar-free alternatives that taste the same? I highly recommend using sugar free products. According to statistics published in 2016, the obesity rates in South Africa are increasing rapidly, with almost 70% of women and 40% of men either overweight or obese. Using sugar-free products decreases your daily calorie intake, which has a role to play in maintaining a healthy weight. Therefore, switching to sugar-free products will inevitably lower the rate of obesity. Whether you’re healthy, overweight or obese, you should be controlling your daily sugar intake and using sugar-free alternatives.”. Smart sips for the family With such knowledge and insight, where does one even start? We suggest starting with healthier drinks options. Let’s start with your daily intake of water and milk. We all know that we should be drinking about 8 glasses of water a day, yet for some of us – just the thought of a colourless and tasteless drink is quite unappealing to say the least. Kudos to those who have managed to enjoy drinking the recommended amount each day!  Here are 6 smart tips to encourage the intake of healthier drink options for yourself and your kids to enjoy as recommended by Dunderdale: 1. Flavoured water (Add a 5g sachet of Delite Foods Tantalize Powdered Soft Drink to a litre of water/sparkling water). Flavoured water is almost certainly going to increase a child’s fluid consumption. 2. Add Tantalize Flavoured Syrup to milk to create a delicious flavoured milk drink. 3. Make ice flavoured ice lollies using Delite Foods products. (more useful during the summer months). 4. Keep them happy by using the Tantalize Milky Mix to make a glass of chocolate milk or warm cup of hot chocolate.  5. Keep everyone hydrated with flavoured ice tea by simply brewing some rooibos tea bags and a sachet of Tantalize Powdered Soft Drink together for the ultimate thirst-quencher. 6. Kids enjoy flavoured drinks, so keep a jug of water and a colourful cup on the dining room table at all times. Stay connected and engage with us on Facebook, Instagram and Twitter.

Dr Tamara Jaye

The 5 C’s of allergy management amidst the Corona pandemic

Allergies, the common cold and other viral flu-like illnesses share many features that are also common to COVID-19. For example, coughing or shortness of breath is associated with many viral illnesses as well as asthma. A runny nose occurs in both allergic rhinitis (hayfever) and the common cold. However, high temperatures, muscle pains and fatigue, which are common to COVID-19 and influenza, do not form part of the presentation asthma or hayfever. Another important clue to remember is that seasonal allergies tend to wax and wane, whereas in a viral illness, such as flu or COVID-19, symptoms steadily worsen. Most common presenting symptoms Asthma Hayfever Common cold Influenza COVID-19 Shortness of breath Runny nose and sneezing Runny nose and sneezing High temperature High temperature Cough Itchy and watery eyes  Sore throat Cough Cough Wheezing Post-nasal drip Fatigue Fatigue Coughing Headaches Shortness of breath Congestion Muscle pains Muscle pains Diarrhoea Sore throat Headache Nausea, vomiting, diarrhoea Control any underlying allergic conditions and continue chronic prescribed medication Asthma too, needs to be well under control during this period. Although research has shown that mild to moderate asthma does not put one into a higher COVID risk category, poorly controlled asthma may lead to certain COVID-related complications. For this reason, good asthma control to prevent asthma exacerbations is key. According to numerous international allergy societies, regular asthma medications required for asthma control such as inhaled glucocorticoids, and montelukasts should not be discontinued during the COVID-19 pandemic.   Because allergic rhinitis (hayfever) presents with sneezing, a runny nose, post-nasal drip and associated itchy eyes, it may be easy to mistake these symptoms for COVID. For this reason, it is important to control allergies, perhaps even to take anti-histamine and nasal steroid medication ahead of allergy season to prevent mistaking COVID-19 for allergies.  Further incentive to good allergy control during the COVID epidemic is that nasal and eye itchiness will present a challenge to mask-wearing and not touching ones’ face.  In summary, as stated by the American College of Allergy, Asthma and Immunology: “There is no data that continuing these allergy and asthma medications will have any effect on increasing your risk of getting the COVID-19 infection or if you get the infection, lead to a worse outcome. It is important to control your allergy and asthma symptoms’’. Caution needs to be exercised when using a nebuliser The use of nebulisers is not recommended during the COVID pandemic as they have been found to increase the risk of aerosol spread of the virus particles. Alternative options to nebulisers are asthma pumps, in young children with a spacer attached, to deliver bronchodilator medication.   Consult your doctor if you have concerns If you or your child experiences any symptoms of chest tightness, difficulty breathing or wheezing, please consult your GP. Doctors are still seeing the ‘usual’ winter respiratory illnesses, and so any worrying symptoms should please be discussed with your healthcare provider. Should you develop symptoms suggestive of COVID, or have a positive COVID result, it is imperative that you make your doctor is aware so that the appropriate management steps can be taken. Cover your nose and mouth with a mask, observe social distancing and wash your hands At this stage, these simple measures are our most effective defence against COVID-19! Take care and stay safe!

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